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Background: Percutaneous endoscopic gastrostomy (PEG) placement in children has come under scrutiny with reports of improved safety profiles using laparoscopic-assisted techniques. However, these reports are generally limited by their retrospective nature and the inclusion of historically determined PEG complication rates in children. Complication rates associated with PEG placement in children have not been prospectively studied, and a true modern understanding of the safety profile of PEG when performed in children is unknown. We prospectively followed children undergoing PEG to establish a clear and current understanding of the complication rates associated with this procedure., Methods: Consecutive PEG procedures performed between December 2009 and August 2010 at a single, tertiary-care pediatric hospital were enrolled for study. Patients were followed prospectively for 90 days with data regarding complications acquired via standardized interviews at 7, 30, and 90 days postoperatively., Results: We enrolled 103 patients for study. Median age and weight at time of operation was 8 months (range, 2 weeks-21 years) and 6.9 kg (range, 2-42). Patients underwent primary placement of either a PEG button (n = 70) or PEG tube (n = 33). There were no intraoperative complications, with a 100% procedure completion rate. Six deaths occurred during this follow-up time period (mean of 37 days postoperatively) and were attributed to causes other than PEG placement. Four patients were lost to follow-up. One PEG tube was electively discontinued before the end of the follow-up period without complication. Of the remaining 92 patients with complete data, 13 complications were observed in 10 patients. Total complication rate was 14%., Conclusion: Rates of PEG complications observed in this prospective study are low and are generally minor. Observed rates of PEG-specific complications are lower than historic reports. The safety profile of PEG when performed in today's pediatric population remains comparable in safety to techniques such as laparoscopic-assisted gastrostomy., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Background: Intussusception remains a common cause of bowel obstruction in young children and results in significant morbidity and mortality if not promptly treated. The goal of this study was to determine the current success rate of radiologic reduction, the requirements for operative intervention, and the effect of delay in presentation on outcome., Methods: Children treated for intussusception over a 15-year period were reviewed after treatment at a tertiary children's hospital. Records were reviewed for patient outcomes from radiologic evaluation and surgical intervention., Results: Two hundred forty-four children with intussusception were identified. Median age was 8.2 months (range, 16 days to 12.7 years). Eighty-seven percent of patients had ileocolic or ileoileocolic intussusception. The most common presenting symptoms were emesis (81%), hematochezia (61%), and abdominal pain (59%). Contrasted enemas were performed in 190 children, with successful reduction in 46%. Air-contrasted enema reduction was more successful than liquid-contrasted techniques (54% vs 34%; P = .017). Success in reduction was greater if symptom duration was <24 hours compared with >24 hours (59% vs 36%; P = .001). Despite failed prior attempts at reduction, 48% were reduced on reattempted enema reduction. One hundred forty children required surgical intervention for intussusception with 50% requiring bowel resection. Children with symptom duration >24 hours had a greater risk of requiring surgery (73% vs 45%; P < .001) and bowel resection (39% vs 17%; P = .001) than those with symptoms for <24 hours. Pathologic lead points were encountered in 14%. There were 2 deaths and complications occurred in 19%. Length of stay after surgical reduction was 3.9 days, but 6.1 days if bowel resection was required., Conclusions: Success of intussusception reduction is improved with air-contrasted techniques and is not affected by previously failed, outside attempts. Delay in presentation decreases success in radiologic reduction and increases risk of operative intervention and bowel resection.

Background: Information concerning long-term operative outcomes in patients with cystic fibrosis (CF) is relatively sparse in the operative literature., Methods: A retrospective review of CF patients with operative conditions was performed (1972-2004) at a tertiary children's hospital to analyze outcomes including long-term morbidity and survival., Results: A total of 226 patients with CF presented with an operative diagnosis (113 men, 113 women). A total of 422 operations were performed in 213 patients (94%). The mean age at operation was 4.1 +/- 6.2 years (range, 1 d to 26 y) and 109 were neonates. Fifteen of 42 (36%) babies with simple meconium ileus (MI) were treated nonoperatively with hypertonic enemas, 27 of 42 and all 45 patients with complicated MI required operation, including 15 with jejunoileal atresia (17%). Seventeen of 27 (63%) patients with meconium ileus equivalent had MI as neonates; 7 of 27 (26%) required operation. Eight of 9 (89%) with fibrosing colonopathy required operation. Organ transplantation was required in 21 patients. Follow-up evaluation was possible in 204 of 213 (96%) patients. The duration of follow-up evaluation was 14.9 +/- 8.5 years (range, 2 mo to 35 y). Operative morbidity was 11% at 1 year, 2% at 2 to 4 years, 1% at 5 to 10 years, and less than 1% at more than 10 years. There were 24 deaths (11%); 22 followed CF-related pulmonary complications and included 8 of 16 (50%) children with pneumothorax., Conclusions: Long-term survival in CF patients has improved significantly (89%), with many surviving into the fourth decade. MI may predispose to late complications including meconium ileus equivalent and fibrosing colonopathy. Pneumothorax in CF patients is an ominous predictor of mortality. Children with CF are living longer and are good candidates for operation, but require long-term follow-up evaluation because of ongoing exocrine dysfunction.

Background: The goal of this study was to review current injury characteristics, severity, intervention, and outcome of duodenal injuries from a single, pediatric trauma facility., Methods: A retrospective review was performed of duodenal injuries in children less than 16 years of age from 1990 to 2000., Results: Twelve children had duodenal injuries as a result of blunt abdominal trauma. Six injuries were the result of motor vehicle crashes. Nonaccidental trauma (2) and contact injury (4) provided the remaining cases. Diagnosis was achieved by abdominal computed tomography. Severity of duodenal injury included grade I (1), II (8), and III (3). Seven patients had associated visceral or neurologic injuries. Average Injury Severity Score was 18. Duodenal repair was required in 9 of the 10 patients explored. Treatment included observation (3); primary repair, alone, (2) or with proximal decompression (4); and pyloric exclusion with gastrojejunostomy (3). Exclusion techniques had fewer complications (0% vs 57%) and fewer hospital days (19 vs 23)., Conclusions: Blunt abdominal trauma remains the most prevalent mechanism for pediatric duodenal injuries. Patients undergoing pyloric exclusion for severe duodenal trauma had a lesser morbidity and a shorter hospital stay in this small series. Pyloric exclusion remains an alternative for the treatment of severe duodenal injuries in selected children.