Journal of pediatric surgery
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Postoperative apneas are reported in up to 49% of premature infants undergoing anesthesia for inguinal hernia repair. Our current practice is to monitor all of these babies in the intensive care unit (ICU) overnight after surgery. In addition to the considerable expense to the health care system, these cases are cancelled if no ICU bed is available. ⋯ Postoperative apnea in premature infants after inguinal hernia repair using current anesthetic techniques is much less common than previously reported. Infants with prior history of apneas are at highest risk. Other risk factors appear to include gestational age, birth weight, weight at time of surgery, and a complicated neonatal course. Selective use of postoperative ICU monitoring for high-risk patients could result in significant resource and cost savings to the health care system.
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The epidemiology of pediatric blunt intraabdominal arterial injury is ill defined. We analyzed a multiinstitutional trauma database to better define injury patterns and predictors of outcome. ⋯ Blunt intraabdominal arterial injury in children usually affects a single vessel. Associated injuries appear to be nearly universal. The high mortality rate is influenced by serious associated injuries and is reflected by overall injury severity scores.
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To investigate injuries among children and adolescents who participate in downhill sports. ⋯ As the popularity of snowboarding rises, snowboarding injuries in children are increasing. Pediatric surgeons should be wary of the "snowboard spleen."
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Case Reports
Abdominal cutaneous nerve entrapment syndrome after blunt abdominal trauma in an 11-year-old girl.
Chronic abdominal pain is a common complaint in children. Pain originating from the abdominal wall is often overlooked. Nevertheless, recognizing this type of pain prevents unnecessary examinations (Editorial: Abdominal wall tenderness test: could Carnett cut costs? Lancet. 1991, 337:1134). ⋯ The treatment also is equally simple and effective. We describe an 11-year-old girl with ACNES after blunt abdominal trauma, what we believe has not been reported before. Abdominal wall pain, for example, caused by ACNES, as other types of chronic pain, has a serious impact on a child's well-being and future coping mechanisms with disease and health behavior.
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We report on 2 sisters presenting with acute torsion of a wandering spleen within a 3-year interval. The diagnosis was made preoperatively by computed tomography (CT) in both cases. A high index of suspicion because of our experience with the first patient, who underwent splenectomy, enabled a correct early diagnosis in the sibling. On urgent surgery, reversible ischemic changes were found, and detorsion and splenopexy resulted in preservation of the spleen.