Search

Total avulsion and transection of the esophagus at the esophagogastric junction are very rare after blunt trauma, and their management is challenging. Here, we present the case of a boy with this injury. To date, only two cases have been reported in children. One was treated successfully and the other died. The initial emergency operation should aim to save the life and native esophagus. Therefore, a primary or early thoracal end esophagostomy with gastrostomy should be performed, while primary repair should not be. [ABSTRACT FROM AUTHOR]

Heteropagous conjoined twins are rare and umbilical heteropagous conjoined twins are extremely rare. We present a case with umbilical heteropagous conjoined twins and discuss the diagnosis and management. The parasitic component of heteropagous can be separated and treated successfully in the majority of cases. [ABSTRACT FROM AUTHOR]

Presents an experimental study aimed to evaluated and compare the effects of orchidopexy and orchidectomy on ipsilateral and contralateral testes in rats subjected to ipsilateral abdominal testis and vas deferens obstruction. Effect of distressing conditions on the ipsilateral and contralateral testes; Materials and methods; Lactate levels in contralateral testes; Information on tissue hypoxia, an oxygen deficiency resulting in an altered or interrupted tissue metabolism.

Background: Isolated oesophageal atresia without tracheo-oesophageal fistula represents a major challenge for most paediatric surgeons. Here, we present our experience with six neonates with isolated oesophageal atresia who successfully underwent immediate primary anastomosis using multiple Livaditis circular myotomy.Materials and Methods: All six neonates were gross type A isolated oesophageal atresia (6%), from among 102 neonates with oesophageal atresia, treated between January 2009 and December 2013. Five neonates were female; one was male. The mean birth weight was 2300 (range 1700-3100) g.Results: All six neonates successfully underwent immediate primary anastomosis using multiple myotomies (mean 3; range 2-4) within 10 (median 3) days after birth. The gap under traction ranged from 6 to 7 cm. One neonate died of a major cardiac anomaly. Another neonate was lost to follow-up after being well for 3 months. Three anastomotic strictures were treated with balloon dilatation, and four anastomotic leaks were treated conservatively. The mean duration of follow-up was 33 months.Conclusions: To treat isolated oesophageal atresia, an immediate primary anastomosis can be achieved using multiple myotomies. Although, this approach is associated with high complication rates, as are other similar approaches, these complications can be overcome. [ABSTRACT FROM AUTHOR]

Single-port laparoscopic surgery (SPLS) is a surgical technique with many advantages over conventional laparoscopy. Its range of indications has expanded alongside the development of its unique tools and equipment. We are able to safely perform SPLS with the low-cost glove-port method without need of any specially developed SPLS port or the TriPort Access System. For this study, the files of patients who underwent laparoscopic surgeries performed between the dates of January 2013 and December 2014 at our clinic were reviewed. Umbilical access single-port abdominal surgeries which were performed using glove-port technique were included in the study. Two hundred nineteen patients who underwent SPLS surgery were included in the study. Of these patients, 158 (72.1%) were male and 61 (27.8%) were females. 58.4% of the cases were appendectomies (n = 128), 20% were orchidopexies (n = 44), 8.6% were orchiectomies (n = 19), 5.4% were ovarian cyst excisions (n = 12), 3.6% were varicocelectomies (n = 8), 2.2% were peritoneal dialysis catheter placements (n = 5), and 1.3% were nephroureterectomies (n = 3). In 67 cases (30.4%), Kirschner wire was used to eliminate the need for a second port. The study concludes that glove-port SPLS, which can readily be performed using conventional tools and Kirschner wire rather than expensive specially developed instruments, is a preferable technique because it is reliable, more cost-effective, and results in a scarless recovery. [ABSTRACT FROM AUTHOR]

Objective: Ecballium elaterium(EE) is a plant from Cucurbitaceae family. Its anti-inflammatory role in sepsis is not well understood. We investigated the effects of EE on serum levels of proinflammatory cytokines and further explored the mechanisms underlying histological changes in liver and ileum following EE administration in a polymicrobial sepsis model.Methods:Thirty rats were divided into three groups of 10 rats each. Rats were subjected to sham laparotomy plus normal saline administration (control group, CG), laparotomy withcecal ligation and puncture(CLP) (sepsis group, SG), and laparotomy with CLP plus 2.5 mg/kg EE administration (experimental group, EG). Twenty-four hours after laparotomy, animals underwent cardiac puncture, and blood was collected for interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) assessment. Whole sections of liver and ileum tissues were collected for histologic examination.Results:The serum level of IL-6 was significantly lower in EG as compared to SG. Although IL-6 levels were shown a statistically significant (p< 0.0001) decline to near control values, no significant changes were observed in serum levels of IL-1 and TNF-α after EE treatment. Histologic examination revealed statistically significant reduction in collagen formation (p= 0.001) on serosal surface of ileum and hepatic venous congestion (p= 0.040) in EG as compared to SG.Conclusion:EE might play a protective role in sepsis prevention and treatment by decreasing IL-6 production and reducing liver damage and may influence bacterial translocation by reinforcing intestinal barrier function. [ABSTRACT FROM PUBLISHER]

Purpose: Adrenal gland injury (AGI) caused by trauma may cause bleeding and life-threatening problems in children. The objective of this study was to analyze the prevalence of AGI in final diagnoses of trauma. Materials and Methods: The records of 458 patients with abdominal trauma (out of a total 8,200 pediatric patients with trauma of any sort), who were referred to our clinic between January 2009 and July 2014, were reviewed retrospectively. The numbers of patients with AGI and their ages, gender, trauma patterns, affected organs, pediatric trauma scores (PTSs), and injury severity scores (ISSs) were recorded, as well as the associated ultrasound (US) and tomographic scan data, treatments, and complications. Computed tomography (CT) scans obtained after trauma were subjected to both primary and secondary evaluation. Results: In total, 28 patients with AGI were detected; their average age was 8.54 ± 4.09 (3-17) years. Twenty (71%) patients were male and 8 (29%) were female. Nineteen (68%) patients had fallen from heights; the most commonly injured organs were the kidneys, spleen, and lungs. Injuries were right-sided in 26 (92.9%) patients. The mean ISS was 13.2 (range 5-50) and the mean PTS 8.6 (range 0-11). Seven patients had ISS > 16 and nine had PTS < 8. AGI was diagnosed by CT in 14 (50%) patients and in 3 (9%) by US at primary evaluation. Upon secondary scan inspection focusing on the possibility of adrenal gland injury, such injury was ultimately detected in 28 patients. All patients underwent conservative follow-up, and one died. Conclusion: We recommend calculation of the PTS, as well as other trauma scores, when pediatric patients suffering multiple or blunt abdominal trauma(s) present to the emergency . In addition, we believe that in children with trauma involving the liver, spleen or kidneys, careful evaluation using a CT scan would increase the diagnosis of AGI and reveal a realistic rate of AGI in trauma cases. [ABSTRACT FROM AUTHOR]

Objectives: In our study, the assessment of age, gender, incidence and seasonal differences in the regions related to appendicitis were investigated. Methods: 676 patients that received an operation following a diagnosis of appendicitis in 3 hospitals from 3 different regions of Turkey occurring at different dates were examined retrospectively after being categorized by region. The differences among groups were compared to each. Results: The mean age of male (63%) (n = 426) and female (37%) (n = 250) patients (total = 676) was 10.8 years (range, 1-18 years). The percentage of female patients in the The Black Sea Region (BR) group was significantly higher (48%) than that in the other two groups (%33 for SR, 30% for MR) (P = 0.001). The frequency of appendicitis was higher (36%) in the spring and winter (25%) than that during summer or fall. The number of cases increased the most in the BR group in spring (47%) (P < 0.001). When the types of appendicitis in the different age groups were compared with season, acute appendicitis (P < 0.02) was more frequently (93%) seen in the child-adolesan (CA) group in the spring; however, perfore apandicitis (45%) was greater in the Infant-Preschool (IPS) group (P < 0.02). Acute appendicitis comprised 55% and perforated appendicitis comprised 45% of cases in the IPS group, whereas acute appendicitis comprised 78% and perforated appendicitis comprised 22% in the CA group. Conclusion: According to the results of our study, appendicitis was most frequently seen in the spring and winter seasons and more frequent in boys between the ages of 10-13 years. As age decreases, the frequency of perforated appendicitis increases. Appendicitis is affected by environmental factors. Reducing the incidence of appendicitis may be possible by establishing regional and specific studies related to this subject and the etiologies of the disease. [ABSTRACT FROM AUTHOR]

Objectives: In our study, the assessment of age, gender, incidence and seasonal differences in the regions related to appendicitis were investigated. Methods: 676 patients that received an operation following a diagnosis of appendicitis in 3 hospitals from 3 different regions of Turkey occurring at different dates were examined retrospectively after being categorized by region. The differences among groups were compared to each. Results: The mean age of male (63%) (n = 426) and female (37%) (n = 250) patients (total = 676) was 10.8 years (range, 1-18 years). The percentage of female patients in the The Black Sea Region (BR) group was significantly higher (48%) than that in the other two groups (%33 for SR, 30% for MR) (P = 0.001). The frequency of appendicitis was higher (36%) in the spring and winter (25%) than that during summer or fall. The number of cases increased the most in the BR group in spring (47%) (P < 0.001). When the types of appendicitis in the different age groups were compared with season, acute appendicitis (P < 0.02) was more frequently (93%) seen in the child-adolesan (CA) group in the spring; however, perfore apandicitis (45%) was greater in the Infant-Preschool (IPS) group (P < 0.02). Acute appendicitis comprised 55% and perforated appendicitis comprised 45% of cases in the IPS group, whereas acute appendicitis comprised 78% and perforated appendicitis comprised 22% in the CA group. Conclusion: According to the results of our study, appendicitis was most frequently seen in the spring and winter seasons and more frequent in boys between the ages of 10-13 years. As age decreases, the frequency of perforated appendicitis increases. Appendicitis is affected by environmental factors. Reducing the incidence of appendicitis may be possible by establishing regional and specific studies related to this subject and the etiologies of the disease.r. [ABSTRACT FROM AUTHOR]

Background: There are insufficient data on pre-screening for pancreatic pseudocysts (PC) following pancreatic trauma. This study investigated the use of radiological and laboratory testing for predicting the development of pancreatic pseudocysts after trauma.Materials and Methods: The clinical records of all pediatric patients presenting with pancreatic trauma between January 2003 and December 2014 were reviewed retrospectively. Patients with American Association for the Surgery of Trauma (AAST) scores of Grade 3-5 were enrolled. The patients were divided into groups that developed [Group 1 (n = 20)] and did not develop [Group 2 (n = 18)] PC. The patients were evaluated in terms of their baseline characteristics, additional injuries, Injury Severity Score (ISS), pancreatic injury site, blood amylase levels 2 h and 10-15 days after the trauma, clinical presentation, and duration of intensive care unit (ICU) stay.Findings: We followed 38 patients. Of the patients in Group 1, 70 % had an injury to the tail of the pancreas. The ISS trauma scores and durations of hospitalization and ICU stay were significantly greater in Group 2 (p < 0.05). The mean blood amylase level on Day 1 was 607 U/L (range 183-801 U/L) in Group 1 and 314 U/L (range 25-631 U/L) in Group 2; the respective levels on Day 10 were 838 U/L (range 123-2951 U/L) and 83.2 U/L (range 35-164 U/L). The serum amylase levels were significantly higher (p < 0.001) in Group 1 than in Group 2 on Days 1 and 10. Four patients developed complications and two patients died.Conclusion: Pancreatic pseudocyst formation is more likely in patients with AAST Grade 3 pancreatic injury, also serum amylase levels ten times greater than normal 2 h after the trauma, and persistently elevated serum amylase levels 10-15 days following the trauma. [ABSTRACT FROM AUTHOR]

Splenic hemangiopericytoma is a very rare tumor. So far only 10 patients (9 adults, 1 child) have been reported in the literature and all of them were treated with total splenectomy. Herein, we report the first infant case of the splenic hemangiopericytoma in a 10-month-old girl and the first case that was treated with partial splenectomy for splenic hemangiopericytoma. [ABSTRACT FROM AUTHOR]

Purpose: Magnetic compression anastomosis is used for gastrointestinal, biliary, and urinary anastomoses. We have developed a simple magnetic compression gastrostomy technique in rats. Methods: Animals were randomized into two groups ( n = 12 each): magnetic gastrostomy (MG) and surgical gastrostomy (SG) (control). In the MG group, a magnetic insertion catheter was coupled with the first magnetic ball and introduced transorally into the stomach. A second magnetic ball was placed subcutaneously into the left upper quadrant. The two magnetic balls (4 mm) were strongly coupled together. On postoperative day (PD) 20 (MG group) and PD10 (SG group), rats were killed, gastrostomies were evaluated macroscopically and histopathologically, and mechanical burst testing was performed. Results: Two animals died due to suspected leaks. Macroscopic evaluation indicated no gastrostomy canal in one rat in each group. Mild adhesion was observed in two rats in the MG group. Moderate adhesion was observed in all rats in the SG group. No significant differences were observed in burst pressure between the two groups (means: MG group, 143 mmHg, n = 9; SG group, 159 mmHg, n = 8). Conclusions: Magnetic compression gastrostomy can be performed easily in rats, and may be developed in future as a simple alternative to some gastrostomy procedures in humans. [ABSTRACT FROM AUTHOR]

Objective: To report the first creation of magnetic compression cystostomy (magnacystostomy) using an easy and simple new technique in rats. Magnetic compression anastomoses (magnamosis) have been previously described for gastrointestinal, biliary, urinary, and vascular anastomoses. Methods: Female rats were randomized into 2 groups (n = 10 each): a magnetic cystostomy group and a formal surgical cystostomy group as the control group. In the magnetic cystostomy group, a very small cylindrical magnet was inserted into the bladder. The external magnetic ball was placed subcutaneously into the suprapubic region, and the 2 magnets were coupled together strongly. On postoperative day 20 in the magnetic cystostomy group and day 10 in the surgical cystostomy group, the rats were killed, and the cystostomies were evaluated macroscopically, histopathologically, and by mechanical burst testing. Results: In the surgical cystostomy group, 3 rats died. In the remaining rats, no evidence of complications was observed. However, mild adhesion in 1 rat in the magnetic cystostomy group and moderate adhesions in all the rats in the surgical cystostomy group were observed. No significant difference was found in burst pressure between the 2 groups (mean 162 mm Hg in the magnetic cystostomy group [n = 6] and 185 mm Hg in the surgical cystostomy [n = 5] group). However, the procedure time between the magnetic cystostomy group (7.70 ± 1.64 minutes) and surgical cystostomy group (18.50 ± 2.01 minutes) was significantly different (P < .001). Conclusion: Magnacystostomy is easy and safe in the rat model and could be useful for some suprapubic cystostomy procedures in humans. [ABSTRACT FROM AUTHOR]

A free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. Here, we present the first case with an intraperitoneal free-floating autoamputated ovary that caused an acute abdomen in a child and also review the literature. A 4-year-old girl was admitted with signs and symptoms of acute abdomen. At surgery, the patient had no right ovary and the right tube ended in a thin band that pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen. A calcified mass was found floating in the abdomen and was removed. The pathological examination showed necrotic tissue debris with calcifications. An autoamputated ovary is thought to result from ovarian torsion and is usually detected incidentally. However, it can cause an acute abdomen. [ABSTRACT FROM AUTHOR]

Purpose: Nonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients. Methods: Between 2003 and 2009, 31 patients, 28 male and 3 female, with pancreatic injury due to blunt abdominal trauma were treated in our clinic. All patients were evaluated by ultrasonography, computed tomography (CT), and evaluation of serum amylase levels. Patients with ongoing hemodynamic instability after resuscitation or signs of bowel perforation underwent immediate laparotomy, and the remaining patients were conservatively treated. Conservative treatment consisted of nasogastric tube replacement, total parenteral nutrition, monitoring of amylase levels, and serial clinical examination. Results: The most common mechanism of injury was a fall (35.4%). Ten patients (32.2%) had associated extraabdominal injuries, and 18 patients (58.1%) had associated abdominal injuries. The spleen was the most common site of intra-abdominal injury that was associated with pancreatic trauma. Initial amylase levels were normal in 5 patients, whose CT scans revealed pancreatic injury. Twenty-five patients (80.6%) were conservatively treated. Six patients (19.4%) required surgical intervention because of a hollow viscus or diaphragmatic injury and hemodynamic instability. A pseudocyst developed in 11 of the 25 patients who were nonoperatively treated; 6 patients required intervention for the pseudocyst (percutaneous drainage and cystogastrostomy). No patient succumbed to injury. Conclusions: The majority of the pancreatic injuries in pediatric patients can be successfully treated conservatively, unless there is hemodynamic instability and a hollow viscus injury. The most common complication is a pseudocyst. [ABSTRACT FROM AUTHOR]

Morgagni hernia (MH) is a congenital herniation of the abdominal organs through the subcostosternal portion of the diaphragm. It is a rare type of diaphragmatic hernia that has been associated with other congenital anomalies. The purpose of this clinical review was to determine the incidence of associated anomalies in patients with MH at a major pediatric referral center. The medical records of all patients with the diagnosis of MH were reviewed retrospectively between 1983 and 2006. The age, sex, side of herniation, presenting symptoms and signs, associated anomalies, radiologic features, intraoperative findings, postoperative course, complications, and mortality were recorded. There were 11 males and 5 females. The average age of the patients was 34.5 months (range 2 months-14 years). Twelve patients (75%) had at least one associated congenital malformation and eight (66.6%) of them had multiple anomalies. Six (37.5%) patients had a chromosomal anomaly, Down's syndrome in five and Turner syndrome in one. MH has a high incidence of associated congenital malformations. [ABSTRACT FROM AUTHOR]