Journal of pediatric surgery
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Minimally invasive repair of pectus excavatum (MIRPE) has become widely popular since its introduction in the late 1990s by Nuss. We describe 1 unusual complication after MIRPE and 1 life-threatening bleeding during removal of the pectus bar. ⋯ Numerous operative and postoperative complications after MIRPE are feasible. This is the first report of a life-threatening bleeding during removal of the pectus bar. Minimally invasive repair of pectus excavatum procedure and removal of the pectus bar should only occur in specialized institutions with wide experience in thoracic surgery.
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Case Reports
Renal artery pseudoaneurysm secondary to blunt trauma treated with microcoil embolization.
Renal artery pseudoaneurysms are rarely described sequelae of blunt abdominal trauma. Interventional radiological advances have allowed such lesions to be managed nonoperatively. ⋯ Renal artery pseudoaneurysms that arise after blunt abdominal trauma in the pediatric population may be safely and effectively managed with arterial embolization, thereby avoiding extensive surgical interventions.
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Necrotizing fasciitis is a rapidly spreading soft tissue infection affecting the subcutaneous tissue and underlying fascial layers. Although this infection pattern is commonly seen in adults, it is rarely seen in the neonatal population. Herein, we describe a patient who developed extensive necrotizing fasciitis of the abdominal wall after intestinal resection for necrotizing enterocolitis (NEC).
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A 12-year-old girl was admitted after a bicycle accident, and a grade 4 splenic injury was diagnosed. She became hemodynamically unstable within the first hours after arrival and remained so despite fluid resuscitation and transfusions. ⋯ Nonoperative management of blunt splenic trauma remains the gold standard in pediatric trauma care. In hemodynamically unstable patients, splenic artery embolization should be considered as an adjunct to that strategy.
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Clinical Trial
Effects of surgical repair of congenital diaphragmatic hernia on cerebral hemodynamics evaluated by near-infrared spectroscopy.
Cardiorespiratory stabilization is recommended before surgical repair of congenital diaphragmatic hernia (CDH) because surgery may induce a transitory deterioration of chest compliance and gas exchange. It is not known if surgical intervention can affect cerebral circulation and oxygenation. ⋯ Notwithstanding the initial cardiorespiratory stabilization, surgical repair of CDH was associated with a rise in HR and oxygen requirement and a drop in cerebral tHb and O2Hb, suggesting a reduction in cerebral blood volume and oxygenation. These events were probably due to the combined effects of an increase in right to left shunting (as indicated by the increased oxygen requirement) and a decrease in venous return (possibly due to compression of the inferior vena cava by the viscera positioned into the abdomen). These preliminary results reinforce the importance of achieving a good cardiorespiratory stability before undertaking surgical correction of CDH to minimize the possible interference of the procedure with cerebral circulation and oxygenation.