ABSTRACT
Purpose@#Liver injuries constitute an important cause of hospital admissions, pediatric morbidity, and sometimes mortality. This study was undertaken to assess the spectrum of pediatric liver injuries with special emphasis on the management of acute complications. @*Methods@#This retrospective study used data from the Department of Pediatric Surgery, Bangalore Medical College, Bengaluru, India, between March 2013 and March 2019. All children between 1-18 years were included in the study (n = 33). Children were assessed with relevance to age, sex, mode of injury, hemodynamic stability at admission, need for blood transfusions, surgery, radiological investigations, complications, total number of days of stay in hospital, and mortality. @*Results@#There were 27 (81.8%) males and 6 (18.18%) were females. The most common cause for injury was a road traffic accident (60.6%). The majority (nearly 65%) of pediatric liver injuries were Grade II and III. There were 4 children who had post traumatic complications including 2 pseudoaneurysms, 1 inferior vena cava thrombus, and 1 bile leak with a biloma formation which were managed appropriately. @*Conclusion@#Timely and appropriate radiological evaluation is required for assessments of complications. The majority of complications can be managed conservatively, and minimally invasive techniques like endoscopic retrograde cholangiopancreatography is helpful in the management of complications.
ABSTRACT
Purpose@#Liver injuries constitute an important cause of hospital admissions, pediatric morbidity, and sometimes mortality. This study was undertaken to assess the spectrum of pediatric liver injuries with special emphasis on the management of acute complications. @*Methods@#This retrospective study used data from the Department of Pediatric Surgery, Bangalore Medical College, Bengaluru, India, between March 2013 and March 2019. All children between 1-18 years were included in the study (n = 33). Children were assessed with relevance to age, sex, mode of injury, hemodynamic stability at admission, need for blood transfusions, surgery, radiological investigations, complications, total number of days of stay in hospital, and mortality. @*Results@#There were 27 (81.8%) males and 6 (18.18%) were females. The most common cause for injury was a road traffic accident (60.6%). The majority (nearly 65%) of pediatric liver injuries were Grade II and III. There were 4 children who had post traumatic complications including 2 pseudoaneurysms, 1 inferior vena cava thrombus, and 1 bile leak with a biloma formation which were managed appropriately. @*Conclusion@#Timely and appropriate radiological evaluation is required for assessments of complications. The majority of complications can be managed conservatively, and minimally invasive techniques like endoscopic retrograde cholangiopancreatography is helpful in the management of complications.
ABSTRACT
Background: Gastrointestinal hollow viscous perforations constitute one of the important causes of acute pain abdomen in adults and if not treated properly may lead to significant morbidity and sometimes mortality. Successful treatment requires a thorough understanding of anatomy, microbiology, pathophysiology of the disease process and in-depth knowledge of the therapy, including resuscitation, antibiotics, source control, and physiologic support. Aim: To evaluate the etiopathology, clinical signs and symptoms, investigations in the management of gastrointestinal hollow viscous perforations. Materials and Methods: This was a prospective study conducted on patients presenting with gastrointestinal hollow viscous perforations to the Department of General Surgery, Rajarajeswari Medical College and Hospital over a period of 2-year from July 2013 to June 2015. A total of 110 patients were included in the study. A written, informed consent was taken from all patients before enrolling into the study. The Institutional Ethical Committee clearance was taken before starting the study. A pre-formed questionnaire was used to collect the clinical information from the patients. Results: The majority of the patients involved were males (81%) and in the age group of 30-50 years. 80% of the perforations were noted in the Gastroduodenal region, and the remaining was seen in the small bowel (13%) and appendix (7%). Pain abdomen was the presenting complaint in all patients (100%) while vomiting was seen in 50% and abdominal distension was seen in 80% of the patients. 91% of the patients had gas under the diaphragm. Wound infection (9%) lead the list of post-operative complications with a residual abscess (6%) following behind burst abdomen (4%) and fecal fistula (1%). 2% (2 patients) of patients died due to varied reasons. Conclusion: Even after the introduction of proton pump inhibitors, the incidence of perforations resulting from acid peptic disease is still high. Early recognition of perforation, prompt surgical intervention, good post-operative care, recognition of co-morbid conditions and early recognition, and management of complications would reduce morbidity and mortality.
ABSTRACT
Paraesophageal hernia in children is relatively rare entity. These children usually present with recurrent respiratory tract infection or vague GI symptoms. An 11 year female presented with episodic vomiting, heartburn and features of hypocalcemic tetany. Investigations revealed right paraesophageal hernia. Reduction of the contents and repair of the defect with fundoplication was done. Patient is asymptomatic on follow-up.
Subject(s)
Child , Female , Gastroesophageal Reflux/etiology , Hernia, Hiatal/complications , Humans , Severity of Illness IndexABSTRACT
The neuropathological features of temporal lobe epilepsy were studied utilising 100 consecutive surgical specimens from patients with medically refractory complex partial seizures. A wide spectrum of neuropathological changes was recorded in 98 specimens. Fifty-eight specimens showed features of Ammon's horn sclerosis. Diffuse accumulation of corpora amylacea were demonstrated in the resected temporal lobes from 54 patients. Six patients had neoplastic lesions of temporal lobe. One unique case of dysembryoplastic neuroepithelial tumour showed a melanotic component within the tumour. The neuropathological features were regarded as nonspecific in 31% of cases. Our results indicate that a majority of patients with medically intractable epilepsy of temporal lobe origin reveal significant neuropathological features. Careful documentation of the neuropathological features and its correlation with radiological, electrophysiological and pre- and post-surgical clinical features will help in predicting the seizure outcome after temporal lobectomy for medically refractory epilepsy.