Blunt abdominal injury in suspected child abuse patients: A three-case report.

Objective: To identify characteristics associated with suspected child abuse in the setting of blunt abdominal trauma. Methods: Retrospective review. Results: Three cases of blunt abdominal injury caused by suspected abusive force admitted in Siriraj Hospital between May 2001 and July 2006 are reviewed. The first case is a six-year old boy who had liver laceration grade III at segment II and III. The history of trauma was refused by his parents initially. At last, the patient confessed that he was hit by the mother’s boy friend. The second case is a-10-month old girl who was operated for traumatic rupture in the 3rd part of the duodenum (90% circumference) as well as hematoma at the root of mesentery and ligament of Trietz following shopping with her family without history of traumatic event. Chest X-ray showed multiple old fractures at left posterior 6th, 7th, 8th ribs as well as a callus formation at the costochondral junction of the right 7th rib. Bone survey also demonstrated laminated periosteal reaction of the right tibia from previous fracture. The third case is a 3-year-old boy with intramural duodenal hematoma located between the 2nd part of the duodenum and the D-J junction. The patient told that he was stepped upon during lying down by his grandmother who has abused him many times before. Conclusion: Child abuse is suspected in a case of conflict between physical examination findings and history of the accidental events, especially physically damage than the mechanism of injury. The patterns of inflicted injury are also discussed in this publication. Injury to the duodenum is unusual in the pediatric trauma patients but more commonly is the result of child abuse. Diagnosis and treatments of various types of duodenal injury including intramural duodenal hematoma are elucidated in this article.

Neonatal cholestasis in Thai infants.

The objective of this study was to study etiologies and outcome of neonatal cholestasis in Thai infants. The medical records of infants aged less than 3 months with the diagnosis of neonatal cholestasis in Department of Pediatrics, Siriraj Hospital from 1993 to 2004 were retrospectively reviewed. The etiologies were diagnosed by history, physical examination, and proper investigations. There were 252 infants, including 135 males (53.6%) and 117 females (46.4%). The etiologies of cholestasis were idiopathic neonatal hepatitis (INH) 23%, extrahepatic biliary atresia (EHBA) 22.2%, total parenteral nutrition (TPN)-related cholestasis 18.3%, infection 9.9%, endocrine causes 6%, choledochal cyst 5.6%, Down syndrome 4.4%, hemolytic anemia 1.6%, and miscellaneous causes 9.1%, respectively. TPN-related cholestasis was increasingly found due to advance management of critically ill premature infants. Inborn error of metabolism were suspected in 8 patients (3.21%). Seventeen cases (6.7%) developed cholestasis during the first week of life due to hemolytic anemia, intrauterine infection, hypoxia and others. During the 3 month follow-up period, 6 cases died of progressive dysfunction of liver and one case with idiopathic neonatal hepatitis died from intracranial bleeding from vitamin K deficiency. In conclusion, INH and EHBA are the most common causes of neonatal cholestasis. Due to advance management and nutritional support in critically ill premature infants, TPN-related cholestasis is found more often. Inborn error of metabolism related to neonatal cholestases is uncommon in Thai infants. Overall short-term prognosis of neonatal cholestases is good.

Laparoscopic cholecystectomy versus open cholecystectomy in children.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is well accepted as the standard cholecystectomy only in adult patients. However, the advantages of LC over open cholecystectomy have never been proved in pediatric patients because the number of pediatric cholecystectomies is limited as well as the faster ability of pediatric patients to resume their normal activity. MATERIAL AND METHOD: Retrospective study of 42 pediatric cholecystectomies (laparoscopic cholecystectomy (n = 8) (LCs), open cholecystectomy alone (n = 8) (OCs) and open cholecystectomy concomitant with splenectomy (n = 26)(OCs + S)) done in Siriraj University Hospital, Bangkok, Thailand between 1992 and 2000 was conducted. RESULTS: Statistical comparison revealed that LC was superior to OC in regard to diet resumption. LCs resumed soft diet on 1.38 days, whereas OCs and OCs + S could resume soft diet on 3.38 and 3.35 days respectively. The average length of hospitalization following LCs was significantly shorter than OCs' and OCs + S' ones (3.00 vs 8.38 and 4.85 days respectively). There was no morbidity and mortality in LCs, whereas two OCs and three OCs + S had complications. CONCLUSION: In this preliminary study, laparoscopic cholecystectomy is a preferred method of cholecystectomy in children because it has a shorter post-operative interval of diet resumption and shortens hospitalization with minimal morbidity. However, this study has a limited number of patients and further study is still required to conclude the benefits of LC.