Pediatric surgery international
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Pediatr. Surg. Int. · Apr 2008
Case ReportsPediatric penetrating cardiac injury from abuse: a case report.
While cardiac foreign bodies after trauma have been described in the literature, we report the first case of intentional injury in an infant with an intracardiac needle. We review the literature and stress the need for a high degree of vigilance in evaluating children for potential child abuse.
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Pediatr. Surg. Int. · Apr 2008
Mortality in micro-premature infants with necrotizing enterocolitis treated by primary laparotomy is independent of gestational age and birth weight.
Previous reports indicate that mortality in micro-premature infants with surgical necrotizing enterocolitis (NEC) is inversely proportional to gestational age and birth weight. We have observed that patterns of survival in micro-premature infants with NEC appear to be changing and may be influenced by the use of primary laparotomy (PL). Thirty-one infants <1,500 g who underwent surgery for NEC were classified into two subgroups: extremely low birth weight infants <1,000 g (ELBW, N = 17) and very low birth weight infants 1,000-1,500 g (VLBW, N = 14) and the groups were compared. ⋯ The only variables associated with increased mortality were pannecrosis and longer segment of necrotic bowel (P = 0.005). In our neonatal unit, the mortality of micro-premature infants less than 1,500 g with surgical NEC appears to be independent of gestational age and birth weight. Although the small sample size may mitigate the validity of this study, we found that the most important determinants of mortality were pannecrosis and longer length of necrotic bowel.
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Though various approaches to the thoracic inlet have been described in adults, currently no guidelines exist in children. Reports in the literature of resection of thoracic inlet tumours in children are only anecdotal. ⋯ Experience with a 3.5-year-old boy having a thoracic inlet ganglioneuroma, using the anterior cervico-thoracic trap door incision demonstrated excellent access and minimal morbidity. We recommend the trap door incision as the preferable route for exploring thoracic inlet tumours in children.
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Air enema is the treatment of choice for childhood intussusceptions. Although peritonitis is the established contraindication, studies have attempted to identify factors that affect the outcome of air enema. In our series we studied the impact of such factors on the clinical scenario to determine if it was important to predict the outcome of air enema. ⋯ Small bowel obstruction and prolapsing rectal intussusceptions merely reduce the success of air enema and do not increase the complications. Since the success of air enema is very high, it must be attempted in all children with the exception of peritonitis. Predicting the outcome is not crucial because of the high success rate and low complication rate.
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Pediatr. Surg. Int. · Mar 2008
Laparoscopic appendectomy is recommended for the treatment of complicated appendicitis in children.
Laparoscopic appendectomy in children is well accepted for the treatment of non complicated appendicitis. An increased risk of postoperative intraabdominal abcess formation has been reported in complicated appendicitis. The puropose of this study was to compare open (OA) versus laparoscopic appendectomies (LA) in complicated appendicitis in children and to assess the safety and feasibility of LA. ⋯ Ten patients (15.6%) had postoperative complications in the OA group; intraabdominal collections in 5, wound infection in 3, pleural effusion in 1 and prolonged ileus in 1. In complicated appendicitis the complication rate is lower for LA as compared to OA. We recommend laparoscopic approach to all children presenting with complicated appendicitis.