Journal of pediatric surgery
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Meconium peritonitis is a form of chemical peritonitis resulting from in utero perforation of the gastrointestinal tract, with subsequent leakage of sterile meconium into the peritoneal cavity and the potential spaces connected with it. Involvement of the tunica vaginalis may be the sole presenting clinical manifestation of the gut perforation resolving spontaneously. In such instances, radiologically detectable calcifications in the abdomen, scrotum, and thorax are essential diagnostic points. In this study, a 4-month-old baby with abdominal, scrotal, and thoracic calcifications owing to healed meconium peritonitis is presented.
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Aspiration of foreign bodies remains a major cause of morbidity and mortality in childhood. The aim of this study was to evaluate the predictive diagnostic value of clinical signs and symptoms, the history, and the radiology to perform early diagnosis and therapy. ⋯ A choking crisis in the child's history should alert physicians to the possibility of a foreign body aspiration. In the present series, complications always were related to the diagnostic delay.
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Comparative Study Clinical Trial Controlled Clinical Trial
Free radical formation in infants: the effect of critical illness, parenteral nutrition, and enteral feeding.
An increase in free radical activity has been observed in patients suffering from a variety of illnesses and has been correlated with disease severity. Free radical production is increased by the administration of total parenteral nutrition (TPN) and may be linked to its adverse effects. Some of the complications of TPN can be ameliorated by partial enteral feeding. The aim of this study was to investigate free radical activity during critical illness and during the administration of parenteral nutrition. ⋯ Critical illness causes a rise in free radical production. Parenteral nutrition causes a significant elevation in free radical activity in both stable infants in the ward and critically ill infants in NICU. The addition of minimal enteral feeding to parenteral nutrition does not reduce free radical activity. We hypothesize that the parenteral nutrition solution directly initiates free radical production.
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Comparative Study
The role of prophylactic cholecystectomy during splenectomy in children with hereditary spherocytosis.
Hereditary spherocytosis is an autosomal dominant disorder associated with an intrinsic defect in the red blood cell membrane often necessitating splenectomy to prevent sequestration of spherocytes. When cholelithiasis is present, these patients undergo cholecystectomy at the same surgical setting as splenectomy. After splenectomy alone, it is uncertain whether the amount of hemolysis is adequately decreased to prevent subsequent gallstone formation. This study set out to evaluate the frequency in which symptomatic cholelithiasis subsequently develops in children treated by splenectomy alone. ⋯ Prophylactic cholecystectomy at the time of splenectomy is not indicated in patients with hereditary spherocytosis who do not have gallstones.
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Bile duct injuries are rare in children after blunt trauma. This report describes a 3-year-old child who sustained a blunt abdominal trauma resulting in bile duct, liver, and small bowel injuries. The initial management at another hospital included recognition and repair of a small bowel perforation. ⋯ At laparotomy there were injuries of both right and left hepatic ducts, and an anomaly of bile duct course was noted. The right hepatic duct was repaired primarily and the left one was repaired with Roux-en-Y hepaticojejunostomy. Postoperatively, normal bile drainage was documented by radioisotope scan and the patient remains symptom free at 1 year follow-up.