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   2013| January-March  | Volume 10 | Issue 1  
    Online since March 21, 2013

 
 
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ORIGINAL ARTICLES
Importance of anorectal manometry after definitive surgery for Hirschsprung's disease in children
Suzi Demirbag, Tugrul Tiryaki, Tarik Purtuloglu
January-March 2013, 10(1):1-4
DOI:10.4103/0189-6725.109370  PMID:23519848
Objectives: The purpose of this investigation is to evaluate anorectal function after definitive surgery for Hirschsprung's disease (HD) by anorectal manometry. Materials and Methods: We evaluated the anorectal manometric assessment of 18 children who were operated for HD. Functional outcomes were determined by a questionnaire. Rectoanal inhibitory reflex (RAIR) and maximum anal resting pressure (MARP) were monitored. The results were compared between obstructive patients and asymptomatic patients. Results: The median age at definitive operation was 19 months (range 12-72 months). Anorectal manometry was performed in 14 male and 4 female patients. All the cases underwent three staged procedure for HD and modified Duhamel procedure was performed as definitive procedure for all the patients. Mean age was 4.3 months (range 25 days to 5 years) at time of diagnosis. Post-operative enterocolitis or severe constipation was observed in seven patients (38.8%). There were no patients with incontinence. Eighteen patients underwent anorectal manometry meanly 2 years after definitive operation. RAIR was absent in 14 (77.7%) patients and abnormal in 4 (22.2%). There were no significant differences in the MARP values between symptomatic and asymptomatic patients. Conclusion: The results of our study showed that the majority of the patients have impaired anorectal motility. There were no significant differences in the results of the functional studies for the seven patients with symptoms of obstruction or constipation when compared with asymptomatic patients after surgery for HD.
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TECHNICAL INNOVATION
Laparoscopic morgagni hernia repair using single-site umbilical and full-thickness abdominal wall repair: Technical report of two cases
Martin L van Niekerk
January-March 2013, 10(1):55-57
DOI:10.4103/0189-6725.109401  PMID:23519862
Single incision laparoscopic surgery is used in many centres for routine cases such as appendisectomy, splenectomy and cholecystectomy. Morgagni hernias are uncommon and account for 1-2% of all congenital diaphragmatic hernia. We report our first laparoscopic repair of two Morgagni hernias, using a single umbilical incision and full-thickness abdominal wall repair with standard straight laparoscopic instruments. Operative time was short and compared favourably with the laparoscopic repair.
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CASE REPORTS
Is hypertrophic pyloric stenosis a secondary disease?
Fariba Tabrizian Namini, Seyed Mohammad Ali Raisolsadat, Fateme Omid, Mostafa Mirzade
January-March 2013, 10(1):46-49
DOI:10.4103/0189-6725.109397  PMID:23519860
Hypertrophic pyloric stenosis (HPS) is the most common gastrointestinal obstructive disease in infants which requires surgery. Typical presentation is at 4-6 weeks of life but can present very earlier or congenitally. Here we present 3 cases of HPS which presented in the first day of life with co-existing malrotation, annular pancreas, and duodenal atresia. The exact etiology of HPS is not fully understood, however, genetic and maternal factors, hormonal factors, abnormalities of various components of the pyloric muscle, growth factors, extracellular matrix elements, nerve and ganglion cells synapses, nerve supporting cells, neurotransmitters and interstitial cells, drugs, and feeding have been implicated. In the HPS concomitant with a distal obstruction, mean that these obstructions may role in pathogenesis of HPS or may exacerbate other factors to produce HPS in a very early age or congenitally. The purpose of this manuscript is to present three cases of HPS in the first day of life with other GI anomalies. We hypothesize that the etiology of some cases of HPS may be secondary to distal intestinal obstructions especially when it presents very early in life, or at least to concern a distal obstructions in this very early presentation.
  1 2,889 287
Malignant rhabdoid tumour of the liver in a seven-month-old female infant: A case report and literature review
Matthew G Martelli, Chen Liu
January-March 2013, 10(1):50-54
DOI:10.4103/0189-6725.109399  PMID:23519861
Malignant rhabdoid tumours in children are rare and aggressive neoplasms that occur most commonly in the kidney. Extra-renal malignant rhabdoid tumours are even rarer and have been reported in the central nervous system (atypical teratoid/rhabdoid tumour) and other sites including the liver. To date fewer than 40 cases have been reported in the literature. Here we present a case of a 7-month-old female infant with a primary malignant rhabdoid tumour of the liver and review this entity as it compares to other cases reported in the literature.
  1 4,516 348
An unusual case of intra-abdominal testicular torsion: Role of laparoscopy
Alfonso Papparella, Fabiano Nino, Sandra Coppola, Pio Parmeggiani
January-March 2013, 10(1):29-31
DOI:10.4103/0189-6725.109386  PMID:23519854
The authors report a case of intra-abdominal testicular torsion, where laparoscopy has been useful for diagnosis and surgical management. A boy was presented with a left impalpable testis. Laparoscopy revealed a twisted spermatic cord at the inlet pelvis, which ended in a testicular remnant located in the sub-umbilical area. After orchiectomy, the pathologist confirmed testicular atrophy. Diagnosis of intra-abdominal testicular torsion should be considered in patients with impalpable testis and abdominal pain, but could not be excluded in those with no symptoms.
  1 2,251 146
Giant omental lipoblastoma and CD56 expression
Go Miyano, Takuo Hayashi, Atsushi Arakawa, Shumpei Goto, Geoffrey J Lane, Tadaharu Okazaki, Atsuyuki Yamataka
January-March 2013, 10(1):32-34
DOI:10.4103/0189-6725.109389  PMID:23519855
We report a case of giant omental lipoblastoma in a 13-month-old boy, which was treated successfully by total excision. Tumor cells were positive for S100, CD34 and CD56. This is the first report of lipoblastoma expressing CD56, a fact that could be used to differentiate lipoblastoma from liposarcoma.
  1 1,948 148
Laparoscopic management of a newborn with a right Amyand's hernia and a left incarcerated inguinal hernia
Ciro Esposito, Marianna Iaquinto, Maria Escolino, Alessandro Settimi
January-March 2013, 10(1):35-37
DOI:10.4103/0189-6725.109392  PMID:23519856
A one month old boy presented with left incarcerated inguinal hernia. After unsuccessful manual reduction, we decided to perform laparoscopic herniorrhaphy. Laparoscopic examination showed a left hernia with intestinal loops that entered into the internal inguinal ring, on the right side there was an unknown patency of the peritoneal vaginal duct with the appendix completely incarcerated within the sac. On the left side, the loops were reduced with a combined technique of external manual pressure and internal pulling by forceps; the bowel was inspected, and the hernia was repaired. On the right side, the appendix was strongly adherent with the peritoneal vaginal duct, and the reduction was not possible. The appendix was dissected from the sac using a 3-mm monopolar hook and than reduced into the abdomen, then right herniorrhaphy was performed. Two days after surgery, the baby had fever and abdominal distension. He was re-operated through mini-Pfannenstiel incision and an ischemic appendix was identified and removed. Postoperative period was uneventful. In our case, laparoscopy allowed for simultaneous reduction under direct visual control, inspection of the incarcerated organ, definitive repair and incidentally discovery and treatment of the contralateral incarcerated Amyand's hernia. In case of incarcerated appendix, appendectomy is preferable during the same procedure to reduce the incidence of postoperative complications.
  1 2,093 204
Modified transanal repair of congenital H-type rectovestibular fistula: A technique to avoid recurrence
Taiwo A Lawal, Aiwanlehi Eighemhenrio, Felix O Kumolalo
January-March 2013, 10(1):38-40
DOI:10.4103/0189-6725.109393  PMID:23519857
Congenital H-type rectovestibular fistulas are rare in the spectrum of anorectal malformations. Repair is associated with recurrence rates of up to 30%, using perineal repair, vestibuloanal pull-through or anterior anorectoplasty. The rarity of the malformation has limited experience with the surgical approach; hence, the rate of wound breakdown. We describe the use of a modification of the transanal approach for the repair in a 7-month-old female patient.
  1 3,972 245
ORIGINAL ARTICLES
Spontaneous vesicoureteral reflux resolution in children: A ten-year single-centre experience
Peer Wildbrett, Mandy Schwebs, Jürgen Abel, Holger Lode, Winfried Barthlen
January-March 2013, 10(1):9-12
DOI:10.4103/0189-6725.109375  PMID:23519850
Background/Aim: To evaluate the spontaneous resolution rate in infants and young children with vesicoureteral reflux (VUR). Patients and Methods: Paediatric patients with VUR treated in our hospital from January 2000 to December 2010 were retrospectively analyzed. Only patients with pretreatment and follow-up voiding cystourethrogram were included into the study. Treatment success was defined as complete VUR resolution. Results: The resolution rate for infants less than 1 year of age was 38.6% (17 of 44 renal units). Renal units with mild-moderate VUR (I-III) had a resolution rate of 40% (12 of 30 renal units) compared to 35.7% (5 of 14 renal units) with severe grade (IV-V) VUR. The resolution rate for children over 1 year of age was 39,1% (9 of 23 renal units). Renal units with mild-moderate VUR (I-III) had a resolution rate of 42.9% (9 of 21 renal units) compared to 0% (0 of 2 renal units) with severe grade (IV-V) VUR. Conclusion: Infants less than 1 year of age with nonsymptomatic, mild, moderate or severe VUR have a spontaneous resolution rate of more than 35% and therefore should receive a primary conservative therapy. Children over 1 year of age with nonsymptomatic mild-moderate VUR (I-III) have a spontaneous resolution rate of about 40% and should receive primary conservative treatment as well.
  1 4,182 257
CASE REPORTS
Isolated gallbladder perforation after blunt abdominal trauma in children
Oumar Ndour, Helle Moustapha, Ndeye Aby Ndoye, Gabriel NGom
January-March 2013, 10(1):41-42
DOI:10.4103/0189-6725.109395  PMID:23519858
Injury of the gallbladder after blunt abdominal trauma is rare. Isolated contusion of the gallbladder is exceptional because of its anatomical localization. It is protected by the liver, intestines, the omentum, and ribs. Its clinical presentation is often insidious, the reason why the diagnosis is often made during an exploring laparotomy. The delayed diagnosis is often responsible for high morbidity and mortality. The early diagnosis is thus essential but still remains a challenge. We report a case of isolated perforation of the gallbladder after blunt abdominal trauma in a 15-years-old boy found at the stage of generalized peritonitis. The exploratory laparotomy leads to diagnosis and treating the lesion by cholecystectomy.
  - 2,019 182
Congenital intrapericardial diaphragmatic hernia presenting radiologically as massive cardiomegaly
Wilson E Sadoh, Stanley U Okugbo
January-March 2013, 10(1):43-45
DOI:10.4103/0189-6725.109396  PMID:23519859
Intrapericardial diaphragmatic hernia is uncommon condition in which abdominal content herniate into the pericardium. It is mostly of traumatic origin, sometimes it is congenital. Radiologically, the condition may be suspected when the bowel loops are seen. However, diaphragmatic hernia may simulate acute gastrothorax, pneumotocelles and pneumothorax. The case of a 3-month-old infant with congenital diaphragmatic hernia in whom the bowel loops were not seen on chest radiograph and thus presented as massive cardiomegaly, is presented. The child had a successful surgery and was discharged home.
  - 2,789 148
ORIGINAL ARTICLES
Evaluation of clinical research reporting in African Journal of Paediatric Surgery
Abdulrasheed A Nasir, Kokila Lakhoo
January-March 2013, 10(1):13-16
DOI:10.4103/0189-6725.109376  PMID:23519851
Background: Clinical research forms the cornerstone of efforts to improve the lives of patients. African Journal of Paediatric Surgery has been a major vehicle for dissemination of information to paediatric surgeons in Africa since 2004. Most studies in the paediatric surgical literature are observational studies. This study aims to assess the adequacy of clinical research reporting in African Journal paediatric surgery. Materials and Methods: The authors analyzed all observational studies published in African Journal of Paediatric Surgery from 2006 to 2010 (n = 73). Studies were assessed using a validated tool for 16 baseline criteria essential for the non-biased reporting of clinical data (details regarding surgeons, cases, interventions, and statistical methods). Seven additional criteria pertaining to comparison methods were assessed in studies using controls. Results: Sixty-seven percent of all studies were retrospective, and only 5.5% utilized a control group. There were 72 (98.6%) case series. Most studies met less than half of the essential reporting criteria (mean, 7.3 of 16 baseline criteria). Reporting deficiencies were found in all major aspects of study design and statistical analysis. There is no statistical difference between prospective and retrospective studies. Conclusions: This study has identified deficiencies in the fundamental elements essential to non-biased reporting of clinical research in African Journal of Paediatric Surgery. We recommend that the Journal adopt the validated standard reporting criteria for these studies to improve the ability of its readers to interpret the relevance of clinical research findings to their own practice.
  - 3,142 139
Two-staged management for all types of congenital pouch colon
Rajendra K Ghritlaharey, KS Budhwani
January-March 2013, 10(1):17-23
DOI:10.4103/0189-6725.109378  PMID:23519852
Background: The aim of this study was to review our experience with two-staged management for all types of congenital pouch colon (CPC). Patients and Methods: This retrospective study included CPC cases that were managed with two-staged procedures in the Department of Paediatric Surgery, over a period of 12 years from 1 January 2000 to 31 December 2011. Results: CPC comprised of 13.71% (97 of 707) of all anorectal malformations (ARM) and 28.19% (97 of 344) of high ARM. Eleven CPC cases (all males) were managed with two-staged procedures. Distribution of cases (Narsimha Rao et al.'s classification) into types I, II, III, and IV were 1, 2, 6, and 2, respectively. Initial operative procedures performed were window colostomy (n = 6), colostomy proximal to pouch (n = 4), and ligation of colovesical fistula and end colostomy (n = 1). As definitive procedures, pouch excision with abdomino-perineal pull through (APPT) of colon in eight, and pouch excision with APPT of ileum in three were performed. The mean age at the time of definitive procedures was 15.6 months (ranges from 3 to 53 months) and the mean weight was 7.5 kg (ranges from 4 to 11 kg). Good fecal continence was observed in six and fair in two cases in follow-up periods, while three of our cases lost to follow up. There was no mortality following definitive procedures amongst above 11 cases. Conclusions: Two-staged procedures for all types of CPC can also be performed safely with good results. The most important fact that the definitive procedure is being done without protective stoma and therefore, it avoids stoma closure, stoma-related complications, related cost of stoma closure and hospital stay.
  - 5,572 212
The role of nitric oxide in an experimental necrotising enterocolitis model
Muazez Cevik, Cetin Ali Karadag, Damlanur Ertem Sakiz, Burak Tander, Didem Daskin Embleton
January-March 2013, 10(1):24-28
DOI:10.4103/0189-6725.109381  PMID:23519853
Background: Necrotising enterocolitis (NEC) causes a significant life-threatening gastrointestinal system (GIS) disease with severe mortality and morbidity, particularly in premature infants. Nitric oxide (NO) has many functions in the GIS. Therefore, in the present study, we evaluated the effects of NO in experimentally induced NEC of newborn 1-day-old rats following hypoxia/reoxygenation (HR). Materials and Methods: Thirty Wistar albino rats (weight, 5-8 g) were randomly divided into three groups: group 1 (HR), group 2 (HR + nitroglycerine), and group 3 (control). HR was achieved by placing the rat in carbon dioxide (CO2) for five minutes at 22°C, which was followed by five minutes of 100% oxygen. After HR, nitroglycerine was administered for three days at 50 μg/Kg/day. On day 4, the rats were decapitated and the intestines between the duodenum and sigmoid colon were resected and histopathologically examined. Results: The histopathological findings of groups 1 and 2 were characteristic of NEC. Intestinal injury in group 1 was significantly more prevalent than that in group 2 (χ2 = 21.55, P = 0.000). The intestinal injury score in group 3 was significantly lower than that in the other groups (P < 0.05). Conclusions: NO treatment was effective for treating experimentally induced NEC.
  - 1,822 206
Role of bulking agents in bladder exstrophy-epispadias complexes
Seyed Mohammad Vahid Hosseini, Mohammad Zarenezhad, Sakineh Falahi, Ali Amir Ahmadi, Babak Sabet, Ahmad Reza Rasekhi
January-March 2013, 10(1):5-8
DOI:10.4103/0189-6725.109373  PMID:23519849
Background: Role of pelvic osteotomy in surgical management of bladder exstrophy is controversial But pelvic rim closure importantly. Bulking agents have been used for perineal and pelvic dysfunction in adults. In this study, bladder extrophy repair was performed without pubic closure And bulking agent injections were used as the strut of anterior pelvis for prevention of Organ prolapse and other functions in this series. Patients and Methods: During the period 2008-2012, twenty-five exstrophy-epispadias complex patients with a mean age of 14 months underwent surgical reconstruction. Rectus abdominis Muscle was detached from the superior pubis and sutured to each other in the midline and Re-anchored at the pubis and 8-9 month later urethra was constructed and placed between prineal muscles. Bladder neck repair and intersyphyseal reconstruction was done With bulking agents one year after primary bladder closure when in our series bladder Prolapse mainly occurred. One to 4 mL of bulking agents polyacrylate (vantris/promedon) was injected at the level of the intersymphyseal area and opening on either sides of the urethra. Results: Mean urinary continence score, before, 3 and 6months after injection Were (2.65 ± 074),(1.95 ± 082),(1.75 ± 0.78), respectively.(p < 0.001). The correlation factor Between before injection, 3 and 6 months were % 82, % 74 spectively. Meancapacity of bladder before, 3, 6 months after injection were (31 ± 14.01), (41 ± 12.81), (56 ± 11.98) mml, respectively. The correlation factor before and after injection were 59%. Comparing the CS and CB between male and female before and after Injection were significant. (p < 0.001) but correlation factor in male 99% and Female 74%. Three out of five girls had improved bladder prolapse. There was no Complication, infection or migration of bulking agents. Patients had increased in soft tissue according to MRI. Conclusion: Using bulking agents is a good alternative to sling pelvic floor not only cosmetically but also for ease of patients and operation.
  - 4,683 214
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