Surgical disease of the spleen

It was clear and well accepted that splenectomy results in loss of significant defence functions of the body predisposing the patient to life-threatening sepsis. The evidence led to the condition that the use of total splenectomy greatly curtailed and the splenic preservation, splenorrhaphy, partial splenectomy, or splenic artery ligation is a more appropriate procedure in many circumstances. In recent years, conservative management has become the treatment of choice even for large splenic injuries providing that the surgical team, blood bank, intensive care unit, and radiologic investigative modalities are available for 24 hours a day. (Turk Arch Ped 2010; 45 Suppl: 53-4

Hydatid disease

Hydatid disease is characterized with the cystic lesions in the different organs of the body caused by a taenia, echinococcus granulosis. Liver is the most affected organ followed by the lungs. Diagnosis is not so difficult because of the situation that Turkey is one of the endemic counries in the world. Living in an endemic country, clinical probability, radiological imagining, and serological tests are sufficient enough to reach in diagnosis. The presence of cytic lesions in the family members and multiorgan involvement support the diagnosis. In recent years, the majority of the patients were referred to our institution for their incidentally found asymptomatic cysts because of deliberately used ultrasongraphic investigations for other reasons. Abdominal ultrasonography, abdominal and chest computerized tomographies, and serological tests are the main diagnostic modalities. Possible treatment options are; open surgery, laparoscopic approach, ultrasonography guided drainage procedure, surgery under the coverage of drug treatment, and drug treatment alone using albendazol. With the fear of having complications such as, spillage of the cyst content, incomplete clearance of the septated cysts, abscess formation in the remaining cavity, and the possibility of the recurrence, the laparoscopic intervention and ultrasonography guided drainage procedures are not preferred treatment modalities. Our treatment protocol has changed in the years, from operating every cyst to nonoperative treatment protocol with the use of albendazol alone in selected cases with hydatid disease. As a conclusion: in the operation, there is no point using any type of scolocidal agents. They can even be fatal. After cleaning the cystic cavity, open bile ducts could be found and repaired under direct vision by the maneouver described by the author. No attempt should be made to close or fill the cavity using stiches or an omental patch in liver cysts, they should be leave open to the peritoneal cavity after inserting tube drains into the cavity and at the bottom of the liver. Splenectomy under the coverage of the vaccination for the splenic cysts, partial cystectomy for the renal lesions, and suture ligation of the bronchial openings individualy and capittonage of the cavity for the lung cysts, are recommended. Since 1995, albendazol treatment have been used succesfully in patients without having any side effects or complications that need to stop the treatment protocol. We can remove the lebel of an endemic country from the name of Turkey with education, working together with veterinary society and probably, prophylactic usage of albendazol in the group of people who deal with cattle breeding. (Turk Arch Ped 2010; 45 Suppl: 55-8

Portal hypertension and its complications

Portasystemic collaterals develop as a result of portal hypertension. The collaterals in the cardioesophageal region is the leading cause of bleeding from esophageal varices. Some of the portal hypertensive patients present with bleeding episodes but the others do not, and some of the bleeders do not respond to endoscopic sclerotherapy procedure, although the underlying pathology is the same. The only difference is the changing pattern of the collateral vasular structures. Since the first step of portasystemic collateralization takes place in the naturally existent vascular channels, the capacity of the natural collateral vessels might be a determining factor of the hemorrhagic events. Treatment options have to bu individualized taking the liver status, clinical symptomatology, frequency of bleeding episodes, investigative prosedures, functional capacity of the natural collateral system, and the treatment strategy of the institution into consideration. (Turk Arch Ped 2010; 45 Suppl: 46-52

Prolonged jaundice

Prolonged neonatal jaundice may be due to many different medical and surgical pathologies. Investigations in a jaundiced infant have to be carried on immediately to differentiate the medical causes from the surgical ones. The early diagnosis of surgical jaundice in a neonate is an important step as the success rate of the operation performed in extrahepatic biliary atresia (EHBA), is inversely proportional to the age of the patient. The diagnostic investigations have to be accelerated and the admittance of the patient to the surgical unit must not be delayed. In our institute, during the evaluation of an infant with prolonged jaundice, besides the biochemical and serological tests, fasting abdominal ultrasonography are carried out omitting hepatobiliary scintigraphy and fine needle liver biopsy. An atretic gallbladder and the positive triangular cord sign in the abdominal ultrasonography are highly suggestive of EHBA. The 2nd stage is to perform laparoscopic examination through a trocar inserted infraumbilically. Coarse, irregular liver surface with fine angiomatous development and greenish brown color are observed during laparoscopy in patients with EHBA. The liver is firm in touch with a device, and the gallbladder is, oftenly fibrotic and atretic. In the case of neonatal hepatitis (NH), the liver is smooth and chocolate brown in color and its edge is sharp with the voluminous gallbladder. If the passage of the contrast material is demonstrated in the proximal biliary tracts and the intestinal system with simultaneously performed cholangiographic examination, the diagnosis of NH is achieved and the operation is ended with fine needle liver biopsy. If the gallbladder is obviously atretic, no attempt is made to perform a cholangiography, but rather proceed to laparotomy. Laparoscopic examination of the liver with simultaneous cholangiography will provide the chance to achieve an earlier and accurate diagnosis. This approach, following abdominal ultrasonography, could be performed as the 2nd step of the diagnostic evaluation in neonates with prolonged jaundice. (Turk Arch Ped 2010; 45 Suppl: 42-5

Surgical disease of the pancreas

Abdominal trauma and biliary tract disorders are the most common causes of pancreatitis in childhood. Pancreatitis in the pediatric age group, although uncommon, can be associated with serious morbidity and mortality that the condition should be taken as a surgical emergency when they present themselves with the symptomatology of pancreatitis. Inappropriate elevation of insulin concentration in the presence of hypoglycemia-previously called as nesidioblastosis, a condition of islet cell proliferation-is an important cause of persistent hypoglycemia in infancy and childhood. The disease should be considered as a medical emergency. Prompt diagnosis and aggressive medical treatment followed by surgical intervention, especialy for newborn babies are essential if permanent brain damage is to be avoided. Pancreatic neoplasms can be endocrin or exocrin, benign or malignant. The diagnosis of the endocrin tumors depends on the clinical syndromes due to secretion of special substances from islet cells of the pancreas. Carcinoma of the pancreas originates from the ductal system. Primary resection of pancreatic lesion is the treatment of choice. (Turk Arch Ped 2010; 45 Suppl: 59-61

The effect of an H-2-receptor antagonist on small-bowel colonization and bacterial translocation in newborn rats

Bacterial translocation (BT) is defined as the passage of enteric bacteria from the gastrointestinal tract to extraintestinal tissues. Bacterial overgrowth is one of the main promoting factors of BT, which is thought to play an important role in the pathogenesis of sepsis and necrotizing enterocolitis. It is believed that small-bowel colonization is established by bacterial spread through the rectum. Gastric acid is also involved in this process. An experimental study was designed for investigating the effect of gastric acid inhibition with the use of an H-2-receptor antagonist on intestinal colonization and BT in newborn rats. Animals were divided into two groups: the ranitidine group (n = 20) received ranitidine 10 mg/kg per day intramuscularly for 5 days; the control group (n = 30) received saline solution, Mesenteric lymph node, spleen, liver, stomach, small bowel/cecum, and large bowel specimens were obtained from each rat 5 days later and gram-negative and -positive aerobic bacteria identified by the use of chocolate and Endo agar. It is concluded that: (1) there was a strong correlation between gastric and small-bowel bacterial colonization in the ranitidine group; (2) no correlation between large-and small-bowel colonization could be demonstrated; and (3) BT occurred only in the ranitidine group

Effectiveness of extracorporeal shock wave lithotripsy on intrahepatic biliary calculi developing after choledochal cyst surgery: A case report

The development of intra-and extrahepatic bile duct stones has been reported as one of the most serious complications after choledochal cyst excision with biliary-enteric reconstruction through Roux-en-Y hepaticojejunostomy (HJ). Here, we report our experience with extracorporeal shock wave lithotripsy (ESWL) in a case of giant intrahepatic stones developing after choledochal cyst surgery. ESWL is an excellent therapeutic modality for large intrahepatic biliary calculi, and after dilating the HJ anastomosis percutaneously, it can be offered as first-line therapy to these patients

A case of wandering spleen causing urinary symptoms after correction of a posterolateral diaphragmatic hernia

A 12-year-old girl who had had an operation for a posterolateral diaphragmatic hernia was admitted to the hospital because of enuresis. Physical examination and radiologic studies revealed the spleen behind the urinary bladder, left-sided hydronephrosis, and a high volume of residual urine. The hydronephrosis and residual urine resolved immediately following splenectomy

Radiological evaluation with Doppler sonography and multidetector CT angiography in congenital hepatic arteriovenous malformation in a newborn

Although hepatic arteriovenous malformations are rarely reported, they frequently have life-threatening complications such as cardiac failure and are associated with a high mortality rate. Consequently, accurate prenatal and early postnatal diagnosis is important and therapeutic procedures depend on the imaging features. We report the early postnatal sonographic, Doppler sonographic, multidetector CT and CT angiography findings of a congenital hepatic arteriovenous malformation in a newborn