Complications of circumcision in male children: report of sixty-one cases

The aim of this study is to revise the complications of circumcision and measures of their prevention. Pediatric Surgery Unit, SMC. Prospective study. Sixty-one consecutive cases of circumcision with complications were reviewed prospectively during 18 months, from June 1997 to December 2008. The mean age at presentation was 20 months [range one week to eleven years]. The most common observed complications were redundant foreskin in 28 [46%], followed by minor bleeding in 17 [28%]. Five serious complications had been seen after clamp technique for circumcision [3 glanular trauma and 2 webbed penises]. Eleven minor complications were seen, nine occurred in pediatric surgery unit out of total of 600 circumcisions performed during the study period, 1.5%. Circumcision may be associated with serious complications especially with clamp technique. To prevent these complications, trained physicians should perform this procedure

Thoracoscopic management of complicated parapneumonic effusions in young children

To evaluate the role of thoracoscopic management of complicated parapneumonic effusions [CPE] in very young children. Division of Pediatric Surgery, Salmaniya Medical Complex. Very young children with complicated parapneumonic effusions were prospectively studied between January 2007 and December 2008. Eleven patients under the age of two year with the diagnosis of complicated parapneumonic effusions underwent thoracoscopic management. The patients had chest X-ray, Ultrasound and CT scan of the chest. The patients received antibiotic 3-6 weeks prior to thoracoscopy without improvement. The patients received fibrinolytic agent on the second postoperative day. Three trocars used, one 5 mm for the camera and two 5 mm for working forceps on semilateral position. Eleven cases of CPE were studied during a 2-year period; the age had ranged from 5 to 24 months [average 12 months]. In 3 cases, Streptococcus pneumoniae was found from pleural fluid. Two cases have chest tube before thoracoscopy. Postoperative chest tube drainage had ranged from 3-20 days [average 5 days]. Postoperative Febrile days had ranged from 1- 4 days [average 2 days]. Post thoracoscopy hospital stay had ranged from 5-21 days [average 7 days]. No intra-operative or postoperative major complications were encountered. Three cases developed minor surgical emphysema, which resolved spontaneously. Follow up ranging from 6-12 months [average 6 months] resulted normal recovery and good cosmesis. In this study, the initial outcome of thoracoscopic management of complicated parapneumonic effusions in very young children was safe and effective. Randomized controlled study will lead to the development of standards therapy in these cases

Meconium peritonitis in neonates: Management dilemma

Meconium peritonitis is a rare condition due to perforation of gastrointestinal tract, the management of that condition is controversial. To present three cases with meconium peritonitis in neonates. A retrospective review. Surgical Departments, Salmaniya Medical Complex, Kingdom of Bahrain. Three patients with meconium peritonitis presented to the surgical department between January 2004 to November 2007 were reviewed. The first baby is 3.5 kg female she was born with respiratory distress. Antenatal ultrasound at 30 weeks of gestation showed polyhydromnios and fetal bowel dilatation suggestive of meconium peritonitis. The second baby is 3.3 kg male who was born and presented with septic shock after birth. The third baby is 2.2 kg male was delivered by cesarean section due to spontaneous preterm rupture of membranes and intrauterine fetal distress. The first two cases underwent emergency peritoneal drainage under local anaesthesia, followed by definitive surgery. The third patient underwent emergency laparotomy and resection of ileal segment and primary anastomosis. Meconium peritonitis is a rare disorder of intestinal perforation in utero. Management of this condition is difficult and controversial. Initial drainage of meconium and later definitive surgery in critically ill patients, is safe and effective. Three cases presented to pediatric surgical unit with meconium peritonitis. Two cases were managed successfully by peritoneal drainage followed by definitive surgery and in one case by definitive surgery only

Spontaneous migration of a central line catheter into the heart

Spontaneous migration of central line catheter into the heart is extremely rare complication after initial placement. To present two cases with unusual central venous line-related complication. Retrospective review. Surgical and Pediatric Oncology Departments, Salmaniya Medical Complex, Kingdom of Bahrain. The charts of two patients with spontaneous migration of port-a-cath catheter into the heart presented to the surgical department [between January 2006 to March 2007] were reviewed. The first patient is 12 years old female, a known case of acute lymphoblastic leukemia [ALL] and Down's syndrome, presented with failure to aspirate the central line after 3 months of port-a-cath catheter insertion. The second patient is 7 years old male, known case of acute lymphoblastic leukemia presented with non-functioning line after 5 months of insertion of port-a-cath catheter. Chest x-rays of both patients confirmed the migration of the catheter into the heart. The catheter in the first case was removed by percutaneous retrieval by loop-snare technique, and in the second case the catheter was removed by open neck surgery. Spontaneous migration of port-a-cath catheter into the heart is a rare complication. Chest x-ray is essential to provide early detection and management of migrated catheter. Early diagnosis and removal of the catheter is the rule in all cases

Sublingual ectopic thyroid gland simulating a thyroglossal duct cyst

Ectopic thyroid is a rare embryological aberration of the thyroid descend in children. We present a case of ectopic thyroid simulating a thyroglossal cyst in a two year old boy, who was diagnosed intra-operatively. The patient was treated with L-thyroxine. We review the embryological features and the approach to the diagnosis and management of this congenital anomaly

Laparoscopic pull - through in a boy with hirschsprung's disease. first report from Bahrain

The authors report the first case of primary laparoscopic pull-through operation without colostomy in Bahrain on an infant with recto-sigmoid Hirschsprung's disease. Review of the literature confirmed that primary laparoscopic pull-through is a safe procedure, has acceptable complications and minimizes the cost of the treatment of Hirschsprung's disease