Congenital Diaphragmatic Hernia with Intrathoracic Renal Ectopia: Thoracoscopic Approach for a Complete Anatomical Repair.

Congenital diaphragmatic herniae (CDH) with associated intrathoracic ectopic kidneys are rare congenital anomalies, with a reported incidence of only 0.25%. The authors report a case of a 24-day-old baby girl who was diagnosed with a left-sided CDH on a chest X-ray taken for pneumonia. Computed tomography scan showed CDH hernia, containing small and large bowel and whole left kidney with adrenal gland. Thoracoscopic reduction in the bowel, kidney, and adrenal gland into the abdomen and primary closure of the defect was achieved with no complications. During investigation of the child, it was discovered that her maternal aunt had also had a left-sided congenital diaphragmatic hernia containing the kidney, which was treated via open surgery after birth; she subsequently developed renal cell carcinoma and required radical nephrectomy of that kidney during her third decade.

Surgical Decision Making in Preduodenal Portal Vein: Report of Two Cases in Neonates.

Preduodenal portal vein (PDPV) is a rare anomaly that can cause duodenal obstruction. PDPV is associated with other congenital anomalies, mainly cardiac and gastrointestinal. Treatment usually consists of bypassing the obstruction by duodenoduodenostomy. We report two cases of PDPV in association with atrial isomerism and malrotation with different surgical management.

The value of contrast studies in the evaluation of bowel strictures after necrotising enterocolitis.

PURPOSE: Strictures of the bowel are a frequent complication post-necrotising enterocolitis (NEC). Contrast studies are routinely performed prior to stoma closure following NEC. The aim of this study was to evaluate the ability of these studies to detect strictures and also directly compare them to operative and histological findings. METHODS: Two hundred and fourteen neonates who had a diagnosis of NEC (Bell stage 2 or greater) in a single unit (2007-2011) were analysed. Their case notes, radiology, and histology were reviewed. RESULTS: One hundred and sixteen neonates underwent an emergency laparotomy and 77 had stomas fashioned. Sixty-six patients had a contrast study prior to stoma closure (distal loopogram 18, contrast enema 37, both studies 11). Colonic strictures were reported in 18 patients and small bowel strictures were reported in two patients. Fourteen of these colonic strictures were confirmed at operation and on histology but three colonic strictures were missed on contrast studies; one patient had had both contrast studies and the other two only a distal loopogram. Two small bowel strictures reported were confirmed and an additional small bowel stricture missed on distal loopogram was also detected at the time of operation. The incidence of post-op strictures was 19 out of 68 patients (27.9 %) and 16 (84.2 %) of these strictures were found in the colon. Contrast enemas had a much higher sensitivity for detecting post-NEC colonic strictures than distal loopograms; 93 versus 50 %, respectively; however, they are more likely to give a false positive result and therefore their specificity is lower; 88 versus 95 %, respectively. CONCLUSION: Colon is the commonest site for post-NEC stricture and contrast enema is the study of choice for detecting these strictures prior to stoma closure.

Small bowel obstruction due to adhesions following neonatal laparotomy.

The aim of this study was to assess the incidence of small bowel obstruction (SBO) due to adhesions following laparotomy in the neonatal period. This was a retrospective study of babies born between January 1998 and November 2003 who had a trans-abdominal procedure in the neonatal period in the John Radcliffe Hospital, Oxford, UK. Four hundred and fourteen patients had a trans-abdominal procedure during this period. The follow-up period ranged from 2 months to 6 years (median 39 months). Overall, twenty-three patients (6%) underwent subsequent laparotomy for SBO due to adhesions. Four patients (17%) who developed SBO due to adhesions had another adhesive obstruction requiring a further laparotomy. The majority of adhesions occurred within a year of the original procedure (87%). A single band caused the obstruction in eight patients (35%), multiple adhesions in six (26%), and dense adhesions in nine patients (39%). The incidence of SBO was highest following surgery for meconium ileus, followed by necrotizing enterocolitis (NEC), and malrotation. There were no deaths due to small bowel obstruction in this study.