Retrospective evaluation of inpatients admitted to a tertiary hospital in Somalia for Pediatric surgery

Objective: The aim is to reflect on the epidemiology of the patient population at a tertiary hospital for pediatric surgery, diagnostic pattern, and mortality in Somalia retrospectively. Methods: In this study, 163 patient who were hospitalized to Pediatric Surgery Clinic of Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital in 2018 were included. Data regarding age, gender, diagnosis, surgical condition, mortality rate and cause of the death were recorded from the patient charts and the institutional digital database Results: Of 163 patients 47 were female (28.8%) and 116 were male (71.2%). The mean age of the patients was 6.4 ± 4.8 years. The main diagnoses were congenital malformation (34.4%), acute abdomen (25.8%), traumatic injury (23.3%), infection (9.8%) and neoplasm (6.1%). Mortality rate was 9.8% and the leading cause of death was sepsis by 87.5%. Perforated appendicitis, intestinal obstruction and intussusception were creating the 68.7% of the diseases that result in death. Conclusions: Our results show that two-thirds of the surgical deaths could be prevented with timely presentation. We think that the health policymakers in Somalia should focus on how to improve the access to surgical care, patient transfer, timely presentation, and training of pediatric surgeons and to overcome the poor surgical outcomes. Keywords: Surgery; children; epidemiology; mortality; Somalia

THE EFFECT OF PRESENCE OF DILATED GANGLIONIC SEGMENT ON ANORECTAL AND URINARY FUNCTIONS AFTER ONE STAGE TRANSANAL ENDORECTAL PULL-THROUGH FOR HIRSCHSPRUNG'S DISEASE

Amaç: Hirschsprung hastalığı (HH) tek basamaklı transanal endorektal pull-through (TERP) ameliyatı sırasında, özellikle yenidoğan döneminden sonra, ameliyat öncesi yoğun kolonik irrigasyonlara rağmen genişlemiş ganglionik segmentin çapının düşürülememesi gibi sorunlar yaşanmaktadır. Bu nedenle genişlemiş ganglionik segment (GGS) varlığında yapılan TERP ameliyatlarına ilgi yoğunlaşmaktadır. HH ameliyatları sonrasında ortaya çıkan anorektal sorunlar dışında alt üriner sisteme ait sorunlar da oluşabilmektedir. TERP yöntemi ile yapılan HH ameliyatları sonrasında ise alt üriner sistem fonksiyonlarına ait bilgi literatürde henüz yoktur. GGS varlığında TERP yöntemi ile düzeltici ameliyatı yapılan hastalar ameliyat sonrası alt üriner sistem ve anorektal fonksiyonlar açısından değerlendirildi. Gereç ve yöntem: Kliniğimizde 2000 - 2003 yılları arasında 17 ay ile 3 yaş arasında değişen 12 hastaya (11 erkek, 1 kız) HH nedeni ile TERP ameliyatı yapıldı. Bu hastalarda, GGS varlığında, koloanal anastomozun katlantılar oluşturmadan gerçekleştirilmesi sağlandı. Bu yeni TERP yöntemi sonrası hastaların hastane ve sayısal video kayıtları incelenerek komplikasyonlar, ameliyat süreleri ve takip süreleri karşılaştırıldı. Ailelerinden onay alınan TERP yapılmış hastalara ameliyat sonrası 6 ay beklenerek standart ürodinami yapıldı. Ürodinamik çalışmada mesane kapasitesi, karıniçi basınç, mesane basıncı, detrüsör basıncı, rezidü idrar hacimleri ve pelvik taban kaslarının elektromyografi (EMG) aktivitesi değerlendirildi. Bulgular: Yedi hasta GGS varlığında 5 hasta normal kolonik çap ile ameliyat edildi. Normal kolonik çaplı grup ile karşılaştırıldığında GGS'li grupta ameliyat süresi daha uzun bulundu. Enterokolit yalnızca GGS grubundaki bir hastada ameliyat sonrası saptandı. Diğer bir hastada ise GGS'nin mesane çıkışına basısı sonucu geçici üriner retansiyon gelişti. Normal kolonik çapı olan grupta, bir hasta ameliyat sonrası dönemde iki kez enterokolit atağı geçirdi. Bu yeni TERP yöntemi ile ameliyat edilmiş 6 hastada (5 erkek, 1 kız) ürodinami çalışması yapıldı. Dört hastaya GGS varlığında TERP yapılmıştı. Bu 4 hastada işeme sonrası mesanede idrar kaldığı ve kalan idrar hacminin 20 cc'den az olduğu saptandı. Normal kolonik çap varlığında ameliyat edilen 2 hastada ise işeme sonrası mesanede idrar kalmadığı saptandı. Tüm hastalarda detrüsör aktivitesi normal olarak değerlendirildi. Hastaların takiplerinde hiçbirinde üriner sisteme ait bir semptom ile karşılaşılmadı. Sonuç: GGS varlığında TERP ameliyatı yapılması ameliyat süresini uzatmakta ve geçici idrar retansiyonuna neden olabilmektedir. Ürodinami sonuçları TERP ameliyatının GGS varlığında bile pelvik sinirlere hasar verme riskinin zayıf olduğunu düşündürmüştür. Objective: Before one stage transanal endorectal pull-through (TERP) for Hirschsprung's disease (HD), dilated proximal bowel causes problems such as inability to reduce the caliber of the ganglionic segment despite vigorous colonic irrigations, especially in infants beyond neonatal period. Therefore much concern is focused on the performance of TERP in the presence of a dilated ganglionic segment (DGS). Apart from the anorectal problems occurring after the HD operations, lower urinary system problems could also came across. There is no data in the literature, about lower urinary system functions of the HD patients underwent TERP. The anorectal and lower urinary tract system functions of the patients underwent TERP with presence of DGS were evaluated after the definitive operation. Material and method: From 2000 to 2003, 12 patients (11 boys, 1 girl) underwent TERP for HD. During presence of DGS, the coloanal anastomosis of the DGS was completed without any tapering. Hospital and digital video records of all the patients who underwent TERP were evaluated, and the duration of the operations, complications and follow up periods of the patients were compared. With the consent of their parents, standart urodynamic studies were performed after 6 months. Bladder capacity, intraabdominal pressure, intravesical pressure, detrusor pressure, residual urinary volume and EMG activities of the pelvic floor muscles were evaluated. Results: Five patients were operated with normal caliber colonic segment while 7 patients had DGS. Duration of the operation was found slightly longer in DGS group. One patient in DGS group experienced a single episode of enterocolitis. Temporay urinary retention due to compression of the bladder outlet by DGS occurred in another patient in this group. In normal caliber colon segment group, one patient experienced 2 episodes of enterocolitis. Urodynamic studies were performed to 6 patients (5 boys, 1 girl) who underwent TERP. Among them, the urodynamic studies of the 4 patient who had DGS, revealed presence of postvoiding urine volume, less than 20 cc. There were no postvoiding residual urine present in the 2 patients with normal caliber colon segment. The detrusor activities of the all the patients were evaluated as normal. No urinary system symptoms were encountered during the follow up period. Conclusion: Presence of DGS during TERP lengthens the operation time and sometimes causes reversible urinary retention. According to urodynamic study results of the patients, the risk of damaging pelvic nerves is very low during TERP, even performed under the presence of DGS

The effect of dilated ganglionic segment on anorectal and urinary functions during 1-stage transanal endorectal pull through for Hirschsprung's disease

Background/Purpose: During a 1-stage transanal endorectal pull through (OS-TERP) for Hirschsprung's disease (HD), dilated ganglionic segment (DGS) may pose a problem during coloanal anastomosis. Apart from the anorectal problems occurring after the HD operations, lower urinary tract problems may also be encountered. The anorectal and lower urinary tract system functions of the patients that underwent OS-TERP in the presence of DGS were evaluated

The Diagnosis of Yo-Yo Reflux with Dynamic Renal Scintigraphy in a Patient with Incomplete Ureteral Duplication

The diagnosis of yo-yo reflux in patients with incomplete upper collecting system duplications is difficult. We report a case with recurrent urinary tract infections and ultrasonographically detected duplication in the left collecting system in which the presence of yo-yo reflux is demonstrated with dynamic renal scintigraphy. (MIRT 2012;21:114-116

Altered expression of interstitial cells of Cajal in primary obstructive megaureter

Objective: A marked decrease in the density of interstitial cells of Cajal (ICC) has been shown in patients with ureteropelvic junction obstruction. ICC may also play a role in primary obstructive megaureter (POM). An immunohistochemical study was conducted to investigate the density of ICC in ureterovesical junction (UVJ) segments resected from patients with POM and from control autopsy specimens