ABSTRACT
When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulized or complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay.
Subject(s)
Digestive System Surgical Procedures/methods , Esophageal Atresia/diagnosis , Esophageal Atresia/therapy , Gastric Fundus/surgery , Humans , Infant, Newborn , MaleABSTRACT
Cuando resulta imposible restablecer la continuidad esofágica en las atresias de esófago (AE), el ascenso del estómago sólo y/otubulizado y la interposición de colon son las técnicas más realizadas, normalmente a partir de los 6 meses de edad, en varios tiempos y con alta morbilidad, larga estancia hospitalaria y alto coste social, familiar y económico. Hemos tratado a tres niños con AE, de un total de 34 AE diagnosticadas, en un período de 11 años, tubulizando el fundus gástrico, con suturas mecánicas, en continuidad con el cabo distal esofágico, en período neonatal. La técnica (basada en la técnica de Schärli) conlleva la tubulización desde la curvatura menor gástrica del fundus gástrico, mediante el uso de suturas mecánicas en continuidad con el cabo distal esofágico. De esta manera se efectúa una anastomosis esofago esofágica conservando el cardias y tubulizando el estómago en sentido isoperistáltico. Todos los pacientes han requerido dilataciones neumáticas de la anastomosis esofago esofágica. El control y seguimiento tras 11 años, 8 años y 8meses es satisfactorio en los tres pacientes, los cuales se encuentran bien, sin problemas de deglución y con un aceptable y adecuado desarrollo pondoestatural. Creemos que este tipo de intervención y realización de un neoesófago es útil para tratar las AE de segmento largo en neonatos, al emplazar un tubo esofagogástrico ortotópicamente de calibre homogéneo en continuidad isoperistáltica en período neonatal y en un solo tiempo, prescindiendo de la gastrostomía realizada a las pocas horas de vida, consiguiendo una importante reducción de la morbilidad y estancia hospitalaria (AU)
When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulized or complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulizedor complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay (AU)
Subject(s)
Male , Female , Infant, Newborn , Humans , Esophageal Atresia/surgery , Gastric Fundus/surgery , Intubation, Gastrointestinal/methods , Esophagoplasty/methods , Postoperative Complications/epidemiologyABSTRACT
Las quemaduras en la infancia constituyen un accidente que reviste un alto grado de dramatismo, fundamentalmente por la aparatosidad de las mismas y sus consecuencias inmediatas, y por otro lado por lo doloroso y elevado número de las curas, prolongada hospitalización y las secuelas estéticas e incluso funcionales que suelen dejar de por vida. Presentamos nuestra experiencia con el uso de Biobrane©, entre 1995 y 2000, en el tratamiento de 196 pacientes (edades: 4 meses a 14 años): 141 pacientes con lesiones por quemaduras de primer y segundo grado, 45 recubrimientos de zonas dadoras, 4 protecciones de injertos mallados, 3 dermoabrasiones traumáticas, 2 exéresis de tatuaje cutáneo post-traumático y 1 necrolisis epidérmica tóxica. Ventajas apreciadas al finall del tratamiento: Cicatrización excelente. Ausencia de dolor durante los cambios de apósitos. Menor necesidad de autoinjertos. Muy útil para el recubrimiento de zonas dadoras e injertos mallados. Disminución considerable de la estancia hospitalaria e ingresos. Mayor nivel de satisfacción en pacientes, en sus padres y en el personal sanitario. Posibilidad de tratamiento ambulante en Consultas externas y en Centros de Atención Primaria. Disminución de los costos hospitalarios en general. (AU)
Subject(s)
Child, Preschool , Child , Adolescent , Male , Infant , Female , Humans , Wounds and Injuries , Coated Materials, Biocompatible , BurnsABSTRACT
Burns in the pediatric age are accidents which cause a lot of trauma, on the one hand because of their immediate consequences and on the other hand because of the severity of the pain, the amount of times the dressings need to be change, the lengthy hospital stay and the scars that remain for life. Between 1995 and 2000 we have treated 196 children, (4 months to 14 years old), with Biobrane: 141 patients affected of first and second degree burn injuries, 45 skin donor sites covering, 4 reinforcing of meshed autografts, 3 traumatic dermoabrasions, 2 extirpation of post-traumatic cutaneous tattoo and 1 Toxic epidermic necrolisis. Advantages noticed at the end of the treatment: Excellent skin healing. No pain while changing dressings. Reduction the need to use skin grafts. It is very useful to cover the skin donor sites and meshed autografts. Shorter Hospital stay and less need to be kept in hospital. A higher level of satisfaction is shown by children, their parents and sanitary workers. It offers the possibility of outpatients treatment in First Aid Health Centers. It reduces hospital costs.
Subject(s)
Burns/therapy , Coated Materials, Biocompatible/administration & dosage , Wounds and Injuries/therapy , Adolescent , Child , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
Se presenta un caso de adenocarcinoma de colon en un varón de 10 años, sin factores predisponentes. Clinicámente se manifestó con obstrucción intestinal, consecuencia un avanzado estadío local. La terapeútica quirúrgica y en quimioterapia no modificó por la rápida progresión tumoral por lo que el niño falleció a los 5 meses del diagnóstico.Se comentan los aspectos clinicos,patológicos y evolutivos del cáncer de colon en la edad pediátrica...
Subject(s)
Humans , Child , Adenocarcinoma/surgery , Colonic Neoplasms/surgeryABSTRACT
Se presenta un caso de adenocarcinoma de colon en un varón de 10 años, sin factores predisponentes. Clinicámente se manifestó con obstrucción intestinal, consecuencia un avanzado estadío local. La terapeútica quirúrgica y en quimioterapia no modificó por la rápida progresión tumoral por lo que el niño falleció a los 5 meses del diagnóstico.Se comentan los aspectos clinicos,patológicos y evolutivos del cáncer de colon en la edad pediátrica... {
Subject(s)
Humans , Child , Adenocarcinoma/surgery , Colonic Neoplasms/surgeryABSTRACT
We report a case of bilateral and multilobar congenital cystic adenomatoid malformation (CCAM) in a four-months-old child with good clinical results after resections of the lesions. This is a relatively rare form of pulmonary disease. The final prognosis in these patients depends on the type of malformation, the presence or absence of fetal hydrops and on the extent of affected lung. Few cases of multiple involvement have been reported. We will consider the physiopathological aspects of the case, late clinical presentation and treatment and the positive surgical response based on the findings of the functional and anatomic imaging studies.
Subject(s)
Cystic Adenomatoid Malformation of Lung, Congenital/diagnosis , Cystic Adenomatoid Malformation of Lung, Congenital/physiopathology , Cystic Adenomatoid Malformation of Lung, Congenital/surgery , Humans , Infant , Male , Treatment OutcomeABSTRACT
A case of torsion of the vermiform appendix is described in a five-year-old boy with a two-day history of right-sided abdominal pain. No associated abdominal tenderness was reported, no vomiting nor fever. The pain was localized in the same place for 24 hours and became more severe and constant. Blood film showed a normal white cell count. After two ultrasonographic examinations in the course of 24 hours, the sign of a distended intestinal loop became constant. With the diagnosis of mucous-producing appendicular lesions or appendicular torsion, a laparotomy was performed. The appendix was severely congested and gangrenous; there was a 360-degree anticlockwise twist in its base. The related literature is reviewed and the value of the ultrasound scanner images and the possible mechanism involved is discussed.
Subject(s)
Appendix , Cecal Diseases/diagnostic imaging , Appendix/diagnostic imaging , Cecal Diseases/surgery , Child, Preschool , Humans , Male , Torsion Abnormality/diagnostic imaging , Torsion Abnormality/surgery , UltrasonographyABSTRACT
A rare intestinal malformation is reported in a boy 11 years old with a 3-year history of abdominal pain and chronic anemia. Laparotomy revealed a large cecal mass extending beyond the ileocecal valve in the place of the appendix, with bleeding mucosal ulcers.
Subject(s)
Appendix/abnormalities , Cecum/abnormalities , Intestinal Atresia/surgery , Child , Dilatation, Pathologic , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/surgery , Humans , Intestinal Atresia/pathology , Male , Ulcer/pathology , Ulcer/surgerySubject(s)
Diaphragm/injuries , Child , Child, Preschool , Diaphragm/surgery , Female , Humans , MaleABSTRACT
Koff's procedure in the treatment of distal hypospadias consist in a large mobilization of the distal urethra. The association to a transglandular funelization and minimal urethroplasty is useful for the treatment in the majority of patients with distal hypospadias. In the last two years 34 patients with distal types of hypospadias were operated with a Koff's modified procedure. The technique consists in a urethral advancement without glanduloplasty and distal cutaneous tubulization. The primitive meatal localization was subcoronal (n = 22), glandular (n = 6), and on the distal shaft (n = 6). In 10 cases urethral catheters was not necessary. A patient develops a proximal fistula successfully treated with 14 days catheterization. Cosmetic and functional results were good in all cases. Extensive urethral mobilization can be done in cases of distal hypospadias and is evidence of the preserved vascularity and viability of the mobilized urethra.
Subject(s)
Hypospadias/surgery , Urethra/surgery , Child , Child, Preschool , Humans , Infant , Male , Retrospective StudiesABSTRACT
A seven year old boy, one week after surgical intervention for blunt liver trauma, presents an intrahepatic bilioma. Under ultrasonografic guidance, an external drainage is inserted. Contrast injection shows billiary fistula. Three weeks later, after a new contrast injection, billiary fistula resolution is proved, and dranaige tube is withdrawn. Ultrasonografic and CT Scan studies showed total resolution of intrahepatic collection. Intrahepatic billiary collections are a rare complication of the hepatic traumatism. Conservative management with external drainage, should be keept in mind like a first choice terapeutic option.
Subject(s)
Bile Duct Neoplasms/etiology , Bile Duct Neoplasms/surgery , Bile Ducts/surgery , Drainage , Liver/injuries , Wounds, Nonpenetrating/complications , Bile Duct Neoplasms/pathology , Bile Ducts/pathology , Child , Humans , MaleABSTRACT
Children with splenic trauma are managed conservatively in most circumstances, and the need for surgical interventions is very rare. When a surgical exploration is mandatory, splenic preservation is a worthwhile objective, using various suture methods, biomaterials, or resorbable prosteses. We present our experience over the 4 years with 9 severe splenic injuries. Six of this patients were treated operatively with a reabsorvable mesh, while the other 3 were managed percutaneosly by selective embolization of the splenic artery under fluoroscopic control. We describe our experience in the treatment of the splenic injuries in the last four years.
Subject(s)
Embolization, Therapeutic , Spleen/injuries , Spleen/surgery , Adolescent , Child , Child, Preschool , Female , Humans , MaleABSTRACT
The Rapunzel Syndrome is a rare form of gastric trichobezoar extending throughout the bowel. A 8-year-old girl was admitted to our institution with a six months history of vomiting and astenia. Upper gastrointestinal contrast study showed a lot of filling defects in stomach and the first bowel loops. At laparotomy a large intraluminal mass is observed. Gastrotomy revealed a large tricobezoar with intestinal extension to jejunum, that were extracted. In rare instances, this syndrome presents with a confusing clinical picture. A detailed medical history is an essential point in the diagnosis.
Subject(s)
Bezoars/diagnosis , Bezoars/physiopathology , Bezoars/surgery , Child , Digestive System/physiopathology , Digestive System Surgical Procedures , Female , Humans , Laparotomy , SyndromeABSTRACT
The definitive surgical treatment in the first months of life without colostomy are essential principles at present in the management of Hirschsprung's disease. The appearing of little size stapling devices like EndoGIA, from the development of laparoscopic surgery, make possible the application of the classical surgicall procedures on early age patients. The experience in five patients operated under two months of life with the Duhamel-Martin procedure is reported. Only in one case previous colostomy was performed for one episode of enterocolitis at age of fifthteen days. The stapling of both pouches was performed with EndoGIA. The agartglionic pouch was closed with TA Roticulator. That provides a reduction in the high of the aganglionic pouch at minimum. Follow-up varied from 3 months to 2 years, without any complication.
Subject(s)
Colon/surgery , Hirschsprung Disease/surgery , Rectum/surgery , Age Factors , Anastomosis, Surgical , Follow-Up Studies , Hirschsprung Disease/diagnostic imaging , Humans , Infant , Infant, Newborn , Radiography , Surgical Staplers , Time FactorsABSTRACT
Children with splenic trauma are managed conservatively in most circumstances, and the need for surgical intervention is very rare. When surgical exploration in mandatory, splenic preservation is a worthwhile objective, using various suture methods, biomaterials, or resorbable prostheses. We present our experience over the past year with 5 severe splenic injuries. Three of these patients were treated operatively with a resorbable mesh, while the other two were managed percutaneously by selective embolization of the splenic artery under fluoroscopic control. We describe the embolization technique with its advantages, good outcome with low morbidity, and low economic and social cost.
Subject(s)
Embolization, Therapeutic , Polyglycolic Acid , Spleen/injuries , Splenic Artery , Surgical Mesh , Adolescent , Child , Child, Preschool , Female , Humans , Male , Splenic Rupture/surgeryABSTRACT
The association of imperforate anus with anomalies of rectal innervation is very rare. Moreover, malrotation only rarely accompanies these malformations. We report 2 patients with this unusual triple association and its impact on their management. Retrospectively both patients presented at birth with the same radiological picture of distended distal colon and right-sided small bowel location. We discuss the importance of a systematic search for associated intestinal malformations in cases of imperforate anus in order to avoid serious complications and to choose the optimal operative strategy.
Subject(s)
Anus, Imperforate/surgery , Hirschsprung Disease/surgery , Intestinal Obstruction/congenital , Anastomosis, Surgical , Anus, Imperforate/diagnosis , Colostomy , Follow-Up Studies , Hirschsprung Disease/diagnosis , Humans , Ileostomy , Infant , Infant, Newborn , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Male , ReoperationABSTRACT
Acquired or congenital laryngotracheal stenosis is uncommon in children although premature infants with respiratory distress syndrome (SDR) requiring ventilatory support with prolonged intubation are at great risk. The different treatments used in the past show high rates of morbidity and mortality. Following the technique described by Cotton in 1980, anterior cricoid slit procedure in the upper two tracheal rings has been used as a primary treatment on five patients since 1991, four by intrinsic stenosis and one by extrinsic. Extubation failed in four of them, checking trough bronchoscopy different grades of laryngotracheal stenosis and in the fifth due to respiratory distress, secondary to subcricoid stenosis. Anterior cricoid split procedure with intubation with conventional endotracheal tube (SET) or Montgomery tube (TTM) was performed on infants whose ages ranged from 4 to 18 months old (averaged 8 months). They were extubated between the 5th and 340th days after surgery. Two of them underwent complications: a skin-tracheal fistula and a paresis of the left vocal cord, the two are asymptomatic after four and eighteen months of the procedure. All patients discharged without signs of upper airway obstruction, except one who developed a granuloma which diminished with cortisone. Anterior cricoid split with prolonged intubation is a safe and useful technique for the treatment of laryngotracheal stenosis.
Subject(s)
Laryngostenosis/surgery , Tracheal Stenosis/surgery , Age Factors , Child, Preschool , Follow-Up Studies , Humans , Infant , Intubation, Intratracheal , Postoperative Complications , Time FactorsABSTRACT
Morbidity and mortality are especially increased in pediatric patients affected of short bowel syndrome in whom ileocecal valve was resected. This report concerns 13 infants and children with short gut syndrome with ileocecal valve resected treated in the last 4 years. In two of them we performed intestinal duplication and in seven an antireflux intestinal valve with a segment of bowel. With that procedure we achieved a significant shortening of the hospital stay as well as reduction in time and quantity of total parenteral nutrition. The rest of the patients were treated with conservative management.
