Foreign body ingestion in children: unusual presentations and timely intervention

Background/purpose: Foreign body (FB) ingestion in children is very common. Children can ingest a wide variety of FBs. Most of the ingested FBs pass spontaneously through the gastrointestinal tract. Other FBs, especially uncommonly ingested objects, can present with complications and need intervention to be extracted. The aim of this study was to highlight the importance of timely intervention to extract these FBs.Patients and methods: Between November 2012 and October 2017, patients who presented to our department with variously ingested FBs were retrospectively reviewed to detect those who needed intervention (surgical or endoscopic) to extract these FBs.Results: During the specified time period, 480 patients with FB ingestion presented to our department. Out of these children, 12 patients ingested uncommon FBs or presented with symptoms of complications of impaction and needed intervention to extract these FBs. Three patients ingested multiple magnets. Three patients ingested pins which were impacted in and penetrated the duodenum. One patient ingested a screw which was impacted in the appendix. One patient ingested a sticky rubber toy which was impacted in the pylorus. One patient ingested hair (bezoar), which was also impacted in the pylorus. One patient ingested a disk battery which was impacted in and penetrated the esophagus, and all were surgically extracted. One patient had a slipped stent of repaired choanal atresia which was impacted in the gastroesophageal junction and one patient with repaired tracheoesophageal fistula ingested a stone which was impacted at the site of esophageal anastomosis, and both were endoscopically retrieved.Conclusion: Children who ingested uncommon FBs or presented late with symptoms of complications of impaction needed intervention (surgically or endoscopically) to extract these FBs.Keywords: foreign bodies, foreign body extraction, ingestion, magnets ingestion, pin ingestio

Using the renal pelvis flap to replace the whole hypoplastic ureter: a preliminary report

Background Hypoplastic ureter is a rare condition usually associated with hypoplastic kidney, and it ends with nephrectomy in most of the cases. Many techniques have been described as ureteric substitutes in the literature. Here, we describe a new technique using the renal pelvis flap to replace the whole hypoplastic ureter in two cases. Objective The aim of this study was to describe a new surgical technique in the management of ureteric hypoplasia.Patients and methods Of the two boys diagnosed antenatally, unilateral hydronephrosis was detected in one boy and a huge renal cyst was present in the other, with evidence of postnatal progressive obstruction necessitating surgical intervention. On exploration, hypoplastic ureter throughout its entire length was an accidental intraoperative finding. The renal pelvis flap was taken and tubularized to replace the entire ureter, and reimplanted into the urinary bladder. This technique was the primary procedure in one case, whereas it was the secondary procedure in the other case after failure of initial trial of pyeloplasty.Results The postoperative period was uneventful with adequate drainage of the renal pelvis in the short-term follow-up (6 and 3 months consecutively).Conclusion The renal pelvis flap is a new feasible alternative procedure for ureteric replacement in a hypoplastic ureter when there is preserved renal parenchyma.Keywords: renal pelvis flap, ureteral hypoplasia, ureteric replacemen

One-stage transanal Swenson procedure for rectosigmoid Hirschsprung’s disease in infants and children

Objective: This study aimed to present the outcome of transanal one-stage Swenson pull-through procedure in the management of rectosigmoid Hirschsprung’s disease (HD).Background: HD is a common cause of intestinal obstruction in pediatric age. Several pull-through procedures have been used to treat this pathology.Patients and methods: Between June 2008 and June 2015, 84 children with biopsy-proven HD underwent transanal one-stage Swenson pull-through procedure. Intraoperative details, postoperative complications, and bowel habits were recorded. Follow-up period ranged from 6 to 42 months.Results: The age at the time of surgery ranged from 3 months to 2 years. The length of the resected aganglionic segment ranged from 12 to 34 cm. The operating time ranged from 72 to 180 min. Postoperative hospital stay ranged from 3 to 6 days. There were no anastomotic leaks, no perianal infection, or postoperative bowel obstruction. Twelve patients (14.28%) developed postoperative enterocolitis. Six patients (7.14%) required a posterior internal sphincter myectomy despite repeated dilatations. All patients had less than four times bowel motions per  day, 3 months after surgery. No voiding disturbances were encountered at the end of the follow-up period and none of the patients complained of recurrent constipation. Six patients developed perianal dermatitis, which was treated conservatively within 3 months after surgery. Anastomotic circumference could not be felt at digital examination in 78 patients 3 months after surgery.Conclusion: One-stage transanal Swenson pull-through procedure is a safe alternative and simpler procedure for rectosigmoid HD with low morbidities and accepted outcome as regards postoperative bowel habits.Keywords: Hirschsprung’s disease, rectosigmoid Hirschsprung’s, Swenson procedure, transanal pull-throug

Surgical management of congenital chylous ascites

Objective: The objective of this study was to present our experience regarding the diagnosis and therapeutic approach in cases of congenital chylous ascites that were surgically managed in our department in a 10-year period.Background: Congenital chylous ascites is a rare condition that constitutes a challenge for physicians. This condition is often refractory to therapy, and it is responsible for serious malnutrition and immunological deficiency because of losses of proteins and lymphocytes.Patients and methods: From 2007 to 2017, four cases of congenital chylous ascites were managed at our center. All cases were treated surgically after failure of medical treatment.Results: The first patient had no definite lymphatic leaks rather than presence of a moderate amount of milky ascitic fluid with dilated lymphatics at the root of the mesentery and at the intestinal wall and enlarged regional lymph nodes. The second one had leaking chylolymphatic cyst in the greater omentum that was excised. The third patient had no definite lymphatic leaks rather than thickened greater omentum, and thus, subtotal omentectomy was done. The fourth baby had no definite lymphatic leaks and developed reaccumulation of the ascitic fluid 1 month after surgery; insertion of a peritoneovenous shunt was indicated that succeeded to resolve the ascites. All children are growing up normally with no recurrence of the ascites on long-term follow-up.Keywords: chylolymphatic cyst, chylous ascites, lymphatic leak, peritonealvenous shun

Correction of anterior hypospadias without urethroplasty: glanular rotation procedure (the Hay technique)

Objectives: The aim was to present a simple technique for the correction of anterior hypospadiases without meatal advancement or urethroplasty.Background: Most of the techniques described for the correction of anterior hypospadias had the risk of complications: recession, flaying of the glans, fistula, and meatal stenosis that is not accepted when dealing with a trivial anomaly that is done only for cosmetic correction. A simple technique for correcting granular and some forms of coronal hypospadias without meatal advancement or urethroplasty is presented.Patients and methods: From June 2013 to June 2016, 183 patients presented for surgical repair of glanular or coronal hypospadias. The technique of glanular rotation procedure (GRP) was applied only for those cases that matched the criteria settled after degloving of the penis with an incision made 2mm proximal to the meatus touching the glans on both sides for 3–4 mm. Once the uppermost part of the meatus is at the same line with the upper end of the glans on both sides, the technique is applicable. The patients were followed in the OPD for 1 year after the repair for the evaluation of the results of the technique: the urinary stream, meatal size and position, presence of fistula, and the final cosmetic appearance.Results: Ninety-eight out of 183 (53.6%) boys had matched the criteria for application of the GRP technique. Their age ranged from 6 months to 3 years. All but three had an apical, slit-like meatus with good stream without stenosis and 2–3mm glans tissue encircling the ventral side of the meatus. Four cases had complications in the form of meatal stenosis in two cases, disruption of the glans in one case, and coronal fistula in one case. The overall complication rate was 4.1%.Conclusion: In properly selected cases, GRP is a simple efficient technique that has the advantage of reconstructing the glans over the urethra without the need of meatal advancement or urethroplasty.Keywords: coronal hypospadias, glanular hypospadias, without urethroplast

Monitoring and Assessing the Coastal Ecosystem at Hurghada, Red Sea Coast, Egypt

In the framework of the investment plan, the government of Egypt introduced an accelerated development of Hurghada in collaboration with the private sector, as   early as 1980's.  The government intended to construct tourist resort communities, which required establishment of infrastructures. The  demand  of  such  facilities, in absence of enforced environmental roles led owners  to implement  processes  of  landfilling  and  dredging  for the purpose of smoothing, paving and widening the beach in order to construct swimming pools, marinas and other recreational facilities. Such activities came on the expense of the marine ecosystem and especially assault on the coral reef communities. For monitoring and assessing such oppressive activities;  MSS,  TM,  ETM+,  and SPOT XS 4 satellite images acquired  during  1972,  1984,  1992,  2004  and 2011. Shoreline change detection from 1972 to 2011 reveals landfilling of some 7.56Km2 and dredging of 2.67km2, with loss of 5.34km2 of the reef tracts. At the same period, the region has witnessed expansions in urban and road network by 16.47km2 and 8.738km2 respectively. The Egyptian government issued the essential laws for regulating and saving the coastal ecosystem, yet mostly violated. Activation of such laws, applying judicial officers, toughening penalties and establishment of coastal building front line (CBFL), and a reef protection line (RPL) are important tasks especially south of Hurghada to the Egyptian-Sudanese borders to preserve the remnants of such unique coastal ecosystem. Keywords: Satellite images, Hurghada, Red Sea, coastal ecosystem, shoreline changes, urban, road network, environment law