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   2015| July-September  | Volume 12 | Issue 3  
    Online since November 23, 2015

 
 
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SYMPOSIUM
Radiographic signs of gastrointestinal perforation in children: A pictorial review
Olugbenga T Awolaran
July-September 2015, 12(3):161-166
DOI:10.4103/0189-6725.170177  PMID:26612119
Plain abdominal radiographs remain an important aid for clinicians in the diagnosis of gastrointestinal perforation, especially in neonates and very sick children where clinical features of peritonitis may not be as prominent. Suggestive radiographic features are not always very obvious, especially when taken in the supine position and may lead to delayed or missed diagnosis. Through a pictorial review of plain radiographs, this article highlights a number of documented features of gastrointestinal perforation on X-ray in the paediatric setting, which increases the accuracy of diagnosis.
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ORIGINAL ARTICLES
Laparoscopic-assisted vaginal pull-through: A new approach for congenital adrenal hyperplasia patients with high urogenital sinus
Jacques Birraux, Faustin Tambo Mouafo, Sophie Dahoun, Veronique Tardy, Yves Morel, Pierre Mouriquand, Claude Le Coultre, Pierre-Yves Mure
July-September 2015, 12(3):177-180
DOI:10.4103/0189-6725.170191  PMID:26612122
Background: To open vaginal cavity to the pelvic floor is part of surgical treatment for urogenital sinus (UGS) in girls with congenital adrenal hyperplasia (CAH). For high UGS, this operative procedure can be challenging and may jeopardise urinary continence. Combined perineal and laparoscopic approaches could be useful to minimise perineal dissection and to facilitate the vaginal lowering. Patients and Methods: We report the procedure of a laparoscopic-assisted vaginal pull-through for supra-sphincteric UGS in a 5-year-old girl with CAH. Laparoscopic dissection of the vagina from the posterior wall of the bladder and urethra, division of the confluence and vaginal pull-through to the perineum are described. Discussion: The technique is derived from laparoscopic-assisted treatment for high ano-rectal malformations. Compared with current procedures for treatment for high UGS, laparoscopic-assisted approach allows mobilising vagina with minimal dissection of perineum and complete preservation of urethra. Another major advantage is to provide a direct vision for dissection of the space between rectum and urethra prior to vaginal pull-through. Conclusion: Laparoscopic-assisted vaginal pull-through appears to be an interesting approach for high UGS in CAH patients, reducing dissection and risk of urinary incontinence. This new approach needs to be strengthened by other cases.
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Wilms' tumour: Determinants of prognosis in an African setting
Akinfenwa Taoheed Atanda, Lofty-John Chuhwuemeka Anyanwu, Oladoyin Jareenat Atanda, Aminu Mohammad Mohammad, Lawal Barau Abdullahi, Aliyu Umar Farinyaro
July-September 2015, 12(3):171-176
DOI:10.4103/0189-6725.170185  PMID:26612121
Background: The few studies available in the literature on Wilms' tumour (WT) from sub-Saharan Africa have reported a dismal outcome for children with the tumour. This study evaluated the risk factors that have been correlated with outcome in the literature and compare these with outcome among our patients. Materials and Methods: Cases of histologically confirmed WT between 2009 and 2013 in a tertiary hospital in Northwestern Nigeria were evaluated for gender, age, laterality, symptoms, duration before presentation, stage at presentation, histologic subtype and p53 mutation. These were then correlated with outcome. Results: Totally, 30 cases of WT were diagnosed with mean age of 4.8 ± 1.9 years; and male:female ratio of 2:1. No statistically significant relationship with outcome was found for gender (P = 0.138) or histologic subtype (P = 0.671). The most significant variables which positively influenced the outcome were presentation at earlier stages (P = 0.007) and completion of therapy (P = 0.0007). p53 mutation was seen in 3 (16.7%) of 18 cases and was not associated with a poor outcome (P = 0.089). However, 2 of the 3 cases presented in Stage IV and none of them survived the 1 st year. Conclusion: This study shows that even though p53 mutation was associated with a more aggressive phenotype, the most significant determinants of a good outcome among patients in a developing country like ours is non-blastemal dominant histologic subtype, early stage at presentation and completion of therapy.
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Oesophageal atresia: Diagnosis and prognosis in Dakar, Senegal
Mbaye Fall, Papa Alassane Mbaye, Haingonirina Joelle Horace, Ibrahima Bocar Wellé, Faty Balla Lo, Mamadou Mour Traore, Marie Diop, Oumar Ndour, Gabriel Ngom
July-September 2015, 12(3):187-190
DOI:10.4103/0189-6725.170196  PMID:26612124
Background: Oesophageal atresia is a neonatal emergency surgery whose prognosis has improved significantly in industrialised countries in recent decades. In sub-Saharan Africa, this malformation is still responsible for a high morbidity and mortality. The objective of this study was to analyse the diagnostic difficulties and its impact on the prognosis of this malformation in our work environment. Patients and Methods: We conducted a retrospective study over 4 years on 49 patients diagnosed with esophageal atresia in the 2 Paediatric Surgery Departments in Dakar. Results: The average age was 4 days (0-10 days), 50% of them had a severe pneumonopathy. The average time of surgical management was 27 h (6-96 h). In the series, we noted 10 preoperative deaths. The average age at surgery was 5.7 days with a range of 1-18 days. The surgery mortality rate is 28 patients (72%) including 4 late deaths. Conclusion: The causes of death were mainly sepsis, cardiac decompensation and anastomotic leaks.
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LETTERS TO THE EDITOR
Wilms' tumour and chemotherapeutic access
Sora Yasri, Viroj Wiwanitkit
July-September 2015, 12(3):208-208
DOI:10.4103/0189-6725.170232  PMID:26612130
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ORIGINAL ARTICLES
Traumatic chest injury in children: A single thoracic surgeon's experience in two Nigerian tertiary hospitals
Kelechi Emmanuel Okonta
July-September 2015, 12(3):181-186
DOI:10.4103/0189-6725.170193  PMID:26612123
Background: This study was to determine the extent and outcome of childhood chest injury in Nigeria, and to compare results with that of other literatures. Patients and Methods: A Prospective study of all children under 18 years of age with chest trauma in two tertiary hospitals in Southern Nigeria from January 2012 to December 2014 was reviewed. The aetiology, type, associated injury, mechanism, treatment and outcome were evaluated. The patients were followed up in the clinic. The data were analysed using SPSS version 20.0 with a significant P < 0.05. Results: Thirty-one patients (12.1%) under 18 years of age of 256 chest trauma patients were managed in the thoracic units. The mean age was 9.78 ± 6.77 years and 27 (87.1%) were male. The aetiology in 13 was from falls, 10 from automobile crashes, 3 from gunshots, 4 from stabbing and 1 from abuse. The highest peak of chest injury was on Saturday of the week and April of the year. The pleural collections are as follows: 15 (71.4%) was haemothorax, 4 (19.1%) pneumothorax, 2 (9.5%) haemopneumothorax and 18 patients had lung contusion in combination or alone with the pleural collections. Seven patients who presented >12-h versus 2 who presented <12-h and 6 of children between 0 and 9 years versus 3 at 10-18 years of age had empyema thoracis (P value not significant). One death was recorded. Conclusion: Chest trauma in children is still not common, and blunt chest injury from falls and automobile accidents are more common than penetrating chest injury. Treatment with tube thoracostomy is the major management modality with empyema thoracis as the most common complication.
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Masterly inactivity in infantile haemangioma: Does it still hold relevance?
Nitin Sharma, Minu Bajpai, Ajay Verma, Shasanka Shekhar Panda, Amit K Singh
July-September 2015, 12(3):167-170
DOI:10.4103/0189-6725.170181  PMID:26612120
Background: Haemangiomas are a source of concern to the parents. It has long been advised to plan a conservative management and counsel the attendants in various literatures owing to the spontaneous regression in these cases. We tried to find out the role of conservative management in our setup. The objective of this study was to assess the effect of conservative management in infantile haemangiomas. Materials and Methods: This was a retrospective study from January 2001 to December 2012 including infants with haemangioma in low risk locations. Patients were evaluated at periodic intervals for regression and complications. Interventions done were surgical excision/ cauterisation in cases presenting with complications in the form of bleed or severe ulceration or in residual lesion not responding to the conservative management. Results: A total of 104 cases were included. Mean age of the cases at presentation was 32 weeks (range: 6-48 weeks). Mean follow-up was 48 months (range: 9-68 months). Average lesion size at the time of presentation was 4.2 ± 0.5 cm 2 and the average lesion size at last presentation was 1.8 ± 0.5 cm 2 . A total of 28 cases presented with complications as bleed, ulceration. These cases were located at extremities and were managed by excision in 13 cases and cauterisation in 15 cases. 13 cases presented with rapid proliferation. Thus, 41 (39.4%) cases presented with complications or rapid progression. Complete regression was seen in 49 cases and remaining 14 (22.2%) cases had some residual lesion. Conclusions: Conservative management should be offered only to very small lesions located at concealed sites. Lesions located at extremities and exposed sites should not be considered for conservative management.
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CASE SERIES
Congenital mesenteric hernia in neonates: Still a dilemma
Parkash Mandhan, Noora Alshahwani, Zainab Al-Balushi, Anwar Arain
July-September 2015, 12(3):203-207
DOI:10.4103/0189-6725.170231  PMID:26612129
Congenital transmesenteric hernia in neonates is a rare cause of intestinal obstruction with devastating outcomes and still remains a challenge to diagnose pre-operatively. Patients are often managed with emergency surgical exploration and may need bowel resection. We present 2 neonates with small bowel obstruction secondary to strangulated transmesenteric hernia through a congenital defect in the small bowel mesentery, which were managed successfully. We have also reviewed the literature about congenital transmesenteric hernia in neonates.
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CASE REPORTS
Laparoscopic suture repair of idiopathic gastric perforation in Duchenne muscular dystrophy
Go Miyano, Hiroshi Nouso, Keiichi Morita, Hideaki Nakajima, Mariko Koyama, Masakatsu Kaneshiro, Hiromu Miyake, Masaya Yamoto, Koji Fukumoto, Naoto Urushihara
July-September 2015, 12(3):197-199
DOI:10.4103/0189-6725.170219  PMID:26612127
We report herein an adolescent case of Duchenne muscular dystrophy (DMD) with idiopathic gastric perforation, in which emergency surgical repair was performed laparoscopically. A 14-year-old nonambulatory boy with DMD was brought to our emergency department with sudden onset of severe abdominal pain and distention. Plain radiograph and computed tomography confirmed the presence of free intraperitoneal air and intrapelvic effusion. The patient elected to undergo laparoscopic inspection with 4 trocars, revealing a focal perforation, 3-4 cm in diameter, on the upper gastric body near the diaphragm. The stomach was also found to have a thin wall without evidence of peptic ulcer disease or other abnormalities. An interrupted suture was placed using 4-0 PDS. The abdomen was extensively irrigated, and multiple J-Vac drains were left in situ. Total operation time was 90 min, and no intraoperative complications were encountered. Enteral feeding through a nasogastric tube was started on postoperative day 7. The postoperative course has been uneventful as of the 12-month follow-up. Pediatric surgeons should be aware of the increased risk of gastric perforation associated with DMD, and that laparoscopic repair can be safely performed even in emergency settings.
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Visceral basidiobolomycosis: An overlooked infection in immunocompetent children
Parkash Mandhan, Kamal Osman Hassan, Sandra Moustafa Samaan, Mansour J Ali
July-September 2015, 12(3):193-196
DOI:10.4103/0189-6725.170218  PMID:26612126
Visceral basidiobolomycosis is an unusual fungal infection of viscera caused by saprophyte Basidiobolus ranarum. It is very rare in healthy children and poses a diagnostic challenge due to the non-specific clinical presentation and the absence of predisposing factors. We report a case of gastrointestinal basidiobolomycosis in a 4-year-old healthy girl who presented with a short history of abdominal pain, bleeding per rectum, fever, and weight loss. The diagnosis was based on high eosinophilic count, classical histopathology findings of fungal hyphae (the Splendore-Hoeppli phenomenon), and positive fungal culture from a tissue biopsy. Fungal infection was successfully eradicated with a combined approach of surgical resection of the infected tissue and a well-monitored course of antifungal therapy. The atypical clinical presentation, diagnostic techniques, and the role of surgery in the management of a rare and lethal fungal disease in an immunocompetent child are discussed.
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A conservative approach in a child with haematuria after accidental rectal impalement trauma
Josephine Schijns, Frans Berend Plötz
July-September 2015, 12(3):191-192
DOI:10.4103/0189-6725.170198  PMID:26612125
We present a case of an 11-year-old boy with haematuria after traumatic rectal insertion of a sharp metal stick. It demonstrates that an expectative management with close observation can be considered in patients with rectal impalement trauma presenting with haematuria and stable vital parameters without significant injury on abdominal ultrasound.
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LETTERS TO THE EDITOR
Massive purulent pericarditis in HIV-infected children
Beuy Joob, Viroj Wiwanitkit
July-September 2015, 12(3):209-209
DOI:10.4103/0189-6725.170234  PMID:26612132
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CASE REPORTS
Acute gastric volvulus and congenital diaphragmatic hernia, case report and review
Laura Pérez-Egido, Alberto Parente, Julio Arturo Cerdá
July-September 2015, 12(3):200-202
DOI:10.4103/0189-6725.170230  PMID:26612128
Congenital diaphragmatic hernia (CDH) is the result of the incomplete fusion and closure of the pleuroperitoneal canal during the fetal development. CDH is usually diagnosed prenatally but, if undiagnosed, the clinical presentation ranges from asymptomatic children to serious respiratory or gastrointestinal symptoms. Acute gastric volvulus associated with CDH is a rare surgical emergency in children. We report two cases of acute gastric volvulus associated with CDH and review the literature.
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LETTERS TO THE EDITOR
Childhood non-accidental traumatic brain injuries
Pathoom Sukkaromdee, Viroj Wiwanitkit
July-September 2015, 12(3):208-209
DOI:10.4103/0189-6725.170233  PMID:26612131
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