Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members

Background: In contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world. Methods: A web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021-03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients´ age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis. Results: A total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (> 500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children ≤ 10 and ≤ 5 years of age (p = 0.0014). This situation is aggravated in participants from smaller hospitals (p < 0.01). With regard to hospital size (≤ 500 versus > 500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p < 0.0001), treated children at all ages more frequently (p = 0.0938) and have higher case-loads of severely injured children < 12 years of age (p = 0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p < 0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively). Conclusions: Multi-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management

Splenogonadal fusion – Rare etiology testicular mass

Splenogonadal fusion is a rare congenital abnormality that affects mostly the male gender, and may present as cryptorchidism. A pre-operative diagnosis is rare and difficult, and may be mistakenly diagnosed as a gonadal tumor of malignant nature leading to unnecessary orchiectomy. The authors present two case reports concerning the two types of splenogonadal fusion described, with a subsequent literature review, alerting for the clinical presentations and available complementary exams

Segmental absence of intestinal musculature concerning a child with acute appendicitis

Segmental absence of intestinal musculature (SAIM) is a rare histopathologic entity with few described cases, most of which in neonates. Rare reports of pediatric cases have been made. Pathogenesis is still uncertain. This report aims to highlight a pathologic condition that substantially affects the clinical evolution of an abdominal post-operative state as well as the therapeutic approach. We present the case of a 4-year old child, previously healthy, with a 4-day long intestinal obstruction. The exploratory laparotomy demonstrated peritonitis from a necrosed and perforated acute appendicitis. Post-operatory intestinal perforation led to a second laparotomy, with resection of a perforated ileal segment and one with vascular compromise. Pathologic analysis showed segmental absence of intestinal musculature of the small bowel. On a third operative time, resection of the macroscopically injured bowel segments and high protective enterostomy were made. A three years follow-up shows a healthy, well-developed child, who has already undergone enterostomy closure with no intercurrences. Etiology remains to be defined, possibly related to congenital or ischemic acquired defects. It usually manifests in neonates, but we present a case of a 4-year old child. Treatment consists of resection of the injured bowel segments

Pseudomotor Inflamatório do Pulmão na Criança

O pseudotumor inflamatório é uma lesão rara, considerada reactiva a uma situação inflamatória não neoplásica. Existem poucos relatos destes tumores que ocorrem em diversas localizações na criança. Os autores apresentam o caso clínico duma criança de 14 meses de idade com pseudotumor inflamatório, localizado no lobo superior do pulmão direito e com invasão das estruturas do mediastino.Descrevem as características clínicas e a evolução da doença, no sentido de facilitar o seu reconhecimento pré-cirúrgico. Este tumor deve ser considerado no diagnóstico diferencial das massas pulmonares associadas a resposta inflamatória, e o diagnóstico histológico é importante para a diferenciação das lesões malignas

Litíase do aparelho urinário em idade pediátrica – experiência de um centro

Objetivo: Avaliação da epidemiologia, incidência familiar, etiologia, apresentação clínica, tratamento e complicações das crianças com diagnóstico de urolitíase, com o objetivo de melhorar a sua abordagem e estratégias de tratamento. Métodos: Estudo retrospetivo dos processos clínicos das crianças seguidas em consulta de litíase do aparelho urinário, entre Fevereiro de 2011 e Janeiro de 2014. Procedeu-se a avaliação dos dados demográficos, história familiar, investigação metabólica, apresentação clínica, número, dimensão e localização dos cálculos, tratamento e resultados da análise do cálculo. Resultados: Foram tratados 21 doentes. Existia história familiar de litíase em 52,4%. Cinco dos que realizaram investigação metabólica (19/21) apresentavam alterações e em dois existiam malformações génito-urinárias. A forma de apresentação mais frequente foi a cólica renal (38%). O Diagnóstico foi realizado por ecografia abdominal em todos casos exceto dois, cuja suspeita foi colocada após realização de radiografia. Dos catorze casos de litíase renal, três foram submetidos a cirurgia e onze a litotrícia extra-corpórea por ondas de choque (LEOC). Dos sete doentes com litíase ureteral, um foi submetido a cirurgia aberta e os restantes a terapêutica médica expulsiva. A litíase vesical foi tratada por endolitotrícia com litoclast. Dos sete cálculos analisados por espectofotometria de massa, 57% apresentavam fosfato de amónio e magnésio (struvite) na sua composição. Conclusão: O perfil dos nossos doentes é semelhante ao descrito na literatura de zonas não endémicas. Verificou-se uma elevada incidência de recurso a intervenção cirúrgica por via aberta (19%). Com um diagnóstico e referenciação mais precoces será possível tratar estes doentes de forma minimamente invasiva

Fusão esplenogonadal

A fusão esplenogonadal é uma entidade rara com poucos casos descritos na literatura. O diagnóstico é, em geral, intra-operatório, aquando da exploração do canal inguinal. Associa-se frequentemente a outras malformações, algumas major. Apresenta-se o caso de um rapaz de três anos de idade operado por hidrocelo à esquerda. Durante a intervenção cirúrgica observou-se fusão esplenogonadal contínua, não apresentando outras malformações

An Atypical Presentation of Rhabdomyosarcoma: Date of submission: 25-11-2019 | Date of acceptance: 20-02-2020 | Published: 02-10-2020

Thromboembolism is infrequent in children, nonetheless, whenever malignancy is present, there is an increased risk, around 7% to 25%. Rhabdomyosarcomas are typically asymptomatic masses, but patients can become symptomatic due to mass overgrowth and compression of surrounding structures, therefore presentation might be as a thromboembolic event. Sarcomas have recognized risk factors including large tumour masses, intensive chemotherapy, radiation therapy, extensive surgery and associated limited mobility. Whenever a thromboembolic event presents without a reliable aetiology and with no response to conventional treatment, an underlying malignancy should be excluded. In this context, we present a six-year-old boy who presented with a persistent symptomatic deep venous thrombosis of the inferior limb, despite anticoagulation and, in the subsequent investigation, a retroperitoneal rhabdomyosarcoma was diagnosed. In the light of this case, a brief review of the literature review is presented.O tromboembolismo é um evento raro na população pediátrica, contudo, quando existe neoplasia o risco aumenta, sendo entre 7% e 25%. Os rabdomiossarcomas são massas tipicamente assintomáticas, podendo tornar-se sintomáticas por aumento do volume com compressão das estruturas envolventes, pelo que a apresentação pode ser um evento tromboembólico. Os sarcomas têm fatores de risco para tromboemobolismo que incluem massas tumorais volumosas, quimioterapia intensiva, radioterapia, cirurgia extensa e mobilidade reduzida. Sempre que surge um evento tromboembólico sem uma etiologia reconhecida e que não responde à terapêutica convencional, deve ser excluída uma neoplasia. Apresentamos o caso de uma criança de 6 anos de idade que se apresentou com uma trombose venosa profunda do membro inferior, persistente apesar da anticoagulação e, cuja investigação subsequente revelou um rabdomiossarcoma retroperitoneal. Uma breve revisão da literatura é feita neste contexto

Swyer-James-Macleod Syndrome presentating as pneumothorax

Swyer-James-MacLeod Syndrome is a rare form of post-infectious bronchiolitis obliterans, characterized by unilateral lung hyperlucency due to loss of pulmonary vasculature and alveolar hyperdistention, in the absence of main bronchial obstruction. It is an exclusion diagnosis, usually suspected on chest x-ray and confirmed by high resolution lung computerized tomography. The clinical course and prognosis are influenced by the presence of underlying bronchiectasis and treatment is generally conservative. The authors report a rare clinical case complicated with bilateral apical blebs and bronchiectasis, presenting as a tension pneumothorax. In the light of this index patient, we discuss specific literature review. Keywords: Hyperlucent lung, Swyer-James syndrome, MacLeod syndrome, Bronchiolitis obliteran