Chronic idiopathic intestinal pseudo-obstruction in children, management options and problems

This study has presented 21 cases of chronic idiopathic pseudo intestinal obstruction that have been diagnosed and managed in the Pediatric Surgery Unit and the Pediatric Gastroenterology Specialized Clinic, Ain-Shams University in the years 1998 and 1999. The diagnosis was based on the clinical picture of repeated attacks of intestinal obstruction with no compromise of the lumen. Radiological features included dilated loops of bowel with air fluid levels. Histopathology demonstrated the presence of ganglion cells in the enteric plexuses. Conservative measures were the mainstay of treatment although its results were poor. Surgical interventions were used as a last resort with a variable success rate

Experience in pediatric laparoscopic surgery

An analysis of 306 cases [their age ranged from one month to 15 years with a mean of 7.5 years] of different pathological natures managed by laparoscopy over five years was presented. Laparoscopy was used for diagnostic and/or therapeutic purpose. One hundred and eleven cases had abdominal pain; 91 of them had settled preoperative diagnosis [appendicitis 78, cholecystitis 10 and ovarian cyst 3]. The remaining 20 cases were diagnosed by laparoscopy; subacute appendicitis [5], Meckel's diverticulitis [3], intussusception [1], adhesions [3], acute pancreatitis [2], eosinophilic gastritis [1], torsion of ovarian cyst [2] and no cause was detected in 3 cases. The results of laparoscopy in the remaining 195 cases have shown 75 cases of impalpable testes, 20 cases of intersex, 40 cases of congenital hernia, 13 cases of blunt abdominal trauma, 20 cases of neonatal jaundice, 13 cases of laparoscopic splenectomy for blood diseases, eight cases of idiopathic intussusception and six cases of varicocele ligation. No mortality was recorded in this series. Eight cases were converted to open procedure, three due to technical problems and five for completion of the procedure by laparoscopic assisted technique. The indications, advantages and disadvantages of laparoscopy have been discussed