PNEUMATIC REDUCTION OF INTUSSUSCEPTION IN CHILDREN: EXPERIENCE AND ANALYSIS OF OUTCOME AT JUTH, JOS, A TERTIARY HEALTH CENTRE IN NORTH CENTRAL NIGERIA.

CONTEXT: Intussusception is a common childhood abdominal surgical emergency worldwide resulting in considerable morbidity and mortality if not promptly treated. Ultrasound-guided pneumatic reduction has been proven to be the most reliable and successful non-operative management option with the least complication rate. AIMS: To evaluate our local experience with the ultrasound-confirmed pneumatic reduction of childhood intussusception and to determine factors that predict successful outcome. SETTINGS AND DESIGN: A retrospective study of children less than 2 years old who presented to our facility with uncomplicated idiopathic intussusceptions between June, 2012 and June, 2017. MATERIALS AND METHODS: The clinical diagnosis was confirmed by abdominal ultrasonography. Pneumatic reduction with a locally assembled equipment was performed on selected and resuscitated patients; abdominal ultrasound scan was then performed to confirm successful reduction. The procedure was considered to have failed if unsuccessful after the third attempt. Laparotomy was performed on patients with failed procedure. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences version 24 was used for data analysis. Categorical variables were compared using Fisher exact test (with odds ratios and 95% confidence intervals where appropriate) and numeric variables compared using the student t-test. Statistical significance was set at p< 0.05. RESULTS: Twenty five out of 36 children with intussusception were selected for the procedure with M:F ratio 1.8:1 and a mean age of 7.08 (SD 4.18) months. Only 9 (36%) presented early (ie within 24 hours). While non-bilious vomiting was the commonest symptom, blood-stained finger on rectal examination was the commonest sign in the patients. The overall success rate was 60% (15 patients). Early presentation accounted for only 5 (33%) of successful procedures. The presence of an abdominal mass was associated with increased likelihood of success (OR 9.75,[95% CI [1.38-68.78], p≥0.022), while the presence of a rectal mass was associated with a reduced likelihood of success (OR 0.16 95%CI [0.026-0.917], p≥0.042 ). Age, sex, and duration of symptoms before presentation did not influence outcome. Early presentation was however significantly associated with success at first attempt, compared to late presentation, in those with successful outcomes. Recurrence was observed in one (6.7%) of the successful cases. The mean duration of hospital stay in those that had successful outcome, 3.4(SD1.0) days was significantly shorter than that for those who had laparotomy for failed reduction, 8.0(SD3.1) days (p<0.001). There was no bowel perforation and no mortality recorded. CONCLUSIONS: The successful pneumatic reduction rate was 60%. The major predictors of success in this study were the presence of abdominal mass and the absence of intussusception apex in the rectum. Early presentation was significantly associated with success at first attempt, compared to late presentation, in those with successful outcomes. There was no bowel perforation or mortality. Ultrasound-confirmed pneumatic reduction of intussusception is a simple, easy, safe and effective non-operative management of uncomplicated intussusception in well selected children in our environment.

Congenital diaphragmatic hernia in a 2-month old infant: a case report

Congenital diaphragmatic hernia (CDH) in young infants is easily misdiagnosed as bronchopneumonia yet survival of such patients lies in prompt diagnosis and surgical treatment. The report aimed to increase awareness among Paediatricians and Paediatric Surgeons of the need for high index of suspicion for this condition to allow for early diagnosis and management. A two-month old infant presented with a five-week history of cough of sudden onset and a week history of difficulty in breathing. He had been managed in several hospitals for bronchopneumonia. Examination findings showed features of respiratory distress, widespread coarse crepitations and bowel sounds in the lung fields. Chest radiograph showed `loops of bowel in the mediastinum. He had surgical reduction and repair of the hernia, made excellent recovery post-op and was discharged home. CDH is an uncommon anomaly but a high index of suspicion will allow early diagnosis and treatment with favourable outcome when picked early

Gastrointestinal injuries following blunt abdominal trauma in children.

PURPOSE: Gastrointestinal (GI) injuries in children following blunt abdominal trauma is rare; early diagnosis and treatment is important for good outcome. The purpose of this report is to describe the management problems encountered in children with GI injuries following blunt abdominal trauma. PATIENTS AND METHODS: From January 1996 June 2006, 168 children were treated at our centre for abdominal trauma. Twenty three had GI injuries, 19 were due to blunt trauma while four were due to penetrating trauma. We retrospectively reviewed the clinical data of the 19 children that had GI injuries as a result of blunt abdominal trauma to document the presentation, clinical features, diagnosis and outcome. RESULTS: There were 19 patients, 14 were boys, and five were girls. The median age at presentation was nine years (range 1.5 15 years). Road traffic accident was responsible for injuries in 10, fall from heights in six and assault in two children. In one child the cause of injury was not recorded. Most children presented late and at presentation over 80% had abdominal signs. Diagnosis was mainly by physical examination supported by plain abdominal x-ray in 15 children. All 19 children had laparotomy. There were a total of 23 injuries. Gastric and duodenal injuries accounted for one each. Most of the injuries were in the jejunum and ileum (10 perforations, two contusions with one mesenteric haematoma and one mesenteric tear). There was one caecal perforation and six colonic injuries, one of which was associated with intraperitoneal rectal injury. Five children had other associated injuries (three splenic injuries, one renal injury, one bladder contusion associated with long bone fractures and one severe closed head injury). Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. CONCLUSION: Gastrointestinal injuries due to blunt abdominal trauma pose a management challenge. Management based on decisions from serial clinical examinations and simple tests without recourse to advance imaging techniques may suffice.

Pilot study on one-stage colonic resection without lavage in obstructed left colon in children in an emergency setting.

Classically, left-sided colon obstruction is managed by a multi-staged resection and defunctioning colostomy. The purpose of this study was to examine the feasibility of single-stage resection and anastomosis without intraoperative colonic lavage for acute left-sided colonic obstruction in children. Between October 2000 and May 2006, nine consecutive patients who had a one-stage left-sided colon resection without preceding colonic lavage were evaluated. The main outcome measures were anastomotic leakage, wound infection and death. There were nine patients: six were males and three were females (M:F = 2:1). Their ages ranged from 2-10 years (mean age 6 years). The obstruction was due to irreducible colo-colic intussusceptions in two patients and colo-colic intussusceptions with colonic perforation in four patients, and colo-colic intussusceptions with gangrene in three. All the patients had resection and primary anastomosis without on-table colonic lavage. There were no anastomotic leakages or deaths. Postoperative complications included superficial wound infections in two patients and dry cough in four other patients. Three patients were lost to follow up after 3 years of follow up, but the remaining six are presently doing well. Primary anastomosis without colonic lavage is safe for resection of the left colon in children in an emergency setting.

Paediatric blunt abdominal trauma: challenges of management in a developing country.

BACKGROUND: In developed countries, the availability of advanced imaging techniques has reduced the necessity for laparotomy following blunt abdominal trauma in children. Laparotomy rates still remain high in developing countries where these advanced imaging techniques are lacking. A simple management protocol to identify patients who require laparotomy could reduce the laparotomy rate in children with blunt abdominal trauma in these countries. PATIENTS/METHODS: This is a review of children aged 15 years or below managed in our institution over a 5 1/2-year period for blunt abdominal trauma. The children were divided into two groups. Group A consisted of children managed from January 1999 - December 2000. During this period, there was no protocol. Group B consisted of children managed from January 2001 - June 2004. During this period, a simple management protocol was introduced. The laparotomy rates in the two groups were analysed using a simple chi-square. RESULTS: A total of 48 children, representing 63 % of children with abdominal trauma during the study period, were examined (Group A 17; Group B 31). Their ages ranged from 1.5 years - 15 years (median 9 years). Thirty-four were boys, 14 were girls (M:F = 2.4:1). Road traffic accidents accounted for 38 (79.1 %) and falls from heights for 9 cases (18.75 %), and one boy with a hydronephrotic kidney fell off the staircase at home. The diagnosis was clinical, supported by abdominal ultrasound scan (USS) and plain abdominal film. Twenty-eight (58.3 %) children had laparotomy (15 in Group A; 13 in Group B). There was a statistically significant difference in the laparotomy rates between Group A and B (p < 0.01). Nineteen children were managed nonoperatively (2 in Group A; 17 in Group B); one child died before an operation could be performed. There were 59 abdominal organ injuries in 45 children. In 2 children, ultrasound could not diagnose any organ injury. There were 33 splenic injuries; 15 children had splenic conservation, 7 underwent a splenectomy, while 10 were managed nonoperatively. One child with splenic injury died before operation. Of 7 liver injuries, 4 required suturing of lacerations, 1 subcapsular haematoma was left undisturbed at laparotomy, while 2 were managed nonoperatively. There were 4 pancreatic injuries. Three were managed nonoperatively, while 1 associated with duodenal injury had a laparotomy. All 6 gastrointestinal injuries had laparotomy. There were 5 renal injuries: 3 had laparotomy with suturing, while 2 were managed nonoperatively. There were 4 bladder injuries: 2 had laparotomy with suprapubic catheter insertion, while 2 were managed nonoperatively. There were 7 retroperitoneal haematomas in association with other organ injuries. Associated injuries included head injury in 2, long bone fracture in 2, spinal injury and chest trauma in 1 each. There were 4 deaths, 1 before surgery could be performed. CONCLUSION: Blunt abdominal trauma in children resulted mainly from road traffic accidents. The use of a simple protocol supported by ultrasound scan could reduce the laparotomy rate in countries with limited facilities.

Childhood Wilms' tumour: prognostic factors in North Central Nigeria.

BACKGROUND: Childhood Wilms' tumour or nephroblastoma represents one of the challenges for paediatric oncologists in developing countries. OBJECTIVE: To review the clinical characteristics and outcome of management of childhood nephroblastoma in North- Central Nigeria. METHODS: The clinical, operative and histological records of children aged 15 years and below, that were managed for Wilms' tumour at the Jos University Teaching Hospital between 1998 and 2005 were retrospectively reviewed. RESULTS: There were 32 children (M:F=1.9:1) with histologically confirmed nephroblastoma seen over the 7-year period. Their median(range) age was 4 (3-15) years. The patients invariably presented with a palpable abdominal mass, but haematuria was exceptional. The neoplasm tended to be larger on average than those reported previously among Caucasian children. At presentation, 1 (3.1%) patient was in stage I, 8 (25%) stage II, 11 (34.4%) stage III and 12 (37.5%) stage IV. About 72% of the patients presented with stage III-IV disease. Poorly differentiated neoplasm was more common in male than in female patients. Nephrectomy and chemotherapy were the modality of treatment. Fifteen (46.9%) of the patients received little or no induction chemotherapy due to unavailability of drugs while only 12 (37.5%) received the prescribed maintenance treatment with the remainder getting erratic or no treatment. Overall, only 43.8% were alive between 1 and 9 months (median: 6 months) of follow-up period, but there was no survivor at two years after treatment. CONCLUSION: Childhood nephroblastoma has a high mortality rate in north central Nigeria because of late clinical presentation with advanced disease, poor availability of cytotoxic drugs and frequent interruptions in treatment and inadequate follow-up.

Posterior urethral valves in childhood : experience in a center with scarce facilities

Objective: Posterior urethral valves (PUV) are the most common congenital causes of lower urinary tract obstruction in male children; but few cases have been reported from Nigeria. In this study we describe our 7-year experience of management of PUV in children in order to increase the awareness of this condition in our environment. Patients and Methods : This is a report of 41 consecutive children with PUV who were managed at the Jos University Teaching Hospitals (JUTH); Jos; Nigeria; from June 2000 to April 2006. Their age at presentation ranged from 2 days to 15 years (mean: 2.5 years). The relevant clinical; laboratory and radiological data were entered into a database and analyzed.Results: Twenty-eight patients presented with a condition highly suspicious of PUV; while 7 patients presented with other urological conditions. Six patients presented with non-urological symptoms which caused a delay in diagnosis and institution of treatment. Voiding cystourethrography was diagnostic in all cases. In the majority of patients (n=31); management consisted of transurethral balloon avulsion of the valves yielding a satisfactory outcome in over 80. Conclusion : Although this study was restricted to one hospital; there appears to be a high incidence of PUV in children in North Central Nigeria. An increased awareness of varied clinical features; a high index of suspicion and simple conservative treatment by balloon avulsion of PUV would improve the outcome.of the patients. Urethral stricture was the main complication (which responded to serial dilatation) and occurred in 3 patients. The postoperative mortality rate was 2.6

Management of Conjoined Twins : a Report of Two Sets

Background: Conjoined twinning is a rare congenital anomaly. We present here; our experience in the management of two sets of conjoined twins at a Teaching Hospital in north central Nigeria. Method: Data of conjoined twins managed at the Jos University Teaching Hospital in 1987 and 2004 were retrospectively collated and analyzed. Result: Two sets of pyopagus tetrapus conjoined twins were managed within the period; one was a set of triplets. The conjoined pairs in both sets of twins were females. None of the twins was diagnosed prenatally. Both sets of conjoined twins were delivered spontaneously by vaginal route. Emergency surgical separation was undertaken in both sets be- cause of deteriorating anencephaly in one twin in the first set and anorectal malformation and intestinal obstruction in one twin in the second set. Both sets of twins died after separation. Conclusion: Our experience showed that separation of conjoined twins may be associated with high mortality. Sepsis and electrolyte imbalance appear to be the major causes of morbidity and mortality; particularly when the resultant skin defects are large

Persistent umbilical discharge in infants and children.

BACKGROUND: Umbilical discharge is not an unusual presentation in infants and children. However, the evaluation and management are rarely discussed. METHOD: A retrospective review of 18 patients presenting with persistent umbilical discharge over a period of 22 years, excluding neonates with omphalitis. RESULTS: The patients' ages ranged between 11 days and 9 years. Presentation was usually discharge of clear, serous or purulent fluid or faecal matter from the umbilicus, sometimes dating back to the neonatal period. Evaluation consisted of bacteriology, fistulogram (one patient) and histopathology. The cause of discharge was patent vitello-intestinal duct in 11 patients, umbilical granuloma in three, umbilical sinus in two and patent urachus and osteomyelitis of the ischium in one each. Definitive treatment was exploration and complete excision of the lesion and antibiotics. Two patients with patent vitello-intestinal duct died, one before surgery from hypokalaemia and sepsis, and the other from anaesthetic complications. CONCLUSION: There is a need for early referral and treatment in patients with persistent umbilical discharge. Conservative treatment is usually not successful as the common causes would normally require complete excision.

Anorectal anomaly: a review of 82 cases seen at JUTH, Nigeria.

BACKGROUND: The management of anorectal anomaly remains a challenge to Surgeons. This study was carried out to determine the pattern and outcome of management of anorectal malformations (ARM) in a Nigerian tertiary hospital. PATIENTS AND METHODS: The clinical and operative records of consecutive children with anorectal anomaly managed between October 1990 and September 2000 at the Jos University Teaching Hospital, Jos, were reviewed. RESULTS: There were 82 patients, (57.3%) males and 35 (42.3%) females (m:f=1.3:1). There were 20 (24.4%) cases each of the high and intermediate types, 40 (48.8%) low variety and 2 (2.4%) cases of persistent cloaca. The high type was proportionately commoner in the males. Less than one-third presented within 24 hours. Eighty three percent of patients (mainly males) presented in acute intestinal obstruction. Passage of stools from abnormal sites and "imperforate" anus were complaints in 60 (73.1%) patients each. A total of 63 patients had definitive corrective procedure. Four patients with stenotic anus were treated by serial anal dilatations while 29 with low anomaly had anoplasty during the neonatal period. Twenty eight patients with intermediate or high anomalies or persistent cloaca had definitive repair or pull-through operations carried out 6-12 months after an initial colostomy. The definitive pull-through operations included abdominoperineal pull-through in 11 patients, PSARP in 15, while 2 girls with persistent cloaca had posterior sagittal anorectovaginoure-throplasty (PSARVUP). Twenty nine children were fully continent of stools after surgery; three patients developed occasional faecal soiling; while six patients had faecal incontinence. CONCLUSION: Anorectal anomaly is common, but presentation is late in our environment. Although mortality rate was high (26%), early results of definitive operation among survivors were generally good after a mean follow-up period of 19 months.

Incarcerated umbilical hernia in children.

BACKGROUND: Umbilical hernia is common in children. Complications from umbilical hernias are thought to be rare and the natural history is spontaneous closure within 5 years. PATIENTS AND METHODS: A retrospective analysis was performed of the medical records of a series of 23 children who presented with incarcerated umbilical hernias at our institution over an 8-year period. RESULTS: Fifty-two children with umbilical hernias were seen in the hospital over the period. Twenty-three (44.2%) had incarceration. Seventeen (32.7%) had acute incarceration while 6 (11.5%) had recurrent incarceration. There were 16 girls and 7 boys. The ages of the children with acute incarceration ranged from 3 weeks to 12 years (median 4 years), while the ages of those with recurrent incarceration ranged from 3-15 years (median 8.5 years). Incarceration occurred in hernias of more than 1.5 cm in diameter (in those whose defect size was measured). Twenty-one children (15 with acute and all six with recurrent incarceration) underwent repair of the umbilical hernia using standard methods. The parents of two children with acute incarceration declined surgery after spontaneous reduction of the hernia in one and taxis in the other. One boy had gangrenous bowel containing Meckel's diverticulum inside the sac, for which bowel resection with end-to-end anastomosis was done. Operation led to disappearance of pain in all 6 children with recurrent incarceration. Superficial wound infection occurred in one child. There was no mortality. CONCLUSION: Incarcerated umbilical hernia is not as uncommon as thought. Active observation of children with umbilical hernia is necessary to prevent morbidity from incarceration.

Intestinal malrotation: presentation in the older child.

BACKGROUND: The clinical diagnosis of intestinal malrotation in the older child is not always easy because of its non-specific presentations. The aim of this study was to determine the pattern of presentation of malrotation in older Nigerian children. METHODS: The clinical, radiological and operative records of all the children aged 2 years or above, managed for malrotation at the Jos University Teaching Hospital between March 1992 and December 2002 were retrospectively reviewed. RESULTS: There were 9 patients, with a median age of 5 years (range: 3-14 years). The commonest complaint was intermittent colicky abdominal pain in 9 (100%), followed by recurrent vomiting in 8 (88.9%), haematemesis and constipation each in 5 (55.6%) and repeated episodes of bloody stools and diarrhoea. Other features included abdominal distension in 5 (55.6%) and failure to thrive in 4 (44.4%). Preoperative diagnosis was possible only in 3 patients, through the use of barium meal. Operative findings included obstructing bands of Ladd, partial volvulus and mesocolic hernias. Surgery promptly and satisfactorily relieved the symptoms. CONCLUSION: The diagnosis of intestinal malrotation should be considered in any child with prolonged history of recurrent colicky abdominal pain, vomiting or diarrhoea, especially if there is associated history of failure to thrive. Surgical intervention provides satisfactory relief of symptoms and should be implemented as soon as the diagnosis is made.

Acquired rectal fistula in human immunodeficiency virus-positive children: a causal or casual relationship?

Acquired rectal fistula in human immunodeficiency virus (HIV)-positive children is a new and worrisome entity. The aim of this paper is to highlight the relationship between HIV infection and acquired rectal fistula (RF) in children in order to create awareness among clinicians who attend to children. Over a 1-year period, 11 girls aged 4 weeks-11 months (median 5 months) with acquired RF were managed at our institution. Ten were HIV-positive by enzyme-linked immunosorbent assay and confirmed by Western blot test. One child defaulted before the test. All the mothers and three fathers of the 10 children were seropositive for HIV. Bronchopneumonia, otitis media, oral thrush, diarrhoea, and lymphadenopathy were common associations. Treatment was essentially conservative because the result of surgical intervention was disappointing. Two of the infants and one of the fathers are now dead from full-blown acquired immunodeficiency syndrome. Acquired RF seems to be a sign of HIV infection in children. It will be necessary to screen any child presenting with acquired RF for HIV infection.

Intestinal atresia: management problems in a developing country.

Over a 13-year period, 24 children with intestinal atresia were managed at the Jos University Teaching Hospital, Jos, Nigeria. Intestinal atresia ranks as the second most common cause of neonatal intestinal obstruction (after anorectal malformation) in our hospital. Five children had duodenal obstruction (two atresia, two duodenal webs, one annular pancreas), 17 had jejunoileal atresia, and two had colonic atresia. Fourteen were boys, and 10 were girls (M:F: 1.17:1). The median age at presentation to the surgeon was 6 days (range: 1 day-12 years). The most common presenting features were bilious vomiting and abdominal distension. Six patients did not pass meconium within the first 24 h of birth. The median weight at presentation was 2.6 kg (range: 1.1 kg-5.0 kg). Seven patients (four with jejunoileal atresia and three with duodenal obstruction) had associated congenital anomalies. Diagnostic investigation was plain abdominal x-ray, showing double-bubble gas shadows in duodenal atresia and varying degrees of air-fluid levels in jejunoileal and colonic atresias. An upper gastrointestinal series was done in three patients and a barium enema in one. Retrocolic duodenojejunostomy was done for all patients with duodenal atresia and annular pancreas, duodenotomy and web excision for those with duodenal webs, and resection with end-to-end anastomosis for those with jejunoileal atresia. One child with atresia involving the whole ileum and the colon had a jejunorectal anastomosis, while the other child with colonic atresia had caecostomy followed later by ileorectal anastomosis. Ten neonates died, giving a mortality rate of 41.7%. Mortality from intestinal atresia is still high in our environment, due mainly to lack of neonatal intensive care facilities.

Prevalence of umbilical hernia in a private school admission-seeking Nigerian children.

BACKGROUND: Despite the claims that umbilical hernia (UH) is common among Nigerian children, the socio-economic class-related prevalence or incidence rate of UH in the Nigerian children is not known. We therefore undertook this study to determine the prevalence of UHs among Nigerian children of high socio-economic class. PATIENTS AND METHODS: This 7- years prospective study assessment of the prevalence of primary umbilical hernias among a private school admission seeking Nigerian children. Clinical evaluations of the umbilicus were conducted on 7,968 Nigerian children, attending interview into Nigerian Airforce Military schools from across the country. RESULTS: Umbilical hernia was present in 102 (1.3% ) out of 7968 children, giving a prevalence of 12.8 per 1,000. Fifty-three (52.% ) were boys and 49 (48% ) were girls; their ages ranged from 6 to 9 years (mean 6.5 years). Umbilical hernia was 1.4 times as common in the girls as in the boys, with a prevalence of 15.3 per 1,000 and 11.1 per 1,000, respectively. The overall prevalence in this study is comparatively lower than those previously reported. CONCLUSION: Our study suggests that there is a low prevalence rate of UH among the children of high socio-economic class in Nigeria.

Thyroglossal duct lesions in childhood--a review of experience in Nigerian children.

This is a retrospective study of 36 children with thyroglossal duct lesions managed at a tertiary hospital in Nigeria, between 1993 and 2003. The aim was to determine the pattern of presentation and outcome of management. The majority of patients presented with a chronic thyroglossal sinus with associated recurrent inflammation. The location and relationship of the lesions to the hyoid bone were similar to those encountered in the rest of the world. Despite their well-documented clinical features, thyroglossal duct lesions were misdiagnosed in some patients. The main complications were surgical site infections and recurrence. A plea is made for clinicians to pay attention to clinical and operative details so as to diagnose these lesions accurately and manage them properly.

Acalculous cholecystitis in Nigerian children.

Sixteen children with acalculous cholecystitis (AC) were treated over a 9-year period (13 male and 3 female). Their ages ranged from 8 to 18 years (median 11). Eight (50%) presented with complications (perforation 4, gangrene 2, empyema 2); 13 (80%) presented with acute AC with a duration of symptoms of 2 weeks or less while 3 (20%) presented with chronic AC with symptoms present for more than 3 months. The diagnosis was made by ultrasound except in the patients with complications, who were diagnosed at laparotomy. Salmonella typhi was cultured in the bile and blood in 2 cases and the Widal titre was significantly elevated in 4 others. One child had chronic blockage of the cystic duct by a lymph node; in 9 there was no identifiable cause. Open cholecystectomy was successfully performed in 15 cases, while 1 child was managed non-operatively. The need for early diagnosis of cholecystitis in children is obvious if the potentially life-threatening complications of perforation and gangrene are to be avoided.

Appraisal on fluid and electrolyte management in paediatric surgical patient.

Fluid and electrolyte disorders are common occurrences in Paediatric surgical practice. Despite this, the management of fluid and electrolyte imbalance in the paediatric surgical patients remains problematic. This is partly because authorities vary considerably in their recommendations for therapy, despite the great advances being attained in the understanding of the fluid and electrolyte homeostasis in the Paediatric age group. This has, in no doubt, resulted in a number of morbidity and mortality that could have been prevented based upon rational and acceptable recommendations for fluid and electrolyte therapy in children. In this review, the normal homeostasis, disorders and management of fluid and electrolyte and corrections of metabolic disorders in children are highlighted, with the aim to update the practice of fluid and electrolyte therapy in children.

Sigmoid volvulus and ileosigmoid knotting in children.

Six children with acute intestinal obstruction from sigmoid volvulus (SV) (n=2) and ileosigmoid knotting (ISK) (n=4) are reported. The median age at presentation was 4.5 years (range 2 weeks-15 years). Abdominal pain, distention, vomiting, and constipation were the main features. Two patients with ISK had bowel gangrene. In three children there was no identifiable cause; two had a narrow attachment of the sigmoid mesocolon with redundant colon and one had adhesive bands. Treatment was by resection and colostomy in five cases and derotation of the torted colon in one. One child with SV died following a wound infection. There was no recurrence. SV and ISK are uncommon in children. There are usually no features specific for these conditions, and the diagnosis is established at laparotomy. The prognosis is good when there is aggressive resuscitation and prompt surgery.