Clinical Findings Versus Imaging Studies in the Diagnosis of Infantile Hypertrophic Pyloric Stenosis

Background: Infantile hypertrophic pyloric stenosis is the commonest surgical cause of vomiting in early infancy and can be diagnosed clinically or by imaging studies. OBJECTIVES: To assess the accuracy of clinical examination as compared with ultrasound and upper gastrointestinal contrast imaging in the diagnosis of infantile hypertrophic pyloric stenosis. PATIENTS AND METHODS: A prospective study of 30 patients referred to the pediatric surgical department in pediatric teaching hospital in Erbil with a possible diagnosis of IHPS in the period from June 2006 to January 2009. RESULTS:   The male to female ratio was 3.28:1 .The mean age at onset was 29.5 days. The mean age at presentation was 48 days. Projectile vomiting was present in all infants (100%).  Pyloric mass was palpable in 21 infants (70%). Visible peristaltic waves were noted in 12 infants (40%). 27 patients (90%) had gastric aspirate of more than 10cc. Ultrasound examination was confirmatory in 29 patients (96.6%). Barium study was positive in 27 cases (90%) and different signs were noted with various percentages. All patients underwent Ramstedt`s operation through right upper transverse incision. The average hospital stay was 3.5 days. The long term results in all the 30 cases were excellent. CONCLUSION: A palpable pyloric mass with suggestive history is a sufficient indication for proceeding to surgical treatment without confirming diagnostic imaging studies. However, when physical findings alone are inconclusive, an upper gastrointestinal series or an abdominal ultrasound examination should be done because of their high sensitivity in identifying the underlying problems. DOI: 10.7176/JHMN/76-04 Publication date:June 30th 202

The Role of Saline Enema in Reduction of Intussusception Under Ultra Sonographic Guide a Study of 40 Patients in Alkarama Teaching Hospital

Background: enema reduction of the intussusception under US guide is widely used as a useful alternative to surgical management. This procedure is simple with no radiational effect , less complication rate with good outcome and the parents can stay with their child during the whole procedure. Aim of study : We tried to present our experience in HRIUSG by the use of normal saline enema and to evaluate its safety, outcome and to identify the risk variables for enema failure. Methodology : From the 1st of June 2016 to 1st of January 2017, we received about 45 children at children welfare hospital (medical city complex) that confirmed sonographically to have intussusception. Five patients were excluded from the study because of contraindications (peritonitis, perforation and shock). 40 children were developed enema reduction under sonographic guide. Results : From 40 children underwent HRIUSG their age presentation range from 3 months to 32 month, 67.4 % had respiratory infection while 32.6 % had gastroenteritis. We had a successful rate about 79 % with a median of 1 trial and only 3 patients (9.3 %) developed recurrence within 1st 24 hr. from the 9 patients underwent surgery we had 8 patients had manual reduction and one patient underwent resection of the bowel. Only 3 patients had PLP. 1 patient ( 2.3% ) was reported to have complication ( perforation over sewn ). Age , gender , duration of symptoms not significantly affect the outcome P value < 0.05 while bleeding with stool, initial mass in the left colon and rectum , presence of free fluid and more trial numbers were a bad prognostic factors for enema failure . Conclusion: 1. HRIUSG is simple, safe, less costly, practical, less messy ,no radiational exposure with a low complication rate 2. Age, gender, Duration of symptoms did not affect the outcome significantly. 3. Although bleeding with stool, left colon intussusception mass and free peritoneal fluid is a risk factor for failure of HRIUSG but they are not absolute contraindication. 4. The better scenario for enema reduction success is a patient presented with symptoms < 24 hr. with no bleeding stool and a mass in the cecum and ascending colon with no free peritoneal fluid. Keywords: saline enema; reduction; intussusception ; ultrasound guide . DOI: 10.7176/JHMN/73-04 Publication date: April 30th 202

The Value of Ultrasonography in Diagnosis of Acute Appendicitis in Pediatric Age Group

BACKGROUND Acute appendicitis is one of the most common surgical emergency condition in pediatric age group that need admission to pediatric surgery unit for emergent operation of appendectomy . Any delayed in the diagnosis and operation lead to very serious outcome ,including perforation , abscess formation and appendiceal mass formation and other complications which may lead to high mortality and morbidity rate in case of absence timely performed operation of appendectomy . Ultrasound (USG)is one of the most helpful and informative tool in diagnosis of acute appendicitis in children.it is simple , fast , available and with less complications of ionizing radiation that may associated with other modality of radiological methods , like CT . Aims of the study Evaluate the role of USG examination in :- 1-diagnosis of children with suspected appendicitis 2-defining the sensitivity , specificity and the accuracy rate of acute appendicitis in pediatric age group. 3-Decreasing the normal appendectomy in pediatric age group/. patients and method This prospective study has been achieved in the central child teaching hospital in Baghdad during the period from February 2015 to December 2015, that enrolled 110 patients that were admitted pediatric surgery Center in Central Child Hospital in Baghdad who were complained from right lower abdominal pain and acute appendicitis was highly suspected at time of examination .USG examination had been done to these patients. Result Clinical presentation and USG criteria of acute appendicitis had been found in 57 cases out of 110 patients , and those underwent appendectomy operation in the Central Child Teaching Hospital in Baghdad . Unvisualization of appendix or normal ultrasonography criteria had been found in 53 patients. 6 patients out of the those of 53 patients with negative USG finding underwent appendectomy operation due to persistence of clinical finding, 3 of them were with normal appendix while the 3 others were with inflamed appendix according to histopathological examination. The other 47 patients from 53 cases who were complain from right lower abdominal pain, but with negative USG findings , kept for observation for 24 hours and then discharged home with follow up these cases by clinical examination and USG once weekly for 2 weeks. The overall result of a study is as follow :- Specificity = 100% Sensitivity = 95% Accuracy rate =97.27% Positive predictive value =100% negative predictive value = 50% conclusion ultrasonographic examination have effective role in diagnosis of acute appendicitis in pediatric age group. Keywords:Acute appendicitis , ultrasonogaphy in acute appendicitis , sensitivity , specificity , accuracy rate. DOI: 10.7176/JHMN/73-06 Publication date: April 30th 202