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Neonatal surgical emergencies are challenging, often high‐risk procedures for the pediatric anesthesiologist. Though each emergency presents different anesthetic challenges, several error traps exist that are common to all procedures in this patient population. These error traps include errors in surgical timing, airway management, maintenance of normothermia and normoglycemia, and recognition of pharmacologic and physiologic differences. In this narrative review, we will discuss each error trap to aid the clinician in recognizing, planning for, and mitigating adverse events. [ABSTRACT FROM AUTHOR]

Purpose: Delays in the diagnosis and treatment of infantile hypertrophic pyloric stenosis (IHPS) may lead to laboratory and clinical decompensation in infants. The aim of this study was to determine whether pyloric measurement parameters can be effectively used in the clinical prognosis of IHPS by evaluating the relationship between pyloric dimensions on ultrasonographic evaluation at the time of presentation and clinical and laboratory parameters in infants with pyloric stenosis. Methods: A retrospective observational study was conducted on 122 infants who were followed up with the diagnosis of IHPS in our neonatal clinic and operated on by a pediatric surgeon between January 2005 and December 2020. Results: The mean pyloric dimensions of the infants were pyloric length 20 mm (17–22), pyloric thickness 5 mm (4–5.8), and pyloric index 96.5 (72.2–124). Babies with preoperative laboratory values of hypokalemia, hypochloremia and metabolic alkalosis had statistically higher pyloric thickness >5 mm (4.1–6) and pyloric index >100 (86–130) parameters. Conclusion: Pyloric thickness and pyloric index parameters can predict clinical prognosis in babies diagnosed with IHPS in the perioperative period. [ABSTRACT FROM AUTHOR]

The article presents a case study of two male infants diagnosed with hypertrophic pyloric stenosis, highlighting their clinical presentation and management. Topics discussed include the genetic and environmental factors contributing to pyloric stenosis, the criteria for surgical intervention, and the increased incidence of the condition among twins.

Background: Infantile hypertrophic pyloric stenosis (IHPS) is a condition whose etiology is not clear, but it is characterized by progressive hypertrophy of the circular muscles of the pylorus with consequent obstruction of the gastric outflow, mostly in neonates and infants under the age of one year. Objectives: To assess the treatment outcome and associated factors of infantile pyloric sphincter stenosis among paediatric patients admitted to HFCSUH and JUSHYRH. Methodology: A retrospective patient record review with 78 participants was studied consecutively using a structured questionnaire. The data was processed and analyzed using Epi Info 7 and SPSS version 24. Descriptive analysis was done, and then associated factors to the outcome were assessed using logistic regression analysis. The association's significance was determined using an odds ratio with a 95% confidence interval and a P-value less than 0.05. The study period was from November 1st to 30th, 2022. Results: The magnitude of unfavorable IHPS was 17.1% with a 95% confidence interval of 16.7–23.9%. Hypokalemia (AOR = 2.3, CI = 3.015–19.54), severe dehydration (AOR = 30.9, CI = 2.89–31.75), and delayed presentation (AOR = 7.37, CI = 2.761–12.08) were independent predictors. Conclusions: The study found a highly unfavorable treatment outcome with delayed presentation; dehydration and electrolyte disturbance were the main predictors of poor outcome. It is recommended to increase community awareness about non-bilious vomiting in infants and ensure high suspicion among healthcare providers. Moreover, following guidelines to correct fluid and electrolyte disturbances and managing these patients in the pediatric ICU postoperatively. [ABSTRACT FROM AUTHOR]

Background: Gastric adenomyoma is a rare benign tumor composed of glandular structures and smooth muscle fibers. While some classify gastric adenomyoma as a hamartoma, others view it as an abortive form of heterotopic pancreas. Despite its benign nature, there is a risk of malignant transformation. Predominantly found in the antrum, gastric adenomyoma affects all ages but is most common in adults aged 40–60 years. Symptoms are nonspecific, and its similarity to other lesions complicates diagnosis. This paper aims to provide a review of medical literature on gastric adenomyoma and its diagnosis and treatment methods, along with presenting an additional case report on the same topic. Case presentation: We present the case of a 55-year-old Syrian man who experienced vomiting, weight loss, and chronic partial constipation. An obstructing mass in the pylorus was detected, and then an open surgery was performed to excise the lesion. A biopsy of the resected mass was obtained for histopathological examination. The final diagnosis of the lesion was pyloric-region adenomyoma with severe pyloric stenosis. After the successful surgery, the patient recovered without any recurrence or complications. Conclusions: Several diagnostic approaches are available, including radiological studies, endoscopic examination, and fine needle aspiration guided by endoscopic ultrasonography. Treatment options involve endoscopic submucosal dissection and complete laparotomy resection. Further studies and thorough reviews are recommended to better understand the best clinical practices. Practitioners should consider gastric adenomyoma when encountering a mural gastric lesion. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course. Background: Pyloric obstruction after dichlorvos poisoning causes repeated vomiting and inability to eat. Choledocholithiasis and cholelithiasis are the common digestive diseases, with high morbidity and relapse in elderly patients. However, the complex situation of these diseases' coexistence is a clinically intractable problem, and literature on selecting optimal surgical planning is scarce. Case Report: A thin 79-year-old woman took dichlorvos due to family conflicts. She improved after being urgently sent to local hospital for gastric lavage and detoxification. Over the next 3 months, she presented with intermittent nausea, vomiting, epigastric pain, and mental apathy, and was readmitted. Gastroscopy showed extensive scarring in the antrum, pyloric obstruction, and gastric retention. Magnetic resonance cholangiopancreatography revealed gallstones and choledocholithiasis. Also, she presented with gastric retention, hypertension, moderate anemia, hypoproteinemia, and electrolyte disturbances. After hospitalization, conservative treatment was performed, without improving vomiting, followed by surgical treatment. Gastrojejunostomy, Braun anastomosis, and nasojejunal feeding tube placement were performed for pyloric stenosis; cholecystectomy for cholelithiasis; and choledochotomy, intraoperative choledochoscopy examination, basket stone extraction, and primary suture of common bile duct without indwelling T tube for choledocholithiasis. Patient recovered and was discharged 9 days after surgery. She was recovered well, without vomiting, at 2-month follow-up. Conclusions: Gastrojejunostomy plus Braun anastomosis is effective treatment of elderly patients with pyloric obstruction formed after pesticide-induced corrosion. Careful selection of choledocholithotomy with primary suture without indwelling T tube reduced postoperative pain and accelerated recovery. This complex case of pyloric obstruction with gallbladder and bile duct stones provides useful considerations for clinical treatment. [ABSTRACT FROM AUTHOR]

Copyright of Acta Pediatrica de Mexico is the property of Instituto Nacional de Pediatria (INP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Tesla Revista Científica is the property of Puerto Madero Editorial Academica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aims to share our experience of laparoscopic exploration for infantile hypertrophic pyloric stenosis. Material and methods: This retrospective study was conducted in the Department of Pediatric Surgery, Khyber Teaching Hospital, Peshawar from June 2017 to July 2020. This study includes all patients whose diagnosis of infantile hypertrophic pyloric stenosis (IHPS) was confirmed through ultrasound parameters and laparoscopic pyloromyotomy was performed. Data was retrieved from the laparoscopic surgery record. Retrieved data was tabulated and fed in SPSS 25 for analysis. Results: This study included 42 patients with a mean age of 50.28 ±18.5days and a mean weight of 3.35±0.76 kg. Male patients were 57 % while females were 43 %. The mean time to resuscitate the patient pre-operatively was 34.6±15.4 hours while the mean postoperative hospital stay was 45±12.47 hours. The mean operative time was 31.6±10.4 min. Operative time decreased with time depicting improvement in our learning curve (p=0.004). The method of working instrument placement had no impact on operative time (p=0.337). Meantime to full oral feed was 9.7±5.1 hours. We did not encounter mucosal perforation or incomplete myotomy. No surgery was converted to open. Conclusion: Laparoscopic pyloromyotomy is a safe and effective method of treatment for infantile hypertrophic pyloric stenosis. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine the correlation between obesity, serum levels of leptin and proximal gastric cancer. Sixty-four gastric cancer patients operated on with curative intent were included in the study. We determined the correlation between the preoperative serum levels of leptin and the tumor's location. Serum leptin levels were correlated significantly with the proximal third location (p=0.04), gastric outlet obstructing tumors (p<0.0001), CRP levels (p=0.03) and BMI (p<0.0001). Patients with high serum levels of leptin had significantly more intestinal types of gastric cancer (p=0.033) and better differentiation (p=0.009). The linear regression model determined the proximal tumor location (beta: 0.467; p=0.045), BMI (beta: 0.657; p=0.001), high preoperative serum albumin (beta: 0.563; p=0.016) and the presence of pyloric stenosis (beta: 0.525; p=0.006) as related significantly to serum leptin levels. The Cox proportional hazard model identified age (HR: 0.003; 95 % CI: 0–0.794; p=0.041), preoperative serum levels of leptin (HR: 0.125; 95 % CI: 0.018–0.887; p=0.037) and the number of extracted LNs (HR: 0.001; 95 % CI: 0–0.677; p=0.038) as independent prognostic factors. Serum levels of leptin were significantly elevated in patients with proximal gastric cancer, suggesting that the leptin's effect might be due to its systemic secretion. This might explain the higher incidence of proximal gastric cancer in obese patients. Elevated serum leptin levels were an independent prognostic factor. [ABSTRACT FROM AUTHOR]

Megalourethra is a rare clinical entity of absence or hypoplasia of corpus spongiosum and/or corpora carvenosa or anterior urethral valve along the pendulous urethra causing enlarged penis as a result of cystic dilatation of this part mostly during passage of urine. It may be associated with other congenital anomalies such prune belly syndrome and imperforated anus among others. We present a 10-day old neonate with scaphoid megalourethra associated with imperforated anus and pyloric stenosis. To the best of our knowledge, wehave limitedinformation on megalourethra in most parts of Africa but also, we were unable to find out any published report in East Africa regarding this rare condition especially in association with pyloric stenosis and imperforated anus. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic pyloromyotomy is the preferred surgical management of hypertrophic pyloric stenosis at most centers. We aimed to analyze the learning curve for laparoscopic pyloromyotomy using the experience of five fellowship-trained pediatric surgeons. Methods: A retrospective review of consecutive patients undergoing laparoscopic pyloromyotomy was performed. All cases were performed with general surgery residents. Cumulative sum (CUSUM) analysis for operating time was performed for up to the first 150 consecutive cases for individual surgeons. Outcomes were compared to identify different phases of the learning curve for operative competency. Results: A total of 414 patients were included in the analysis as not all surgeons had reached 150 cases at time of analysis. The mean operating time was 29.2 min for all cases across the 5 surgeons. CUSUM analysis for mean operating time revealed three phases of learning: Learning Phase (cases 1-16), Plateau Phase (cases 17-87), and a Proficiency Phase (cases 88-150). The mean operating time during the three phases was 34.1, 29.0, and 28.3 min, respectively (P = 0.005). There were no differences in complications, reoperations, length of stay, or readmissions across the three phases. Conclusion: Three distinct phases of learning for laparoscopic pyloromyotomy were identified with no differences in outcomes across the phases. The operating time differed only for the Learning Phase, suggesting that some degree of proficiency occurs after 16 cases. [ABSTRACT FROM AUTHOR]

We report a 24-year-old male with blepharophimosis, psychomotor retardation, brachycephaly, microstomia, immobile face, high arched palate, single palmar crease, kyphoscoliosis, talipes equinovarus, inguinal hernia, pyloric stenosis, recurrent infections, bilateral camptodactyly, wide-set eyes, decreased muscle mass, hypotonia, exotropia, and ptosis in the left eye, growth retardation, multiple congenital contractures, and hyporreflexia. Contractures improved with aging, but intellectual disability and blepharophimosis remained. He also presented epilepsy, outbursts of laughter, and predisposition to drug adverse effects (skin lesions with carbamazepine and secondary parkinsonism). [ABSTRACT FROM AUTHOR]

Objective: There are several approaches to pyloromyotomy for the treatment of hypertrophic pyloric stenosis including open transumbilical pyloromyotomy and laparoscopic pyloromyotomy. Beginning in 2012, we adopted intraumbilical longitudinal incision as a new transumbilical approach for pyloromyotomy. We describe details of the operative technique and results of this new approach. Methods: We reviewed records of patients undergoing transumbilical pyloromyotomy from 2005 to 2018. Perioperative outcomes were compared between intraumbilical longitudinal incision and supraumbilical incision, the latter of which is the conventional incision for transumbilical pyloromyotomy. Results: Twenty-four patients underwent pyloromyotomy with intraumbilical longitudinal incision (intraumbilical group) and 28 patients with supraumbilical incision (supraumbilical group). The median operative time was longer in the intraumbilical group (58.0 vs. 43.5 min, p = 0.002). However, the time to full feeding did not differ significantly between the two groups, and the median postoperative stay was shorter in the intraumbilical group (3 vs. 5.5 days, p = 0.003). There was no difference in the rate of complications (4.2% vs. 7.1%, p = 1.0). Scars after intraumbilical longitudinal incision were localized inside the umbilicus. Conclusion: Pyloromyotomy can be performed through intraumbilical longitudinal incision as safely as supraumbilical incision and intraumbilical longitudinal incision may improve cosmetic results. This approach can be an alternative technique for pyloromyotomy. [ABSTRACT FROM AUTHOR]

Metastasis to the gastrointestinal tract is rare. A 59-year-old woman who had a history of an invasive lobular carcinoma of breast with clinical complete response visited our hospital and complained of an upper abdominal pain and distension. We performed an upper gastrointestinal endoscopy which showed only a gastric ulcer without any malignant findings. She experienced a recurrence of symptoms 2 months after this visit. An endoscopy revealed pyloric stenosis, which did not improve with balloon dilatation. We performed a gastro-jejunal and cecal-transverse colonic bypass surgery. Diffuse wall thickening of the antrum was verified during the surgery, and a biopsy sample was collected. The diagnosis of gastric metastasis from breast was confirmed since it showed the same immunohistochemistry pattern as the prior breast lesion. Pyloric stenosis has still been confirmed with an endoscopy, she has been alive with satisfactory oral food intake for >10 years. [ABSTRACT FROM AUTHOR]

Background: Caustic substance ingestion is a high-risk medical emergency associated with high mortality and morbidity. To date, there are several treatment options with no standard method of care. Case presentation: We report a case of a corrosive agent ingestion complicated with third-degree burns and severe stenosis of the esophagus and gastric outlet. After failure of conservative treatment, the patient underwent jejunostomy placement for nutritional support followed by transhiatal esophagectomy with gastric pull-up and intra-thoracic Roux-en-Y gastroenterostomy with good outcomes. The patient recovered from the procedure and has been tolerating oral intake very well with significant weight gain. Conclusion: We put a new technique for treating severe gastrointestinal injuries caused by corrosive agent ingestion that resulted in both esophageal and gastric outlet strictures. These rare complex cases requires difficult treatment decisions. We believe that this technique provides many benefits for such cases and might be a feasible alternative for colon interposition. [ABSTRACT FROM AUTHOR]

Background In this study, we wanted to evaluate the surgical management of peptic perforation and compare between simple closure and definitive surgery. Methods This was a hospital based comparative study conducted among 154 patients who presented with peptic perforations to the Department of Surgery, Heritage Institute of Medical Sciences, Uttar Pradesh, from March 2020 to February 2021, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results The highest incidence was recorded in poor socio-economic status. There was no previous history of peptic ulcer. 91 % of the patients were operated within 72 hours of perforation. The commonest form of presentation was pain abdomen, which was present in all the patients. Gas under the diaphragm was present in 86 % of cases. Gastrografin study was done in some of patients to facilitate diagnosis. Bilious fluid came out in four quadrants peritoneal tap. 67.5 % of the perforations were less than 5 mm in size and 96 % of perforations were less than 10 mm in size. Out of 154 cases, 52 patients (34 %) had post-operative complications. In group -A, mortality was 11.5 % and 7 % in Group - B. Average hospital stay in Group - A was 11.73 days and average hospital stay in group B was 13.05 days. Dyspepsia occurred in 58.4 % of patients; hematemesis and/Melena in 15 (9 %) cases, pyloric stenosis in 4 (2.6 %) cases and re-perforation in 2 (1.7 %) cases in two years of follow up. Ulcer recurrence occurred in 30.5 % of patients and was treated by simple closure in 2 years of follow up; but there was no recurrence in patients treated by definitive surgery during this period. Conclusion Simple closure of the perforation with drainage of peritoneal cavity is safe for those in whom definitive surgery is relatively contraindicated like, elderly patients presenting with moderate to severe shock, after 48 hours of perforation and with concomitant medical illness. Therefore, painstaking efforts are made in selecting proper cases for definitive surgery, so that both immediate and long term good result can be obtained. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Pediatric Surgery is the property of Journal of Clinical Pediatric Surgery Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sarcina ventriculi is an anaerobic gram-positive bacterium capable of surviving in the acidic environment of the stomach and causing gastrointestinal symptoms. We report the case of a 51-year-old patient with no notable medical history who presented with abdominal distension, nausea, and vomiting. Initial endoscopic evaluation revealed a distended stomach in stasis with pyloric stenosis. Biopsies revealed the presence of Helicobacter pylori and S. ventriculi. A therapeutic protocol was administered, but no symptomatic relief was observed. Subsequently, the patient was referred to our institution, where computed tomography imaging of the abdomen was performed. The results corroborated a presentation suggestive of a high obstruction attributable to a right anterior para-duodenal internal hernia. Ultimately, surgery was undertaken, ruling out the diagnosis of right para-duodenal internal hernia and resulting in gastroenteric anastomosis with satisfactory improvement in clinical symptoms. [ABSTRACT FROM AUTHOR]

The occurrence of lymphoma at the gastrojejunostomy (GJ) site is infrequent. Only two GJ site lymphoma cases are reported in the literature. Endoscopy and biopsy are primary methods for diagnosis which should be performed in these patients for the exact diagnosis. Here, we report a case where an elderly patient who developed a non-Hodgkin lymphoma of the GJ site had undergone GJ for benign peptic ulcer disease 5 years ago. Upper gastrointestinal scopy showed polypoidal growth at the GJ site with pyloric stenosis. Diagnosis of poorly differentiated adenocarcinoma was made on a biopsy sent from the GJ site. On laparotomy, there were omental deposits. Biopsy of omental deposits was reported as diffuse large B-cell lymphoma (DLBCL). Both biopsies were sent for immunohistochemistry which showed DLBCL. Palliative GJ was performed; the patient was asked for a follow-up for chemotherapy. After 10 days, he developed septic shock and succumbed. [ABSTRACT FROM AUTHOR]

Copyright of Revista Salud UIS is the property of Universidad Industrial de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of infant vomiting. Emergency department (ED) diagnosis is usually made by pyloric ultrasound and treated by pyloromyotomy. Case Report: An eight-week-old boy with a history of IHPS about six weeks status post pyloromyotomy presented to the ED with vomiting and failure to thrive, and a critically narrowed pylorus was identified by ultrasound. An upper gastrointestinal series confirmed recurrent pyloric stenosis, necessitating another pyloromyotomy. Conclusion: Prolonged vomiting after pyloromyotomy should be concerning for recurrent IHPS. Upper gastrointestinal series should augment ultrasound to diagnose recurrent IHPS and determine whether a second pyloromyotomy is warranted. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Facultad de Medicina Humana is the property of Instituto de Investigaciones en Ciencias Biomedicas de la Universidad Ricardo Palma and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents the December issue of the "Forum of Family Medicine" for the year 2021, which includes a number of significant papers on various medical topics. Among the discussed subjects are atrial fibrillation, the diagnosis and treatment of limb ischemia, as well as the treatment of insomnia in older adults. It also contains studies on hypertension in the context of health risks in the workplace and a clinical case of pyloric stenosis in an infant. The article emphasizes the importance of current guidelines and research for primary care physicians. [Extracted from the article]

Background: Pneumatosis intestinalis is an abnormal presence of free air outside the lumen of the intestines in many shapes. It is classified based on its etiology to primary or secondary, it affects adults as well as infants and can involve any part of the GI tract.Case Presentation: We report a case of a 55-year-old man with a past medical history of a surgically repaired perforated duodenal ulcer who presented with an acute abdominal pain, Flatulence and constipation. On examination of the abdomen; severe distension, tenderness and tympanicity on percussion were noted. An erect CXR was performed and showed bilateral sub-diaphragmatic air levels. We performed an abdominal Paracentesis under the right subcostal margin which led to evacuation of large amounts of air. Next, an investigational laparotomy showed that the reason was a gastric volvulus associated with an anterior and posterior gastric wall lacerations. The suitable surgical repair approach was taken, but another lesion was detected incidentally. A pneumatosis cystoides intestinalis (PCI) was extended along large length of the intestines in many shapes and without any symptoms or signs.Conclusions: Pneumatosis cystoides intestinalis has been reported continuously in relation to peptic ulcer disease (PUD). We aim to report a new association of a gastric volvulus and PCI secondary to pyloric stenosis caused by a duodenal ulcer; which we believe can aid in the diagnosing of dangerous complications, of a rare disease. [ABSTRACT FROM AUTHOR]

Background: Pneumatosis intestinalis is an abnormal presence of free air outside the lumen of the intestines in many shapes. It is classified based on its etiology to primary or secondary, it affects adults as well as infants and can involve any part of the GI tract. Case presentation: We report a case of a 55-year-old man with a past medical history of a surgically repaired perforated duodenal ulcer who presented with an acute abdominal pain, Flatulence and constipation. On examination of the abdomen; severe distension, tenderness and tympanicity on percussion were noted. An erect CXR was performed and showed bilateral sub-diaphragmatic air levels. We performed an abdominal Paracentesis under the right subcostal margin which led to evacuation of large amounts of air. Next, an investigational laparotomy showed that the reason was a gastric volvulus associated with an anterior and posterior gastric wall lacerations. The suitable surgical repair approach was taken, but another lesion was detected incidentally. A pneumatosis cystoides intestinalis (PCI) was extended along large length of the intestines in many shapes and without any symptoms or signs. Conclusions: Pneumatosis cystoides intestinalis has been reported continuously in relation to peptic ulcer disease (PUD). We aim to report a new association of a gastric volvulus and PCI secondary to pyloric stenosis caused by a duodenal ulcer; which we believe can aid in the diagnosing of dangerous complications, of a rare disease. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the occupational and environmental factors in the etiology of infantile hypertrophic pyloric stenosis (IHPS). Methods: Protocol was drafted according to the PRISMA guidelines and registered on PROSPERO (CRD42020152460). A search for a combination of terms related to IHPS, fetus and neonates, and environmental exposure was performed for studies published between 2000 and 2020 in the EMBASE, Pubmed, and MEDLINE databases. Results: Overall, 2203 abstracts were identified and 829 were screened. The full text of the selected articles (N = 98) was assessed for eligibility. Fifteen studies were included in quantitative synthesis. IHPS risk was significantly lower in black and Hispanic mothers than in white mothers [OR 0.47 (95% CI 0.44–0.51, p < 0.001), OR 0.85 (95% CI 0.77–0.94, p = 0.002), respectively]. Lower maternal education level and maternal smoking were risk factor for IHPS. We further observed a non-significant association between maternal folic acid usage and IHPS risk. Data were insufficient to evaluate occupational exposure. Conclusion: This review provides an understanding of the role of environmental exposures in IHPS etiology. Lower maternal educational level, maternal smoking, and white ethnicity are associated with a significantly increased risk of IHPS, while folic acid use seems non-significantly associated with IHPS risk. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Aim: This study aims to determine the sequelae of corrosive ingestion in children. Methods: A retrospective study was conducted in the Department of Pediatric Surgery at a Tertiary Center. The children presenting between January 2015 and December 2020 with a history of ingestion of caustic agents were included in the study. Results: A total of 26 children were included in the study. The children with suicidal attempts were significantly older than those who ingested the corrosive agents accidentally (14.2 ± 1.9 years vs. 6 ± 3.3 years; P < 0.01; Student's t-test). Sixteen (62%) children had esophageal strictures, 8 (31%) had pyloric strictures, and a child (4%) had both esophageal and gastric strictures. Eight (31%) children required an initial feeding jejunostomy and 6 (23%) required a feeding gastrostomy as they had significant weight loss on presentation. Eleven (65%) esophageal strictures responded to the dilatation regimen and are symptom-free on follow-up. Three (18%) children with esophageal stricture underwent esophageal replacement. Eight (31%) children had a pyloric stricture and all of them were treated with a modified Billroth I gastro-duodenostomy. The children who presented after 2 months were found to have a significantly increased need for esophageal replacement (3/9 vs. 0/17; P = 0.03; Fischer's exact test). Conclusion: The corrosive ingestion in children is associated with higher morbidity. The sequelae include esophageal and antro-pyloric strictures. A feeding gastrostomy or jejunostomy was required in more than half of the patients. The children presenting after 2 months of ingestion were associated with an increased need for esophageal replacement. [ABSTRACT FROM AUTHOR]

Purpose: A new novel technique for the treatment of pediatric hypertrophic pyloric stenosis (HPS), transumbilical single-site laparoscopic pyloromyotomy with a single instrument (TUSSLP), was introduced. TUSSLP was compared with the transabdominal three-site laparoscopic pyloromyotomy (TATSLP) procedure.Methods: Patients with HPS who underwent TUSSLP and TATSLP between January 2016 and September 2020 were assigned to group A and group B, respectively. The descriptive variables, perioperative clinical characteristics and postoperative follow-up results were retrospectively analyzed and compared between the 2 groups. The primary outcome of this study was the rate of switching to conventional pyloromyotomy.Results: Sixty-four patients were enrolled in this study. Of these patients, 29 (22 males, 7 females, 54.4 ± 22.6 days) who received TUSSLP were assigned to group A. The remaining 35 (28 males, 7 females, 54.5 ± 27.6 days) who received TATSLP were assigned to group B. The data of preoperative patient variables were comparable between the 2 groups (P > 0.05). The mean operative time (ORT) was 28.1 ± 5.6 min in group A, which was not significantly different from 25.8 ± 3.1 min in group B (P = 0.25). The other perioperative features were not significantly different between the 2 groups (P > 0.05). During follow-up (39.1 ± 14.7 m in group A and 35.4 ± 16.1 m in group B, P = 0.51), no significant difference was observed in the overall incidence of vomiting between the 2 groups (P = 0.26).Conclusions: TUSSLP is a feasible and reliable minimally invasive method for HPS. It has the advantages of an improved cosmetic appearance. The postoperative follow-up results of TUSSLP are comparable with those of TATSLP. [ABSTRACT FROM AUTHOR]

Mucosal perforation/injury during pyloromyotomy is a rare and frantic complication. The classical technique of repair is a full-thickness approximation (both mucosal repair and serosal repair) and re-pyloromyotomy at the opposite site. Alternatively, the simple primary mucosal repair is also reported. Such mucosal injury can be repaired with equal efficacy using both the classical full-thickness repair and pyloric rotation and primary closure technique in terms of complications and outcome. Here, we describe three cases of iatrogenic mucosal injury, which were treated successfully by full-thickness repair in two cases and one case with a primary mucosal repair. [ABSTRACT FROM AUTHOR]

Pyloric stenosis is characterised by a thicker, lengthened, and larger pylorus as well as hypertrophy of the circular and, to a lesser extent, the longitudinal smooth muscles. The classical presenting features are non-bilious, projectile vomiting, visible peristalsis and hypochloremichypokalaemic metabolic alkalosis. Definitive treatment is often performed by a relatively quick surgical procedure shortly after diagnosis. Surgery for pyloromyotomy is usually performed when fluid, acid/base, and electrolyte imbalances have been properly and completely corrected, which in turn results in speedy recovery of patient. The complications linked to these diseases call for caution when administering anaesthesia for even ostensibly straightforward surgical procedures. The case report is about a 1-month old male neonate who presented with features of pyloric stenosis. Weighing the increase risk of complications and mortality, the neonate was managed using rapid sequence induction approach in combination with caudal block for an adequate analgesia. [ABSTRACT FROM AUTHOR]

Background: Our aims were to determine if the diagnostic threshold for diagnosing hypertrophic pyloric stenosis (HPS) on ultrasound scan (USS) should be adjusted based on birth weight (BW), current weight (CW), gestational age (GA), chronological age (CA) or corrected gestational age (CGA). Methods: All patients who underwent either an USS and pyloromyotomy (Group 1) or an USS for possible HPS (Group 2) at our tertiary centre between July 2013 and June 2019 were identified. Ideal threshold values are identified by measuring Youden's Index (J = sensitivity + specificity – 1; higher is better). Mean maximum Youden's Index for stratified results was compared to that for combined results. Results: Two hundred and eighty‐four patients were included (142 patients in both Group 1 and Group 2). Combined maximum Youden's Index for all patients was 0.92 for pyloric canal thickness (PMT) and 0.87 for pyloric canal length (PCL). Mean maximum Youden's Index was higher when patients were stratified by GA, CGA, BW or CW, and equivalent for CA. For pyloric canal length (PCL), mean maximum Youden's Index was lower for all variables when stratified compared to combined. There was no visual trend observed in the diagnostic thresholds between groups. Conclusion: Stratifying USS PMT diagnostic thresholds values based on age and weight is statistically more accurate than a single threshold in diagnosing HPS. However, the lack of visual correlation indicates a larger dataset is required to validate these results. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we evaluated the impacts of ad libitum feedings on outcomes following laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis.Methods: Pediatric patients with infantile hypertrophic pyloric stenosis who underwent laparoscopic pyloromyotomy were included. Patients were stratified into ad libitum and structured feeding groups. Primary outcomes were times from surgery completion to goal feeding and discharge.Results: A total of 336 patients were included in the study with 63 patients (18.8%) in the ad libitum feeding group. The ad libitum feeding group experienced significantly shorter times from surgery completion to both goal feedings (10.7 h vs 18.7 h; p < 0.001) and hospital discharge (21.6 h vs 23.1 h; p = 0.008) compared to the structured protocol group. Postoperative emesis (47.% vs 30.8%; p = 0.011) was higher in the ab libitum cohort, but the rates of return to an emergency department and/or readmission (4.8% vs 2.2%; p = 0.26) were similar.Conclusion: Ad libitum feeding after pyloromyotomy decreases time to reach goal feeding and hospital discharge. While it may contribute to a higher incidence of emesis, it does not appear to significantly increase hospital readmission. Ad libitum feeding appears to be a safe and beneficial alternative to structured feeding protocols following pyloromyotomy.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: Bottle feeding is associated with diarrheal disease morbidity and mortality and risk of pyloric stenosis, especially in developing countries. Even though, World Health Organization (WHO) recommended avoiding bottle feeding among children, still higher magnitude was reported in developing countries. This study aimed to assess the spatial distribution and determinants of bottle feeding among children 0-23 months in Ethiopia.Methods: This study was conducted based on Ethiopian Demographic and Health Surveys data (EDHS). The data were weighted using sampling weight for probability sampling and non-response to restore the representativeness of the data and get valid statistical estimates. Then a total of 4,275 weighted samples of under two years children were used to investigate the study. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. A multilevel binary logistic regression model was fitted. P-value < 0.05 was taken to declare statistical significance. A spatial analysis was done using ArcGIS and SaTScan software.Results: The prevalence of bottle feeding practice among under two years children in Ethiopia were 13.5% (95%CI: 11.16, 15.29) and ranges from the lowest 5.16% (95% CI: 3.28, 78.73) Amhara region to the highest 55.98% (95% CI: 47.98, 61.46) Addis Ababa region. Women with secondary and above education status [AOR=2.49; 95%CI; 1.66, 3.74], women from richest household [AOR=1.33; 95%CI; 1.01, 1.78], child 12-23 months age [AOR= 1.59; 95%CI; 1.23, 2.05], multiple birth [AOR=4.30; 95%CI; 1.88, 9.84], rural residence [AOR=0.49; 95%CI; 0.16, 0.82] and large central region [AOR= 0.15; 95%CI; 0.08, 0.27] have significantly associated with bottle feeding. Addis Ababa, Central Oromia, Dire Dewa, Somali and Harari regions were the hot spot areas for bottle feeding practice among under two years children.Conclusion and Recommendations: The prevalence of bottle feeding practices in Ethiopia is relatively moderate. Maternal education, wealth index, child age, multiple births, residence and region were significant predictors of bottle feeding. These findings highlight that, the Ministry of Health Ethiopia (MOH), policymakers, and other stakeholders had better give prior attention to preventable factors such as empowering women, enhancing household wealth status to decreasing bottle feeding practice in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: Duodenal and pyloric web (DW/PW) can present at any age, symptoms depend upon the location of the web along with the presence and size of the opening in the web. The surgical management is not straightforward always. Here, in this study, we aim to assess clinical characteristics, management, and outcome of children with DW/PW. Materials and Methodology: This was a retrospective study from 2005 to 2019, and data were collected from record registers. All children of DW/PW presented between this duration were included in this study. Results: A total of 45 patients (age range = 1 day to 11 years) included in the study, 40 had DW while 5 had PW. Seven patients were diagnosed antenatally and 20 patients had associated congenital anomalies. Most patients presented with vomiting either bilious or nonbilious. Plain X-ray was sufficient for the diagnosis in 60% of patients, the rest diagnosed on contrast study. The web excision and pyloroplasty were done for PW. The web excision and Heineke-Mikulicz type enteroplasty was the preferred surgery for DW but some patients were required Kimura's duodeno-duodenostomy. For postoperative nutrition, enteral feeding was established through the placement of a feeding tube beyond anastomosis. Ten patients died due to septicemia and associated anomalies. Four patients had a minor leak which was managed by conservative means. Four patients required redo surgery, adhesive obstruction was the most common indication. During follow-up, all 35 patients were doing well with no major complaints. Conclusion: DW/PW has different presentations as compared to other intestinal atresia and can present at any age. A contrast study confirms the diagnosis when plain X-ray is inconclusive. Associated anomalies and septicemia are the poor prognostic indicators. Postoperative enteral feeding helps in maintaining adequate nutrition and improves the outcome even in children with a minor anastomotic leak. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to report surgical outcomes of the neonates who have undergone various surgical procedures. Materials and Methods: In this retrospective study, 39 neonates who have undergone a surgical procedure in Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, between October 2018 and March 2019 were included. Data regarding age, gender, diagnosis, surgical procedure, length of hospital stay, mortality, and cause of mortality were recorded. Results: Of 39 neonates, 12 were female (30.7%) and 27 were male (69.3%). The mean age of the neonates at admission was 7.7 ± 7.6 days (1–30 days) days. The most common diagnoses were anal atresia (n = 12, 30.8%), esophageal atresia (n = 9, 23.1%), and pyloric stenosis (n = 5, 12.8%). The most common surgical procedures were colostomy creation (n = 10, 25.6%), esophageal anastomosis (n = 9, 20.5%), primary closure of anterior abdominal wall defects including bladder exstrophy (n = 6, 15.4%), and pyloromyotomy (n = 5, 12.8%). Mortality rate was 17.9%, and mortality causes were sepsis (n = 4, 57.1%) and congenital heart disease (n = 3, 42.9%). Neonates with the highest mortality by underlying primary surgical diagnosis were esophageal atresia (n=4, 57.1%). Conclusion: The mortality rate from the surgical procedures of the neonates in Somalia is extremely high when compared with the developed countries. Employment of experienced pediatric surgeons and well-trained nurses, strict attention to the sanitary measures and shortening the time from birth to presentation might improve the surgical outcomes of the neonates in Somalia. [ABSTRACT FROM AUTHOR]

Gastric Outlet Obstruction (GOO) is a clinical syndrome characterized by postprandial vomiting, epigastric pain, and abdominal distension due to mechanical or motility disorders. The suspicion will mainly rely on abdominal radiological imaging (computed tomography, barium studies) that might not be widely available or even be contraindicated. We report a 65-year-old male who developed progressive epigastralgia, anorexia, and vomiting. Physical examination revealed mild abdominal distension and epigastric tenderness on deep palpation. With the presumptive diagnosis of gastric outlet obstruction, an abdominal point-of-care ultrasound (POCUS) was performed and showed impaired gastric emptying and a "target sign." A gastroscopic exploration confirmed inflammatory pyloric stenosis due to coexisting antral and duodenal ulcers. POCUS could play an essential role in the easy ultrasonographic diagnosis of gastroparesis, helping to differentiate from other causes of obstruction and even raise suspicion in the diagnosis of pyloric stenosis as a consequence of a GGO. POCUS may serve as a first-line imaging test that can raise suspicion of this difficult to diagnose and probably underreported disease. [ABSTRACT FROM AUTHOR]

Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The early observations of those who first described babies with pyloric stenosis (PS) are used as a backdrop for the development of the Inherited Primary Hyperacidity theory of cause. Those early truths, uncomplicated by modern technology, have acted as a springboard for pathogenesis. Hyperacidity, male predominance, family history, self-cure, enhanced appetite, and time-sensitive presentation were all well known to the early pioneers. Any system of pathogenesis must explain all these clinical features. The Inherited Primary Hyperacidity theory does this and is a credible explanation for all the clinical features established by these early pioneers. The evidence which supports a delay in maturation of the negative feedback between gastrin and gastric acidity is presented. Such a phenomenon further supports the Primary Hyperacidity theory. [ABSTRACT FROM AUTHOR]

Background: When the disposable arthroscopic banana knife (Linvatec, Largo, FL) became unavailable, many pediatric surgeons adapted the use of spatula tip cautery for laparoscopic pyloromyotomy; however, reusable arthroscopic knives remain readily available and are well suited to the procedure. Methods: We compared laparoscopic pyloromyotomy with a reusable arthroscopic banana knife (Sklar, West Chester, PA; catalog no. 45-6050) to those using spatula tip cautery at a single institution between September 1, 2012, and December 31, 2019. Mann-Whitney U test was used to compare operative time, room time, and time to discharge between groups. Results: Overall, 109 patients underwent pyloromyotomy for hypertrophic pyloric stenosis during the study time period. Of these, 12 were open and one was undertaken with the Storz pyloromyotomy knife, so these were excluded. A total of 74 (77.1%) laparoscopic cases with spatula tip cautery and 22 (22.9%) with the banana knife were included. Mean age at the time of surgery was ∼37 days. The majority of patients in each group were white, male, and full term. The most common comorbid conditions were reactive airway disease and neonatal abstinence syndrome. There were no significant differences in operative time (P = .61), room time (P = .41), or time from surgery to discharge (P = .26) between procedures using the banana knife and those using the cautery spatula tip. There were no perforations or recurrences. Conclusion: Our findings suggest that the reusable banana knife is a safe and effective alternative to spatula tip cautery for laparoscopic pyloromyotomy, with no difference in operative time, time from surgery to discharge, or complications. [ABSTRACT FROM AUTHOR]

The etiology of pediatric abdominal disorders is poorly understood, and the relationship with maternal mental health is understudied. We sought to determine the association between maternal psychiatric disorders and abdominal conditions in childhood. We performed a retrospective cohort study of 1,080,518 newborns in Quebec, Canada, between 2006 and 2020. We identified maternal mental disorders before or during pregnancy and computed the incidence of abdominal disorders in offspring before 1 year of age. Outcomes included Hirschsprung disease; hypertrophic pyloric stenosis; and esophageal, intestinal, and biliary atresia. We calculated adjusted risk ratios (RR) with 95% confidence intervals (CI) for the association of maternal mental disorders with these pediatric abdominal disorders. Among 51,371 children exposed to maternal mental disorders, 200 children had an abdominal condition, for a rate of 38.9 cases per 10,000 children (95% CI 33.6–44.3) compared with 27.7 per 10,000 for children who were unexposed to maternal mental disorders (95% CI 26.7–28.7). Compared with no mental disorder, maternal mental disorders were associated with hypertrophic pyloric stenosis (RR 1.39, 95% CI 1.16–1.68). Associations were stronger for severe mental disorders and were more marked for depression and stress and anxiety disorders. Maternal mental disorders are associated with the risk of hypertrophic pyloric stenosis in offspring. The origin of hypertrophic pyloric stenosis may relate to maternal mental disorders that were present during pregnancy. [ABSTRACT FROM AUTHOR]

Background and Aim: There have been studies on risk factors for stenosis after pyloric endoscopic submucosal dissection (ESD). However, the most appropriate strategies for the management of cases with these risk factors have not been established. This study aimed to investigate post‐ESD management by evaluating the timing of stenosis and the effectiveness of endoscopic balloon dilation (EBD) after pyloric ESD. Methods: We retrospectively reviewed cases of pyloric ESD. We first reassessed risk factors for stenosis in multivariate analysis and receiver operating characteristic curve and defined patients with the identified risk factors as the risk group. The primary outcome was the timing of stenosis in the risk group assessed by the Kaplan–Meier method. Results: We reviewed 159 cases with pyloric ESD and observed pyloric stenosis in 25 cases. Cases with circumferential mucosal defect ≥ 76% were identified as the risk group. The stenosis‐free probability in the risk group was 97% (95% confidence interval [CI]: 79–100%), 94% (95% CI: 76–98%), and 85% (95% CI: 66–93%) on days 7, 14, and 21, respectively. It decreased every week thereafter and did not significantly change after day 56. Twenty‐three stenosis cases, except for conservative improvement, including six whole circumferential pyloric ESD cases, were improved by EBD without complications. Conclusions: Post‐ESD stenosis often developed from the third to the eighth week. In all pyloric ESD cases, including whole circumferential pyloric ESD cases, pyloric stenosis was improved following EBD without complications. [ABSTRACT FROM AUTHOR]

Background: Our aims were to evaluate the ultrasound scan (USS) criteria in diagnosing hypertrophic pyloric stenosis (HPS), determine the best diagnostic threshold values for pyloric muscle thickness (PMT) and pyloric canal length (PCL), and assess the accuracy of flow through the pylorus. Methods: All patients who underwent pyloromyotomy at our tertiary paediatric surgery centre between July 2013 and June 2019 were identified (Group 1). All patients undergoing an USS to investigate for a possible HPS and did not undergo pyloromyotomy were also identified (Group 2). Accuracy was determined by Youden’s Index (J) with the highest J determining the ideal cut-off value. Results: Two hundred and eighty-four patients (142 patients in each group) were included in the analysis. Using only the last USS before surgery, PMT provided an area under the curve (AUC) of 0.987 (n = 275), and PCL an AUC of 0.977 (n = 267). Ideal threshold values were 3.0 mm for PMT (J = 0.92), and 14.5 mm for PCL (J = 0.87). Combining PMT ≥3.0 mm with a PCL ≥14.5 mm resulted in a sensitivity of 95% and specificity of 99% (J = 0.94). The absence of flow through the pylorus on dynamic USS provided a sensitivity of 99% and specificity of 91% (J = 0.91; n = 277). Conclusion: Combining threshold values of 3.0 mm for PMT and 14.5 mm PCL provides the highest accuracy for diagnosing pyloric stenosis on an ultrasound scan. These combined values were more accurate than observing for the absence of flow through the pylorus. [ABSTRACT FROM AUTHOR]

Copyright of Family Medicine Forum / Forum Medycyny Rodzinnej is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We present a case of early gastric cancer in the pylorus with a type 3 hiatal hernia, which was treated by endoscopic submucosal dissection (ESD). A 70‐year‐old man was referred to our hospital with a hiatal hernia. Endoscopy revealed early gastric cancer, and we performed an ESD adaptation at the pylorus. The ESD was successful, but post‐ESD pyloric stenosis occurred. Symptoms of hiatal hernia worsened because of the pyloric stenosis. Laparoscopic hiatal hernia repair with Toupet fundoplication and Heineke‐Mikulicz pyloroplasty was simultaneously performed. The postoperative course was good, and follow‐up after discharge was uneventful. To our knowledge, there have been no reports in which laparoscopic hiatal hernia repair, fundoplication, and pyloroplasty were simultaneously performed for a substantial hiatal hernia with post‐ESD pyloric stenosis. [ABSTRACT FROM AUTHOR]