Subject(s)
Lacerations/surgery , Tongue/injuries , Tongue/surgery , Child , Child, Preschool , Humans , Mouth Mucosa/injuries , Mouth Mucosa/surgery , Suture TechniquesABSTRACT
BACKGROUND: Traditionally, a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC). We compared the outcome of resection and anastomosis (RA) with stoma formation (RS). METHODS: Sixty-eight neonates undergoing laparotomy for IIP (n = 20), NEC (n = 43), and indeterminate cause (n = 5) were reviewed retrospectively. Intestinal resection was followed by either anastomosis or stoma. The primary outcome measure was the frequency of anastomosis- and stoma-related complications. RESULTS: The median gestational age (GA) was 28.5 weeks and birth weight (BW) was 940 g. Thirty-seven neonates had RA (NEC 22, IIP 14, 1 unknown), 28 RS (NEC 21, IIP 6, 1 unknown), and 3 laparotomy only. Twenty-five neonates died postoperatively. The mean +/- SD GA of those who survived was 30 +/- 4.5 weeks and those who died was 27.2 +/- 3.5 weeks (P = .008). The mean BW for those that survived was 1440.5 +/- 865.1 g and those who died was 827.7 +/- 385.1 g (P = .002). There was no statistically significant difference between the RA and RS groups for GA (P = .93), BW (P = .4), general complications (P = .96), anastomosis and stoma complications (P = .48), and deaths (P = .42). CONCLUSIONS: RA, rather than stoma, is an acceptable option in the surgical management of preterm neonates with IIP or NEC.
Subject(s)
Enterocolitis, Necrotizing/surgery , Infant, Premature, Diseases/surgery , Intestinal Perforation/surgery , Surgical Stomas , Anastomosis, Surgical , Humans , Infant, Newborn , Retrospective StudiesABSTRACT
Hirschsprung's disease (HD) in Down's syndrome (DS) patients is stated to have a worse outcome than HD alone. In our study we reviewed the immediate and long-term outcomes of these children and questioned whether DS should influence the operative management. Data were collected on all children with HD (including total colonic aganglionosis), between January 1990 and December 2000. They were divided into two groups based on the presence or absence of Trisomy 21 and compared retrospectively. In this time period we treated 173 children with HD; 17 of these had DS. Both the groups were comparable in their mean gestational age, birth weight and presentation except that the DS group had a significantly higher overall incidence of pre and/or postoperative enterocolitis. A tota1 of 164 children underwent a Swenson pull-through and 9 had a Soave's procedure. Follow-up ranged from 1 to 10 years. Continence assessed using the Wingspread scoring system in children over the age of 4 years showed no significant difference. Although children with both HD and DS are predisposed to complications and required a more cautious management, long-term outcome in terms of continence was not significantly worse than in HD alone. Thus the co-existence of DS should not influence the decision to offer these children and their parents the choice of definitive repair.
Subject(s)
Down Syndrome/complications , Hirschsprung Disease/complications , Hirschsprung Disease/surgery , Proctocolectomy, Restorative , Case-Control Studies , Child , Enterocolitis/etiology , Fecal Incontinence/etiology , Female , Humans , Infant, Newborn , Male , Proctocolectomy, Restorative/adverse effects , Retrospective Studies , Treatment OutcomeABSTRACT
We describe the case of a 700-g neonate who presented with abdominal discolouration, distension, and rapid clinical deterioration. At laparotomy, a perforation in the neck of the gallbladder was found, which was simply over-seen. Perforation of the gallbladder should be considered in the differential diagnosis in such neonates. The surgical management should be direct repair, without resorting to a cholecystectomy.
