Gastrointestinal Injuries Following Blunt Abdominal Trauma In Children

Purpose: Gastrointestinal (GI) injuries in children following blunt abdominal trauma is rare; early diagnosis and treatment is important for good outcome. The purpose of this report is to describe the management problems encountered in children with GI injuries following blunt abdominal trauma. Patients and Methods: From January 1996 June 2006, 168 children were treated at our centre for abdominal trauma. Twenty three had GI injuries, 19 were due to blunt trauma while four were due to penetrating trauma. We retrospectively reviewed the clinical data of the 19 children that had GI injuries as a result of blunt abdominal trauma to document the presentation, clinical features, diagnosis and outcome. Results: There were 19 patients, 14 were boys, and five were girls. The median age at presentation was nine years (range 1.5 15 years). Road traffic accident was responsible for injuries in 10, fall from heights in six and assault in two children. In one child the cause of injury was not recorded. Most children presented late and at presentation over 80% had abdominal signs. Diagnosis was mainly by physical examination supported by plain abdominal x-ray in 15 children. All 19 children had laparotomy. There were a total of 23 injuries. Gastric and duodenal injuries accounted for one each. Most of the injuries were in the jejunum and ileum (10 perforations, two contusions with one mesenteric haematoma and one mesenteric tear). There was one caecal perforation and six colonic injuries , one of which was associated with intraperitoneal rectal injury. Five children had other associated injuries (three splenic injuries, one renal injury, one bladder contusion associated with long bone fractures and one severe closed head injury). Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. Conclusion: Gastrointestinal injuries due to blunt abdominal trauma pose a management challenge. Management based on decisions from serial clinical examinations and simple tests without recourse to advance imaging techniques may suffice. Keywords: Gastrointestinal injury, Blunt abdominal trauma, children. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 250-25

Congenital anomalies in low- and middle-income countries: the unborn child of global surgery.

Surgically correctable congenital anomalies cause a substantial burden of global morbidity and mortality. These anomalies disproportionately affect children in low- and middle-income countries (LMICs) due to sociocultural, economic, and structural factors that limit the accessibility and quality of pediatric surgery. While data from LMICs are sparse, available evidence suggests that the true human and financial cost of congenital anomalies is grossly underestimated and that pediatric surgery is a cost-effective intervention with the potential to avert significant premature mortality and lifelong disability

Sacrococcygeal teratoma: Clinical characteristics and long-term outcome in Nigerian children

Background/Purpose : The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-term morbidity for the child. We reviewed our experience with SCT in a tertiary health care facility in a developing country with particular interest on the long-term sequelae. Methods : Between January 1990 and May 2008 inclusive, 38 consecutive children with the diagnosis of SCT were identified from the operation register and the Cancer Registry of the Jos University Teaching Hospital. Their clinical presentation, investigation, operative findings, histology report, and outcome were recorded and analyzed. The long-term follow-up of some of the patients were also recorded and analyzed. Results : There were 31 females and 7 males. Twenty-three patients presented during the neonatal period with a median age at presentation of 7 days (range 1-18 days) and a median weight at presentation of 2.8 kg (range 2.0-3.6kg), 10 presented between 1 month and 12 months, while 5 were older than 1 year at presentation. Most of the patients had significantly external tumors. Excision of the tumor was mainly by the sacral route, four had abdominal-sacral excision. Histology was mainly benign; four were malignant at presentation. Four children with malignant disease had chemotherapy in addition to excision of the tumor. Eight had immediate post-operative wound-related complications while three children died, two of the deaths were related to anesthesia, while one died of colostomy complications. Twenty-one (60%) were followed up for a median duration of 6 years (range 1 month-8 years). Two (9.5%) had recurrent disease after primary excision; five (23.8%) had some degree of functional impairment at the follow-up. Conclusion : While SCT is usually benign, recurrence, malignant transformations in patients who present late and long-term functional sequelae are problems that must be tackled by the care givers. A multi-center study may be necessary to characterize this disease in developing countries and assess the long-term functional sequelae in survivor

Clinical characteristics and outcome of surgical treatment of childhood rhabdomyosarcoma: A 7-year experience

Background: The aim of this study was to describe the outcome and determine the prognostic factors of outcome of childhood rhabdomyosarcoma in a tertiary hospital in a developing country. Patients and Methods: This was a retrospective review of the clinical presentation, investigation, intervention, and treatment outcomes of children with rhabdomyosarcoma in our hospital over a 7-year period. Statistical analysis was performed using Chi-square test. Results: A total of 18 patients were identified with two-thirds being males (n = 12) with median age of 7 years. Most of the children were below 10 years of age. Lower limbs tumour predominated (n = 6) followed by the upper limbs and head and neck (n = 4 each). Other sites included perianal/perineal (n = 3) and the orbit (n = 1). Two patients were Intergroup Rabdomyosarcoma Study (IRS) group I, four group II, five group III, and seven group IV. Lymph node involvement was the commonest site of metastasis. Clinical group and stage was significantly more advanced in patients older than 10 years compared to younger than 10 years (P = 0.010, P = 0.008, respectively). There were 12 patients with alveolar disease while six had embryonal type of rhabdomyosarcoma. Treatment was by combination chemotherapy, and surgical excision which was done primarily in 11, after chemotherapy in four, and after radiotherapy in one. Two had biopsy only. Five patients are alive, two of them without evidence of disease at average follow-up period of 2 years. Conclusion: Mortality from rhadomyosarcoma in our setting is still unacceptably high. Late presentation may be the major contributor to high mortality. A more aggressive multimodality treatment approach may improve the outcome African Journal of Paediatric Surgery Vol. 5 (1) 2008: pp. 19-2

Colostomy complications in children

Background: Colostomy is a common procedure in children and may be attended by significant morbidity. Method: This is a retrospective study of morbidity and mortality associated with the formation and closure of colostomy in children between 1991 and 2001, at the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Results: There were 116 children with a median age of 3 weeks (range: one day 14 years). The male: female ratio was 2:1. The indications for colostomy were Hirschsprung's disease 68 (58.6%), anorectal malformations 44 (37.9%) and trauma to the rectum 4(3.5%). A total of 122 complications occurred in 62(53%) patients after colostomy formation. The commonest complication was excoriative dermatitis 46(74.2%), followed by prolapse 24(38.7%) and wound infection. Difference in complications between transverse and sigmoid colostomies was statistically significant (P< 0.05). One hundred and eight (93.1%) children had intraperitoneal closure of colostomy, 21 (19.4%) of who developed surgical site sepsis. The overall mortality was 16 (13.8%), exclusively from colostomy closure. Conclusion: Colostomy-related procedures in children are associated with high morbidity and mortality in our environment. Improved health care delivery may improve the present outcome. Colostomy-related operations should not be relegated to minor importance. Keywords: Colostomy, complications, childre

Association of midgut malrotation with intussusception

Background: The cause of intussusuception in most infants is unclear. Intestinal malrotation has been postulated as a possible cause in some infants. Waugh,s syndrome is the association of intestinal malrotation with intussusception.Patients/Methods: Of 18 children with intussusception managed in the Paediatric Surgical Unit of our hospital over a 3-year period, eight had abnormality of intestinal rotation and fixation. Their case notes, operation notes and discharge summary sheets have been retrospectively reviewed.Results: There were five boys and three girls. Their ages ranged from 13 days – 12 months (median 10 months). The main clinical features were bilious vomiting, blood stained diarrhoea and abdominal distension. In two infants, the intussusceptions had prolapsed through the anus at presentation. One neonate had ruptured omphalocoele minor containing a caeco-colic intussusception that had perforated at presentation. Two other infants had mid gut volvulus, one as a simultaneous finding with intussusception while the other one 72 hours after operative reduction of intussusception. All had laparotomy. In six infants, the intussusception was ileo-colic while in two it was caeco-colic. There was no lead point in any infant. Four infants had successful operative reduction while four had bowel resection with end-to-end anastomosis. All had Ladd's procedure. One child died of overwhelming sepsis following resection of gangrenous bowel. Conclusion: Intestinal malrotation may be associated with idiopathic intussusception. It is important to look for this association when managing infants with intussusception. Keywords: Waugh's syndrome, intussusception, malrotation, midgut volvulus, Ladd's procedure Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 159-16

Hirschsprung’s disease presenting in the neonatal period in Jos,Nigeria

Background: While most cases of Hirschsprung’s disease are diagnosed during the neonatal period in developed countries, majority of the cases present outside the neonatal period in developing countries.We reviewed our experience with Hirschsprung’s disease presenting during the neonatal period to document the presentation and management.Patients/Methods: A retrospective analysis of the presentation and management of 31 neonates with Hirschsprung’s disease over a nine year period in a Tertiary pediatric surgical centre in Nigeria wasperformed.Results: From January 1996 – December 2004, 78 children were managed for Hirschsprung’s disease in our unit. Thirty-one (39.7%) were aged 30 days or below. The median age at presentation was eight days (range 2-30 days). There were 23 boys and 8 girls. The median weight at presentation was 2.8kg (range 2.3 – 4.5kg). Fifteen weighe

Necrotizing Fasciitis: An Unusual Sequela Of Injections In Children

Background: Necrotising fasciitis (NF) of the head and the trunk in children is a serious infection that carries high morbidity and mortality. We recently managed two infants with NF from injection mishap of the head and the trunk, respectively. The aim of this report is to highlight ways of effectively treating and/preventing cases of NF in children. Patients and methods: Two children who presented with NF as sequela to injections to the head and the gluteus area were managed at the Jos University Teaching Hospital between July and November, 2002. Radical ulcer debridement, adequate antibiotic cover and skin cover were the mainstay of the treatment. Result: The infants were aged fourteen and eleven months, respectively, with ulcers measuring 18-21cm wide; average hospital stay was 10.9 weeks. Swab from the head lesion yielded a mixture of Streptococcus and Klebsiella spp, but none from the second ulcer. Polymicrobial therapy (cefuroxime and metronidazole) was effective. Split skin grafting yielded satisfactory outcome. Both patients survive. Conclusion: NF is a dangerous infection of the skin and the subcutaneous tissue and very often runs a fatal course in children. Early recognition of NF may help to avert some of the mortal effects of this condition. Successful treatment of NF involves adequate resuscitation, administration of broad-spectrum antimicrobials, adequate debridement and skin cover. Prevention in the form of cautious use of injections to treat childhood illnesses cannot be over emphasised. Key words: Necrotising fasciitis, injection, children. Highland Medical Research Journal Vol.2(1) 2004: 61-6