Idiopathic intussusception in infancy and childhood

Idiopathic intussusception is an important cause of abdominal pain, bleeding per rectum and intestinal obstruction in infancy and childhood. This aim of this study was to undertake a retrospective review of all children who presented with idiopathic intussusception over a 17-year period. The medical records of children who presented with idiopathic intussusception from January 1984 through December 2000 at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia were reviewed. The data obtained included age, sex, clinical presentation, diagnostic investigations, mode of treatment, length of hospital stay and results. Thirty-three children [21 male, 12 female] presented with 37 episodes of intussusception. Their mean age was 8.4 months [range 5 hours to 36 months]. The clinical features included rectal bleeding [81%], vomiting [78%], abdominal colic/pain [65%] and abdominal mass [62%]. All cases were ileocolic intussusception with no leading point. Barium enema was attempted in 36 cases with success in 20 [56%]. Laparotomy was required in 16 cases, manual reduction being successful in 11 [30%] and 6 [16%] had bowel resection. At surgery, after attempted barium reduction, 9 [56%] cases had the intussusception already reduced to the cecum. Seventy% of the cases presented within 24 hours of onset of symptoms. The 4 recurrences in 3 children had successful enema reduction. There was no mortality but 3 operative cases required late surgery for adhesive intestinal obstruction including one requiring bowel resection. Idiopathic intussusception commonly presents as an ileo-colic type but is uncommon in our institution. The clinical features are classical, rectal bleeding being the most common. The majority presented within 24 hours of onset of symptoms and barium enema reduction was successful in 20 out of 36 cases in which it was attempted. Since most intussusceptions were already in the cecum at surgery after failed enema reduction, a repeat or delayed enema reduction could be considered in stable cases. Recurrent intussusception occurred in 3 non-operated cases and adhesive intestinal obstruction in 3 laparotomy cases

Pediatric thoracic trauma

A retrospective analysis of the medical records of children up to 12 years of age inclusive, who sustained thoracic injuries during a 6-year period. Ninety-one children were treated at King Fahad National Guard Hospital, Riyadh from January 1993 through December 1998. The clinical data included age, sex, mechanism of injury, associated injuries, pediatric trauma score, treatment and mortality. Eighty-seven children [96%] had injuries from blunt trauma and 4 from penetrating injuries. Of the blunt trauma cases, 82 children sustained motor vehicle accident related injuries, 62 as pedestrians and 20 as passengers. Penetrating thoracic injuries occurred in 4 children: 1 stab wound and 3 gunshots. The most frequent thoracic injuries were pulmonary contusion [70], pneumothorax [32], fractured rib [20] and fractured clavicle [18]. Extrathoracic injuries included head [45], abdominal [41] and skeletal [26]. Thoracotomy was required in only 1 child, laparotomy being necessary in 9 children for intraabdominal injuries. Tube thoracostomy was required in 33 children. Nine children died from motor vehicle accident related fatal head and neck injuries, 8 as pedestrians all with a pediatric trauma score <= 6. Thoracic injuries in children below 12 years of age are usually from motor vehicle accident related blunt trauma. Pulmonary contusion and pneumothorax are the most common thoracic injuries. Most thoracic injuries can be managed either conservatively or by tube thoracostomy. Thoracic trauma in children is an indicator of multisystem injury with head injury being the most common cause of mortality

experience of modified soave procedure in King Khalid University Hospital

A modification of the original Soave procedure is described in this paper. Eight patients within the age range 6 months to 14 years at the time of presentation were operated upon. Three of those were referred after trial of conservative treatment for constipation to exclude or confirm Hirschsprung's disease; in five, transverse colostomy had already been performed. There was no operative mortality but three patients had postoperative complications; namely anal stenosis and subacute intestinal obstruction