Hirschsprung’s Disease and Rehbein’s Procedure – Our Results in the Last 30 Years

Hirschsprung’s disease is congenital anomaly of the intestine and Harald Hirschsprung gave the first description of this disease1. The aim of this follow-up study was to evaluate the results of Rehbein’s procedure in the treatment of Hirschsprung’s disease in the last 30 years in Children’s Hospital Zagreb. Hirschsprung’s disease is congenital intestinal aganglionosis as the results of arrested fetal development of the myenteric nervous system. Hirschsprung’s disease is affecting between 1:5000 to 1:8000 live births. A total of 124 children underwent Rehbein’s lower anterior resection at Children’s Hospital Zagreb. The principle of Rehbein’ procedure is to remove aganglionic narrow segment and dilated sigmoid colon and anastomosis between normal intestine with rectal stump. The postoperative outcome was analysed for early and late complications like wound infections, abscesses, anastomotic insufficiency, postoperative enterocolitis, constipation, fecal incontinence, need for reoperation, ileus and mortality. On the basis of our results and data from literature we concluded that Rehbein’s procedure is an excellent method for treatment Hirschsprung’s disease

Necrotizing enterocolitis – three case reports and literature review

Nekrotizirajući enterokolitis je gastrointestinalna bolest novorođenačke dobi opasna za život. Do dana današnjeg patogeneza bolesti nije jasna, ali je prihvaćeno da je multifaktorska. Rizični čimbenici za nastanak ove bolesti su u prvom redu nedonošenost i niska porođajna masa. Bolest se dijagnosticira na temelju kliničke slike upotpunjene radiološkim i laboratorijskim nalazima. Način liječenja ovisi o težini kliničke slike i stadiju bolesti. U većini slučajeva dostatno je simptomsko i antimikrobno liječenje uz praćenje laboratorijskih i radioloških parametara. Novorođenčad s teškim oblikom bolesti i perforacijom crijeva zahtijeva hitno kirurško liječenje. Kako bismo približili ovo stanje, prikazali smo troje pacijenata liječenih u Klinici za dječje bolesti Zagreb u 2016. godini.Necrotizing enterocolitis is a life-threatening gastrointestinal disease of newborns. Although the disease pathogenesis has not yet been elucidated, it is considered to be multifactorial. The major risk factors for the disease onset are prematurity and low birth weight. The diagnosis is based on clinical features complemented by radiological and laboratory fi ndings. Treatment modality depends on the severity of clinical features and stage of the disease. In most cases, symptomatic and antimicrobial treatment is suffi cient, with laboratory and radiological monitoring. Newborns with a severe form of the disease and intestinal perforation require urgent surgical treatment. To bring this situation closer, we present three patients treated at the Zagreb Children’s Hospital in 2016

LESS FREQUENT CAUSES OF ACUTE SURGICAL PAIN IN CHILDREN - OUR EXPERIENCE IN THE PAST 10 YEARS

Akutna bol se kod djece može pojaviti zbog različitih razloga. Pod pojmom akutni abdomen smatra se skup simptoma koji se javljaju kod iznenadne bolesti tjelesnih organa. Prema Međunarodnoj udruzi proučavanja boli, bol je definirana kao "neugodno osjetno i osjećajno iskustvo povezano s pravom ili potencijalnom ozljedom tkiva, ili uvjetovano tom štetom ili ozljedom". Bol se po intenzitetu može razlikovati od lagane, teške te naposljetku agonizirajuće, i to kao stalne ili nestalne. Bol se može doživjeti kao oštru, pulsirajuću, mučnu, goruću, strijeljajuću ili kao kombinaciju navedenih. Željeli smo prikazati nekoliko bolesnika s različitim problemima i različitim kliničkim slikama, koji nisu uobičajeni u svakodnevnom rutinskom liječenju. Svi su bolesnici imali akutnu ili kroničnu bol, a svi su u početku bili liječeni medikamentima. Kod svih je bolesnika bilo potrebno kirurško liječenje. Kod postojanja boli u trbuhu moramo uvijek razmišljati o svim mogućnostima koje bi mogle izazvati tegobe. Često postoje dijagnostičke poteškoće u tome kako dokazati uzrok i razlog akutnog abdomena.Acute pain in children can occur for different reasons. The term acute abdomen is considered to be a set of symptoms that occur with a sudden illness of the body\u27s organs. According to the International Association for the Study of Pain, pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Pain intensity can vary, starting from light, then severe, and finally agonizing and can occur as permanent or nonpermanent. It may be experienced as sharp, throbbing, agonizing, burning, stabbing or as a combination of these. We wanted to show a few patients with different problems and different clinical pictures that are not common in daily routine treatment. All patients had acute or chronic pain, and all were initially treated with medication. All of them required surgical treatment. When we have patients with abdominal pain we must always consider all the possibilities that could be causing the problems. There is often a diagnostic problem which is the cause of acute abdomen

A 10-Year Experience in the Treatment of Intraabdominal Cerebrospinal Fluid Pseudocysts

The aim of this retrospective study was to assess a ten-year experience in the treatment of rare complications of ventriculoperitoneal shunting – intraabdominal cerebrospinal fluid pseudocysts. At this time there are no data about incidence, clinical course and treatment of these complications in Croatia. Cerebrospinal fluid (CSF) abdominal pseudocyst is an uncommon but important complication of ventriculoperitoneal shunts. Retrospective data were obtained from 5 children with abdominal CSF pseudocysts, treated between 1996 and 2007. The incidence of intraabdominal CSF pseudocysts in our study is 2.9%. All patients were girls ranged in age from 4 to 12 years old (mean 8.8 years). In most cases etiology of hydrocephalus was congenital, idiopathic. Abdominal pain and distension were the most frequent clinical finding (4/5). Although infection has been reported as responsible for pseudocyst formation, we did not found it in our series. Laparotomy with cyst wall excision and catheter replacement was performed in 2/5 cases, and only cyst fluid aspiration with catheter replacement in 3/5 cases. Recurrence of the abdominal cyst was observed in one girl who was in terminal stadium of anaplastic ependymoma. It is our opinion that only catheter replacement and cyst fluid evacuation, as one of the treatment modalities, may be successful, even in large CSF intraperitoneal pseudocysts

LOW BACK SYNDROME RECIDIV ANS AND WORK ABILITY (10 years study)

Provedena je ·retrospektivna studija u vidu upitnika na 221 bolesnika s recidivirajućim lumbalnim bolnim sindromom, a odnosila se na desetogodišnje razdoblje. U ispitivanje je uključeno 124 muškarca (65,2%) i 97 žena (43,8%). Prosječna dob prve atake lumbalnog bolnog sindroma bila je 31,1 godinu s rasponom od 15-60 godina, a zadnje atake 48,9 godina s rasponom od 25-80 godina. Prosječni vremenski interval između prve i zadnje atake bio je 17,1 godina. Najveća učestalost lumbalnog bolnog sindroma bila je u dobnoj skupini od 40-44 god. (28% bolesnika). U više od jedne trećine bolesnika javila se lumboishialgija, a u 50% bolesnika rendgenološki osteohondroza L;; - S1 segmenta.. U ostalih 20% bolesnika nađene su kongenitalne anolalije· i statički deformiteti lumbalne kralješnšice. U navedenom vremenskom razdoblju 83% bolesnika koristilo je bolovanje, 2,7% skraćeno radno vrijeme, 10% bolesnika je moralo promijeniti radno mjesto i 4% zanimanje radi osnovne bolesti.A retrospective study covering a period of 10 years was performed in 221 patients suffering from reccurent lumbar painful syndrome. All patients were asked to complete a questionnaire. The study group i.ncluded 124 men (65.2%) and 97 women (43.8%). The mean age of patients at the time of the first attack was 31.1 years with a range of 15 to 60 years, the oorresponding figures for the last! attack being 48.9 years with a range of 25 to 80 yeaTs. The mean interval between the first and the last attack was 17 .l years. The highest recurrence rate wa-s observed in those aged 40 to 44 years (28% of patients). Disc herniation was found in 4.5% of patients, whereas 36.6% developed lumbo-sciatica. Degenerative changes in the form of osteochondrosis or discarthorsis were established in 80% of patients. In 50% of them osteochondrosds affected the L 5 - S1 segment. The remaining 20% had congenital abnormalities and static deformit\u27ies of the lumbar spine. Over the 10-year period studied 83% of patients stayed off work for an average of 28 months per patient or 2.6 months per year. Only 2.7% worked part-time. 10% were forced to change their jobs and another 4% to be retrained for new occupat:ions

LOW BACK SYNDROME RECIDIV ANS AND WORK ABILITY (10 years study)

Provedena je ·retrospektivna studija u vidu upitnika na 221 bolesnika s recidivirajućim lumbalnim bolnim sindromom, a odnosila se na desetogodišnje razdoblje. U ispitivanje je uključeno 124 muškarca (65,2%) i 97 žena (43,8%). Prosječna dob prve atake lumbalnog bolnog sindroma bila je 31,1 godinu s rasponom od 15-60 godina, a zadnje atake 48,9 godina s rasponom od 25-80 godina. Prosječni vremenski interval između prve i zadnje atake bio je 17,1 godina. Najveća učestalost lumbalnog bolnog sindroma bila je u dobnoj skupini od 40-44 god. (28% bolesnika). U više od jedne trećine bolesnika javila se lumboishialgija, a u 50% bolesnika rendgenološki osteohondroza L;; - S1 segmenta.. U ostalih 20% bolesnika nađene su kongenitalne anolalije· i statički deformiteti lumbalne kralješnšice. U navedenom vremenskom razdoblju 83% bolesnika koristilo je bolovanje, 2,7% skraćeno radno vrijeme, 10% bolesnika je moralo promijeniti radno mjesto i 4% zanimanje radi osnovne bolesti.A retrospective study covering a period of 10 years was performed in 221 patients suffering from reccurent lumbar painful syndrome. All patients were asked to complete a questionnaire. The study group i.ncluded 124 men (65.2%) and 97 women (43.8%). The mean age of patients at the time of the first attack was 31.1 years with a range of 15 to 60 years, the oorresponding figures for the last! attack being 48.9 years with a range of 25 to 80 yeaTs. The mean interval between the first and the last attack was 17 .l years. The highest recurrence rate wa-s observed in those aged 40 to 44 years (28% of patients). Disc herniation was found in 4.5% of patients, whereas 36.6% developed lumbo-sciatica. Degenerative changes in the form of osteochondrosis or discarthorsis were established in 80% of patients. In 50% of them osteochondrosds affected the L 5 - S1 segment. The remaining 20% had congenital abnormalities and static deformit\u27ies of the lumbar spine. Over the 10-year period studied 83% of patients stayed off work for an average of 28 months per patient or 2.6 months per year. Only 2.7% worked part-time. 10% were forced to change their jobs and another 4% to be retrained for new occupat:ions

Aplasia cutis congenita of the scalp: The success of conservative approach in treatment of a large defect

Aplasia cutis congenita is a rare malformation that usually involves the scalp. It may occur as an isolated defect or be combined with congenital malformations. We present a case of a female infant at the age of 2 days with aplasia cutis congenita of the scalp. Although there is no consensus about the treatment, we have decided for a conservative approach because sagittal sinus, large veins, or brain were not exposed. Ten months since the onset of conservative treatment, the aplastic area was almost completely cured

LESS FREQUENT CAUSES OF ACUTE SURGICAL PAIN IN CHILDREN - OUR EXPERIENCE IN THE PAST 10 YEARS

Akutna bol se kod djece može pojaviti zbog različitih razloga. Pod pojmom akutni abdomen smatra se skup simptoma koji se javljaju kod iznenadne bolesti tjelesnih organa. Prema Međunarodnoj udruzi proučavanja boli, bol je definirana kao "neugodno osjetno i osjećajno iskustvo povezano s pravom ili potencijalnom ozljedom tkiva, ili uvjetovano tom štetom ili ozljedom". Bol se po intenzitetu može razlikovati od lagane, teške te naposljetku agonizirajuće, i to kao stalne ili nestalne. Bol se može doživjeti kao oštru, pulsirajuću, mučnu, goruću, strijeljajuću ili kao kombinaciju navedenih. Željeli smo prikazati nekoliko bolesnika s različitim problemima i različitim kliničkim slikama, koji nisu uobičajeni u svakodnevnom rutinskom liječenju. Svi su bolesnici imali akutnu ili kroničnu bol, a svi su u početku bili liječeni medikamentima. Kod svih je bolesnika bilo potrebno kirurško liječenje. Kod postojanja boli u trbuhu moramo uvijek razmišljati o svim mogućnostima koje bi mogle izazvati tegobe. Često postoje dijagnostičke poteškoće u tome kako dokazati uzrok i razlog akutnog abdomena.Acute pain in children can occur for different reasons. The term acute abdomen is considered to be a set of symptoms that occur with a sudden illness of the body\u27s organs. According to the International Association for the Study of Pain, pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Pain intensity can vary, starting from light, then severe, and finally agonizing and can occur as permanent or nonpermanent. It may be experienced as sharp, throbbing, agonizing, burning, stabbing or as a combination of these. We wanted to show a few patients with different problems and different clinical pictures that are not common in daily routine treatment. All patients had acute or chronic pain, and all were initially treated with medication. All of them required surgical treatment. When we have patients with abdominal pain we must always consider all the possibilities that could be causing the problems. There is often a diagnostic problem which is the cause of acute abdomen

Rare Abdominal Wall Malformation: Case Report of Umbilical Cord Hernia

The umbilical cord hernia is the rarest form of abdominal wall malformations, anatomically completely different from gastroschisis and omphalocele. It occurs due to the permanent physiological evisceration of abdominal organs into umbilical celom and persistence of a patent umbilical ring. The umbilical cord hernia is often mistaken for omphalocele and called “small omphalocele”. Here we present a case of a female newborn with umbilical cord hernia treated in our Hospital. After preoperative examinations surgery was done on the second day of life. The abdominal wall was closed without tension. The aim of this article is to present the importance of the proper diagnose of these three entities and to stimulate academic community for the answer, is this umbilical cord hernia or small omphalocele