Enteral reduction and oblique anastomosis: a novel technique in the treatment of small bowel atresia

Background: Jejunoileal atresias are major causes of neonatal intestinal obstruction, and various surgical techniques were described for their treatment. Resection and/or tapering of the proximal dilated pouch and end-toend or end-to-back enteral anastomosis are the most commonly used techniques. Either of these techniques, however, has shortcomings such as loss of bowel length, kink obstruction, and anastomotic leak due to anastomotic line mismatch.Objective: The aim of this study was to describe an alternative surgical technique for bowel atresia repair, enteral reduction and oblique anastomosis.Patients and methods: The technique involves reduction of the dilated bowel diameter by removing an elliptical fullthickness part of the anterior wall of the proximal dilated pouch and oblique anastomosis of the resultant window with a longitudinally incised posterior wall of the distal bowel.Results: This technique was used in seven successive neonates, four female and three male, in 1 year. Their ages at operation ranged between 2 and 30 days (median 3 days). Six neonates recovered well. Enteral feeds were tolerated in 7–10 days and the length of hospital stay ranged between 15 and 36 days. One baby, who underwent surgical repair at the age of 30 days, died following severe sepsis and anastomotic leak.Conclusion: Enteral reduction and oblique anastomosis is an easy and safe alternative to current surgical techniques used for the treatment of small intestinal atresia. No bowel resection is required while proximal bowel tapering is achieved.Keywords: oblique anastomosis, small bowel atresia, taperin

An unusual presentation of pediatric gastrointestinal stromal tumor arising from stomach

Gastrointestinal stromal tumors (GIST) are extremely rare in the pediatric population and, as a result, many clinicians may never encounter this diagnosis in children during their practice. Contrary to the usual clinical presentation of pediatric GIST as painless GI bleeding, we report here a case of a young girl with GIST whose main clinical presentation was a large cystic abdominal mass

An Epidemiological Survey of Extended-Spectrum β-Lactamases Producing Bacteria Genotypes and the Evaluation of the Antimicrobial Effect of Rhazya stricta Leaf Extract

An epidemiological survey and evaluation of the anti-bacterial growth effect of the aqueous leaf extract of the traditional medicinal plant Rhazya stricta were undertaken for extended-spectrum β-lactamase’s producing bacteria isolates collected from the King Abdulaziz Hospital and Oncology Center. Results showed high rates of extended-spectrum β-lactamase (ESBL) isolates (49.2%) compared to non-ESBL isolates (50.8%). The surgical intensive care unit was the hospital site showing the highest rate (15.1%) of infection, followed by the women\u27s medical ward (11.2%). Urine samples were the highest source of infection (40%). Prevalence among Saudis was 66.67% as compared to non-Saudis (33.33%). Prevalence according to gender was 51.94% females and 48.06% males. Age groups 51-60 years, 21-30 years, and 61 years and over showed the highest rates (20.93%, 20.54% and 20.16%, respectively) compared with other age groups. E. coli resistance rates were 94.5% for ceftazidime, 98.18% for cefotaxime, 92.73% for cefepime and 93.75% for aztreonam. On the other hand, in cases of K. pneumoniae resistance, rates were 100% for ceftazidime, 100% for cefotaxime, 98.68% for cefepime and 97.29% for aztreonam. Genetic analysis showed 8 genotypes, 4 of them were for E. coli and 4 for K. pneumoniae. Analysis also showed genetic diversities between the ESBL and the non-ESBL types in their genomic DNA. There was no antimicrobial effect of the plant extract against all study isolates, although the antimicrobial growth had an effect upon some of the control strains

Amyand's hernia in children

Background: Amyand's Hernia (AH) is a rare entity described as the presence of the vermiform appendix in an inguinal hernial sac. Though its prevalence is three times more in children than adults, owing to the presence of patent processus vaginalis, its occurrence with acute appendicitis is more uncommon in children, especially in infants. Seldom diagnosed correctly ahead of surgical exploration, it is often clinically diagnosed as an incarcerated inguinal hernia or as a case of acute scrotum. The management of such cases depends upon the per-operative findings. Case presentation: In this series, we report four cases of AH treated at King Saud Medical City Hospital Riyadh between 2018 and 2022.All the four patients were male and three of them were infants. Three patients had right sided hernia, while one had bilateral inguinal hernia. One of the patients was diagnosed with strangulated hernia and upon exploration it was AH with acute appendicitis and appendectomy was done. One child had recurrent, irreducible hernia and upon exploration, found appendix densely adherent to the hernial sac. Another patient had early suppurative inflammation at the tip, while the patient with bilateral hernias had appendix adherent to the right hernial sac. In all our cases appendectomy was performed either due to inflammation or adhesions. Conclusion: There is a rarity of this condition and few cases have been reported in the literature. Such cases need to be reported to keep the surgeons aware of this condition and its different manifestations. Herein, we aim to share our experience of four cases of AH with varied presentations and a literature review

Chronic inflammatory changes seen in gallbladders of patients with pancreatico-biliary malunion years after transduodenal sphincterotomy: Is it a precursor for gallbladder carcinoma?

The original publication can be found at www.springerlink.comCommon pancreaticobiliary channel malunion (PBM) is known to be associated with increased frequency of gallbladder (GB) cancer in adults. Few studies have reported the presence of histological changes in the GB following transduodenal drainage procedures in children with PBM. The aim of this study was to document the histological changes in the GB in children who underwent interval prophylactic cholecystectomy up to 18 years following PBM drainage procedure. All children who underwent open transduodenal sphincterotomy (TDS) for symptomatic PBM followed by prophylactic synchronous (open) and interval (laparoscopic) cholecystectomy between 1987 and 2007 were studied retrospectively. Eight children with PBM were identified. The median age at initial presentation and open transduodenal sphincterotomy was 8 months (1 month–3.5 years). The average interval between open TDS and prophylactic cholecystectomy was 5.5 years (0–18 years). Two children had synchronous TDS and cholecystectomy. At initial presentation, all patients presented with obstructive jaundice. Mild common bile duct dilatation was encountered in all patients. The dilated ducts returned to normal, and remained normal after transduodenal sphincterotomy. Histopathology in seven out of eight GB specimens (87.5%) showed microscopic evidence of chronic inflammation. Chronic cholecystitis (n = 7), Rokitansky–Aschoff sinuses (n = 3), cholesterosis (n = 1) and intestinal metaplasia (n = 1) were observed in the GB biopsies. Only one patient, who had TDS and a synchronous cholecystectomy in the neonatal period, did not have histological changes in the GB. Average follow-up in years ranged between 3 months and 19 years (from TDS) with a median of 8 years, and between 3 months and 6 years (from cholecystectomy) with a median of 2 years. Chronic inflammatory changes were found in seven of eight GB specimens from patients with PBM despite previous drainage procedure in six patients and in one of two patients who underwent synchronous TDS and cholecystectomy. These changes may be the precursor of malignant transformation in GB of patients with PBM.Abdelbasit E. Ali, Alex I. Blythe and William D. A. For

Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries.

BackgroundSurgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life.MethodsEpidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries.ResultsAn estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year.ConclusionsImproving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life

Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries.

BACKGROUND: Surgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life. METHODS: Epidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries. RESULTS: An estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year. CONCLUSIONS: Improving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally