Foreign body ingestion in children.

INTRODUCTION: Evaluation of results of the group of paediatric patients treated for swallowed foreign bodies in the digestive tract. METHODS: Retrospective analysis of patients treated for foreign bodies in the digestive tract, managed at the University Hospital of Hradec Králové between 2011-2018. RESULTS: 365 patients (182 boys, 183 girls) with a foreign body in the digestive tract have been evaluated. The mean age was 2.4 years. Most of the children were treated as outpatients (280 children, 76.7%) and only 85 children (23.3%) were hospitalized. The most commonly swallowed frequent bodies included coins (26%) and batteries (14.5%); sharp objects occurred in 5.2%. Unusual foreign bodies were noticed, too. We can mention for example a pen or a plant nutrition product. In 302 cases (82.7%) the foreign bodies passed easily per vias naturales. Endoscopy was necessary in 63 cases (17.2%) - in 51 children the object had to be removed from the oesophagus and in 12 children the object had to be removed from the stomach. None of the swallowed bodies caused complications such as digestive tract perforation or bowel obstruction. No patient in the group was indicated for laparotomy to remove the foreign body. CONCLUSION: Foreign bodies entrapped in the oesophagus have to be removed endoscopically. In most cases, foreign bodies in the stomach require only observation in the outpatient setting because they leave the stomach easily, without complications, per vias naturales. If a battery remains at the same place of the digestive tract for more than 24 hours, endoscopic removal is indicated at our department. In addition, endoscopy is done in cases of swallowed multiple magnets or bodies that are too large and remain in stomach for several weeks or months. Surgical removal of foreign bodies should be reserved only for complicated cases.

[Open versus laparoscopic appendectomy for acute appendicitis in children]. / Otevrená versus laparoskopická operace akutní apendicitidy u detí.

INTRODUCTION: Acute appendicitis is a common disease affecting both adults and children. The basic therapeutic procedure is an appendectomy. Open appendectomy has been gradually supplemented and sometimes replaced by a laparoscopic approach in numerous departments. The aim of our work was to compare laparoscopic and open surgery objectively. METHOD: Retrospective analysis of data from patients operated on at the Department of Pediatric Surgery and Traumatology, Teaching Hospital in Hradec Králové in 20092016. Only the precisely evaluated parameters, i.e. the time of anesthesia, the time of surgery and the duration of post-operative pain, were assessed within the scope of objectification. Data were evaluated only in a homogeneous group of patients with phlegmonous appendicitis. RESULTS: During the above period, 261 patients with acute appendicitis were operated on at our department, 166 of whom suffered from phlegmonous appendicitis. 133 children were operated laparoscopically and 33 by open procedure. The results obtained were statistically significantly different only for the time of anesthesia (p=0.00035) which was shorter in open operations. The time of surgery was also shorter in the open operation group, but only at the limit of statistical significance. A statistically significant difference was not found in the time of duration of pain for individual surgical approaches. CONCLUSION: Laparoscopic approach in the surgical treatment of acute appendicitis is a more modern method than open surgery and it has become a standard procedure in some departments. However, the results of our study confirm that the open approach remains an equivalent alternative to the treatment of acute phlegmonous appendicitis.Key words: appendicitis open appendectomy laparoscopy.

[Retrogastric bronchogenic cyst]. / Retrogastrická bronchogenní cysta.

The authors present a case of an incidental finding of an asymptomatic retrogastricaly localized bronchogenic cyst. In a 3.5 year old boy, abdominal US, which was performed because of constipation complains, revealed a cystic mass. MRI study confirmed the presence of a simple cyst, located in the retrogastric region. The patient underwent laparotomy and the cyst, measuring 3 cm in a diameter, was removed from the omental bursa. During the postoperative period, no complications or symptoms were recorded. Histologicaly, the finding was surprisingly identified as a bronchogenic cyst. Occurence of bronchogenic cysts within the abdominal cavity is reported very rarely in the literature.

Laceration and degloving injury of a child's foot--a case report.

Laceration and degloving injury to a child's foot is quite a rare occurence, mostly resulting in persistent consequences. Treatment options for such an injury depend on the specific type of injury and the customary practice of each surgical department. The authors present the interesting case of 4-year-old boy with laceration and degloving injury to his right foot after a collision with a truck, suggesting simple treatment using skin graft which has an excellent functional and cosmetic effect. Several methods have been described in management of this kind of injury, such as microvascular free tissue transfer, free or local flap and skin graft. A full-thickness skin graft was used in this case with good result, and in our opinion this treatment option need not be reserved for plastic surgeons.

[Rupture of the interventricular septum after the blunt trauma of thorax]. / Traumatická ruptura mezikomorového septa jako následek tupého poranení hrudníku--kazuistika.

Authors present the case of little patient with the dissection, pseudoaneurysm and finally a rupture of the interventricular septum after the blunt thracic injury. The patient was smitten as a pedestrian by a car and during the whole period of her stay in the hospital she was showing signs of circulatory instability. Due to the current intraabdominal injuries this circulatory decompensation was first assigned to hemoperitoneum, for which the girl was operated on about 3 hours after admission. Nevertheless, even after the abdminal cavity check, after the treatment of supreficial liver lacerations and intensive volume resuscitation the patient showed signs of insufficiency. Diagnosis was finally determined on the base of the transthoracic echocardiography (TTE), which proved the traumatic rupture of interventricular septum. The operation followed correcting the defect, which was performed with a good result according to the TTE postoperatively. Nevertheless, 27 hours after the admission the patient died due to the electromechanical dissociation. In the discussion the authors then evoke a number of papers concerning the same topic.

[A ventral slit of the prepuce in phimosis]. / Ventrální discize predkozky u fimózy.

The appearance of the penis after circumcision is frequently not appreciated favourably by the patients nor their parents. An alternative surgical method in phimosis is a ventral slit of the prepuce. When properly indicated, an almost normal appearance of the prepuce is preserved. This operation was performed in 25 boys. An ideal result, where an almost normal shape of the prepuce is preserved and the latter can be drawn over the glans, was achieved in 19 patients. In four boys the prepuce can be freely drawn over the glans but a slight strangulation ring forms. A relapse of phimosis occurred in two boys. The authors recommend to use ventral slit of the prepuce instead of circumcision in children with phimosis, when the prepuce is sufficiently long. The method is not suitable for short prepuces with cicatricial phimosis.

[Cysts and pseudocysts of the spleen in children]. / Cysty a pseudocysty sleziny u detí.

A cyst in the upper pole of the spleen was diagnosed in three children. In all the pole of the spleen was resected -in two instances it contained a cyst, in one a pseudocyst. The postoperative course was without complications. All patients had scintigraphic check-up examinations, in all three instances functional lienal tissue was found which did not differ much as to its size from that of a normal spleen. In cysts situated in the splenic pole the authors consider partial resection of the affected portion of the spleen as the optimal surgical method. In cysts of other portions of the spleen it would be better to select a different surgical procedure, e.g. enucleation of the cysts, partial decapsulation of the cyst or percutaneous puncture of the cyst combined, if necessary, with sclerotization.

[Laparoscopy-assisted appendectomy in children]. / Laparoskopicky asistovaná apendektomie u detí.

During a 13-month period (March 1, 1995 March 31, 1996) the authors performed in 70 children a laparoscopically assisted appendectomy. 68 children were operated on account of chronic appendicitis, two on account of acute appendicitis. During the postoperative period early, not very serious, postoperative complications were recorded in 7 children. One girl had on the second day after operation fever and severe abdominal pain, four children developed on the 5th-7th day after surgery abdominal pain, associated in three instances with fever and in two instances with the pathological finding of pericoecal fluid. The complaints receded within 1-2 days in all five patients after conservative treatment. In another two children the wound healed per secundam intentionem. No late complications were recorded.

A simplified procedure for studies of intestinal immunity in rabbits.

As interest in the development of oral vaccines continues to rise, alternative animal models for studies of mucosal immunity are needed. The present study examines a simplified procedure for delivering antigen to rabbit Peyer's patches via an indwelling cannula. The cannula was placed 3-4 cm proximal to the Peyer's patch, and was used to deliver four weekly doses of the potent mucosal immunogen, cholera toxin (CT). Anti-CT specific fecal secretory IgA (S-IgA), serum IgG and serum IgA were found in essentially equal amounts in rabbits with cannulas and in rabbits fitted with Thiry-Vella (T-V) isolated ileal loops. In contrast to animals with T-V loops, the intestinal flora of animals with cannulas contained less bacterial overgrowth with Pseudomonas sp. Further, the villus architecture remained histologically normal in appearance and there were fewer post-surgical complications associated with this technique than with T-V loops. This simplified technique should allow wider use of rabbits in studies of mucosal immunity.

[Disorders of intestinal rotation and fixation in older children]. / Poruchy strevní rotace a fixace u vetsích detí.

The authors discuss five older children where malrotation of the gut was diagnosed. The youngest child was three years old, the oldest 16 years. In three children the malrotation was diagnosed from clinical symptoms and examination by imaging methods, in two it was detected by chance during operation. In the two children where the impaired rotation of the gut was detected on operation, non-rotation was involved. In the remaining three children twice a left side paraduodenal hernia was diagnosed and once an external stenosis of the duodenum by Ladd's bands.

[Diagnosis and therapy of post-traumatic hemobilia]. / Príspevek k diagnostice a lécbe poúrazové hemobilie.

The submitted case-history deals with a successfully diagnosed and treated case of post-traumatic hemobilia in a 13-year-old girl. Hemobilia was manifested clinically by the typical Sandblom triad of symptoms. It was due to a pseudoaneurysm of the peripheral arteriole of the hepatic artery diagnosed by selective liver angiography. In treatment selective intraarterial embolization of the supplying artery proved useful.

[Adnexal torsion in childhood]. / Torze adnex v detském veku.

During the 7-year period (1987-1993) the authors treated nine girls on account of torsion of the adnexa. In six girls torsion of primarily unaltered adnexa occurred, in one girl torsion of an ovary enlarged by a cyst and in two torsion of the ovary affected with a benign tumour, a coetaneous teratoma. In seven instances the organ affected with ischaemic necrosis had to be resected. In two girls detorsion of the ovary was performed, according to a sonographic control examination, however, in one the affected ovary atrophied. In the discussion the authors deal with the diagnosis of torsion of the adnexa and the method of treatment. The authors consider ultrasonic examination of organs of the abdominal cavity and retroperitoneum a very suitable method in all cases of abdominal pain in childhood, as this method can greatly contribute to the diagnosis of acute abdominal and gynaecological attacks. During surgery they recommend to preserve adnexa with a doubtful vitality because there is certain hope that they will be saved. During the postoperative period they recommend the long-term follow up of girls clinically and by ultrasonographic checks. If pathological changes are detected on the preserved adnexa, they recommend early re-operation and elimination of the risk factor (cysts etc.). The operation should be supplemented by prophylactic fixation of the preserved adnexa if this fixation was not done already during the primary operation.

[Comparison of the results of conservative and surgical therapy of dislocated supracondylar fractures of the humerus in children]. / Porovnání výsledku konzervativní a operacní lécby dislokovaných suprakondylických zlomenin humeru u detí.

The authors evaluate retrospectively in a group of 121 children with a dislocated supracondylar fracture in 1984-1993 the results of different therapeutic methods. The highest percentage of excellent and satisfactory results was recorded in children treated by closed reposition with percutaneous pinning with Kirschner wires (88%). In open reposition with Kirschner wires 60% of the results were excellent of satisfactory. The lowest percentage of excellent and satisfactory results was recorded when fixation with a plaster bandage was used (48%). The highest percentage of poor results was observed in surgical reposition with internal fixation (37%). The cause of failure in the majority of patients is according to the authors inadequate reposition of fragments. The authors discuss different types of treatment. They recommend non-surgical reposition with percutaneous pinning, even for less dislocated extension supracondylar fractures of the humerus as well as for fractures complicated by vascular injuries.

[A solitary congenital hepatic cyst]. / Kongenitální solitární cysta jater.

The author discusses a congenital, solitary, multilocular liver cyst in a two-year-old boy. The cyst originated in the margo ventralis of the right liver lobe. Clinically it was manifested by marked enlargement of the abdomen. The diagnosis was established by ultrasonography. The whole cyst was removed surgically.

[Splenosis]. / Splenóza.

Four patients where during childhood splenectomy was performed on account of a traumatic indication were after 9-12 years subjected to sonographic and scintigraphic examination focused on possible evidence of splenosis. In one case asymptomatic splenosis was detected by scintigraphy.

[Conservative therapy of liver injuries in children]. / Konzervativní lécba poranení jater u detí.

During the 14-year period between 1979 and 1992 the authors treated by conservative methods nine children with liver injuries. They operated on four children. The liver injury did not bleed during operation or haemorrhage was only minimal and probably the patients would have also recovered after conservative treatment. In the discussion the authors mention diagnostic approaches in liver injuries and criteria and methods of conservative treatment. The authors consider conservative treatment of liver injuries in children to be a very suitable method which is associated only with a very small number of complications, and which proves successful in the majority of patients. The prerequisite for its application are high standard of diagnostic visualization methods, monitoring of the child's condition and the possibility of immediate surgery, if conservative treatment fails.

Giant Meckel's diverticulum.

A case of incomplete intestinal obstruction caused by a giant Meckel's diverticulum in a 13-year-old girl is reported. Short resection of the ileum with the diverticulum and end-to-end anastomosis was carried out. The possibilities of diagnosis and treatment as well as the controversial classification of this rare congenital anomaly are discussed.

Endoscopic retrograde cholangiopancreatography in childhood.

ERCP was performed in 19 children and adolescents aged 4 to 16 years. In 13 children the examination was done under general anesthesia, in 6 cases with the usual premedication using dolsin and atropine. Indications for examination were unclear abdominal pain with occasional amylase elevation, in 3 patients status after an abdominal injury. In 16 patients the examination clarified the complaints by detecting organic disease of the gallbladder or the pancreas. ERCP is an important procedure in the event of uncertain diagnosis in children and adolescents and, if the indication is correct, and the technique good, is well tolerated by the patients.

[The significance of endoscopic retrograde cholangiopancreatography in the diagnosis of pancreatic injuries in children]. / Význam endoskopické retrográdní cholangiopankreatografie v diagnostice poranení pankreatu u detí.

The condition of the main pancreatic duct determines very probably in a decisive way the fate of posttraumatic pancreatic pseudocysts and acute pancreatic injuries. Endoscopic retrograde cholangiopancreatography is the only diagnostic method which makes possible to evaluate the condition of this duct. The authors performed ERCP in three children, in two of them an internal drainage of the pseudocyst was carried out on account of verified ductal rupture. In the third girl, after evidence of an intact main pancreatic duct, conservative therapy was successfully applied. In the discussion the authors summarize data from the literature regarding the use of ERCP in the preoperative diagnosis of posttraumatic pancreatic pseudocysts and acute pancreatic injuries. The authors consider ERCP a method which renders the diagnosis of posttraumatic pancreatic pseudocysts and acute pancreatic injuries more accurate.