Journal of pediatric surgery
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Tracheoesophageal fistula (TEF) is the most common congenital tracheal abnormality, frequently associated with esophageal atresia. Respiratory symptoms are associated with all types of TEF, even after surgical repair of the fistula. Gastroesophageal reflux (GER) with aspiration of gastric contents, structural instability of the airways (tracheomalacia), abnormal respiratory epithelium, abnormal esophageal motility, recurrent TEF, and esophageal stenosis contribute to postsurgical complications. ⋯ We hypothesize that the diverticula impaired airway clearance and contributed to persistent respiratory symptoms. Possible mechanisms for the diverticulum contributing to poor airway clearance include facilitating the pooling of secretions and acting as a "barrier" to the lower airway clearance mechanism. The diagnosis of a diverticulum should be considered early in patients with persistent respiratory symptoms after management of GER and tracheomalacia. Early obliteration of tracheal diverticula might improve respiratory status in some patients.
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Case Reports
Laparoscopic extraction of an intrahepatic foreign body after transduodenal migration in a child.
We report on a 3-year-old boy who, after ingestion of turpentine, had an x-ray and was incidentally diagnosed with an intrahepatic needle. He was asymptomatic with no history of needle ingestion. Imaging (ultrasound and computed tomographic scans) showed a needle in segment 1, close to the inferior vena cava, with a proximal end in contact with the superior angle of the duodenum. ⋯ Laparoscopic extraction of an entire sewing needle was performed. Postoperative course was uneventful; the child was discharged home after 2 days and is alive and well 19 months after surgery. Laparoscopy may be useful in children for extraction of intrahepatic foreign bodies, after transduodenal migration.
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Case Reports
Hereditary pancreatitis in children: surgical implications with special regard to genetic background.
Hereditary pancreatitis (HP) is the primary etiology of chronic pancreatitis during childhood, progressing through recurrent episodes of acute pancreatitis and finally leading to pancreatic insufficiencies. Hereditary pancreatitis is because of mutations of the cationic trypsinogen (PRSS1) gene. Some other genes, such as SPINK1 or CFTR, have been associated with familial idiopathic chronic pancreatitis. The aim of our study was to clearly define diagnostic and therapeutic strategies for HP patients, through an analysis of our study group and a review of the literature. ⋯ Hereditary pancreatitis is associated with severe pancreatitis, with a greater risk of developing pancreatic cancer. It must therefore be diagnosed correctly and treated to prevent its considerable complications.
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Case Reports
Malignant tumor of the trachea in children: diagnostic pitfalls and surgical management.
Primary tracheal malignant neoplasms are very rare. Histologically, squamous cell and adenoid cystic carcinomas are the most common types of malignant primary tracheal tumors when all age groups are studied. In the past 5 years, we treated 2 children with tracheal mucoepidermoid carcinoma. Herein we report both cases and review the literature on the subject with particular emphasis on diagnosis and surgical management.
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This study was conducted to evaluate early diagnosis, clinical course, and treatment outcome in children with pyomyositis. ⋯ Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of immediate onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as major complications such as abscess formation and sepsis can be avoided. Having a high sensitivity to reactive inflammatory changes, MRI is a valuable tool in the armamentarium of the clinician in early diagnosis of pyomyositis.