Search

Byline: Murat Kemal CA+-gdem (1), Abdurrahman Onen (1), Selcuk Otcu (1), Hatun Duran (1) Keywords: Wound dehiscence; Evisceration; Burst abdomen; Children Abstract: Postoperative abdominal evisceration may lead to high morbidity and mortality. The purpose of the present study was to determine possible risk factors, morbidity and mortality associated with abdominal evisceration in children. A total of 3,591 children underwent abdominal exploration in our clinic between 1983 and 2005. In this study, we retrospectively reviewed 29 patients who developed abdominal evisceration after abdominal exploration. The incidence for abdominal evisceration was found to be 0.8%. The mean age was 16 months (range 1 day--13 years), while 48.2% of the patients were younger than 1 month. The incidence of abdominal evisceration was significantly higher in patients younger than 1 month (2.5%) compared to older ones (0.4%) (P < 0.0001). The mean time interval between primary abdominal exploration and development of abdominal evisceration was 7 days (2--21 days). The risk for development of evisceration was significantly higher in patients who underwent colonic or small bowel surgery compared to those underwent laparotomy alone (P < 0.0001, P < 0.01, respectively). Absorbable suture was used in 15 patients for closure of abdominal fascia, while a silk suture material was used in 14 patients (P > 0.05). The age--weight percentile was lower than 3% in 41.3% of patients. At the follow-up period, 19 patients recovered completely whereas 10 (34.5%) died. As a result, the age (neonates), primary surgery (colo-rectal), type of incision (median), and emergency surgery were significant risk factors for development of abdominal evisceration in children. Author Affiliation: (1) Department of Pediatric Surgery, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey Article History: Registration Date: 13/06/2006 Accepted Date: 12/06/2006 Online Date: 05/07/2006

Byline: Murat Kemal Cigdem (1), Abdurrahman Onen (1), Hatun Duran (1), Hayrettin Ozturk (1), Selcuk Otcu (1) Keywords: Stoma; Colostomy; Children; Anorectal malformation; Hirschsprung's disease Abstract: The purpose of this study was to determine the morbidity, mortality and possible risk factors in children who underwent colostomy. A total of 473 children who underwent colostomy in our clinic between 1983 and 2005 were retrospectively reviewed. Of these patients, 278 were boys and 195 were girls. The major indications for colostomy were anorectal malformation (252 patients), Hirschsprung's disease (117), and trauma (66). The patients' age ranged from 1 day to 15 years. Of the 473 patients, 254 (53.6%) were < 1 month of age, 97 (20.5%) were 1--12 months of age, and 122 (25.7%) were > 12 months of age. The side of colostomy was transverse in 341 (72%) patients and sigmoid in 132 (28%). The type of colostomy was loop in 364 (77%) patients and diverting in 109 (23%). Postoperative complication was observed in 80.5% of patients excoriation (46.5%), prolapse (20.5%), stomal obstruction/stenosis (6.1%), and stomal bleeding (2.1%). A stomal revision was required for 26 (5.5%) patients. Overall, 50 (10.5%) patients died 37 were related directly to major congenital anomalies, while 13 (2.7%) patients had a colostomy complication. The age of patients who died was < 1 month in 46 (92%) patients. The incidence of morbidity and mortality in children with colostomy is significantly high, particularly in neonates. Prompt colostomy procedure by an experienced hand, prompt stomal care under the supervision of a trained and experienced stomal care giver and early closure of the colostomy may increase the survival of these patients. Author Affiliation: (1) Department of Pediatric Surgery, Dicle University, 21280, Diyarbakir, Turkey Article History: Registration Date: 13/06/2006 Accepted Date: 12/06/2006 Online Date: 13/07/2006

Byline: Abdurrahman Onen (1), Murat Kemal Cigdem (1), Hayrettin Ozturk (1), Selcuk Otcu (1), Ali Adeghsan Dokucu (1) Keywords: Meckel's diverticulum Childhood Acute abdomen Abstract: To determine the morbidity and mortality of Meckel's diverticulum (MD) as a cause of acute abdominal disorders and to evaluate the relationship between patient age, MD complications, and postoperative complications. We reviewed 74 patients who underwent surgery between 1990 and 2000 for an acute abdominal syndrome with a MD diagnosed intraoperatively. Forty children were treated before 1995 and reviewed retrospectively, while the remaining 34 were reviewed prospectively. The average age was 4.8 years the male/female ratio was 2.5/1 34 (46%) were less than 2 years old, 32 were between 2 and 8 years, and 8 were older than 8 years. None of the symptoms was suggestive of the diagnosis of MD. Thirty-nine MDs were asymptomatic (21 intussusception, 18 volvulus), but all were the secondary cause of the acute abdomen. The remaining 35 children had a symptomatic MD (diverticulitis in 14, diverticular bleeding in 11, diverticular perforation in 10). The risk of complications due to a MD occurring in children under 2 years and between 2 and 8 years of age was significantly higher compared to children older than 8 years (P = 0.02). Postoperative complications occurred more commonly in children between 2 and 8 years of age compared to other patients. There is thus an increased risk of morbidity in a symptomatic MD in patients less than 2 and between 2 and 8 years of age, and there is no predictive factor for the development of diverticular complications. Resection of the MD is recommended in all children younger than 8 years, including asymptomatic ones, in the absence of absolute contraindications. Author Affiliation: (1) Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280, Diyarbakir, Turkey Article History: Accepted Date: 19/02/2002 Article note: Electronic Publication

Byline: Abdurrahman Onen (1), Ali Dokucu (1), Murat Cigdem (1), Hayrettin Ozturk (1), Selcuk Otcu (1), Selcuk Yucesan (1) Keywords: Typhoid perforation Children Parenteral nutrition Abstract: To determine the factors affecting morbidity in patients with typhoid intestinal perforation (TIP), 42 patients who had been operated upon for TIP between 1990 and 2000 were reviewed. The average age was 10.4 years, the male-to-female ratio 2.5/1. The mean interval from admission to operation was 6 h. Twenty-three children had multiple perforations. Primary closure (PC) was performed in 55% of the patients, ileostomy in 26%, and resection with anastomosis (RA) in 19%. Parenteral nutrition (PN) was available for 22 patients for an average of 9 days. Postoperative complications occurred more commonly in patients with delayed admission and/or severe peritonitis. Hospitalization was shorter and the postoperative complication rate lower in patients who received PN and in those who underwent ileostomy. None of the patients developed an enterocutaneous fistula. The 2 deaths (4.8%) resulted from overwhelming sepsis. The most significant factors affecting morbidity were prolongation of perforation-operation interval and severe peritonitis. No operative procedure is likely to be the best in all cases therapy should be individualized. Ileostomy appears to be an effective procedure, particularly in patients with severe abdominal contamination and delayed presentation. The use of PN in addition to standard medical and surgical therapy in patients with TIP may be beneficial. Author Affiliation: (1) Department of Pediatric Surgery, Medical Faculty of Dicle University, DiyarbakA+-r, Turkey (2) Department of Pediatric Surgery, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkiye Article History: Accepted Date: 13/12/2001 Article note: Electronic Publication

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.

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]

Meckel's diverticulum (MD) is a congenital disorder of the gastrointestinal tract that is usually asymptomatic. Perforation of an MD by foreign bodies is an extremely rare cause of acute abdomen in children. We present a rare case of perforation of an MD in a child after eating melon seeds. The patient was treated successfully with segmental resection and primary anastomosis and had an uneventful postoperative recovery.