The data on pediatric iatrogenic AVFs mostly consist of case reports and series, with largest reporting on five patients,2 so diagnosis and treatment is mostly guided by large adult series.3 One ...series that reviewed data on 1431 pediatric femoral catheterizations found five AVFs (0.3%) that were diagnosed clinically.2 The incidence has been shown to be higher with active Doppler screening after catheterization because it also identifies a fraction of AVFs that are small and close spontaneously. Covered stents, although successful in adults, are not well studied in children, for whom they are often not suitable because the stent in small children may be palpable and cause skin breakdown, patients require long-term anticoagulation, stent diameter may not secure sufficient blood flow as the limb grows, and stent thrombosis may lead to chronic ischemia and extremity length discrepancy in younger children. Because less invasive techniques used in adults have potential difficulties in children, pediatric AVFs are usually treated by open surgery with good results.
Cilj istraživanja: Predstaviti naše inicijalno iskustvo s laparoskopskom pijeloplastikom u djece, procijeniti sigurnost i kratkoročni ishod. Ispitanici i metode: Retrospektivno je analizirana ...medicinska dokumentacija sve djece koja su u trogodišnjem periodu od 2019. do 2022. godine laparoskopski operirana zbog opstrukcije pijeloureteričnog vrata u Kliničkom bolničkom centru Zagreb. Rezultati: Ukupno desetoro djece, dobi od 10 mjeseci do 17 godina (medijan 4,3 godine) operirano je laparoskopski. Četiri djevojčice i šest dječaka. U osmero bolesnika se radilo o lijevom bubregu, a kod dvoje o desnom. Prosječni promjer pijelona je iznosio 35 mm i prosječna separatna funkcija zahvaćenog bubrega je bila 40%. Intrizična stenoza kao uzrok opstrukcije našla se kod osmero djece, a kod dvoje se radilo o aberantnim krvnim žilama za donji pol bubrega. Prosječno vrijeme trajanja operacije bilo je 190 minuta (raspon 120 – 240 min) dok je prosječno vrijeme hospitalizacije bilo 3,2 dana (raspon 2 – 6 dana). Kod dvoje djece stavljen je abdominalni dren. Nije bilo konverzije u otvoreni zahvat, kao ni intraoperativnih i ranih postoperativnih komplikacija. Peroralni unos je započet 4 – 10 sati nakon operacije. Praćenje pacijenata je bilo od 2 do 40 mjeseca (prosječno 7,8). Prosječni postoperativni promjer pijelona u djece kod kojih je prošlo više od 6
mjeseci od operacije bio je 9,5 mm. Zaključak: Laparoskopska pijeloplastika je sigurna i učinkovita metoda u liječenju djece s opstrukcijom pijeloureteričnog vrata.
Objective
Small bowel obstruction after unrecognized or conservatively treated uterine perforation is extremely rare. It is a surgical emergency and the delay in diagnosis and treatment has ...deleterious consequences for the mother. The purpose of this study is to critically review the available literature and ascertain the level of evidence for the mechanisms, diagnosis and management of small bowel obstruction after uterine perforation due to surgical abortion.
Methods
Systematic literature search was conducted in Pubmed (1946 to 2012) and Pubmedcentral (1900 to 2012) including all available English and French language fulltext articles. Three evaluators reviewed and selected all available case reports and case series. Search terms included small bowel obstruction, bowel obstruction, bowel incarceration, bowel entrapment, vaginal evisceration, uterine perforation, uterine rupture, and abortion. The exclusion criteria were (1) complex injuries where small bowel incarceration was present but with bleeding and/or bowel perforation as the leading symptomatology; (2) articles only numbering the patients without details on the topic. Analyses of incidence, risk factors, mechanisms of the disease, time of clinical presentation, diagnostic modalities, treatment, and maternal outcome were included.
Results
Of the 73 articles screened 30 cases of small bowel obstruction were included in the review forming incidence, risk factors, and mechanisms of the disease, diagnosis, therapy, and maternal outcome.
Conclusions
A systematic review defined four mechanisms of small bowel obstruction after transvaginal instrumental uterine perforation with significant variations in clinical presentation and time of presentation. Duration of symptoms depend on the mechanism of small bowel obstruction. Vaginal evisceration is surgical emergency and treatment is mandatory without diagnostic workup. Survival rate during last century is 93 %. Multicentric trials and publication of all such cases are needed to determine algorithms for diagnosis and management of small bowel obstruction caused by instrumental uterine perforation.
Abstract Background/Purpose Congenital diaphragmatic hernia (CDH) is associated with high mortality. Survival is influenced by the extent of pulmonary hypoplasia and additional congenital defects. ...The purpose of this study was to assess the association of congenital anomalies and admission capillary carbon dioxide levels (PcCO2 ), as a measure of extent of pulmonary hypoplasia, on survival in neonates with CDH. Methods This is a retrospective review of neonates with CDH admitted to a tertiary neonatal intensive care unit between 1990 and 2014. Logistic regression was used to assess whether hospital survival was associated with admission PcCO2 or associated anomalies (isolated CDH, CDH with cardiovascular anomalies, and CDH with noncardiac anomalies). The probabilities of survival (POS) score, based on birth weight and 5-min Apgar as defined by the Congenital Diaphragmatic Hernia Study Group were included as a covariate. Results Of 97 patients, 55 had additional malformations (cardiovascular n = 12, noncardiac anomalies n = 43). POS was lower in CDH with other anomalies compared to isolated CDH. Survival rate was 61.9%, 53.5% and 41.7% in isolated CDH, CDH with noncardiac anomalies and CDH with cardiovascular anomalies, respectively. After adjusting for POS score the likelihood of survival in CDH groups with additional anomalies was similar to isolated CDH (OR 0.95, 95% CI 0.22–4.15, and 1.10, 0.39–3.08, for CDH with and without cardiovascular anomalies, respectively). After adjusting for POS score, lower PcCO2 levels (OR = 1.25 per 5 mmHg decrease, P = 0.003) were associated with better survival. Conclusions Neonates with CDH have a high prevalence of congenital malformations. However, after adjusting for POS score the presence of additional anomalies was not associated with survival. The POS score and admission PcCO2 were important prognosticating factors for survival.
Gastric perforation (GP) in neonates is a rare entity with high mortality. Although the etiology is not completely understood, it mostly occurs in premature neonates on assisted ventilation. ...Combination of duodenal atresia and gastric perforation is very rare. We present a case duodenal atresia who developed gastric perforation after operetion for duodenal atresia. Analysis of the patient medical record and histology report did not reveal the etiology of the perforation.
Abdominal aortic thrombosis is a rare entity in neonates and has mostly been associated with umbilical artery or cardiac catheterization. We present a complicated case of an otherwise healthy neonate ...who developed thrombosis of abdominal aorta with renal failure. Therapy with intravenous heparin was unsuccessful, and thrombolysis was contraindicated because of disseminated intravascular coagulation so we decided to perform open thrombectomy using the left retroperitoneal approach. The following day, thrombosis recurred in the same extent and despite high risk of bleeding Alteplase was eventually given, which resulted in recanalization of the aorta 6 hours later. Renal function recovered, dialysis was discontinued, and further course was uneventful. The treatment of abdominal aortic thrombosis in neonates should be considered on a case-by-case basis because the available data on the condition are limited to case report and series. If open thrombectomy is performed, retroperitoneal approach should be preferred because it allows for easy institution of peritoneal dialysis should the need arise.
The presence of ductal plate malformation (DPM+) on liver histology in children with biliary atresia (BA) is a marker of early intrauterine disease onset and an indication of an unfavorable ...prognosis. We studied the prognostic value of DPM in infants with BA after hepatoportoenterostomy (HPE). We reviewed 28 BA patients who underwent HPE in a single medical center. We examined the time of jaundice onset after delivery (conjugated hyperbilirubinemia): early onset (
fetal
phenotype with no jaundice-free interval) vs. late onset (
perinatal
phenotype with jaundice-free interval) and the presence or absence of DPM (DPM+ or DPM−) histopathology. Primary outcome was jaundice clearance at 3 months after HPE and survival with native liver (SNL). Eight children had fetal and 20 had perinatal BA (8 DPM+, 12 DPM−). At 3 months after HPE, no patients with fetal BA had achieved jaundice clearance, while jaundice clearance was achieved in five patients with DPM+ perinatal disease and four patients with DPM− perinatal BA (
P
= 0.03, comparing all three groups;
P
= 0.36, comparing DPM+ vs. DPM− perinatal patients). Median SNL was 8.6 months for fetal BA patients, 148.2 months for DPM+ perinatal BA patients, and 93.2 months for DPM− perinatal BA patients (log-rank test,
P
< 0.001, comparing all three groups;
P
= 0.59, comparing DPM+ vs. DPM− perinatal patients). After adjusting for BA type, age older than 2 months at HPE was associated with worse SNL
P
= 0.03; hazard ratio = 4.0 (95 % CI, 1.1–14.2).
Conclusions:
Early onset of jaundice, regardless of DPM histology, was the most ominous sign of poor outcome in infants with BA after HPE.
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