Meralgia paresthetica after “all-in-one” appendectomy

AbstractMinimally invasive approaches have become standard for pediatric appendectomy. The laparoscopic assisted single port approach, also known as the “all-in-one” appendectomy, has gained recent popularity [1]. We describe a child who suffered meralgia paresthetica (a neuropathy in the distribution of the lateral femoral cutaneous nerve) after a laparoscopic assisted single port appendectomy, perhaps secondary to mobilization of the cecum

Review of the evidence on the closure of abdominal wall defects

Infants with congenital abdominal wall defects pose an interesting and challenging management issue for surgeons. We attempt to review the literature to define the current treatment modalities and their application in practice. In gastroschisis, the overall strategies for repair include immediate closure or delayed operative repair. The best level of data for gastroschisis is grade C and appears to support that there is no major difference in survival between immediate closure or delayed repair. In patients with omphalocele, the management techniques are more varied consisting of immediate closure, staged closure or delayed closure after epithelialization. The literature is less clear on when to use one technique over the other, consisting of mostly grade D and E data. In patients with omphalocele, a registry to collect information on patients with larger defects may help determine which of the management strategies is optimal

Occurrence of Crohn\u27s disease in children after total colectomy for ulcerative colitis

Background: Colectomy is the definitive treatment for ulcerative colitis (UC) to remove the inflammatory burden. Crohn\u27s disease, however, can affect any portion of the bowel with a propensity to involve the terminal ileum. In some patients with fulminant colitis, distinction between the two is imperfect. Manifestations of Crohn\u27s after colectomy can be devastating because the ileum is needed for restoration of continuity. There is currently little information in the pediatric literature addressing this concern. Therefore, we reviewed all of our patients who underwent colectomy for inflammatory bowel disease to evaluate the risk of subsequent Crohn\u27s manifestations and to document the outcomes.Methods: A two-center retrospective review of children who underwent colectomy for IBD from January 2000 to July 2010 was performed. Demographic, diagnostic, management, and outcome variables were recorded.Results: We identified 70 patients who underwent colectomy for UC. The mean age at diagnosis was 12 y ± 7 y, and 59% were female. Clinical diagnosis prior to colectomy was UC in 90%, and indeterminate colitis in 10%. There was discordance between clinical and pathologic diagnosis in five patients, two patients were clinically diagnosed with UC but had an indeterminate biopsy, and three patients were clinically diagnosed as indeterminate colitis with a biopsy confirming UC. Indications for colectomy were refractory bleeding in 63%, failure of medical treatment in 28%, toxic megacolon in 6%, and perforation in 3%. A restorative pouch was created after colectomy in 46% using a two-stage approach while, 53% were managed with an initial colectomy and three-stage approach. In one patient, Crohn\u27s was intraoperatively diagnosed from the operative colectomy specimen. This patient had a clinical diagnosis of UC with concordant biopsy prior to surgery. After total abdominal colectomy, 68 patients went on to ileal pouch anal anastomosis by either a two-stage or three-stage approach. In these patients, nine (13%) had a change in their diagnosis to Crohn\u27s after reconstruction. Crohn\u27s complications requiring an operation consisted of two patients with anastomotic dilations, four patients with fistulotomies, and one patient with perianal abscess drainage procedures.Conclusions: In the children studied, 13% had a diagnostic change to Crohn\u27s disease, and 13% were diagnosed with Crohn\u27s after ileal pouch-anal anastomosis (IPAA). In patients with IPAA and Crohn\u27s, there were more operative interventions for perianal disease