A 4-Year-old Male Presenting with Acute Abdomen

no abstrac

Comparison of Endoscopic Balloon Dilation with Bougie Dilation in Children with Esophageal Atresia

Abstract Introduction: Esophageal stenosis is a complication that can occur following surgical treatment of esophageal atresia. Esophageal stenosis should be treated with some methods. One of these methods is using dilation and there are different devices for dilation. In this study we compared the outcome of the Balloon dilation and Bougie dilation for endoscopic treatment after esophageal atresia. material and methods: this is a cross-sectional study that was performed on 40 pediatrics in two groups including the Bougie group and the Balloon group with equal members. The balloon and bougie dilations were performed for patients and data of these procedures were collected and analyzed. Result: there were 20 pediatrics in both groups and the mean age of all of them was 21/33±12/46 months. All of stenosis symptoms were resolved by performing the bougie or the balloon dilation and these procedures were significantly effective but there was no difference about the balloon dilation or bougie dilation method. Conclusion: there is no difference between balloon and bougie dilation. Both of them can be use for esophageal stenosi

Reliability of Ultrasound for diagnosis of appendicitis in children

Introduction: In the medical world, acute appendicitis is one of the common surgeries. The Aim of this study is determining reliability of ultrasound in acute appendicitis. Materials and Methods: The ethical code has been gotten in this research firstly. Based on the archives at Mofid Hospital, the list of appendectomy children in a six- months period has been extracted when they used the ultrasound prior to surgery. Demographic data, medical history and findings of appendicitis, even during the surgery, have been recorded using designed questionnaire based on patients’ documents. According to the surgeon report, not only have appendicitis patients  been operated but also confirmed. The ultrasound results have been compared with surgical results (as the gold standard). For each of the ultrasound findings, based on SPSS software as has used for analyzing, some parameters have been calculated such as sensitivity index, specificity, positive and negative predictive value, accuracy and area under the ROC curve.  Results:     In this study, 111 children with diagnosis of appendicitis have been operated. Based on the ultrasound prior to surgery, 71 patients (64%) with purulent appendicitis showed direct sonographic signs of appendicitis, 11 patients (9.9%) showed indirect signs, 6 patients (5.4%) revealed complicated signs, 7 patients (6.3%) with mesenteric lymphadenopathy and 16 patients (14.4%) negative in ultrasound. Also, according to the final diagnosis after surgery, 105 patients (94.6%) had appendicitis and 6 people (5.4%) were negative for appendicitis. The significant relationship was found between the ultrasound results prior to surgery and the final diagnosis after surgery for patients (p<0.05). The diagnostic value of ultrasound results prior to surgery in order to determine the appendicitis in children undergoing surgery has been revealed by different factors such as sensitivity, specificity, positive predictive value, negative predictive value and accuracy . These factors are at 83.8%, 100%, 100%,83% and 92.3%, respectively (p< 0.05). Conclusion:   It seems that Ultrasound prior to surgery is the useful method to determine the children appendicitis

Full-Thickness Rectal Prolapse in children: Sclerotherapy versus Lockhart Mummery Rectopexy

Introduction: Rectal prolapse is a relatively common disorder in childhood. In this phenomenon, the whole layers of the rectum protrude throughout the anus. Self-limiting cases of rectal prolapse are more common in children below four years old, and overall prevalence is higher in the first year of life, with a predominance of male children. Formerly, the therapeutic efforts insisted on surgery. Nowadays, noninvasive methods like Sclerotherapy have entered the arena. Materials and Methods: This study aimed to compare the efficacy and postoperative complications of 56 children suffering from full-thickness rectal prolapse retrospectively randomized in two groups of conventional surgery and Sclerotherapy referring to the Mofid children's hospital from 2017 to 2020. The authors have used Lockhart mummery rectopexy and Sclerotherapy methods with hypertonic dextrose 50%. Results: Our results revealed a statistically significant difference in mean hospital stay (P-value <0.0001) and follow-up time (P-value=0.009) in the sclerotherapy group compared to other group, but surgical complications (P-value=0.58) and recurrence rate (P-value= 0.62) were statistically non-significant in both groups. Conclusion: careful selection of patients based on symptoms has a vital role in the success of the chosen method for treating rectal prolapse in children. &nbsp

Epidemiological Aspects, Clinical Features and Treatment Outcome in Children Suffering Hepatoblastoma

Introduction: Hepatoblastoma (HBL) is the most common primary liver tumor within childhood. Entire tumor resection is basis for ultimate cure for HBL and supports the only pleasant chance of long-standing disease-free survival. Objectives: In the current survey, we attempted to evaluate the long-term survival of children with HBL with surgical resection in a referral children hospital in Iran within the last decade. Materials and Methods:This retrospective descriptive study was conducted on all children who suffered HBL and undergone surgery between 2006 and 2016. Reviewing the recorded hospital files led to a sample of 30 eligible patients. The baseline characteristics of the patients were all collected by reviewing the files. Results:In total, 30 consecutive children (21 male and 9 female) suffering HBL were described. Of those, 40.0% aged less than 12 months and only 6.7% aged higher than 36 months. The most common clinical manifestations were asymptomatic abdominal mass (in 66.7%) followed by fever (in 10.0%) and pain (in 10.0%). In more than half of the patients (53.3%), right lobe involved, while left lobe involved in 16.7%. based on histologicalreport,marginal involvement was found in 75.0% of children, margin intact in 15.0% and margin free feature in 5.0%. Forty percent of children suffered from epithelial subtype of tumor, 20.0% from mixed epithelial and mesenchymal subtypes, and 13.3% from embryonal pattern. In total, 63.3% were scheduled for complete surgical resection followed by chemotherapy. Postoperatively, 40.0% of children remained free of complications, whereas postoperative bleeding occurred in 20.0% and biloma in 40.0%. Overall, 76.9% of patients were completely cured, 7.7% suffered from pulmonary metastasis and 3.9% required liver transplantation. Postoperative death occurred in 11.5%. Conclusions: Considering surgical resection followed by chemotherapy leads to high cure rate, however a notable number of affected children suffer postoperative complication, requiring liver transplantation, pulmonary metastasis, or even non-survived emphasizing a serious review of the treatment protocols.  &nbsp

High Dose Botox Injection for Patients with Internal Anal Sphincter Achalasia Persistent to Posterior Internal Anal Sphincter Myectomy

Introduction: one of the most common reported chief complaints in visits to pediatricians is constipation. Although in a majority of cases with no anatomical defect, dietary manipulation, stool softeners, and oral laxatives are successful, some patients fail to respond. Internal Anal Sphincter (IAS) Achalasia is one of the causes of constipation.It results in failure of IAS relaxation and has similar clinical presentation to Hirschsprung’s disease with absence of rectosphincteric inhibitory reflex on anorectal manometry (ARM) and presence of ganglion cells on rectal biopsy. Although posterior internal anal sphincter myectomy (ISM) is considered the standard treatment for IASA, some cases fail to respond and present with intractable constipation which may be associated with soiling. This research aims to assess the role of botox injection for treatment of patients who presented with intractable constipation and have already beentreated by posterior IAS myectomy. Materials and Methods:Internal anal sphincter Botox injection was performed (with a dose of 20 U/Kg) in 14 patients with internal anal sphincter achalasia (IASA); who had presented with intractable constipationafter being treated by posterior internal anal sphincter myectomy. Patients were followed for 2 years after injection. Result: of all 14 patients with persistent constipation (resistant to oral laxatives), 12 patients (85.7%) had regular bowel function for more than 6 months after botox injection therapy (P < 0.05). Of all 14 patients that had needed rectal enema for defecation, no patient needed rectal enema after botox injection therapy (P < 0.05). Of 5 patients with fecal soiling before botox injection therapy (4 had occasionalsoiling, and 1 had soiling every day without social problems) only a single patient experienced transient fecal soiling for 2 weeks after botox injection therapy (P < 0.05). No patient needed another botox injection in 2 years of follow up. Conclusion: IAS Botox injection therapy (BIT) was successfully used to manage IASA patients who had presented with intractable constipation after posterior myectomy. This method significantly reduces the need for laxatives and rectal enema; and improves constipation, fecal soiling and bowel movements at the same time

Vaginal foreign body in a 4 year old girl: a case report

Vaginal foreign body is an uncommon clinical entity in the pediatric population but it is more common in mentally retarded and young children. In this case report, we present a 4-year-old girl who was brought to the emergency room with a history of self-insertion of a pen cap into the vaginal orifice which had no vaginal bleeding, vaginal discharge, abdominal pain or urinary symptoms

Management and outcomes of hidden penis in children

Introduction: Hidden penis may have different categories: Concealed, trapped, and buried types. The aim of this study was to evaluate the results and outcomes of repaired cases.Material and Methods: A total of 40patients (5months -12years old) underwent surgical repair for different types of hidden penis from April 2010 to December 2015 in our hospital. Multiple surgical procedures were performed for each type. Data were collected and evaluated for number of patient’s, type of anomalies, surgical techniques, outcome and follow-up.Results: All forty cases underwent surgical repair. In all cases of concealed and buried penis penile degloving and penile fixation was used. In all of our cases improved function and good outcome was reported.Conclusions: Patients with hidden penis are in great psychological risks. The aim of hidden penis repair is to restore an aesthetic and functional penis which we are happy that we provided for our patients