Surgical procedures performed in the neonatal intensive care unit on critically ill neonates: feasibility and safety

Transferring unstable, ill neonates to and from the operating room carries significant risks and can lead to morbidity. We report on our experience in performing certain procedures in critically ill neonates in the neonatal intensive care unit [NICU]. We examined the feasibility and safety of such an approach. All surgical procedures performed in the the NICU between January 1999 and December 2005 were analyzed in terms of demographic data, diagnosis, preoperative stability of the patient, procedures performed, complications and outcome. Operations were performed at bedside in the NICU in critically ill, unstable neonates who needed emergency surgery, in neonates of very low birth weight [<1000 g] and in neonates on special equipment like high frequency ventilators and nitrous oxide. Thirty-seven surgical procedures were performed including 12 laparotomies, bowel resections and stomies, 7 repairs of congenital diaphragmatic hernias, 4 ligations of patent ductus arteriosus, and various others. Birthweights ranged between 850 g and 3500 g [mean, 2000 g]. Gestational age ranged between 25 to 42 weeks [mean, 33 weeks]. Age at surgery was between 1 to 30 days [mean, 10 days]. Preoperatively, 19 patients [51.3%] were on inotropic support and all were intubated and mechanically ventilated. There was no mortality related to surgical procedures. Postoperatively, one patient developed wound infection and disruption. Performing major surgical procedures in the the NICU is both feasible and safe. It is useful in very low birth weight, critically ill neonates who have a definite risk attached to transfer to the operating room. No special area is needed in the the NICU to perform complication-free surgery, but designing an operating room within the the NICU would be ideal

Primary omental torsion in children. the pre-disposing factors and role of laparoscopy in diagnosis and treatment

To determine the predisposing factors and to evaluate the role of laparoscopy in the diagnosis and management of primary omental torsion in children. We retrospectively reviewed the clinical records of all children treated for primary omental torsion from August 1999 to December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. Demographic data, clinical presentation, diagnostic and therapeutic modalities were evaluated. Follow-up was also obtained. Six children were included in the study. Their age ranging between 9-12 years [average 10.4 years]. All of them presented with right lower quadrant [RLQ] pain mimicking appendicitis. The duration of symptoms varied from 3-5 days prior to presentation. Localized RLQ tenderness with guarding was demonstrated in all patients. All children were noted to be obese. Only one patient had low grade fever and nausea. None of the patients had an elevated white blood cell count. Laparoscopic exploration was carried out in all cases for possible appendicitis. Appendix was found to be normal and torted omentum was clearly seen in all cases. The infarcted omentum was removed laparoscopically; all patients had uneventful recovery and were discharged on second postoperative day. Pathological examination showed necrotic infarcted omentum with no other abnormalities. Follow-up documented complete resolution of the patient's symptoms. Clinical presentation of primary omental torsion mimics that of acute appendicitis. Its diagnosis is usually difficult and almost impossible pre-operatively. Obesity, paucity of gastrointestinal symptoms and relatively long duration of symptoms should increase the index of suspicion. We believe that the laparoscopic approach is an excellent tool for the diagnosis and treatment for the primary omental torsion

Possible pneumococcal vaccine associated thrombocytopenia in a child

Idiopathic thrombocytopenia is a relatively common condition for which different modalities of therapy have been tried, including splenectomy. The patients who undergo splenectomy usually receive pneumococcal vaccine to protect them from the risk of post splenectomy sepsis. This is usually considered a safe vaccine and very few side effects have been reported. Here, we report a patient whose thrombocytopenia recurred following splenectomy and after pneumococcal vaccine. We wish to suggest that there may be a causal relationship between the thrombocytopenia and pneumococcal vaccine and alert other physicians to the potential for this to occur