Clinical recognition and management of pediatric blunt abdominal trauma without ultrasound or computed tomography scan in community hospitals in Mexico.

PURPOSE: The aim of this study was to characterize the evaluation and clinical course of children with blunt abdominal trauma in second-level hospitals. METHODS: The authors reviewed the medical records of children, age 1 to 17 years, admitted with blunt abdominal trauma between the years 1988 to 1998. The initial evaluation included a Pediatric Trauma Score (PTS) ABCD clinical assessment, resuscitation, diagnostic peritoneal lavage (DPL), Glasgow Coma Scale (GCS), x-ray, and laboratory values. Surgical indications included active bleeding, perforated hollow viscus, or traumatic diaphragmatic hernia. Sixty-four children with blunt abdominal trauma were divided into 4 major groups: group I, obtunded children who required abdominal surgery; group II, obtunded children that did not require abdominal surgery; group III, responsive children that required abdominal surgery; group IV, responsive children that did not require abdominal surgery. RESULTS: Analyses of each group determined that the PTS, the GCS, and ABCD assessments accurately reflected the degree of injury and outcome. Jointly with DPL they may obviate the need of ultrasound and CT scan in hospitals of second level that do not have access to these resources. CONCLUSIONS: Recognition of blunt abdominal trauma in children may be complicated by associated multisystem injury. Systematic evaluation minimizes missed diagnosis and facilitates rapid and effective treatment. The benefit of data acquired from a good ABCD assessment, PTS, GCS, clinical and radiological, and DPL evaluation, facilitates the decision to conduct a rapid laparotomy, and they help to predict the outcome of this kind of patient.

Splenectomy complications in hematological diseases.

The postoperative complications observed in a group of 27 patients with hematological diseases that underwent splenectomy are reported: 21 patients had a non-malignant hematological condition, whereas the rest had a hematological malignancy. Seven complications presented in 6 patients (two wound infections, two severe post-operative hemorrhages, one incisional hernia, one sepsis by capsulated bacteria and one fatal hemophagocytic syndrome). The overall complication rate was 27%, whereas the fatal complication rate was 3%. The complication rate in patients with malignant diseases was 83%, whereas that in benign conditions was 9%. The size of the spleen was related with the complication rate (median weight of patients with complications was 990 g versus 132 g in those without complications; p < 0.01). The two patients that underwent splenectomy before age six months had complications, in one case related to parental negligence. In splenectomies performed for hematological disease the benefits must be balanced carefully against the risks.

Amebic hepatic abscess in children.

The authors retrospectively reviewed all case histories of children with amebic hepatic abscess treated from 1975 to 1993 at their hospital. Twenty boys and 12 girls were diagnosed. Their ages ranged from 10 months to 12 years, with a mode of 1 and 2 years. In 17 (53%) of the patients, the abscess remained confined to the liver and was treated medically with dehydroemetine and metronidazole. Imminence of complication was present in 9 patients (52%), and required percutaneous needle aspiration. Imminence of complication was evidenced by: (1) clinical worsening of the patient despite adequate medical treatment, (2) presence of an abscess of 6 cm or more in a septic patient, or (3) clinical or ultrasonographic findings of an abscess on the verge of rupture. All 9 patients did satisfactorily. Fifteen cases (47%) were complicated by rupture and required surgical treatment. One of these patients died of sepsis. Medical treatment alone was excellent for small abscesses. Percutaneous needle aspiration was a successful approach in patients with imminence of complication. Surgery was reserved for ruptured abscesses.

[Prenatal ultrasonographic diagnosis and early surgical treatment in choledochal cyst]. / Diagnóstico ultrasonográfico prenatal y tratamiento quirúrgico precoz en quiste de colédoco.

The clinical case of a 23 days old male newborn with prenatal ultrasonographic diagnosis of choledochal cyst is described and discussed. The diagnosis was first suspected in the 23rd gestation week and confirmed in the 35th. The advantages of prenatal ultrasonographic diagnosis and early surgical management in patients with choledochal cyst are emphasized.

Hemorrhage into mesenteric cyst following trauma as a cause of acute abdomen.

Intraabdominal lymphangiomas are rare. Most cases are asymptomatic, except when complicated. This is a case report of a 8-year-old boy with hemorrhage into a mesenteric lymphangioma following trauma, as a cause of acute abdomen. Prompt diagnosis and operation were imperative in the proper management of this child.

[Recurrent complete rectal prolapse as a complication of posterior perineostomy, cured with posterior sagittal ano-rectoplasty]. / Prolapso rectal recurrente completo como complicación de perineostomía posterior, curado con ano-rectoplastia sagital posterior.

Among the anal-rectal malformations seen in females, the vestibular fistulae is frequently underestimated and tried to be corrected with a simple posterior perineostomy which may eventually cause, besides a esthetic problems, anatomical and physiological irregularities as those seen in a three year old girl, who after a posterior perineostomy for a vestibular fistula, suffered a complete recurrent rectal prolapse, which was intended to be corrected after eight unsuccessful surgical interventions. Finally, the child was cured after a posterior sagittal ano-rectoplasty. After a two year follow-up, the child has not had another rectal prolapse.

Las ventajas del adiestramiento pediatrico en la formacion del cirujano. / Advantages of pediatric training in the education of the surgeon

Las ventajas del adiestramiento pediatrico en la formacion del cirujano, es el conocimiento del nino como "un todo" y no como la parcelacion fragmentaria de un sistema vivo, lo que conduce a una deshumanizacion del cirujano y de la medicina como ciencia y como arte. "Un cirujano es un medico y algo mas". Esta es la razon por la que el cirujano pediatra necesita conocer a traves de su adiestramiento: neonatologia, infectologia, patologia, laboratorio, genetica, hematologia, nefrologia, oncologia, cardiologia, radiologia y a traves de la educacion medica continua, nutricion, bioquimica, inmunologia y los avances en cirugia pediatrica. Las cualidades especialmente deseables en un cirujano pediatra son: conocimiento profundo de la anatomia, de la fisiologia y de la patologia del nino; entusiasmo, agilidad mental, salud, humildad, honestidad, compasion, comprension y amor por el nino enfermo, su familia y su ambiente