Journal of pediatric surgery
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Injuries to the foot caused by foreign bodies are a frequent cause of local wounds and infections. In most cases, removal of the debris is easy and no comprehensive surgical care is needed. This case report is about a patient who stepped on a toothpick 10 years ago. ⋯ Surprisingly, an almost completely preserved toothpick surrounded by a distinct reaction of a foreign body granuloma was found. In conclusion, foreign-body injuries, as easy as they might seem, need a careful diagnostic workup and sufficient therapy. With injuries documented in medical history, the possibility of a retained foreign body should be considered.
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Case Reports
Early management of traumatic pancreatic transection by spleen-preserving laparoscopic distal pancreatectomy.
Pancreatic trauma is a common cause of acute pancreatitis in children and is often treated by conservative measures alone. Conservative measures are more likely to fail when there is complete pancreatic duct disruption. ⋯ The patient was successfully managed by a laparoscopic spleen-preserving distal pancreatectomy and recovered quickly without complications. The merit of a laparoscopic approach to severe pancreatic injury in children is discussed.
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Expeditious care within minutes of severe injury improves outcome and is the driving force for development of trauma care systems. Transition from hospital care to rehabilitation is an important step in recovery after trauma-related injury. We hypothesize that delay in the transition from acute care to rehabilitation adversely affects outcome and diminishes recovery after traumatic brain injury (TBI). ⋯ These data demonstrate the price of delay of comprehensive rehabilitation, especially for the most vulnerable TBI children with best potential for salvage. The "golden hour," which has become the mantra for continued refinement of systems of emergency and trauma care, must progress without interruption to the "golden day," during which comprehensive critical care seamlessly transitions to timely and aggressive rehabilitation to effect the greatest functional recovery.
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Typhlitis is clinically defined by the triad of neutropenia, abdominal pain, and fever. Radiologic evidence of colonic inflammation supports the diagnosis. We report a single United Kingdom tertiary center experience with management and outcome of typhlitis for 5 years. ⋯ The diagnosis of typhlitis was based on clinical features, supported by radiologic evidence in almost half of the study group. Surgical intervention should be reserved for specific complications or where another surgical pathologic condition cannot reasonably be ruled out.
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Comparative Study
Appendicitis in children: a comparative study between a specialist paediatric centre and a district general hospital.
The study aimed to compare paediatric appendicectomy practice in a specialist paediatric centre (SPC) with a district general hospital (DGH). ⋯ Our findings have important implications for local practice in our 2 centres but may also have wider implications for the national organisation of the surgical care of children and for the training of general surgeons.