Inflammatory myofibroblastic tumor of the small intestine: a case report of a 2 month-old infant.

Benign intestinal tumors are rare in children; however, the authors describe an inflammatory myofibroblastic tumor (IMT) of the terminal ileum in a 2-month-old infant who presented with an intestinal obstruction. During laparotomy, an annular mass around the terminal ileum was resected, from which a histological diagnosis of IMT was made. A review of the literature for this rare condition was done to delineate the natural history of this tumor and to do a histological confirmation of its benign nature. Because of the risk of local recurrence, IMT cases should have a long-term follow up.

Gastroschisis: delivery and immediate repair in the operating room.

BACKGROUND: Gastroschisis is a congenital abdominal wall defect with the small and large bowel protruding through. Early closure prevents heat and water loss, infection, and bowel edema. Immediate primary fascial closure should be done when possible. OBJECTIVE: To compare the outcome of a group of gastroschisis neonates diagnosed before birth who underwent delivery and immediate surgical repair in the operating room (IOR group) with another group who underwent delivery outside the operating room and urgent surgical repair in the operating room later (OOR group). MATERIAL AND METHOD: A retrospective cross sectional study between January 1, 2005 and December 31, 2007 was conducted on 49 neonates with gastroschisis treated at Khon Kaen Regional Hospital by one pediatric surgeon. RESULT: Thirteen neonates were in the IOR group and 36 in the OOR group. Statistical significance was observed between both groups with regard to delivery-operation interval and operative procedure. The time interval from birth to operative repair of IOR group was shorter (0.8 +/- 0.4 vs. 11.4 +/- 4.2, p < 0.001). The abdominal wall defect of all neonates in IOR group could be corrected by primary fascial closure (100%) compared with only 61.1% in the OOR group (p < 0.01). There were no statistical significant difference between the two groups regarding days to extubation (4.7 +/- 2.7 vs. 8.3 +/- 6.3, p < 0.058), days to enteral feedings (10.5 +/- 4.5 vs. 13.7 +/- 5.9, p < 0.092), and length of stay (21.7 +/- 9.9 vs. 28.7 +/- 19.6, p < 0.235), but there was a trend in the IOR group toward earlier extubation, toleration of enteral feeding, and discharge. Overall mortality rate was 14%. All of the IOR group survived There were 19% deaths in the OOR group. CONCLUSION: Delivery and immediate surgical repair in the operating room appear to be safe and feasible. Delivery-operation interval was decreased. The repair was easier and increased the possibility of primary fascial closure. The patients ate sooner and were discharged earlier. A policy of making immediate surgical repair upon the delivery in the operating room leads to decreased morbidity in infants with gastroschisis. A well prepared team is an important factor for this policy.

Peutz-jeghers syndrome and colon cancer in a 10-year-old girl: implications for when and how to start screening?

The Peutz-Jeghers syndrome (PJS) is characterized by hamartomatous polyposis of the gastro-intestinal (GI) tract, with mucocutaneous pigmentation. We have experienced a case of a 10-year-old girl who presented with PJS, intussusception, colonic perforation and colonic adenocarcinoma. Finally, this case developed airway obstruction from the mediastinal mass. In order to prevent cancer and short bowel syndrome, aggressive screening is recommended.

Successful separation of thoracopagus conjoined twins with a single extra-hepatic biliary system.

A pair of thoracopagus conjoined twins were separated at the age of 3 months at Khon Kaen Regional Hospital, Thailand on November 19, 2004. Pre-operative investigations showed separate hearts, joined duodenum, and fusion of the livers. Separation of the extra-hepatic biliary systems was suspected. Operative findings revealed fusion of the intestines from the second part of the duodenum to the terminal ileum with two normal colons. An intussusception was found at the terminal ileum. Fusion of the livers with only one extra-hepatic biliary system was noted In one of the twins, the gastrointestinal tract was anastomosed with Roux-en- Y enteric loop to one area of good bile drainage at the cut surface of liver Post operative course was hectic but both twins recovered satisfactorily. Both are doing well at present, two years after the separation. This was the first reported case of thoracopagus conjoined twins with complex biliary tract anomalies in Thailand. From the literature, pre-operative investigations in most cases of these conjoined twins failed to define the precise anatomy of the biliary system and may be misleading as in the presented case. The mortality rate remains high. Meticulous pre-operative planning, decision-making in the operative field and postoperative management as well as a multidisciplinary team are very important for a successful separation.

Study on performance following Key Performance Indicators for trauma care: Khon Kaen Hospital 2000.

This study was conducted in 2000-2001 in order to improve the quality of trauma care by establishing the Key Performance Indicators (KPIs) as a guideline in providing trauma care service and to study the personnel's performance following 27 indexes of KPIs for trauma care in Khon Kaen Hospital. After the implementation of the KPIs by the method of participatory action research (PAR), the trauma preventable death rate was decreased to 1.3 per cent which was statistically different from the preventable death rate in 1997 (2.0%).