Vacterl association with hypertrophic pyloric stenosis

The acronym VACTERL is actually a combination of associated anomalies. We found a case of VACTERL association with hypertrophic pyloric stenosis. A six-weeks-old male infant was referred to us with hypertrophic pyloric stenosis. He had a history of esophageal atresia, imperforated anus and cardiac anomalies. This case shows hypertrophic pyloric stenosis in a patient with ‘VACTERL’ anomalies

Alvarado vs. Pediatric Appendicitis Score (PAS) in Acute Appendicitis of Children

Introduction: Acute appendicitis in children is associated with morbidity and mortality due to late diagnosis. Several scoring systems, such as Alvarado and PAS have been developed to help diagnose acute appendicitis in children to make the most accurate and prompt decision. The purpose of this study was to compare the efficacy and diagnostic value of these scoring systems. Materials and Methods: In this cross-sectional study, 130 children aged 5-14 with suspected acute appendicitis were included. After the collection of demographic data, all patients were scored by Alvarado and PAS systems. The decision for surgery was made by a surgeon, independently of these scores. The diagnosis of acute appendicitis was affirmed by surgical and pathologic findings. Results: Male: Female ratio was 1.32:1, and the average age of the patients were 9.2±2.7 years. The mean Alvarado and PAS scores were higher in patients with positive pathologic findings. Neutrophilia >75% and RLQ tenderness had the highest relationship with the diagnosis of the disease. The diagnostic value of Alvarado was higher than PAS concerning the area under the ROC curve. The cutoff point of 7 was associated with a sensitivity of 74.5% and specificity of 66.7% for the Alvarado score, and a sensitivity of 58.5% and specificity of 79.2% for the PAS score. Conclusions: The results showed the high sensitivity of Alvarado and the high specificity of PAS. However, the sensitivity, specificity, PPV, and NPV of these criteria were not satisfactory for the confirmation of the diagnosis

Results of gastric pull-up procedure in neonatal long-gap esophageal atresia: a single center prospective study

Introduction: The management of long-gap esophageal atresia (LGEA) remains challenging and esophageal replacement is inevitable in some patients. The current study aimed at assessing the outcomes of gastric pull-up surgery for esophageal reconstruction in neonates with LGEA, and investigating the postoperative results, complications, and mortality.Materials and Methods: In a prospective study 16 patients with LGEA were studied at Tabriz Children’s Hospital, Tabriz, Iran. Gastric pull-up technique was used for esophageal replacement in all the patients. The study duration was 23 months from April 2014 to March 2016.Results: The mean age of the neonates was 7.31 ± 3.91 days. Eleven patients (68.75%) were male and five (31.25%) female. Seven neonates (44%) had esophageal atresia type A and nine patients (56%) had type C. All of them (100%) were in need for postoperative mechanical ventilation. Mean period of postoperative mechanical ventilation was 0.87±5.69 days. Postoperative mortality was observed in three patients (18.75%). Patients were followed up for six months after the operation; poor feeding was observed in four patients (30.77%), mild respiratory distress in three patients (23.08%), and choking and aspiration in three patients (23.08%).Conclusion: It was observed that gastric pull-up technique is a feasible and safe surgical method for neonates with long-gap esophageal atresia when primary anastomosis is not possible. Quality of life, feeding, and growth pattern were also acceptable. However, long-term outcomes were not assessed in the current study

A Case of Giant Gastric Trichobezoar

Trichobezoar is an unusual form of bezoar found in the digestive tract, mostly in the stomach. The patient is often a female in her adolescence who pulls out and swallows her hair. This habit could stem from anxiety and the trichotillomania disorder. These hairs accumulate in the stomach and cause gastrointestinal symptoms. Our patient is a 14-year-old girl who came to us complaining of abdominal pain. Upon further evaluation by ultrasonography and endoscopy, trichobezoar was diagnosed. Laparotomy and gastrotomy were performed,and a large bezoar was removed. Although the occurrence of trichobezoar is rare, surgeons should always consider the situation in patients with vague gastrointestinal symptoms and psychological problems, especially in young female individuals

Outcome of children operated for congenital anorectal malformations: A prospective single center study

Introduction: Anorectal malformations (ARM) have an incidence of 1 in 5000 live births and affect male and female almost equally. Operative correction of pediatric ARM is of potential clinical interest; however, longterm outcome of patients in respect to probable complications requires precise follow up and surveillance. The aim of our study was to assess the outcomes of children undergoing surgical correction of ARMs.Materials and Methods: In a prospective follow-up study, we wanted to assess occurrence of incontinence, constipation, soiling, abdominal distension, diarrhea, stenosis, dilated sphincter and failure to thrive (FTT) in ARM patients. In addition, management of these conditions has been discussed. Reoperations have also been reviewed. The primary outcome of the study was determination of occurrence of incontinence at follow-up visits. Secondary outcomes were occurrence of constipation, anal stenosis, soiling, abdominal distension, dilated sphincter, diarrhea and FTT at followup visits. In addition, the decision of research team on patients at followup visits was considered as secondary outcomes.Results: Two hundred and ninety patients were studied. Of the study patients, 174 (60.4%) were boys and 114 (39.6%) were girls. Mean age of boys was 4.8 ± 2.0 years and mean age of girls was 5.0 ± 2.0 years. The mean follow-up period of our patients was 39.5 ± 29.1 months. During the study follow-up period, 63 patients (21.7%) had complications. The most common complication was constipation. It was present in 21 patients (33.3%). Soiling, incontinence, dilated sphincter, FTT, stenosis, abdominal distension and diarrhea were present in 21 (33.3%), 11 (17.5%), 9 (14.3%), 6 (9.5%), 6 (9.5%), 5 (7.9%), 3 (4.8%) and 2 (3.3%) patients respectively.Conclusion: We found that the most common complications following ARM surgery are constipation, soiling, incontinence, dilated sphincter, FTT, stenosis, distension and diarrhea. The overall complication rate was 21.7%. 7.2 % and 3.1% of study population experienced constipation and incontinency respectively. In 3.1% of the study population reoperation was required. We revealed that outcome of surgical correction of ARMs is considerably good and complication rates are acceptable. Continence rate was also acceptable

Is there any correlation between duration of vomiting before pyloromyotomy and eradication of symptoms after pyloromyotomy in hypertrophic pyloric stenosis?

Introduction: Hypertrophic pyloric stenosis (HPS) is among common GI disorders in young infants, with an incidence of 1-2:1000 live births in the world. In this study, we wanted to investigate the correlation between duration of symptoms before surgery and eradication of symptoms after pyloromyotomy in HPS.Materials and methods: One hundred and twenty five (102 boys and 23 girls) patients with suspected infantile HPS were treated surgically by Ramstedt pyloromyotomy between 2004 and 2014 at pediatric surgery ward of Tabriz Children’s Hospital, Iran. The demographic features, clinical findings, diagnostic work-up and postoperative specifications of the patients were studied retrospectively.Results: We studied 125 patients with HPS. Male to female ratio was 4:1. The patients were 16 to 90 days of old and the mean age was 39±1.42 days. The range of pyloric canal length was 7.60 to 29.00 mm and the mean length was 19.54±3.42 mm. Pyloric muscle diameter was 2.70 to 9.00 mm and the mean diameter was 4.86±1.14 mm. Seventy two percent of patients had episodes of vomiting after operation. Mean time of persistence of vomiting after pyloromyotomy was 15.73±0.15 hours. Mean discharge time was 55.22±0.08 hours. Radiologic findings did not show any significant correlation with persistence of vomiting or discharge time. Conclusion: The present study revealed that duration of vomiting before surgery and continuing symptoms could not predict postoperative symptom eradication after pyloromyotomy in HPS

Head Trauma in Children: An Epidemiological Study

Introduction: Brain injury is one of the most common causes of death among victims of trauma in various accidents. The type of accident and outcome could be different in children from adults. Therefore, we aimed to investigate the epidemiology of traumatic head injury in children. Materials and Methods: In this cross-sectional study, 114 patients (age≤15 years) with head trauma, who were admitted to trauma ward of Imam Reza hospital in 2018 were enrolled in the study. Data regarding the demographic characteristics, mechanism of trauma, season of trauma, hemodynamic findings and outcome of the patients were collected. Results: The mean age amongst victims of trauma was 6.52±3.95 years and majority of them (70.2%) were male. Most of traumatic accidents took place in the spring (27.2%) and summer (32.5%). Traffic accidents (pedestrians or passenger) (55.3%) and falling (39.5%) were the most common mechanism of trauma. Also, epidural hematoma (EDH) and brain contusion were the most encountered type of brain injury (1.75%). Nine patients (7.89%) underwent brain surgery. Eventually, eight patients (7.17%) died. Conclusion: Falling and vehicle accidents are the main causes of head injury among children. Increasing the parents’ awareness toward these types of accidents and proper preventive measures can reduce traumatic brain injury

Fetus-in-Fetus: Our Case Series and Review of the Literature

Fetus in fetu is a rare condition commonly presenting as an epitomized pedunculated vertebrated fetiform mass in a newborn infant. Different kinds of presentation and locations have been reported in the hosts. Although numbers of instances have been reported the fascination and curiosity about other presentations and genesis of fetus in fetu remains confirmed. In Tabriz pediatric surgery ward we have had five different presentations of fetus in fetu. The aim of this case series and a subtle literature review is gathering these interesting presentations

Congenital diaphragmatic hernia: Prognostic value of hernia sac and size of defect

Introduction: Congenital diaphragmatic hernia (CDH) is a congenital malformation with challenging management. The aim of this study was to evaluate the effect of the presence of hernia sac and defect size on the prognosis of CDH in Tabriz children’s hospital. Methods: In this prospective study, all the infants with the diagnosis of CDH that were admitted to the Tabriz children’s hospital since 2016-2019 were enrolled. The presence or absence of a hernia sac was evaluated, and the largest diameter on diaphragmatic defect was measured before the repair. Postoperative outcomes, including instability, duration of mechanical ventilation, mortality rate, or hospital discharge were obtained and analyzed. Results: Over the study period, 30 patients with CDH met the inclusion criteria, consisting of 15 males and 15 females. Fifteen cases were diagnosed during the first 24 hours of life and 16 cases experienced hypoxia in the first hour after birth. Defect size was significantly smaller in survived patients (P=0.041). Postoperative death occurred in 9 (42.85%) patients without a hernia sac. Results showed that none of the cases with hernia sac expired (P=0.035). Conclusion: In our study, the presence of the hernia sac was related to a lower postoperative mortality rate. Defect size in survived group was also smaller. It can be suggested that the presence of hernia sac and lower diameter of defect size act as good prognostic factors in the outcome of patients with CDH

Congenital nasal pyriform aperture stenosis: The report of four rare cases

Congenital nasal pyriform aperture stenosis (CNPAS) is an unusual cause of upper airway obstruction that may happen because of respiratory distress, cyclic cyanosis or feeding problems. Bony overgrowth of maxillary nasal process sounds responsible for this deformity. Diagnosis is based on clinical evidence and radiologic findings. Failure to conservative management, respiratory distress and feeding problems are all indications of surgical treatments. In our experience, the sublabial approach is known as the most effective to these patients at any age. Otolaryngologists and pediatricians should therefore consider CNPAS as a rare but treatable cause in the patients with upper respiratory problems