Gastrointestinal angiodysplasia in three Saudi children.

Angiodysplasia is a term used to describe distinct gastrointestinal mucosal ectasias that are not associated with cutaneous lesions, systemic vascular disease or a familial syndrome. Seventy-seven percent of angiodysplasia are located in the cecum and/or ascending colon. Fifteen percent are located in the jejunum and/or ileum and the remainder are distributed throughout the alimentary tract. Most commonly, the angiodysplastic lesions are typically seen in elderly patients of both genders, although gastric and duodenal lesions have been reported occasionally in subjects within the third decade of life. However, data on infants and children are scarce. We describe three cases (ages 7 days, 2 years, and 5 years) who presented to our unit with gastrointestinal bleeding. One of these patients developed moderate-to-severe symptoms and was blood-transfusion dependent. She was misdiagnosed as having inflammatory bowel disease and underwent a total colectomy and ileoanal anastomosis. The other two patients were managed conservatively for up to 5 years with no further bleeding.

Laparoscopic pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy.

BACKGROUND: Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is considered the most common cause of persistent neonatal hypoglycemia. Management of PHHI involves use of medical agents and its failure is an indication of surgical intervention. Traditionally, an open pancreatectomy was the standard of care but recently laparoscopic pancreatectomy was described. We report our experience with laparoscopic pancreatectomy for PHHI for the period from March 2004 to February 2008. METHODS: A retrospective chart review was conducted for patients managed for PHHI with laparoscopic pancreatectomy for that period. Demographic and clinical data were retrieved. Descriptive data were generated, and SPSS version 10 statistical package (SPSS, Chicago, Ill) was used. RESULTS: Twelve patients diagnosed with PHHI were managed with laparoscopic pancreatectomy for that period. Median age at procedure was 11.5 months (range, 0.5-89 months). Median extent of pancreatectomy was 90% (range, 85%-95%). There were 2 (16%) conversions to open technique. One patient (8%) required reoperation 3 months after the procedure. Patients were followed up for a median of 23.5 months (range, 3-48 months). Four (33%) were euglycemic with no medications. Three patients remained on octreotide postoperatively to be euglycemic, and 3 patients needed a combination of octreotide and diazoxide. One patient remained euglycemic for 10 months then started on octreotide because of recurrence of hypoglycemia. One patient remained hypoglycemic postoperatively and required reoperation 3 months later to control symptoms. He became diabetic 4 months after reoperation on insulin. CONCLUSIONS: Our data suggest that laparoscopic pancreatectomy for medically unresponsive PHHI is feasible and safe. Longer follow-up is needed to ascertain effectiveness.