ABSTRACT
@#Reported here is the case of a 6 year old male child with a left Congenital Diaphragmatic Hernia who underwent thoracoscopic repair. The use of continuous low pressure CO2 insufflation pneumothorax during the procedure not only made manipulation during the reduction of bowel contents back into the abdomen easier, but also facilitated repair of the defect as it maintained bowel reduction during suturing. Although prolonged CO2 has been hypothesized to be hazardous leading to hypercapnea and aggravating pulmonary hypertension in Congenital Diaphragmatic Hernia patients. The authors found it to be a safe modification of the technique as long as pre-operative planning, patient selection and intra-operative maneuvers were proprely performed.
Subject(s)
Hernias, Diaphragmatic, CongenitalABSTRACT
@#Presented is a rare case of Wilms' Tumor (WT) in a 3-month old female with a palpable nontender left flank mass. In the early infancy period (<6 months), there is a low incidence of malignancy in renal masses, and congenital benign renal lesions (like congenital mesoblastic nephroma) predominate in this age group. We did nephroureterectomy and lymph node sampling. Histopathology revealed localized non-metastatic COG Stage I WT with favorable histologic features. The patient underwent adjuvant chemotherapy with dactinomycin and vincristine using an institution based protocol, which offers upfront surgery followed by chemotherapy. This approach is similar to the Children's Oncology Group (COG) protocol.
Subject(s)
NephrectomyABSTRACT
@#Reported here is the first documented laparoscopic repair of a rare partial diaphragmatic eventration in a pediatric patient. The case involves a three year old female who had recurrent cough. While a Morgagni hernia was the initial impression, an eventration of the left anterior diaphragm was instead found on laparoscopy. Repair was aided by using transcutaneous traction, with plication achieved by intracorporeal sutures. The patient recovered uneventfully and follow-up x-ray after six months demonstrated an intact repair.
Subject(s)
Diaphragmatic Eventration , Hernia, Diaphragmatic , LaparoscopyABSTRACT
@#<p style="text-align: justify;">Pancreaticoduodenectomy (Whipple's) procedure is indicated for complex pancreatic injuries, with immediate reconstruction for stable patients and delayed reconstruction for unstable patients. This study aimed to review the authors' experience with trauma-related Whipple's procedure at the East Avenue Medical Center (EAMC).<br /><strong>METHODS: </strong>This study reviews cases where Whipple's procedure was performed from 2011 to 2015 at EAMC. Data collected included age, gender, mechanism of injury, presentation, patient Injury Severity Score (ISS), time interval between injury to presentation, associated injury, surgical procedure, time and type of surgical reconstruction after resection complications and 30-day mortality.<br /><strong>RESULTS: </strong>During the 5 year period, 4 patients underwent Whipple's. All patients were male, mean age of 33.25 (range 29-48). Penetrating gunshot trauma was the predominant mechanism of injury (75% of cases) whereas peritonitis was the most common presentation (75% of cases). Mean ISS score is 29.5 (range 25-37). Among them, 2 underwent initial resection with delayed reconstruction and the other 2 underwent immediate reconstruction. Pancreaticojejunostomy was done for all pancreatic reconstruction. Cholecystojejunostomy (75%) and Choledochojejunostomy (25%) for biliary enteric conduit. Complications included pancreatic leak (50%), sepsis (25%) and pneumonia (25%). Overall, 30-day mortality rate was 25%.Pancreatic leak was noted on all patients without stent placed on the pancreatic anastomosis. <br /><strong>CONCLUSION:</strong> Use of stents in pancreatic anastomosis in Whipple's for trauma may lessen the pancreatic leak rates, further studies are needed to prove this. Cholecystojejunostomy can be an option for biliary enteric continuity, but further studies are needed to identify long tem patency rates.</p>