Pediatric ovarian torsion: Follow- up after preservation of ovarian tissue.

BACKGROUND: The aim of this study was to evaluate the efficiency of the preservation of ovarian tissue in cases of ovarian torsion. MATERIALS AND METHODS: A retrospective study was performed of patients treated at our hospital for ovarian torsion from January 2007 to December 2017. This research does not include patients with antenatal ovarian torsion and 1 girl with an immature teratoma, in whom the twisted ovary was removed during the initial operation. Follow-up ultrasonography of all patients was performed after 4-6 weeks and again after more than 12 weeks. Volume, blood flow and folliculogenesis of the ovary were measured and assessed. RESULTS: All 42 ovaries (39 patients) preserved their normal anatomy and folliculogenesis after detorsion. All patients had an enlarged ovary at the time of detorsion. In all cases of ovarian torsion, enlargement of the ovary up to an average of 58.14 ±â€¯52.86 (17.37-86.83) ml was detected. After 4-6 weeks, all untwisted ovaries decreased in volume by an average of 9.01 ±â€¯13.69 (2.33-9.30) times, and 59.5% of them became normal in size. In 3 girls, enlarged ovaries were still observed after 12 weeks. Teratoma was diagnosed for these patients and ovarian sparing operations were performed. CONCLUSIONS: It is safe to perform detorsion regardless of the level of ischemia or volume of the affected ovary. The follow-up is essential, especially for the further diagnostics of potential pathological structures or tumors; therefore, the normalization of blood flow and the volume of the ovary must be monitored. TYPE OF STUDY: Prognosis retrospective study. LEVEL OF EVIDENCE: II.

Conservative treatment of caustic oesophageal injuries in children: 15 years of experience in a tertiary care paediatric centre.

INTRODUCTION: Endoscopic dilatation is good choice of conservative treatment for caustic digestive tract injuries in children. AIM: To set up a strategy of management of caustic digestive tract injury based on our experience and literature review. MATERIAL AND METHODS: We retrospectively analysed medical records of 34 paediatric patients who were admitted to the Centre of Paediatric Surgery of the Children's Hospital between 2000 and 2017. Age at presentation, gender, anatomic location, circumstances and distribution of injury, early and late complications, clinical signs, and the first aid were analysed. Upper gastrointestinal (GI) endoscopy was performed within 12-24 h after ingestion in all cases. The Zargar classification system was used to grade the severity of the injury. Fisher's exact test was used for statistical analysis, with p < 0.05 considered as the limit of statistical significance. RESULTS: The upper GI endoscopy revealed caustic injuries in 5 (15%) and 8 (23%) patients were classified as grade IIa and IIb, respectively. Oesophageal and ventricle caustic injuries in 3 (9%) and 2 (6%) patients were classified as grade IIIa and IIIb, respectively. Thirteen patients with grade IIa and IIIb injuries suffered permanent damage and required repeated dilatation. All patients underwent stricture treatment using late or early endoscopic dilatation of the oesophagus. An average of 15 dilatation procedures were required to achieve a satisfactory lumen. CONCLUSIONS: Our experience of 34 children revealed that endoscopic dilatation may be required as a primary treatment for oesophageal strictures.

Ovarian torsion in children: management and outcomes.

BACKGROUND: The purpose of this study is to evaluate the clinical symptoms, diagnosis, management, and outcomes in children with ovarian torsion. METHODS: The charts of 50 patients with 53 cases of ovarian torsion treated between January 1989 and March 2012 were reviewed retrospectively. Long term follow up was available for 20 girls who had their ovaries left in the abdominal cavity after detorsion. RESULTS: In 22 cases ovaries were removed, and in 31 cases the torsion was relieved and the ovaries left in the abdominal cavity. Twenty-five of the salvaged ovaries were black-bluish and 10 bluish in color. Since 2005, after a change in preferred treatment, all ovaries treated by detorsion were left in the abdominal cavity. The long term results were observed clinically and by ultrasound in 20 girls. Multifollicular ovaries were found in 17 girls. One girl had a normal size paucifollicular ovary, a one-year-old girl had a normal size ovary with microfollicles, and one girl had no ovarian material detectable by ultrasound. CONCLUSIONS: Long term analysis of the treatment of ovarian torsion revealed that ovaries treated by detorsion and left in the abdominal cavity preserved their normal anatomy and function. Conservative surgical treatment proved to be safe. None of the girls had thromboembolism or peritonitis, and no malignant tumors were found in the operated ovaries.

Duplication cyst of the pylorus: a case report.

INTRODUCTION: Pyloric duplication is an extremely rare gastrointestinal tract malformation in neonates. This is the first case report of pyloric duplication in our country (Lithuania). CASE PRESENTATION: We report the case of a 2-day-old Lithuanian girl who suffered from pyloric duplication mimicking an alternative common bile duct cyst or other intra-abdominal organs cysts. A laparotomy was performed and the cystic formation of the pyloric area was successfully resected. The postoperative course was uneventful. CONCLUSIONS: There are only a few reports describing abdominal masses caused by pyloric duplication mimicking common bile duct cyst or other intra-abdominal organs cysts. Therefore thorough clinical and instrumental examination is needed to determine the most accurate diagnosis that allows one to choose the right treatment.

[Renal trauma in children]. / Vaiku inkstu traumos.

In 1987 and 1999, fifty five children were treated with a renal injury after blunt abdominal trauma at the Department of Pediatric Surgery of Vilnius University Children Hospital. There were 40 boys and 15 girls. Using a G.S. Nicolaisen and J.W. McAninch (1985) classification of injury staging, 23 (41.8%) patients were ascertained as having type I, 16 (29.1%) - type II, 15 (27.3%) - type III, 1 (1.8%) - type IV. Conservative methods were used for treatment in 91% children and 4 (7.3%) had indication for operative treatment: 2 of these children underwent nephrectomy, in 2 cases kidneys were sutured.