Introduction: Trauma is a major problem which has a significant health, social, and economic impact. Particularly, pediatric trauma carries substantial mortality and morbidity. This is a great ...concern for subspecialized general and pediatric surgeons. Therefore, a global initiative for pediatric trauma care is warranted and should be initiated. Aim: The international association “Global Initiative for Children’s Surgery” (GICS) would like to propose and organize a children’s trauma care (CTC) initiative. This initiative should comprehensively address pediatric trauma management globally, especially in low- and middle-income countries (LMICs). The initiative seeks to achieve a structured cooperation and collaboration with respective sister organizations and local stakeholders. Methods: The initiative will address these relevant aspects: 1. first aid; 2. prehospital primary trauma care; 3. hospital primary trauma care; 4. advanced care (ATLS); 5. diagnostic facilities; 6. operation room (OR) equipment; 7. specialized surgical services; 8. rehabilitation; 9. registry, research, and auditing; 10. specialization in pediatric trauma; 11. capacity and confidence building in pediatric trauma; 12. prevention. The GICS CTC provided activities have been recorded and evaluated in a structured manner. This statement paper is based on data of a narrative review as well as expert opinions. Results: The Trauma Working Group of GICS provided specialized trauma prevention leaflets available for translation to different languages. A one-day children’s primary trauma course has been designed to be delivered at the physical GICS meetings. Exercising advocacy, the group addressed several meetings on prevention of pediatric trauma, which included the 75th United Nations General Assembly (UNGA) (2020), GICS IVth meeting in Johannesburg (2020), Norwich (UK) Joint SPRINT Symposium on Pediatric Surgery for Pediatricians (2021), the second online Pan African Pediatric Surgical Association (PAPSA) meeting (2021), the seventh World Congress of the World Federation of Associations of Pediatric Surgeons (WOFAPS) in Prague (2022), and GICS pediatric trauma webinar (2023). Additionally, the working group participated in the preparations of a pediatric trauma module for the World Health Organization (WHO) and published several related studies. The contents of the selected articles added relevant information to the categories stated above. Conclusions: The CTC initiative of GICS is proposed as a mean to address pediatric trauma comprehensively through a process of collaboration and advocacy with existing organizations to achieve awareness, health education, prevention, health, and training. Further, it will support the provision of suitable facilities to health institutions. The establishment of a specialization in pediatric trauma is encouraged. GICS CTC initiative aims to improve pediatric trauma care in LMICs by developing injury prevention strategies; optimizing the use of locally available resources; obtaining commitment by LMICs governments; improvement in all fields of hospital care; improvements in infrastructure, education and training, and attention to data registry and research.
Correspondence to Dr Fazal Nouman Wahid; fazalnoman@hotmail.com Emergency neonatal intestinal problems, such as necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), intestinal ...atresia, meconium cyst and meconium ileus, pose serious challenges for pediatric surgeons and neonatologists. Other disadvantages include stoma-associated complications, such as high-output losses, electrolyte derangements, stenosis, skin excoriation, prolapse or retraction of the stoma, and parastomal protrusion or internal herniation through a mesenteric defect.1–4 Primary anastomosis should be performed in a neonate who is stable and has localized bowel disease.6 7 Potential problems with primary anastomosis are anastomotic leak, peritonitis, anastomotic stricture, stasis, and bacterial overgrowth. Table 1 shows the summary of characteristics of all neonates and their outcomes.Table 1 Summary of characteristics of all neonates No GA (wk) Sex Weight (kg) Diagnosis ‘T-tube’ days Complication Outcome 1 32 F 1.9 NEC 12 None Discharged 2 30 M 1.5 NEC 12 None Discharged 3 32 M 1.35 NEC 20 Pneumoperitoneum after 10 days postsurgery Discharged 4 25 M 0.72 NEC 16 Enterocutaneous fistula Discharged 5 32 M 1.9 NEC 11 Recurrent NEC Discharged 6 24 F 0.68 NEC 12 None Discharged 7 32 M 1.35 NEC 12 None Discharged 8 25 M 1.17 NEC 15 None Died 9 37 M 2.5 Jejunal atresia 12 None Discharged 10 37 F 3 Jejunal atresia 13 None Discharged 11 34 M 1.8 Jejunal atresia 15 None Discharged 12 37 F 2.7 Meconium cyst 11 None Discharged 13 26 M 0.78 Ileal stenosis with perforation 12 None Died 14 28 F 1 SIP 12 None Died F, female; M, male;GA, gestational age; NEC, necrotizing enterocolitis; SIP, spontaneous intestinal perforation. The ‘T-tube’ enterostomy was first used in Texas Children’s Hospital in 1959 but reported later. Since the first report of ‘T-tube’ enterostomy by Harberg et al in 1981,11 many reports described the use of ‘T-tube’ enterostomy in a variety of bowel problems.12–14 Most of the initial reports were focusing on use of ‘T-tube’ in the management of meconium ileus11–13; subsequent works described the use of this technique in various intestinal problems.9 10 14 In 2007, Rygl et al10 showed the use of ‘T-tube’ enterostomy for intestinal perforations in five ELBW neonates with good survival and with no serious surgery-related complications.10 Survival following the use of this technique was reported to be 71% in NEC, 83% in SIP, and 100% in meconium ileus.9 However, survival following resection and primary anastomosis in NEC has been reported to be 48%.15 We did not have any patients with meconium ileus, probably owing to the rarity of this abnormality in our pediatric population.
Trauma is rising as a cause of morbidity and mortality in lower- and middle-income countries (LMIC). This article describes the Epidemiology, Challenges, Management strategies and prevention of ...pediatric trauma in lower- and middle-income countries. The top five etiologies for non-intentional injuries leading to death are falls, road traffic injuries, burns, drowning and poisoning. The mortality rate in LMICs is twice that of High-Income Countries (HICs) irrespective of injury severity adjustment. The reasons for inadequate care include lack of facilities, transportation problems, lack of prehospital care, lack of resources and trained manpower to handle pediatric trauma. To overcome these challenges, attention to protocolized care and treatment adaptation based on resource availability is critical. Training in management of trauma helps to reduce the mortality and morbidity in pediatric polytrauma cases. There is also a need for more collaborative research to develop preventative measures to childhood trauma.
Background
Gastrointestinal (GI) tract bezoars are aggregates or concretions of inedible and undigested material mostly found in the stomach but can also be found elsewhere in the gastrointestinal ...tract. Trichobezoar, an infrequent form of bezoar seen mostly in young females, consists of a compact mass of swallowed hair. It is primarily located in the stomach but may extend through the pylorus into the duodenum and small bowel, a condition labelled as Rapunzel syndrome.
Cases presentation
In this series, we report four consecutive cases of trichobezoars in the paediatric age group, all managed at a single institution King Saud Medical City Hospital Riyadh between 2019 and 2022. All the cases were girls between the ages of ten to fourteen with psychosocial problems. All the patients had a definite mass in the epigastrium and a history of not gaining weight. One presented with intestinal obstruction. X-ray abdomen and computed tomography (CT) scan abdomen were the imaging modalities that led to the diagnosis. All patients underwent surgery with successful removal of the trichobezoar and were referred to a psychiatrist for evaluation and treatment of a psychological disorder.
Conclusion
Trichobezoar is a rare entity that should be considered as a differential diagnosis in young female patients with vague, non-specific clinical symptoms and a palpable, upper-abdominal mass. In our experience and in line with the published literature, conventional laparotomy is still the gold standard in cases of GI trichobezoars.
Along with the removal of the trichobezoar, treatment of the existing psycho-social ailment is of utmost importance and needs long-term counselling with periodic psychological evaluation in follow-up clinics to avoid recurrence.
Gastrointestinal stromal tumors (GIST) are extremely rare in the pediatric population and, as a result, many clinicians may never encounter this diagnosis in children during their practice. Contrary ...to the usual clinical presentation of pediatric GIST as painless GI bleeding, we report here a case of a young girl with GIST whose main clinical presentation was a large cystic abdominal mass.
Amyand's hernia in children Jalil, Shazia; Azhar, Muhammad; Malkani, Izzat ...
Journal of pediatric surgery case reports,
February 2023, 2023-02-00, 2023-02-01, Letnik:
89
Journal Article
Recenzirano
Odprti dostop
Amyand's Hernia (AH) is a rare entity described as the presence of the vermiform appendix in an inguinal hernial sac. Though its prevalence is three times more in children than adults, owing to the ...presence of patent processus vaginalis, its occurrence with acute appendicitis is more uncommon in children, especially in infants. Seldom diagnosed correctly ahead of surgical exploration, it is often clinically diagnosed as an incarcerated inguinal hernia or as a case of acute scrotum. The management of such cases depends upon the per-operative findings.
In this series, we report four cases of AH treated at King Saud Medical City Hospital Riyadh between 2018 and 2022.
All the four patients were male and three of them were infants. Three patients had right sided hernia, while one had bilateral inguinal hernia. One of the patients was diagnosed with strangulated hernia and upon exploration it was AH with acute appendicitis and appendectomy was done. One child had recurrent, irreducible hernia and upon exploration, found appendix densely adherent to the hernial sac. Another patient had early suppurative inflammation at the tip, while the patient with bilateral hernias had appendix adherent to the right hernial sac. In all our cases appendectomy was performed either due to inflammation or adhesions.
There is a rarity of this condition and few cases have been reported in the literature. Such cases need to be reported to keep the surgeons aware of this condition and its different manifestations. Herein, we aim to share our experience of four cases of AH with varied presentations and a literature review.
The commonest complication of traumatic pancreatitis is the development of pancreatic pseudocyst. We report a patient with traumatic pancreatitis following blunt abdominal trauma who developed an ...intrathoracic pancreatic pseudocyst late in the course of non-operative management, and discuss the management of this very rare complication of traumatic pancreatitis.
Common pancreaticobiliary channel malunion (PBM) is known to be associated with increased frequency of gallbladder (GB) cancer in adults. Few studies have reported the presence of histological ...changes in the GB following transduodenal drainage procedures in children with PBM. The aim of this study was to document the histological changes in the GB in children who underwent interval prophylactic cholecystectomy up to 18 years following PBM drainage procedure. All children who underwent open transduodenal sphincterotomy (TDS) for symptomatic PBM followed by prophylactic synchronous (open) and interval (laparoscopic) cholecystectomy between 1987 and 2007 were studied retrospectively. Eight children with PBM were identified. The median age at initial presentation and open transduodenal sphincterotomy was 8 months (1 month–3.5 years). The average interval between open TDS and prophylactic cholecystectomy was 5.5 years (0–18 years). Two children had synchronous TDS and cholecystectomy. At initial presentation, all patients presented with obstructive jaundice. Mild common bile duct dilatation was encountered in all patients. The dilated ducts returned to normal, and remained normal after transduodenal sphincterotomy. Histopathology in seven out of eight GB specimens (87.5%) showed microscopic evidence of chronic inflammation. Chronic cholecystitis (
n
= 7), Rokitansky–Aschoff sinuses (
n
= 3), cholesterosis (
n
= 1) and intestinal metaplasia (
n
= 1) were observed in the GB biopsies. Only one patient, who had TDS and a synchronous cholecystectomy in the neonatal period, did not have histological changes in the GB. Average follow-up in years ranged between 3 months and 19 years (from TDS) with a median of 8 years, and between 3 months and 6 years (from cholecystectomy) with a median of 2 years. Chronic inflammatory changes were found in seven of eight GB specimens from patients with PBM despite previous drainage procedure in six patients and in one of two patients who underwent synchronous TDS and cholecystectomy. These changes may be the precursor of malignant transformation in GB of patients with PBM.
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