ABSTRACT
BACKGROUND: Establishment of enteral nutrition is necessary after intestinal surgery. In resource-strained environments, it can be critical. This study examined the effect of early feeding in pediatric patients undergoing stoma closure in a country with mid-level socioeconomic indices. METHODS: With parenteral consent and ethics board approval, patients were prospectively enrolled in early feeding (Group 1), starting feeds 24h post-operation with a protocol driven increase. They were compared with similar patients managed without a specific protocol over the 12 months prior (Group 2). RESULTS: There were 31 patients in each group with similar mean age and weight. The mean first sustained feed was achieved at 28.5 ± 4.4 h* in Group 1 vs. 153.8 ± 28.6 h in Group 2. Full feeds were achieved within 62.3 ± 19.2 h* vs. 196.0 ± 40.5 h in Group 1 and 2, respectively. Mean hospital stay was 7.2 days* in Group 1 vs. 9.4 days in Group 2. A reduction in postoperative fever and wound infections was observed in Group 1 (*p<0.05). CONCLUSION: Early enteral feeding after elective bowel anastomosis is well tolerated in children and results in shorter hospital stay and fewer complications.
Subject(s)
Colostomy , Enteral Nutrition , Ileostomy , Postoperative Care , Surgical Stomas , Anastomosis, Surgical , Child , Child, Preschool , Developing Countries , Digestive System Abnormalities/surgery , Elective Surgical Procedures , Enteral Nutrition/economics , Female , Fever/epidemiology , Follow-Up Studies , Humans , India , Infant , Intubation, Gastrointestinal , Male , Postoperative Care/economics , Postoperative Complications/epidemiology , Postoperative Nausea and Vomiting/epidemiology , Surgical Wound Infection/epidemiologyABSTRACT
Recurrent small-bowel volvulus is a state of recurrent intermittent or long-standing persistent twisting of small-bowel loops around its mesentery. The association of mesenteric cysts with recurrent small-bowel volvulus as the cause or effect is a much debated issue in the literature. We report two cases of mesenteric lymphangioma and one case of enteric duplication cyst seen in association with recurrent small-bowel volvulus of long duration in absence of malrotation.
Subject(s)
Intestinal Volvulus/diagnosis , Jejunum/pathology , Lymphangioma, Cystic/diagnosis , Mesenteric Cyst/diagnosis , Peritoneal Neoplasms/diagnosis , Child , Child, Preschool , Humans , Infant , Intestinal Volvulus/complications , Intestinal Volvulus/surgery , Lymphangioma, Cystic/complications , Lymphangioma, Cystic/surgery , Male , Mesenteric Cyst/complications , Mesenteric Cyst/surgery , Peritoneal Neoplasms/complications , Peritoneal Neoplasms/surgery , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, ColorABSTRACT
OBJECTIVES: To report the observation of involvement of the umbilicus with alteration of its morphology in association with peritoneal tuberculosis. METHODS: This is a retrospective observational case series of abdominal tuberculosis (ATB) in children, treated in the department of pediatric surgery of a tertiary-care children's hospital in the period from January 2004 through April 2010. RESULTS: Out of a total of 38 cases of ATB in children, 22(57.9%) were of the peritoneal type, 14(36.8%) were of the intestinal type, and 2(5.3%) involved the mesenteric lymph nodes. Of the patients manifesting with peritoneal tuberculosis, 11 cases (50%) had involvement of the umbilicus with changes in the umbilical shape and appearance. In seven cases the umbilicus was found retracted and transversely oriented (a slit-like "smiling" appearance) with loss of the umbilical hollow. In two cases there was puckering of the umbilicus. Other findings included umbilical erythema with inflammation in one patient and a fecal fistula at the umbilicus in another patient. While seven cases responded to treatment with antituberculous therapy (ATT), four cases underwent surgery (two laparotomy and two laparoscopy). Findings were similar in all four patients, consisting of adhered dilated bowel loops studded with tubercles which also covered the parietal peritoneum and the falciform ligament. All four cases responded to postoperative ATT. CONCLUSIONS: Morphological changes of the umbilicus can provide an additional clue to the diagnosis of peritoneal tuberculosis in children.
Subject(s)
Peritonitis, Tuberculous/diagnosis , Tuberculosis, Gastrointestinal/diagnosis , Umbilicus/pathology , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Female , Humans , Male , Peritonitis, Tuberculous/pathology , Peritonitis, Tuberculous/therapy , Retrospective Studies , Tuberculosis, Gastrointestinal/drug therapy , Tuberculosis, Gastrointestinal/surgeryABSTRACT
This report describes two unusual cases of anorectal malformation. The first had a type III congenital pouch colon with a colovesical fistula. In the other very similar case, segmental dilatation of the colon was present along with penoscrotal hypospadias and, distally, a length of normal colon ending in a rectourethral fistula. In both patients, the appendix was short, stubby and a Y-shaped duplication of the normal colon was present just proximal to the dilated segment of colon.
