Antibiotics administration before enema reduction of intussusception: is it necessary?

BACKGROUND: Some centers advocate using antibiotics before enema reduction to prevent septic complications. Our objective was to determine whether using antibiotics before reduction provided any improvement in outcomes. METHODS: With institutional review board approval, patients from 2 centers were compared: 1 where antibiotics were administered, and one where they were not. This retrospective cohort study from January 2005 to December 2010 evaluated demographic data, episodes of postreduction fever, hospital stay, and analgesia requirements. RESULTS: One hundred eighteen patients were identified: 83 males (70.3%) and 35 females (29.7%). The median age was 24 months (range, 1-180). Fifty-six patients (57.7%) received antibiotics, whereas 41 (42.7%) did not. Twenty-one patients (17.8%) had missing data and were excluded. The incidence of fever postreduction was not statistically different between groups: 12.8% for those who received antibiotics vs 17.9% for those who did not (P = .7367). No adverse antibiotic reactions were reported. Average time to oral feeds was 7.3 vs 10.6 hours (P = .06), and the length of stay was 1.7 vs 1.4 days (P = .07). CONCLUSION: Although antibiotics are administered routinely in some centers, they appear of little value. Financial costs and potential adverse reactions must be considered. Further prospective evaluation is being conducted using a larger sample size to confirm these results.

Congenital esophageal stenosis and antral web. A new association and management challenge.

Congenital esophageal stenosis is a rare condition that may be associated with other anomalies. Antral web is also a rare congenital condition. Association of both conditions is extremely rare. We present this rare association in preterm baby in whom initially misdiagnosis of esophageal atresia and trachea-esophageal fistula then followed by a dilemma in differentials diagnosis to explain the uneventful postoperative recovery. The aim of this report is to highlight the diagnostic and therapeutic difficulty of this rare condition.

Magnetic toy ingestion leading to jejunocecal fistula in a child.

The accidental ingestion of a foreign body is a common problem in children, but ingestion of magnets is rare. When multiple magnets are ingested, they may attract each other and cause pressure necrosis through the bowel walls and eventually lead to serious complications like obstruction, perforation, and fistula formation. We report a case of a 5-year-old girl with jejunocecal fistula following ingestion of 2 magnet toys; it highlights the diagnostic challenge and the need for early surgical intervention in children especially when multiple magnets are ingested.

Thoracoscopic repair of tracheoesophageal fistulas: a case-control matched study.

INTRODUCTION: To date, there is no comparative study of thoracoscopic repair (TR) vs conventional open repair (COR) for tracheoesophageal fistula (TEF). The aim of the study was to compare the 2 techniques in neonates with TEF. METHODS: A multi-institutional case-control study of cases of TEF was undertaken. The minimum follow-up was 6 months. Patients were considered for TR based on surgeon's preference. Cases were frequency matched on a 1:1 ratio based on gestational age and weight. Outcomes of interest were operative time, postoperative leaks, and postoperative stricture development. Statistical analysis using univariate analysis was performed. RESULTS: Twenty-three neonates underwent TR. There were no differences between TR and COR groups with regard to weight and gestational age. The distribution of associated anomalies was similar in both groups. The mean operative time was 149.4 and 179 minutes in TR and COR, respectively (P = .18). Three patients were converted to COR. There were 4 leaks in TR and 3 in COR (P = .728). Inversely, 2 patients in the TR group developed a stricture necessitating dilation as compared with 4 patients in the COR group (P = .414). CONCLUSION: Thoracoscopic repair of TEF is safe and comparable with conventional open repair.

Thoracoscopic division of vascular rings in infants and children.

OBJECTIVE: Traditionally vascular rings in infants and children are treated through an open thoracotomy. Recently, thoracoscopic surgery has been used for these complex procedures. This study reports our early experience with thoracoscopic division of vascular rings and evaluates the efficacy and safety of this approach. MATERIAL AND METHODS: Patients who underwent thoracoscopic division of vascular rings at King Khalid University Hospital, Riyadh, Saudi Arabia, from December 2004 to January 2006 are included. Their data were carefully analyzed looking at demographics, clinical presentation, diagnostic modality, type of the anomaly, operative details, complications, and outcome. RESULTS: A total of 9 patients underwent thoracoscopic division of vascular rings. Age at surgery ranged between 2 and 108 months (mean, 24 months). Weight varied between 5.3 and 32 kg (mean, 10.3 kg). All patients were symptomatic. Computed tomographic scan was diagnostic and accurately defined the type of anomaly in all the patients. Four patients had a right aortic arch with an aberrant left subclavian artery and left ductus/ligamentum arteriosum, 2 had double aortic arches, and 3 had a right aberrant subclavian artery. One patient developed right-sided pneumothorax on the contralateral site, and another one developed apnea 12 hours after surgery, requiring mechanical ventilation. There was no mortality. Operative time ranged between 50 and 145 minutes, the mean being 107 minutes. The average hospital stay was 4 days. Five patients had their preoperative symptoms completely resolved, and the rest are showing steady improvement. The average follow-up period is 6 months. CONCLUSION: Our early experience indicates that thoracoscopic division of vascular rings is safe and effective. Because it takes away the need for thoracotomy, it is likely that it can result in less postoperative pain and rapid convalescence. It also prevents the ill effects of thoracotomy and gives good cosmetic results.

Primary omental torsion: a rare cause of acute abdomen.

Torsion of the greater omentum is a rare condition with symptoms resemble those of acute appendicitis and is infrequently diagnosed preoperatively. Treatment is surgical excision. Laparoscopic approach is an excellent diagnostic and therapeutic tool.