Buccal mucosal graft for crippled hypospadias [experience in 11 cases]

Hypospadias is defined as the incomplete virilization of the genital tubercle causing an incomplete development of the tissues forming the ventral urethra. Free buccal mucosal graft is an excellent option if the genital tissue is fibrous or deficient. We would like to present our small experience with buccal mucosa on-lay graft for the treatment of anterior urethral stricture and recurrent urethra-cutaneous fistula after hypospadias

repair in male children. Between October 2004 and March 2007 we operated upon nine male patients. Their age ranged from 3-12 years old. Free buccal mucosal on-lay grafts from the inner aspect of the lower lip were taken for three cases of complicated anterior urethral stricture and for six cases of recurrent urethra-cutaneous fistula after previous multiple penile hypospadias repairs. Nine on-lay free grafts were ventrally placed on the penile urethra. The grafts length ranged from 0.5 to 6 centimeters. All these operations were performed in one stage by a single surgeon and his team. The follow up period was from 2 to 5 years. The success was achieved in 8 out of 11[73%] patients. Urethral complications occurred in three cases which were evident by one month and three months postoperatively. The first one had severe proximal and distal urethral strictures which eventually required a proximal urethrostomy as a first stage. The second one had a mild stenosis which required two meatal dilitations and at last a meatoplasty. The third one had a small fistula which was simply closed later. One patient developed a hypertrophied scar at the harvest site which spontaneously resolved over a period of three months. Complex hypospadias surgery is challenging and should be done by an experienced pediatric surgeon. Utilizing the buccal mucosa in case of deficient genital skin is an efficient, practical, and safe technique of managing the crippled cases that need redo surgery

Percutaneous central venous catheterization in children, is it efficient?

To evaluate the frequent use of percutaneous central venous catheters [CVCs] in pediatric age group. Retrospectively we reviewed the records of all children that had percutaneous CVCs in the pediatric surgical ward and pediatric intensive care unit at King Hussein Medical Center between January 2007 and December 2007 [one year]. Patients were evaluated with respect to their age, gender, catheter type, indication for CVC insertion, site of CVC insertion. The duration of catheter use and eventual complications were also taken into consideration. A total of 120 percutaneous CVCs were inserted in 104 children. Patient age ranged from one day to 14 years. The average catheter insertion time was 12.5 days. We noted 66 [18.8%] CVC- related complications. Complications related to percutaneous CVCs insertion were malposition of catheter [5.4%] and pneumothorax [0.9%]. Occlusion of CVCs [4.3%], catheter related bloodstream infections [CRBI] [4.0%], dislodgment [3.7%] and catheter damage [0.6%] were complications associated with length of CVCs use. We conclude that percutaneous central venous catheterization is a safe and efficient procedure that can be done at bedside with minimal complications in pediatric age group

Bowel injury in a neonate post cord clamping

To report a case of a newborn male baby with a congenital hernia of the umbilical cord who suffered an accidental intestinal injury caused by an umbilical clamp. A four day old male newborn, full term, delivered by caesarean section with a birth weight of 4.5Kg was admitted to the pediatric unit of due to fever, bilious vomiting, decreased activity and poor oral feeding. On examination it was noted that he had a wide based umbilical cord with a clamp applied at 2cm from the anterior abdominal wall. The abdomen was distended, tender on palpation with visible peristalsis; the nasogastric tube contained bile stained liquid. A barium enema showed that the dye went towards the umbilicus. A laparotomy was done; the umbilical clamp was released, followed by resection of the gangrenous bowel and an end-to-end anastomosis, repair of a minor omphalocele and umbilicoplasty. Where there is a wide based umbilical cord with an umbilical cord clamp situated close to the anterior abdominal wall in asymptomatic patient, this may suggest iatrogenic intestinal injury and immediate surgical intervention is advised to decrease the associated morbidity and mortality

Total traumatic pancreatic transection in a child, non-operative management: a case report

We hereby report a case of total traumatic pancreatic transection through the body of pancreas in a 7 years old boy, who sustained a blunt abdominal trauma. The patient was managed nonoperatively and showed a speedy and complete recovery without complication. This is relatively a rare childhood injury which responded dramatically to conservative therapy. Therefore, we feel it worths reporting