Patterns of pediatric thoracic penetrating injuries: A single-trauma-center experience in Riyadh, Saudi Arabia.

OBJECTIVES: To review the patterns and outcomes of pediatric thoracic penetrating injuries in a level one trauma center. METHODS: Retrospective chart review of pediatric patients who presented to the King Abdulaziz Medical City Emergency Department (KAMC-ED), Riyadh, Saudi Arabia with thoracic penetrating injury from 2001 to 2016. RESULTS: Eighty-nine patients had a penetrating injury to the thorax were identified. The mean age was 15.5 ± 3.6 years. The mean length of hospital stay was 3.87 ± 5 days. The most common cause was stabbing followed by gunshot. Isolated injury to the thorax was seen in 58 patients. The most common injuries sustained were pneumothorax and hemothorax. In the ED, tube thoracostomy was required in 65 patients, endotracheal intubation in 12, blood transfusion in 14, massive blood transfusion in one, pericardiocentesis in one, and ED thoracotomy in 2. Only 15 patients required surgical intervention. The overall mortality rate was 3.4%. Death was mainly caused by associated injuries to the heart, aorta and/or inferior vena cava. CONCLUSION: Thoracic injuries represent 25% of the overall penetrating traumas in pediatric age group. Most sustained injuries can be safely managed non-operatively, with a favorable outcome. Prompt resuscitation and intervention are required to identify and manage life-threatening injuries.

Distal Airway Aspirated Metallic Foreign Body, Case Report of Spontaneous Expectoration.

BACKGROUND Foreign body aspiration is one of the life-threatening conditions seen in the adult and pediatric population with most cases occurring within the first 3 years of life. It can result in serious complications or even lead to death. Bronchoscopic removal has been described as the management of choice. Spontaneous expectoration could happen, though it is extremely rare. CASE REPORT A 7-year-old male presented to the Emergency Department within 3 hours of aspirating a metallic nail. He had a brief choking episode at the beginning and remained asymptomatic thereafter. The initial chest x-ray showed a metallic foreign body (nail) at the retrocardiac area with patent centralized tracheobronchial tree. No radiologic signs of pneumothorax nor pleural or pericardial effusion. Computed tomography (CT) scan was performed the night of admission and revealed a 2 cm nail at the posterior basal segment of the left lower lobe bronchus. Bronchoscopy, thoracoscopic-removal, and possible thoracotomy were discussed. Management options and complications were explained. The parents preferred to wait and observe before making any decision regarding surgical intervention. Surprisingly, while in the hospital, the patient had repetitive cough and the nail was spontaneously expectorated. CONCLUSIONS Urgent bronchoscopy for foreign body aspiration is mandatory as early as possible, however, expectant management in asymptomatic distal airway foreign body aspiration is reasonable. Spontaneous expectoration is a possible outcome though extremely rare.

Fetal Tracheal Occlusion for Severe Pulmonary Hypoplasia in Isolated Congenital Diaphragmatic Hernia: A Systematic Review and Meta-analysis of Survival.

OBJECTIVE: To evaluate fetal survival after tracheal occlusion in fetuses with severe pulmonary hypoplasia and isolated congenital diaphragmatic hernia (CDH). BACKGROUND: Despite recent advances in neonatal intensive care, CDH still has a high mortality and morbidity. Fetoscopic endoluminal tracheal occlusion (FETO) stimulates lung growth and improves gas exchange in animal models of CDH, but the effects in humans are still under investigation. METHODS: We searched Pubmed, Cochrane, EMBASE, and Scopus databases for clinical studies on tracheal occlusion and CDH. All studies comparing FETO and a contemporary control group were included. The primary outcome was survival, with the need for oxygen on discharge the secondary outcome. Meta-analysis of outcome measures was performed and odds ratios, relative risk ratios, and 95% confidence intervals were estimated with a fixed-effects model and were reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. RESULTS: Between 1997 and 2015, five eligible studies describing 211 patients were included (101 control and 110 FETO). All studies selected isolated severe CDH fetuses with a lung-to-head ratio 1.0 or less and liver herniation into the thoracic cavity. FETO favored survival outcome (odds ratio 13.32; 95% confidence interval, 5.40-32.87). Meta-analysis of the secondary outcome oxygen need at discharge could not be calculated, because it was not reported in all included studies. CONCLUSIONS: FETO improves survival in isolated CDH with severe pulmonary hypoplasia compared with the standard perinatal management.

Laparoscopic-assisted anorectal pull-through for anorectal malformations: a systematic review and the need for standardization of outcome reporting.

INTRODUCTION: Laparoscopic-assisted anorectal pull-through (LAARP) is becoming an increasingly common procedure to correct high and intermediate anorectal malformations (ARMs). The aim of this review was to evaluate worldwide experiences with LAARP with regard to indications, outcomes, and quality of reporting. METHOD: A systematic review was conducted. The search was limited to studies reported in English and performed in humans. In addition to Medline and PubMed, a manual search of the Journal of Pediatric Surgery, Pediatric Surgery International, Surgical Endoscopy, and the Journal of Laparoendoscopic & Advanced Surgical Techniques published between June 2000 and April 2008 was conducted. RESULTS: Seventeen studies were included in the final analysis. Of the included studies, none were randomized, 2 were prospective in nature, and 4 compared outcomes of posterior sagittal anorectoplasty and LAARP. The studies included 124 patients (96 males, 28 females) with 80% reported as having high/intermediate malformations. All studies reported short-term outcomes. Reported outcomes included continence, rectal prolapse, the position of the rectum (7 studies using Kelly score), manometry (1 study), contrast enema (1 study), postanal endosonography (3 studies), and postoperative magnetic resonance imaging (3 studies). Outcomes varied widely between reports precluding a meta-analysis. CONCLUSION: The number of studies dealing with LAARP is low. There is a need for both a standardization and improvement in the quality of reporting in LAARP research. This will ultimately allow for evidence-based surgical decision making.