Journal of pediatric surgery
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Case Reports
Intrapleural streptokinase for the treatment of complicated parapneumonic effusion and empyema in 2 newborns.
The management of complicated parapneumonic effusions by conventional first-line treatment with closed intercostal tube drainage and antibiotic therapy may fail because of thick viscous fluid and multiple pleural space loculations. Intrapleural fibrinolytic treatment is a non-invasive therapeutic option. In this report, we present successful use of intrapleural streptokinase for complicated parapneumonic effusion and empyema in 2 newborns. Intrapleural fibrinolytic therapy with streptokinase appears to be a safe and effective adjunctive therapy of choice and may have significant benefit even in newborns with complicated parapneumonic effusion and empyema, and thus, it can obviate surgical intervention.
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The purpose of this study was to examine the impact on the family of immediate appendectomy compared with initial nonoperative management for perforated appendicitis in children. ⋯ Immediate appendectomy or initial nonoperative management can effectively manage perforated appendicitis in children with no statistically significant differences in the number of missed school or employment days. Greater improvements in family impact are associated with initial nonoperative management as measured by the Impact on Family Scale at completion of therapy.
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This study evaluates the effect of peritoneal irrigation and drainage on postoperative morbidity when used together for perforated appendicitis. ⋯ This study demonstrates that peritoneal irrigation and drainage in children with perforated appendicitis is not required, and in fact, these procedures cause an increase in operative time.
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Case Reports
Percutaneous revascularization of reoccluded meso-Rex shunts in extrahepatic portal vein obstruction.
Extrahepatic portal vein (PV) obstruction (EHPVO) is a rare disorder in early childhood with unknown incidence and mostly unknown etiology. In children with EHPVO, the hepatopedal flow of the mesenteric venous blood is hindered by an obstruction of the PV resulting in prehepatic portal hypertension. ⋯ Despite good primary patency, reocclusion of a meso-Rex bypass and its treatment can be challenging. We present 2 patients with EHPVO with subtotal functional occlusion of a meso-Rex shunt treated by percutaneous interventions with short- and mid-term follow-up.
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The urinary bladder is the second most commonly injured genitourinary organ. The objective of this study was to describe the management of pediatric traumatic bladder ruptures in the United States and their association with surgical repair and mortality. ⋯ After bladder trauma, pediatric patients demonstrate significantly improved survival when the bladder is surgically repaired. With only 67% of intraperitoneal bladder injuries being repaired, there appears to be underuse of a life-saving procedure.