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Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

Background Hirschsprung's disease (HD) is a rare but important congenital pediatric disease of the colon, and its incidence varies widely between ethnic groups. Its incidence was first studied in Bahrain in 1980 using hospital-based data. Over a 16-month period, 10 cases were reported, representing a relatively high incidence rate: 1 per 4000 births. Even though the number of live births in Bahrain has increased dramatically over the last four decades (doubling from 10,000 to 20,000 per year), published studies about the incidence of HD are uncommon. In this research, we aimed to determine both the prevalence and the clinical characteristics of HD at a tertiary hospital in Bahrain. Methods This retrospective observational cross-sectional study included children diagnosed with HD at a tertiary hospital in Bahrain over the last seven years (2014-2020). Children over 10 years were excluded. Clinical data collected included gestational age, birth weight, gender, associated anomalies, clinical features at presentation, disease management, and complications. Results The prevalence of HD in Bahrain was found to be 1.3 per 10,000 live births, according to 18 patients qualified for inclusion in this study. The median age at diagnosis was 18 days; approximately 72% were males, and nearly 94% were Bahraini nationals. Three patients (16.7%) had associated anomalies including cardiac and urogenital malformations. Abdominal distention was the most common clinical presentation (83.3%) followed by constipation (77.8%). Half of the patients (50%) passed meconium within 48 hours of birth. Transanal full-thickness rectal biopsy was the method of diagnosis in most patients (83.3%). Seven patients (38.9%) were diagnosed comparatively late (beyond the neonatal period), at a mean age of 1-2 years. Significant associations between age at diagnosis and clinical presentation, initial management, or surgical intervention were not found. A total of 17 patients (94.4%) underwent the definitive surgery (transanal pull-through procedure). In this surgical group, initial colonic decompression was performed via rectal washout in six patients (35.3%) and via temporary stoma in three patients (17.8%). Laparotomy combined with the definitive surgery was necessary for six patients (35.3%). Most of the patients treated surgically had a short segment disease (70.5%). Conclusions The awareness of HD is highly important, especially with more than one-third of cases diagnosed outside the neonatal period and half of them passing meconium within 48 hours of birth. In addition, early detection of HD in the neonatal period would result in a less complicated course by reducing the number of patients requiring a multi-stage surgery and further laparotomies.

Background Trauma is the main cause of morbidity and mortality in the pediatric population. Blunt trauma to the abdomen accounts for the majority of abdominal injuries in children. Pancreatic injury, although uncommon (2 to 9%), is the fourth most common solid organ injury. Unlike other solid organ injuries, pancreatic trauma may be subtle and difficult to diagnose. Computed tomography currently is the imaging modality of choice. As the incidence of pancreatic injury in children sustaining blunt abdominal trauma is low, management remains a challenge. Case presentation We present a 7-year-old Bahraini boy who sustained blunt trauma to his abdomen. He presented with abdominal pain and vomiting. His examination revealed abdominal distension and an epigastric bruise. Contrast-enhanced computed tomography reported grade III liver injury, grade I bilateral renal injury, a suspicion of splenic injury, and a grade III to IV pancreatic injury. He was admitted to Pediatric Intensive Care Unit and was treated conservatively. Because he was stable, he was discharged to the surgical ward at day 3. At day 18 he developed a pancreatic pseudocyst that was aspirated and recurred at day 25 when a pigtail catheter was inserted. He was kept on total parenteral nutrition through a peripherally inserted central catheter. The pigtail catheter was removed on day 36 and a low fat diet was started by day 44. He was discharged home at day 55 in good health. Out-patient follow-up and serial abdominal ultrasound showed resolution of the cyst and normalization of blood tests. Conclusion Non-operative management of pancreatic injury is effective and safe in hemodynamically stable patients with no other indication for surgery.

Background Acute appendicitis in a neonate and premature baby is still considered a rare entity as diagnosis is always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis. Our reported case is a premature baby who had a perforated appendix with no evidence of peritonitis. Case presentation We describe the case of a premature Bahraini girl born at 29 weeks of gestation by spontaneous vaginal delivery to a 39-year-old G6P5 mother. She was kept on a ventilator for the first 6 days of life, and had an uneventful Neonatal Intensive care stay until her 47th day of life when she developed sepsis that required ventilator support for 3 days. At day 51 she developed abdominal distension and was referred to a pediatric surgeon by day 54 with pneumoperitoneum. Her abdomen was soft with minimal tenderness and no evidence of erythema or edema. In view of pneumoperitoneum and previously reported sepsis, she was taken for exploratory laparotomy. The findings were consistent with a perforated appendix with no evidence of peritonitis or necrotizing enterocolitis. An appendectomy was performed. She had a smooth postoperative recovery. Conclusions Neonatal appendicitis continues to be a diagnostic challenge. Only with a high index of clinical suspicion and teamwork can these cases be managed successfully and mortality and morbidity rates may reduce.

Pleuropulmonary blastoma (PPB) is a rare aggressive malignant tumor of infancy and early childhood. The tumor arises in the lung and pleura and is regarded as a pulmonary dysontogenetic or embryonic neoplasm. Four types are defined in literature. Type I PPB is a rare, cystic lung neoplasm in infants characterized by subtle malignant changes and a good prognosis. Recurrences after type I PPB are usually advanced with a poor prognosis.We report this case to increase awareness about this entity so that the pediatricians, pediatric surgeons, radiologist, and pathologist recognize it early.

Iron ingestion accounts for approximately 3% of calls to poison control centers. The profound local and systemic effects of an iron overdose have an associated mortality rate of 5%. Laparotomy and gastrotomy has been reported as a life-saving maneuver to extract the retained iron aggregates that are notoriously resistant to, removal by conventional emesis or lavage techniques. In this paper, we describe, for the first time, the use of laparoscopic-assisted gastrotomy in the treatment of an iron overdose. A 14-year-old girl attempted suicide by means of a polydrug drug overdose, which included ferrous fumarate, at a calculated potentially lethal dose of 70 mg/kg. A gastric iron bezoar was seen on plain radiograph. The regional poison control center recommended surgical removal of the retained iron tablets. Upper endoscopy confirmed the retention of iron and showed its dense adherence to the gastric mucosa. A 5-mm laparoscope was introduced at the umbilicus, and the stomach was grasped by an instrument introduced through a left-upper quadrant incision. The incision was then enlarged to allow the formation of a gastrotomy. The iron bezoar was removed with the aid of digital disimpaction and copious saline irrigation. The patient made a rapid postoperative recovery prior to undergoing psychiatric treatment. We conclude that laparoscopic-assisted gastrotomy is a simple and safe option in the acute management of a retained iron bezoar.