Journal of pediatric surgery
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Bile-stained vomiting in infancy is abnormal. Malrotation with small bowel volvulus is probably the most worrying of possible causes because if untreated for too long, it can result in massive bowel necrosis. As a consequence, if examination or plain radiography does not suggest another cause, an upper gastrointestinal (GI) series is often performed to exclude malrotation. ⋯ The mesentery was derotated, and the cyst removed with the attached section of jejunum. This case highlights the need to reinvestigate patients with bilious vomiting despite a previous normal upper GI series. The case raises the issue of whether bilious vomiting, with a normal upper GI series, should be investigated further with an abdominal ultrasound scan to identify more unusual causes such as jejunal lymphatic vascular malformations.
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The objective of this study is to quantify the overall burden (operative and nonoperative) of small bowel obstruction caused by adhesions after laparotomy in children. ⋯ This population-based study has demonstrated that children have a high incidence of readmissions owing to adhesions after lower abdominal surgery. The risks are related to the site and the type of the original surgery. The risk of further readmissions was highest in the first year but continued with time. The data enable surgeons to target antiadhesion strategies at procedures that lead to a high risk of adhesions.
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Historical reports indicate that active rewarming with extracorporeal membrane oxygenation (ECMO) can salvage a patient after hypothermic cardiac arrest. We created a protocol that includes ECMO for extreme hypothermia to guide rewarming of the hypothermic patient. ⋯ A preemptive strategy for the severely hypothermic patient provides an organized approach and prompt response. Expeditious rewarming can make the difference in an opportunity for survival.
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Review Case Reports
Challenges to cannulation for extracorporeal support in neonates with right-sided congenital diaphragmatic hernia.
Right-sided diaphragmatic defects represent less than 20% of all congenital diaphragmatic hernias (CDH). Recent data suggest that right CDH (R-CDH) may carry a disproportionately high morbidity as well as increased rates of extracorporeal support when compared with left CDH. Treatment of infants with R-CDH may be further complicated by anatomical distortion unique to right-sided defects. ⋯ At autopsy, a dilated azygous vein was evident as a result of inferior vena cava compression by a malpositioned liver. The possibility of azygous vein cannulation may be increased in neonates with R-CDH and has not been previously reported. When evaluating infants with R-CDH for ECMO, clinicians must recognize the possibility of azygous cannulation and its potentially lethal consequences, and should anticipate alternative venous cannulation.
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The widespread popularity of magnetic toy sets has resulted in increased reports of magnet ingestion and subsequent complications. Traditional algorithms for ingested foreign bodies have advocated passage of these objects through the gastrointestinal tract spontaneously. In regard to magnet ingestion, the unique mechanism of pathogenesis, attraction of 2 or more magnets across multiple loops of bowel, has led to several cases of intestinal perforation caused by bowel wall erosion and necrosis between the magnets. ⋯ The recent increase of case reports related to magnet ingestion has resulted in proposed treatment regimens for patients ingesting multiple magnets. We would also initiate the magnet algorithm if even presumably a single magnet was ingested. This would include close observation and early intervention, either with endoscopy or surgical exploration, which would theoretically prevent the more severe complications, reported in the literature.