Neonatal gastric perforation: Case report Vacaru, Alexandra; Sharafeddin, Fransua; Maidan, Alexandra ...
Journal of pediatric surgery case reports,
August 2023, 2023-08-00, 2023-08-01, Letnik:
95
Journal Article
Recenzirano
Odprti dostop
Neonatal gastric perforation (NGP) is a life-threatening condition associated with high morbidity and mortality rates. Despite several proposed etiological theories, the causative principle is still ...unclear and controversial.
A male neonate was born at 26 weeks 3 days gestation. The patient showed symptoms of acute respiratory failure and hypoxia and was admitted to the neonatal intensive care unit. On day of life (DOL) 2, a chest and abdominal radiography showed a large amount of free intraperitoneal air, for which exploratory laparotomy was performed. A small antimesenteric perforation in the distal ileum was found and repaired primarily. On DOL 7, a chest and abdominal radiography demonstrated recurrent pneumoperitoneum for which a repeat exploratory laparotomy was performed. The patient had global intestinal ischemia and a perforation in the anterior wall of the stomach, which was repaired. On DOL 12, a planned upper gastrointestinal water-soluble contrast study showed spillage of contrast into the anterior abdomen, for which the patient underwent a repeat exploratory laparotomy. We found a dehiscence of the prior gastric repair and closed it primarily. The remainder of the hospital course was uneventful and the patient reached full feedings on DOL 41.
Premature neonates are at risk for gastric perforation. Gastric perforation should be in the differential diagnosis of a premature neonate who presents abdominal distension and pneumoperitoneum. Due to the fragility of the premature neonatal tissues, confirming the integrity of the gastric closure with a contrast study is recommended prior to initiating enteral feedings.
Trisomy 18 and necrotizing enterocolitis Maidan, Alexandra; Sacks, Marla A.; Raymond, Steven L. ...
Journal of pediatric surgery case reports,
October 2022, 2022-10-00, 2022-10-01, Letnik:
85
Journal Article
Recenzirano
Odprti dostop
Both Trisomy 18 (T18) and Necrotizing enterocolitis totalis (NEC-T) are major causes of morbidity and mortality in neonates. However, to our knowledge there has never been a case of a full-term ...infant born with both T18 and NEC-T published in the literature.
We present a case of NEC totalis in male neonate born at 39 weeks gestation with Trisomy 18. He was diagnosed with T18 in-utero, and after genetic counseling, the mother carried the pregnancy to term. After delivery, the newborn developed signs of respiratory distress, requiring use of continuous positive airway pressure support. On day of life (DOL) 8, multiple bloody bowel movements raised suspicion for NEC and after supplemental investigations prompted a series of exploratory laparotomies that revealed extensive necrotizing enterocolitis involving the entire gastrointestinal tract. On DOL 12, the family opted for palliative care and the patient subsequently expired.
To our knowledge, after searching through the English literature, no cases were found showing a neonate with a combination of T18 and NEC-T.
Left labial edema after kidney transplantation Salcedo, Andrea; Maidan, Alexandra
Journal of Case Reports and Images in Obstetrics and Gynecology,
12/2023, Letnik:
14, Številka:
2
Journal Article
Odprti dostop
Introduction: The differential diagnoses for labial edema are diverse. Labial edema after a kidney transplantation requires a thorough understanding of the various common and uncommon causes. ...Comprehensive history taking, physical examination, and awareness of anatomical knowledge will lead to proper diagnosis and treatment.
Case Report: We present the case of an 18-year-old female with a past medical history of end stage renal disease secondary to bilateral atrophic kidneys and grade 3 vesicoureteral reflux status post deceased donor kidney transplant. She presented to the emergency department on postoperative day 5 due to uncontrolled hypertension and significant left labia minora edema with extreme pain to palpation. Gynecology evaluation and consultation determined the lesion was not suspicious for infection, abscess, or hematoma, and supportive care and conservative measures were initiated. Computed tomography (CT) was performed to rule out other causes of the anasarca, and after conservative management and doses of furosemide on hospital days 3 and 4, the patient showed improvement of the labial edema and blood pressure.
Conclusion: A comprehensive differential diagnoses with reliance on anatomy and potential anomalies will lead clinicians and surgeons to properly treat potential postoperative complications. In this case, a thorough understanding of Mullerian anatomy and hemodynamic balance with implementation of conservative measures postoperatively resulted in resolution of the patient’s symptoms.
