Is Bowel Rest a Prerequisite for Successful Outcome in Nonoperative Management of Extrahepatic Bile Duct Blunt Injury in Children?

Extrahepatic bile duct injury resulting from blunt abdominal trauma in children is not common. Nonoperative management has become the standard of care. During a two-year period from January 2005 to December 2006, we treated 1015 pediatric traumas. Of those, 103 were blunt abdominal trauma. Only two patients had injury to the extrahepatic bile ducts. Both cases were managed nonoperatively; however, the clinical presentation required a different approach. Facilitation of bile flow by means of sphincterotomy, or putting a transampullary stent, had the most significant impact on successful outcome. Bowel rest did not influence outcome. Therefore nonoperative management of blunt extrahepatic bile duct blunt injuries in children should be based on ensuring adequate bile flow. Bowel rest does not seem to be a prerequisite for successful outcome.Index Word: Blunt abdominal trauma; extrahepatic bile duct injury; nonoperative

A minimally invasive option for the treatment of persistent postoperative esophageal leak

Persistent postoperative leaks in esophageal surgery in children are highly morbid. They usually require technically difficult major reoperations. A less invasive approach is always desirable. During the period 2003 to 2007, we used a minimally invasive approach for the treatment of persistent postoperative esophageal leaks in two children by injection of fibrin glue into the leak site through a small catheter that was introduced through the chest tube. The procedure was successful in one case. We introduce this approach as an alternative to surgery. We found it to be a safe and viable option for the treatment of persistent postoperative esophageal leaks.Keywords: chest tube, esophageal leak, fibrin glu

A valid treatment option for isolated congenital microgastria

Congenital microgastria (CM) is an extremely rare anomaly of the caudal part of the foregut. Treatment of CM has not yet been standardized. We present the case of a 34-monthold girl with an isolated CM complicated by nasogastric tube-related gastric perforation. During the definitive reconstructive surgery, a scarred structure (1.5 1.5 cm) was found to follow a dilated esophagus. The scarred microstomach was resected, and a Roux-en-Y esophagojejunostomy was performed. The patient has been followed for 6 months. She tolerates a regular oral diet and has reached acceptable growth parameters. We describe the first case of CM to be treated with resection of the microstomach and with a Roux-en-Y esophagojejunostomy.Keywords: congenital microgastria, gastrectomy, Roux-en-Y esophagojejunostom

Community-associated methicillin-resistant Staphylococcus aureus causing diffuse xanthogranulomatous pyelonephritis in a neonate

Xanthogranulomatous pyelonephritis (XGP) is an uncommon variant of chronic pyelonephritis; often associated with ipsilateral urological obstructive pathology and infection. It occurs rarely in the pediatric population and is caused usually by gram-negative bacteria. We herein present a case of a 6-week old male patient who presented with fever, gross hematuria and left flank tenderness. Urine and blood cultures were negative. Radiological investigations suggested an infiltrating malignant neoplasm of the kidney. There was no evidence of nephrolithiasis or obstructive pathology. A left radical nephrectomy was performed and histopathological examination revealed diffuse XGP. Microbiological culture of the perinephric purulent discharge proved positive for methicillin-resistant Staphylococcus aureus (MRSA). To the best of our knowledge, this is the first reported case of MRSA-induced XGP in a neonate emphasizing the expanding spectrum of disease secondary to community-associated MRSA