ABSTRACT
In 1974 to 1999 at the Department of Paediatric Surgery in Bratislava 142 patients aged 3 days to 14 years were treated on account of Hirschsprung's disease. Seventy-four patients suffered from the classical type of Hirschsprung's disease affecting the recto-sigmoid segment of the large bowel, in 43 the long segment of the large bowel was affected. In nineteen patients an ultrashort segment was afflicted and six patients suffered from total aganglionosis of the large bowel. In 131 patients the diagnosis was established by irrigographic examination and during operation it was confirmed by histological examination of the whole month of the large intestine. In 11 patients the diagnosis was established by peroperative collection of the whole month of the large bowel. In 43 patients the diagnosis was made during the neonatal period. All 142 patients were operated. Nineteen patients with an ultrashort segment were subjected to dorsal myectomy according to Lynn and in 121 patients a retrorectal pull-through according to Duhamel in Ikeda-Soper's modification was performed. In 99 patients before the final operation a colostomy was made, orally from an aganglionic portion of the large bowel. Twenty-two patients were treated in one session by means of a direct stapler without protective colostomy. Two patients died several days after establishment of the colostomy from anaerobic septic complications. After the final operation no death was recorded. Duhamel's operation in Ikeda-Sopor's modification is in the authors' opinion very effective in treatment of congenital megacolon, being associated with a minimum of complications and is the prerequisite for achieving excellent functional results.
Subject(s)
Hirschsprung Disease/surgery , Adolescent , Child , Child, Preschool , Female , Hirschsprung Disease/complications , Hirschsprung Disease/pathology , Humans , Infant , Infant, Newborn , Male , Postoperative ComplicationsABSTRACT
The authors present a patient with diastematomyelia and associated congenital malformations of the spinal cord. They caused tethering of the spinal cord. Patient had cutaneous marks of malformation from birth. The congenital malformation was operated at the age 5 years. MRI and surgical findings confirm the existence of diastematomyelia together with thick tethered filum terminale and lipoma of filum terminale. On surgery the bony septum was removed, the filum terminale was resected and the lipoma was excised. Each of the anomalies caused the tethering of the spinal cord and restricted its physiological ascent. Only careful surgical revision with subsequent removal of all causes of the tethering of the spinal cord produced good result. Diastematomyelia is a congenital malformation with some morphological variations and coexistence of other malformations. The presented case is a typical example of malformations associated with diastematomyelia.
Subject(s)
Neural Tube Defects/complications , Spinal Cord/abnormalities , Cauda Equina , Child, Preschool , Female , Humans , Lipoma/complications , Lipoma/surgery , Neural Tube Defects/pathology , Neural Tube Defects/surgery , Peripheral Nervous System Neoplasms/complications , Peripheral Nervous System Neoplasms/surgery , Spinal Cord/surgeryABSTRACT
Authors presented their experience in diagnosis and treatment of 5 cases of traumatic rupture of urethra. Clinical symptoms of the closed type of the urethra are frequently not clear. In 70% of patients, outer urethral orifice bleeding is usually omitted. When this injury could be suspected, urethral catheterization is not recommended because it might extend level of damage. Urethrography is recommended as it would offer sufficient information on the injury. Pulling the balloon catheter to approach proximal and distal part of the injured urethra will result in creating fibrous channel between the ruptured parts of urethra however, this fibrotic part tends to develop dilatation resistant stricture.
Subject(s)
Urethra/injuries , Child , Child, Preschool , Humans , Male , Perineum/injuries , RuptureABSTRACT
Twenty-five patients with thyreoglossal cysts were treated during a 7 years long period. Most of the cysts (in 64 of patients) were typically located between the hyoid bone and the thyreoid gland. The complete Sistrunk's operation was performed in 40% of the patients and 48% patients underwent an extirpation of thyroglossal cyst with a resection of the hyoid bone body. Three of the patients (12%) suffered a relapse. In one of the patients, this was due to the lateral cyst swapping and in two patients an incomplete extirpation of the ductus thyreoglossus remnant happened. In another patient, an iatrogenic hypothyreossis occurred. To avoid relapse, authors recommend to resect at least 10 mm of the hyoid body and 5 mm of the ductus thyreoglossus remnant behind the hyoid bone.
Subject(s)
Thyroglossal Cyst/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Male , Postoperative ComplicationsABSTRACT
The authors report study of patients with blunt splenic trauma treated at Paediatric Surgery Department in years 1991-1999. During 9 years period 50 patients (36 males, 14 females) with demonstrated rupture of the spleen were analyzed. 46 patients (92%) were treated conservatively (group A). Complications appeared in 7 patients (15.22%), rebleeding in two patients, arterio-venous fistula in early posttraumatical period in one patient and during control in one patient, fluidothorax in two patients and posttraumatic pseudocyst of the spleen in one patient. Four patients (8%) were operated (group B). Two of them submitted splenectomy, one patient was treated by splenorrhaphy and one patient by partial splenectomy. Period of the hospitalization in average lasted in group A 12,67 days, in group B 15 days. With regard to the immunologic functions of the spleen especially in childhood authors prefer conservative treatment, in case that laparotomy is inevitable authors try to preserve the spleen.
Subject(s)
Spleen/injuries , Wounds, Nonpenetrating/therapy , Child , Female , Humans , Male , Wounds, Nonpenetrating/surgeryABSTRACT
Tracheooesophageal fistulae (TEF) without atresia of the oesophagus cause in children relapsing respiratory diseases. The authors present diagnostic and therapeutic procedures in seven children. The symptoms of aspiration with attacks of non-productive cough and suffocation when fed were recorded in all children since birth. In five the diagnosis was made late. In four children the diagnosis was established by oesophagoscopy, in two by cinematooesophageography and in one by Fabian's test (Koop's test). All seven children were operated by a transcervical approach. After surgery all children are in a good condition and have no respiratory complaints.
Subject(s)
Tracheoesophageal Fistula/congenital , Child, Preschool , Esophageal Atresia/complications , Female , Humans , Infant , Infant, Newborn , Male , Tracheoesophageal Fistula/complications , Tracheoesophageal Fistula/diagnosis , Tracheoesophageal Fistula/surgeryABSTRACT
The authors describe the treatment of a patient with an inborn bronchobiliary fistula. The ex post finding that the fistula had two insertions in the bronchus called in the final stage for a combined thoraco-abdominal approach with resection of the right lower pulmonary lobe with ligature of the fistula beneath the diaphragm. Although inborn bronchobiliary fistulae are very rare, they must be considered in the differential diagnosis of causes of chronic respiratory distress syndrome in children. Early diagnosis and adequate surgical treatment make it possible to prevent serious chronic cardiorespiratory disease.
Subject(s)
Biliary Fistula/complications , Bronchial Fistula/complications , Respiratory Insufficiency/etiology , Biliary Fistula/congenital , Bronchial Fistula/congenital , Humans , Infant , MaleABSTRACT
Analysis of 40-year experience with operations for pectus excavatum over the period from 1950-1988 is presented. In a series of 177 children ten different surgical approaches were used in succession. Since 1975 operations were performed exclusively by the method according to Ravitch and Welch which does not apply any fixation splints. The procedure is substantiated by the pathologico-anatomical and metabolic causes of the origin and development of inborn deformities of the chest. The operation consists of several exact procedures on the muscles, cartilages, and sternum, which have to be carried out consistently. The important parts of the surgical procedure are described. Since 1975 the method was used in 28 children, with very good and good results in 92.8%.
