Pancreatic injury in children: a case report and review of the literature.

BACKGROUND: Trauma is the main cause of morbidity and mortality in the pediatric population. Blunt trauma to the abdomen accounts for the majority of abdominal injuries in children. Pancreatic injury, although uncommon (2 to 9%), is the fourth most common solid organ injury. Unlike other solid organ injuries, pancreatic trauma may be subtle and difficult to diagnose. Computed tomography currently is the imaging modality of choice. As the incidence of pancreatic injury in children sustaining blunt abdominal trauma is low, management remains a challenge. CASE PRESENTATION: We present a 7-year-old Bahraini boy who sustained blunt trauma to his abdomen. He presented with abdominal pain and vomiting. His examination revealed abdominal distension and an epigastric bruise. Contrast-enhanced computed tomography reported grade III liver injury, grade I bilateral renal injury, a suspicion of splenic injury, and a grade III to IV pancreatic injury. He was admitted to Pediatric Intensive Care Unit and was treated conservatively. Because he was stable, he was discharged to the surgical ward at day 3. At day 18 he developed a pancreatic pseudocyst that was aspirated and recurred at day 25 when a pigtail catheter was inserted. He was kept on total parenteral nutrition through a peripherally inserted central catheter. The pigtail catheter was removed on day 36 and a low fat diet was started by day 44. He was discharged home at day 55 in good health. Out-patient follow-up and serial abdominal ultrasound showed resolution of the cyst and normalization of blood tests. CONCLUSION: Non-operative management of pancreatic injury is effective and safe in hemodynamically stable patients with no other indication for surgery.

It's Rare So Be Aware: Pleuropulmonary Blastoma Mimicking Congenital Pulmonary Airway Malformation.

Pleuropulmonary blastoma (PPB) is a rare aggressive malignant tumor of infancy and early childhood. The tumor arises in the lung and pleura and is regarded as a pulmonary dysontogenetic or embryonic neoplasm. Four types are defined in literature. Type I PPB is a rare, cystic lung neoplasm in infants characterized by subtle malignant changes and a good prognosis. Recurrences after type I PPB are usually advanced with a poor prognosis. We report this case to increase awareness about this entity so that the pediatricians, pediatric surgeons, radiologist, and pathologist recognize it early.

Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.

BACKGROUND: Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extrapyramidal reactions, which are associated with some of the earlier generation of antiemetics. OBJECTIVES: To assess the effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Central register of Controlled Trials (CENTRAL), which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register (searched 28 July 2005), MEDLINE (1966 to July 2005) and EMBASE (1980 to July 2005). Published abstracts from conference proceedings from the United European Gastroenterology Week and Digestive Disease Week were handsearched. Cochrane UGPD Group members were contacted for details of any ongoing or relevant unpublished clinical trials. The search was re-run on 12th July 2006 and 24th June 2008 and two further trials were found. SELECTION CRITERIA: Randomised controlled trials comparing antiemetics and/or placebo in children and adolescents, under the age of 18, with vomiting due to gastroenteritis. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study investigators were contacted for additional information. MAIN RESULTS: Four trials involving 501 participants were included. No data was available for the precise time to cessation of vomiting: one trial reported a higher proportion of patients without vomiting over 24 hours in the ondansetron and metoclopramide groups than placebo. Oral ondansetron in one trial ensured cessation of emesis for 8/12 (67%) patients within the first 4 hours and 7/12 (58%) patients in the first 24 hr period. In one trial 14% of patients who received oral ondansetron vomited during oral rehydration compared to 35% to the placebo group. In a further trial intravenous rehydration was required in 21.6% (ondansetron group) versus 54.5% (placebo group) P< 0.001. AUTHORS' CONCLUSIONS: The small number of included trials provided some limited evidence favouring the use of ondansetron and metoclopramide over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. The increased incidence of diarrhea with both ondansetron and metoclopramide was considered to be as a result of retention of fluids and toxins that would otherwise have been eliminated through the process of vomiting.

Bilateral hippocampal hyperintensities: a new finding in MR imaging of heat stroke.

We present a child aged 2 years 3 months who suffered heat stroke after being accidentally locked in a car during summer. She was unconscious with hyperthermia on admission and later showed biochemical evidence of liver, cardiac and muscle injury and associated electrolyte imbalance. Her level of consciousness gradually improved, but she showed evidence of cortical blindness, which had improved on follow-up. MR imaging on the 5th day revealed bilateral hippocampal hyperintensities along with hyperintensities in the cerebellum and in the cerebral cortex. Previous case reports of imaging in heat stroke revealed involvement of the cerebellum, thalami, basal ganglia and scattered cerebral involvement. We report this unique finding of hippocampal hyperintensities due to heat stroke.