Idiopathic Gastric Rupture in a Child: Critical Situation

Idiopathic gastric rupture is extremely rare condition in children. We report herein a 4-years-old girl with Idiopathic GR who presented with shock. Resuscitation and early surgical intervention led to saving the child's life. Index Word: Gastric rupture, Pneumoperitoneum, Abdominal distension, Resuscitation

Risk factors for peritoneal dialysis catheter failure in children

Background Peritoneal dialysis catheter (PDC) failure still remains a common clinical problem in pediatric patients despite advancements in catheter placement and dialysis techniques. Our aim was to determine the risk factors that may lead to PDC failure, especially those factors that could be potentially modified to minimize PDC failures.Patients and methods This study was designed as a retrospective chart review of 31 patients less than 12 years of age who had end-stage renal disease (ESRD) on whom a total of 54 operative PDC placements were carried out at the tertiary Children’s Hospital, King Fahad Medical City, Riyadh, Saudi Arabia, from January 2007 to December 2010. The data included patient demographics and perioperative and operative variables.Results Fifty-four PDCs were inserted in 31 pediatric patients with ESRD, of whom 17 (55%) were boys and 14 (45%) were girls. Young age showed a statistically significant effect on PDC failure [1.8 (± 5) vs. 5 (± 7.8), P = 0.007], whereas weight did not (P = 0.085). Five types of PDCs were used, which showed significant association with PDC failure (P =0.009). Supraumbilical paramedian abdominal entry incisions were used in 49 (90.7%) patients without peritoneal leakage in any case. Nonsimultaneous omentectomy and upward PDC exit site orientation showed significant association with PDC failure (Pr0.001). The causes of PDC failure included idiopathic peritonitis in 13 (56.5%), PDC occlusion by omentum in five (21.7%), PDC malposition in four (17.4%) patients, and PDC leakage in one (4.4%) patient. Peritonitis showed a high statistical significance in PDC failure with P value of less than 0.001. The serum albumin level at the time of PDC insertion was not statistically significant in terms of PDC failure (P = 0.40) but had a high association with idiopathic peritonitis.Conclusion Our study provides some recommendations to minimize PDC failures that include improvement of patients’ nutritional status, use of a swan-neck double-cuffed catheter, paramedian abdominal entry incision, simultaneous omentectomy, downward orientation of exit site, and use of an up-to-date technique by a dedicated team for proper use of PDC. However, prospective studies possibly on a multicentric basis are necessary to standardize the best PDC insertion and maintenance techniques to minimize PDC failures and improve the quality of life for children with ESRD. Keywords: end-stage renal disease, pediatric patients, peritoneal dialysis, tenckhoff cathete

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication