Acute abdominal pain in children; clinical outcomes and value of symptoms and signs in diagnosis

To determine the clinical outcomes of acute abdominal pain and evaluation of symptoms and signs in children admitted in pediatric surgery department. Cohort study. This study was conducted in Department of Paediatric Surgery Shaikh Zayed Hospital, Lahore between August 2010 to August 2012. Children aged 2 to 14 years who presented to emergency department with complaint of acute abdominal pain of less than 5 days duration and admitted in pediatric surgery department were included. Presenting symptoms, signs, hospital course of patients and discharge diagnosis were recoded. Data was analyzed by SPSS. Out of 73104 patients who were seen in Paediatric emergency 1420 [1.94%] were referred for surgical evaluation. Out of these 157 children were admitted. Six patients left against medical advice so 151 patients were studied. Patients were divided into acute appendicitis, non-specific pain abdomen and miscellaneous categories on the basis of discharge diagnosis. Acute appendicitis was diagnosed in 61[40.4%] patients. The patients who were admitted and no cause of pain abdomen could be found in them, were included in non-specific pain abdomen group. NSPA group had 39 [25.8%] patients. Rests of the 51 [33.8%] patients were included in miscellaneous group. Anorexia, fever, pain in right lower quadrant, tenderness in right iliac fossa, guarding, rebound tenderness and tachycardia were all significantly higher in patients with acute appendicitis. Most of the children with acute abdominal pain would not require surgery. Detailed history and thorough physical examination is cornerstone of the diagnosis

Acute appendicitis in children; correlation of clinical data with histopathological findings

The study was conducted to identify clinical features significantly associated with histopathologically proven appendicitis in children. Cross-Sectional Observational. This study was conducted in Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore between August 2010 to August 2012. Children aged 2 to 14 years who underwent appendectomy for acute appendicitis during the study period were included. Patients who had appendectomy for any reason other than appendicitis were excluded. Presenting symptoms, signs, hospital course of patients and histopathological diagnosis were recoded. Data was analyzed by using SPSS. Sensitivity, specificity, positive predictive value and negative predictive value for each symptom and sign were calculated. Out of 1420 patients who were evaluated during the study period for acute abdominal pain, 70[5%] were diagnosed with acute appendicitis. Four patients left against medical advice so 66 patients were studied. Patients were divided into acute appendicitis and non-inflamed appendix group on the basis of histopathology of resected appendix. Acute appendicitis was confirmed histologically in 43 [65%] cases and perforated appendicitis was found in 8 [12%]. No evidence of acute inflammation was found in 15 [22%] cases. Among clinical features only involuntary guard [p-value 0.01] and rebound tenderness [p-value 0.004] were significantly different among acute appendicitis and non-inflamed appendix group. Total leukocyte count more than 11,000 was significantly higher in acute appendicitis group. The cornerstone of diagnosis of acute appendicitis in children is thorough history and meticulous physical examination. Involuntary guard, rebound tenderness and total leukocyte count more than 11,000 were significantly more prevalent in biopsy proven cases of appendicitis

Hazards of multiple magnet ingestion in children; a case report

Foreign body ingestion is relatively common in the paediatric population and most object pass through the gastrointestinal tract spontaneously. With the popularity of small magnetic toys, there have been numerous reports of magnet ingestion with morbidity and even mortality. We report a case of 3-years old boy who presented with clinical features of subacute intestinal obstruction with no history of foreign body ingestion. On exploratory laparotomy, he was found to have multiple small bowel perforations due to two small magnets. Magnets were removed and perforations repaired. The aim of this report is to aware paediatricians of the importance of early surgical referral in case of magnet ingestion, to prevent severe complications

Childhood nephrectomies for benign renal lesions

To conduct an audit of nephrectomies done in children for benign renal pathology. Evidence based study. Place and Duration: National Institute of Child Health, Karachi, during the year 2004-2005. The record of all the paediatric age group patients undergoing unilateral nephrectomy for benign renal diseases over a 2-year period were reviewed for the underlying diagnosis and indication for nephrectomy. Patients of Wilms` tumor subjected to nephrectomy were excluded. In the study nephrectomy was carried out in a total of 12 patients. There were 8 males and 4 females. The age range was 4 to 12 years. Nephrectomy was performed for renal tuberculosis in 5, pelvi-ureteric junction obstruction [PUJO] in 5, congenital hypoplastic kidney in 1 and one for multicystic dysplastic kidney. All the patients following nephrectomy remained well in the immediate post operative period and thereafter. Late presentation and delay in diagnosis of benign lesions of the kidney remained the main culprit in loosing a vital organ in childhood

Complication problems of colostomy in infants and children

To determine the frequency of complications/problems occurring with construction of colostomy in infants and children. Descriptive study. Surgical Unit B, National Institute of Child Health, Karachi, from September 2001 to March 2003. All the patients admitted in the unit who required colostomy as part of their management were included in the study. The patients who were operated upon previously or operated elsewhere and referred after having colostomy, were excluded. Problems associated with colostomy construction like skin excoriation and chronic blood loss were also recorded. Chi-square test of proportion was used to determine the p-value. There were 121 patients. Most of the patients were operated due to anorectal malformations [n=71] and Hirschsprung's disease [41]. Complications/problems related to colostomy occurred in 67.7% patients. The most common problem was skin excoriation. Second in rating was chronic blood loss from stoma. Prolapse of stoma was more common in transverse loop colostomies. Divided colostomies had higher number of complications as compared to loop colostomies, similarly, transverse colostomies had high number of complications but in both the cases difference was not statistically significant. Four [3.3%] patients died. Construction of colostomy in paediatric patients carries high frequency of complications/problems and requires careful technique. The role of stoma care clinic and enterostomal therapist can be instrumental in preventing problems associated with colostomy

Duhamel pull through in Hirschsprung's disease: experience at Shaikh Zayed Hospital

Hirschsprung's disease is one of the common causes of neonatal intestinal obstruction. It can even present in older child with chronic constipation. We report our experience of Duhamel's procedure for definitive treatment. Twenty patients were included in the retrospective analysis. Out of these, 11 had rectosigmoid disease, 5 had ultra-short segment disease and 4 had total colonic aganglionosis. Early complications were seen in 5 patients and 7 patients had long term problems. They all settled over a period of time

Surgical management of renal tumors in children

To analyze case records of children with renal tumors. Case series. Surgical Unit B, National Institute of Child Health, Karachi during years 2004-2005. Case records of all patients managed during the study period were reviewed for clinical presentation, investigations and surgical management. National Wilms' Tumor Study. Group [NWTSG] and International Society of Pediatric Oncology [SIOP] protocols were used depending upon stage in cases of Wilms' tumor. Trucut biopsy was done for tissue diagnosis as proposed by UK Children's Cancer Study Group [UKCCSG]. Touch imprints were also made. Surgical procedure was analyzed in terms of ease of dissection, tumor spillage and extent of excision. Twenty-one patients of renal tumors were managed in two years period. Nearly 60% of patients were less than 2 years of age. Majority [n 14] presented with abdominal mass. Few had complaints of abdominal pain. One patient an infant, presented with profuse hematuria. Trucut biopsy was done in 18 cases to have tissue diagnosis. Three patients underwent primary exploration. There were 17 cases of Wilms' tumor and in one case it was suspected on touch imprints. Fourteen patients of Wilms' tumor were given pre operative chemotherapy [SIOP protocol]. Twelve of them were in stage III and IV. Nine out of this have undergone nephrectomy. Marked tumor regression in size of tumor was noted. The tumor also became firm. Only one tumor ruptured during excision. In one tumor with horse-shoe kidney, residual tumor left at margins of dissection. Three patients underwent primary nephrectomy. Two of these were in stage I and one in stage III [NWTSG protocol]. Patient in stage III died in immediate post operative period because of hemorrhage. There was one case each of mesoblastic nephroma, cystic nephroma and rhabdoid tumor. In all these nephrectomy was done following trucut biopsy. Patient with rhabdoid tumor received pre operative chemotherapy. This tumor ruptured during surgery and gross spillage occurred. Wilms' tumor was the most common pediatric renal tumor. Most of the patients were younger than the reported age and presented with advanced stage of disease. SIOP protocol found more appropriate in our group of patients

Experience with circum-umbilical incision in Infantile Hypertrophic Pyloric Stenosis at Sheikh Zayed Hospital, Lahore

Circum-umblical incision was used in 35 infants and results were studied regarding perioperative complications and hospital stay. There was a definite advantage of excellent cosmetic scar with no significant difference in morbidity. We recommend circum-umbilical Incision as an alternate approach for IHPS to right upper quadrant incision