Cilj: Castelmanova bolest rijetko je oboljenje koje karakterizira benigna hiperplazija limfnih čvorova. Glavni je cilj prikazati Castelmanovu bolest kao mogući uzrok retroperitonealne tvorbe u ...pedijatrijskoj populaciji. Prikaz slučaja: Na Zavod za hematologiju, onkologiju i kliničku genetiku Klinike za pedijatriju Kliničkog bolničkog centra Rijeka zaprimljen je petnaestogodišnji dječak radi verifikacije ekspanzivne tvorbe u području burze omentalis, koja je utvrđena ultrazvukom prilikom obrade recidivirajućeg povraćanja. Naime, dječak je deset dana pred prijam svakodnevno povraćao ujutro nakon doručka u tri do četiri navrata. Ultrazvučno je bila prikazana dobro ograničena tvorba promjera 4 x 3 cm između duodenuma i pankreasa. Kompjutoriziranom tomografijom prikazala se tvorba koja se utiskivala u želudac bez znakova infiltracije okolnih struktura. Prema karakteristikama tvorbe vidljivih magnetskom rezonancijom zaključilo se da se radi o solitarnoj benignoj tvorbi. Učinjena je iglena punkcija pod kontrolom endoskopskog ultrazvuka, a na temelju citološkog nalaza postavila se klinička sumnja na Castelmanovu bolest hijalino-vaskularne varijante. Napravljena je kirurška ekstirpacija tvorbe što je ujedno i standard liječenja unicentrične Castelmanove bolesti. Patohistološka analiza potvrdila je radnu dijagnozu unicentrične Castelmanove bolesti miješane varijante. Poslijeoperacijski tijek prošao je uredno i dječak je otpušten kući dobrog općeg stanja. Na redovnim kontrolama nije bilo znakova recidiva osnovne bolesti. Zaključak: Iako je Castelmanova bolest rijetka, pogotovo retroperitonealne lokalizacije i u pedijatrijskoj populaciji, treba je uvrstiti u diferencijalnu dijagnozu pri pronalasku tumorske tvorbe na toj lokalizaciji.
Aim: Castelman’s disease is a rare condition characterized by benign lymph node hyperplasia. The aim of this paper is to present Castelman’s disease as a possible cause of retroperitoneal mass in the pediatric population. Case report: A fifteen-year-old boy was admitted to the Department of Pediatric Hematooncology for verification of an expansive formation in the area of omental bursa. The formation was detected by ultrasound during diagnostics due to recurrent vomiting. The boy complained of vomiting during ten days before admission, three to four times daily, usually after breakfast. Ultrasound showed a well-limited formation 4 x 3 centimeters in diameter located between the duodenum and pancreas. Computed tomography confirmed localisation of the tumor showing no signs of infiltration of surrounding structures and magnetic resonance imaging reported benign characteristics. Endoscopic ultrasound guided needle biopsy was preformed and a clinical presumption of a hyaline-vascular variant Castelman’s disease was made. Surgical extirpation was performed. Complete tumor resection is a standard treatment for unicentric Castelman’s disease. The pathological analysis confirmed the diagnosis of unicentric mixed variant Castelman’s. Postoperative recovery went smoothly and the boy was discharged home in good general condition.There were no signs of recurrence of the underlying disease at regular check-ups. Conclusion: Although Castelman’s disease is rare, especially localized retroperitoneally and in pediatric population, it should be included in the differential diagnosis when considering retroperitoneal tumorous formations.
Aim: To report the clinical courses of two patients with intestinal obstruction caused by duodenal web, who were diagnosed with this rare congenital anomaly at Clinical Hospital Center Rijeka in a ...span of 5 months. Case report: One of the patients was prenatally suspected to have duodenal obstruction due to ultrasonographic findings, while the other showed signs of obstruction by not tolerating oral intake from the second day of life (DOL). Ceasing enteral feeding, placing a nasogastric tube and introducing intravenous hydration and parenteral nutrition was performed as initial management. Abdominal ultrasonography, abdominal radiography, upper gastrointestinal contrast study and contrast enema were performed but showed no signs of obstruction. Both patients showed improvement in tolerating oral intake over the next few days. However, the first patient did not tolerate meals exceeding 15 mL of infant formula, and the second patient again did not tolerate any oral intake from the 15th day of life. A broad diagnostic workup was repeated but did not show conclusive evidence of obstruction regarding the first patient. Esophagogastroduodenoscopy found duodenal obstruction of unknown origin regarding the second patient. Laparotomy was performed on the 19th and 25th DOL, respectively. Duodenal web was visualized and excised in both patients following duodenotomy. Postoperative recovery was orderly with minor nonsurgical complications. The patients were discharged from hospital on the 21st and 36th postoperative day, respectively. Conclusions: Diagnosing a perforated duodenal web is often challenging because of possible intermittent nature of its symptoms. Exploratory laparotomy is sometimes required to reach diagnosis.
Cilj: Prikazati klinički tijek dviju djevojčica s kongenitalnom crijevnom opstrukcijom uzrokovanom duodenalnom membranom, liječenih od ove rijetke anomalije u Kliničkom bolničkom centru Rijeka u razmaku od pet mjeseci. Prikaz slučaja: Kod prve je djevojčice sumnja na duodenalnu opstrukciju postavljena zbog prenatalnog ultrazvučnog nalaza, dok je kod druge sumnja na opstrukciju postavljena postnatalno jer od drugog dana života nije tolerirala oralni unos hrane. U sklopu inicijalnog zbrinjavanja u obje je djevojčice obustavljena enteralna i uvedena parenteralna prehrana, postavljena je nazogastrična sonda te uvedena parenteralna nadoknada volumena. Ultrazvuk abdomena, radiografija abdomena, pasaža crijeva i irigografija nisu pokazali znakove gastrointestinalne opstrukcije. Obje djevojčice ubrzo su počele sve bolje tolerirati enteralni unos. Međutim, prva djevojčica nije tolerirala obroke veće od 15 mL instant-formule, a druga nakon 15. dana života ponovno nije tolerirala enteralni unos hrane. Ponovljena je široka dijagnostička obrada koja u prve djevojčice nije dokazala duodenalnu opstrukciju. U druge je djevojčice ezofagogastroduodenoskopijom utvrđena duodenalna opstrukcija nepoznate etiologije. U 19., odnosno 25. danu života provedena je laparotomija. Intraoperativno, nakon duodenotomije, u oba je slučaja vizualizirana duodenalna membrana koja je potom ekscidirana. Poslijeoperacijski oporavak bio je uredan s manjim nekirurškim komplikacijama. Djevojčice su otpuštene iz bolnice 21., odnosno 36. poslijeoperacijskog dana. Zaključci: Postavljanje dijagnoze duodenalne membrane često je vrlo složeno zbog intermitentne prirode simptoma. Eksplorativna laparotomija katkad je nužna kako bi se postavila konačna dijagnoza.
Testicular torsion is a real emergency condition which requires prompt diagnosis and surgical management to prevent testicular loss. During the coronavirus (COVID-19) pandemic, an increased avoidance ...of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature.
The aim of this study was to investigate whether the COVID-19 pandemic caused increased number of orchiectomies in pediatric patients presenting with acute testicular torsion compared to pre-COVID-19 period.
A total number of 119 pediatric patients who underwent surgery for acute testicular torsion from January 2019 to December 2020 were enrolled in retrospective multi-center study from six institutions in Croatia. The patients were divided in two groups. The first group (pre-COVID-19) consisted of the patients who underwent surgery before COVID-19 pandemic (n = 68), while the second group (COVID-19) consisted of the patients who underwent surgery during the COVID-19 pandemic (n = 51). Main outcomes of the study were orchiectomy rates and time from onset of the symptoms to emergency department presentation.
During the COVID-19 pandemic period 43.1% (22/51) of the patients underwent orchiectomy while orchiectomy was performed in 16.2% (11/68) of the patients from the pre-COVID group (p = 0.001). Median time from onset of the symptoms to emergency department presentation during COVID-19 pandemic and pre-COVID-19 periods was 14h (IQR 5, 48) and 6h (IQR 3, 22) (p = 0.007), respectively. A higher proportion of patients waited over 24 h to present to emergency department during the COVID-19 pandemic compared to the pre-COVID-19 period (47% vs 8.8%, p = 0.007).
During COVID-19 pandemic a significantly higher rates of orchiectomies and increase in delayed presentations for testicular torsion was found. More patient education during pandemic in regards to management of emergency conditions such as testicular torsion is required. Display omitted
To assess the number of visits to pediatric emergency departments in Croatia and reasons for visiting before and during the coronavirus disease 2019 (COVID-19) pandemic.
We reviewed the medical ...records of pediatric patients visiting emergency departments of four tertiary medical centers between February 25 and April 25, 2018 and 2019, and between February 25 and April 24, 2020. Antimicrobial prescription was analyzed as well.
There were altogether 46 544 visits - 18218 in 2018, 19699 in 2019, and 8634 in 2020. The overall number of visits in 2020 significantly decreased compared with 2018 and 2019 (52% and 56% reduction, respectively), mostly due to a decreased number of visits due to certain infectious diseases: acute gastroenteritis (89.2%), sepsis/bacteremia (81.2%), urinary tract infections (55.3%), and lower respiratory tract infections (58%). Most visits were self-referrals regardless of the analyzed period, and the majority of patients did not require hospitalization. There were no significant differences in the number of visits requiring urgent medical care, such as those due to seizures and urgent surgery. The most frequently prescribed antibiotic in all periods was amoxicillin, followed by amoxicillin/clavulanate and oral cephalosporins.
A significant reduction in the number of pediatric emergency department visits and hospital admissions is indirectly related to the COVID-19 pandemic. Most of the reduction was due to a decreased number of infectious disease cases. However, the number of visits requiring urgent medical intervention did not change.
Cilj: Osvijestiti o mogućnosti postojanja sindroma Rapunzel u adolescentica s akutnim pankreatitisom. Prikaz slučaja: U hitnu pedijatrijsku ambulantu javila se petnaestogodišnja djevojka zbog ...povremenih bolova u gornjem dijelu abdomena koji su se intenzivirali par dana pred dolazak. Prilikom fizikalnog pregleda nađena je u epigastriju i lijevom hipohondriju bolna rezistencija veličine otprilike 10 cm u promjeru. Opsežnom laboratorijskom analizom našle su se povišene koncentracije enzima gušterače te se postavila dijagnoza akutnog pankreatitisa. Daljnjom obradom indicirala se gastroskopija kojom se prikazala masa kose na ulazu u želudac. Kompjutoriziranom tomografijom uočilo se da ona seže sve do bulbusa duodenuma. Nakon provedenog konzervativnog liječenja pankreatitisa abdominalni bolovi su regredirali, došlo je do normalizacije enzima gušterače te je bilo indicirano operativno liječenje. Učinila se eksplorativna laparotomija i gastrotomija. Ekstirpirao se trihobezoar težine 1 kg i dužine 25 cm oblika odljeva lumena želuca i početnog dijela duodenuma. Postavila se dijagnoza sindroma Rapunzel. Dječji psihijatar potvrdio je prisutnu trihotilomaniju i trihofagiju te se djevojku uključilo u psihoterapijski tretman. Zaključak: Sindrom Rapunzel vrlo je rijetko stanje, ali treba biti uključeno u diferencijalnu dijagnozu akutnog pankreatitisa u adolescenata. Specifični simptomi trihotilomanije i trihofagije u kombinaciji s nespecifičnim simptomima, poput dugotrajnog bola u abdomenu, trebali bi pobuditi sumnju na razvoj trihobezoara.
Aim: To raise awareness about the existence of Rapunzel syndrome in female adolescents with acute pancreatitis. Case report: A 15-year-old girl came to the emergency pediatric clinic due to the occasional pain in the upper abdomen, which had intensified a few days before her arrival. During physical examination, a painful resistance of approximately 10 cm in diameter was palpated in the epigastrium and the right hypochondrium. Extensive laboratory analysis revealed raised concentrations of pancreatic enzymes so a diagnosis of acute pancreatitis was made. Further examination indicated gastroscopy, which showed a mass of hair at the entrance to the stomach. Computed tomography revealed that the mass reached all the way to the duodenal bulbus. After the conservative treatment of pancreatitis, the abdominal pain regresses and the pancreatic enzymes returned to normal so the operative treatment was indicated. Exploratory laparotomy and gastrotomy were performed. A kilogram heavy and 25 cm long trichobezoar in the shape of the gastric lumen and the initial part of the duodenum were exploited. Rapunzel syndrome was diagnosed. The child psychiatrist confirmed the presence of trichotillomania and trichophagia, so the girl was referred to the psychotherapy treatment. Conclusion: Rapunzel syndrome is a very rare condition but should be included in the differential diagnosis of acute pancreatitis in adolescents. Specific symptoms of trichotillomania and trichophagia in combination with non-specific symptoms such as prolonged abdominal pain should raise the suspicion of the development of trichobezoars.
Abstract
Sarcina ventriculi is an increasingly common bacterium with a variable pathogenic role. It is often an incidental finding in asymptomatic patients but can also lead to life-threatening ...conditions, such as gastric perforation and emphysematous gastritis. We report a case of a 14-year-old boy with fatal emphysematous gastritis caused by S. ventriculi, who presented with abdominal pain and vomiting. His medical history included infantile left hemiparesis and operation of patent ductus arteriosus. Emergency surgery was scheduled due to the extremely dilated stomach and gastric pneumatosis, and a total gastrectomy was performed. On the third postoperative day, he suddenly dies, and the diagnosis was confirmed postmortem. This case is an opportunity to review the clinical presentation of emphysematous gastritis and to point out the role of the histopathological examination for the identification of the bacteria.
A case of 16-year-old female with secondary psoas abscess as the complication of the Crohn’s disease was analysed. Her pre-hospital, long lasting, non-specific symptoms led to ultrasound (US) and ...radiologic imaging confirming the diagnosis. The antibiotic treatment was insufficient and worsening of the patient’s condition required surgical treatment including descendent colectomy, abscess drainage and negative pressure wound therapy (NPWT). In spite of numerous complications the condition of the child gradually improved and she was discharged from the hospital on the 71st postoperative day. Two years after the colectomy, the occlusion of her colostomy was performed.
Abstract Background Elastic stable intramedullary nailing (ESIN) osteosynthesis has been used in our department for the treatment of long-bone fractures in children and adolescents for more than 17 ...years. During this period we have shown that ESIN has several advantages compared with other methods of treatment. However, as with every other method, ESIN has its drawbacks and complications. These occur primarily if indication criteria are not respected or ESIN technique is inadequate. This paper presents the rate of complications that occurred with this method in our patients, and the means of prevention and treatment of these complications. Patients and methods A total of 270 patients treated with ESIN osteosynthesis for fractures of long bones of the extremities completed treatment. The study was conducted at the Department of Child Surgery and Orthopaedics of the Clinical Hospital Centre in Rijeka. All the Nancy Nails used in the study were of the same quality, from one manufacturer and were applied using the standard ESIN technique. In 228 patients (84%), ESIN was the primary treatment, whereas in the remaining 42 patients (16%), ESIN was applied after an attempt at manual reposition and immobilisation of bone fragments. All patients had control radiography at least three times and postoperative monitoring was conducted for at least two years. Results A total of 35 of the 270 observed patients developed complications; some patients had several complications. There were 53 early intraoperational complications and 29 late postoperative complications. All complications resolved with appropriate therapy. The treatment was satisfactory in all patients except those with an elongation of the extremity (leg) of more than 1 cm. Conclusion Postoperative complications related to the ESIN method of osteosynthesis in the patients in this study were detected by radiological control examinations and long-term clinical monitoring. All the complications of ESIN were relatively easy to treat with current medical methods. The frequency of particular complications is significantly reduced if indication criteria for ESIN are respected and correct ESIN technique is used.
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