The introduction of Malone antegrade continence enema) in the management of children with fecal incontinence has brought remarkable improvement in patient care, Malone originally described appendix as a conduit and it has become widely accepted. However, surgeons are faced with situations where appendix is not available, the selection and creation of other conduit is always a challenge. We present our technique and experience with the use of alternative catheterizable conduits for antegrade continence enema (ACE).
Retrospective review of children who underwent ACE procedure in our institution from March 2009 to January 2014. The details retrieved: indication, reason for non availability of appendix, type of conduit, complications and patient's satisfaction.
Five children were identified in whom the appendix was not available or suitable. In four children cecal/colon-based flap was used and in one child, ileal (Monti) segment was used to create a conduit. The mean follow-up was 3.2 years. All patients were satisfied with the procedure and no stenosis or loss of conduit was noted in the follow-up.
Continent catheterizable conduit for ACE can be accomplished with transverse tubularized intestinal segments and cecal/colonic flaps, with excellent outcome, irrespective of tissue used. Surgeon's preference and the patient's peculiar anatomy should determine the surgical technique to be used.
Although nonoperative treatment of appendicitis (NOTA) in the pediatric population has been well reported recently, patient selection and treatment scheme varies among studies, making it difficult to establish treatment standards for NOTA.
In a single medical center, patients younger than 18 years who were diagnosed with appendicitis: 1) with abdominal pain not exceeding 24 hours, 2) without radiologic evidence of appendicolith or appendiceal perforation or pelvic abscess, and 3) without signs of frank generalized peritonitis were offered NOTA, and their data were prospectively collected.
Twenty-two patients with uncomplicated appendicitis agreed to NOTA and were enrolled in the study. The initial success rate (resolution of abdominal pain and hospital discharge without appendectomy) was 100% (22 out of 22 patients). At a median follow-up period of 23.8 months, two patients had recurrence at two and three months after completion of NOTA. These patients underwent laparoscopic appendectomy.
Stringent patient selection may be necessary to apply NOTA safely for all children with uncomplicated appendicitis. Further studies concerning patient selection and conformed treatment protocols for NOTA are required.
Undescended testis (UDT) is a developmental defect in which one or both testicles do not arrive in the scrotum. Its prevalence at birth and one year after is 2%–4% and less than 1%, respectively. Currently, surgery is recommended to treat congenital cryptorchidism in order to prevent testicular degeneration. Classic method is performed via incision in inguinal and scrotum and the new method is done via incision in scrotum.
Sixty male participants with 65 UDT undergoing surgery were randomly assigned to scrotal incision (n=31) and classic inguinal incision methods (n=34). Patients were followed for 6 months and testicular atrophy, infection, recurrence, and duration of surgery were compared between two groups.
Scrotal incision compared to classic incision method had significantly lower duration of surgery (19.06±2.96 minutes vs. 30±10.42 minutes; p=0.002) and recurrence during follow-up (0 vs. 5 cases; p=0.026). There was only one surgical site infection in the scrotal incision method. There were hematoma and post-operative swelling in 13.3% of cases after scrotal incision method.
Scrotal incision is an alternative method for the UDT with lower duration of surgery, lower recurrence rate, and better cosmetic results.
Congenital absence/hypoplasia/fusion of ribs are very rare anomalies and presentation varies from asymptomatic to life-threatening. Visibly evident cases are straightforward to diagnose but this is not always the case. Familiarity and awareness of these anomalies can help to diagnose cases with subtle signs and symptoms. Proper radiological investigations are vital for anatomical delineation. Absence or hypoplasia of the inferior ribs along with its attached muscles can cause ‘lung hernia’ that produces an unstable chest leading to paradoxical respiratory movements. Here, we present a case of hypoplastic and fused ribs in an infant, who presented with respiratory distress and created a diagnostic dilemma.
Esophageal atresia (EA) is a diverse disease entity. We present a case of long gap EA without fistula corrected through totally laparoscopic and thoracoscopic esophageal replacement using gastric tube. A male baby weighing 3,000 g, with suspicion of EA, was born at gestational age of 37+6 weeks. Gastrostomy was made at an age of two days; seven months later, definite operation was planned. We determined to perform the gastric tube replacement due to long gap revealed by fluoroscopy. Gastric mobilization, gastric tube formation, and pyloroplasty were performed laparoscopically. An isoperistaltic 9 cm gastric tube was made using 2 Endo GIA 45, and interrupted end-to-end esophago-esophagostomy was performed thoracoscopically. With laparoscopy, gastropexy to the diaphragm was performed through the interrupted suture. Operation time was 370 minutes; there was no intraoperative event. Postoperative course was uneventful. He underwent esophageal balloon dilatation due to anastomosis stenosis in the months after surgery.
Hemolytic uremic syndrome (HUS) is associated with consumption of under cooked gound beef, characterized by triad of renal failure, microangiopathic hemolytic anemia and thrombocytopenia. Early recognition of this disease, maintenance of fluid balance and proper dialysis seems to prevent acute mortality. A 23-month-old boy was admitted with abdominal pain, bloody diarrhea and fever. On hospital day (HD) #2, he developed aggravated abdominal pain compared to the initial assessment. Contrast abdominal computed tomography demonstrated findings suggestive acute appendicitis so the patient was underwent laparoscopic appendectomy. On HD #3 and #4, his laboratory findings showed marked thrombocytopenia and serum creatinine elevation. He was transferred to another hospital for dialysis with the impression of acute renal failure. Later, verotoxin-producing
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