Our Neonatal Surgery Experiences in Somalia.

Purpose: The aim of this study is to report surgical outcomes of the neonates who have undergone various surgical procedures. Materials and Methods: In this retrospective study, 39 neonates who have undergone a surgical procedure in Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, between October 2018 and March 2019 were included. Data regarding age, gender, diagnosis, surgical procedure, length of hospital stay, mortality, and cause of mortality were recorded. Results: Of 39 neonates, 12 were female (30.7%) and 27 were male (69.3%). The mean age of the neonates at admission was 7.7 ± 7.6 days (1-30 days) days. The most common diagnoses were anal atresia (n = 12, 30.8%), esophageal atresia (n = 9, 23.1%), and pyloric stenosis (n = 5, 12.8%). The most common surgical procedures were colostomy creation (n = 10, 25.6%), esophageal anastomosis (n = 9, 20.5%), primary closure of anterior abdominal wall defects including bladder exstrophy (n = 6, 15.4%), and pyloromyotomy (n = 5, 12.8%). Mortality rate was 17.9%, and mortality causes were sepsis (n = 4, 57.1%) and congenital heart disease (n = 3, 42.9%). Neonates with the highest mortality by underlying primary surgical diagnosis were esophageal atresia (n=4, 57.1%). Conclusion: The mortality rate from the surgical procedures of the neonates in Somalia is extremely high when compared with the developed countries. Employment of experienced pediatric surgeons and well-trained nurses, strict attention to the sanitary measures and shortening the time from birth to presentation might improve the surgical outcomes of the neonates in Somalia.

Retrospective evaluation of inpatients admitted to a tertiary hospital in Somalia for Pediatric surgery.

Objective: The aim is to reflect on the epidemiology of the patient population at a tertiary hospital for pediatric surgery, diagnostic pattern, and mortality in Somalia retrospectively. Methods: In this study, 163 patient who were hospitalized to Pediatric Surgery Clinic of Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital in 2018 were included. Data regarding age, gender, diagnosis, surgical condition, mortality rate and cause of the death were recorded from the patient charts and the institutional digital database. Results: Of 163 patients 47 were female (28.8%) and 116 were male (71.2%). The mean age of the patients was 6.4 ± 4.8 years. The main diagnoses were congenital malformation (34.4%), acute abdomen (25.8%), traumatic injury (23.3%), infection (9.8%) and neoplasm (6.1%). Mortality rate was 9.8% and the leading cause of death was sepsis by 87.5%. Perforated appendicitis, intestinal obstruction and intussusception were creating the 68.7% of the diseases that result in death. Conclusions: Our results show that two-thirds of the surgical deaths could be prevented with timely presentation. We think that the health policymakers in Somalia should focus on how to improve the access to surgical care, patient transfer, timely presentation, and training of pediatric surgeons and to overcome the poor surgical outcomes.

An Unusual Complication of Foley Catheterization in a Child: Urethral Foreign Body.

Iatrogenic urethral foreign bodies are rare conditions in clinical practice, and the relevant data are limited to adult cases in the literature. In this paper, we presented a pediatric case in which a fragment of Foley catheter balloon remained in the posterior urethra.

Altered expression of interstitial cells of Cajal in primary obstructive megaureter.

OBJECTIVE: A marked decrease in the density of interstitial cells of Cajal (ICC) has been shown in patients with ureteropelvic junction obstruction. ICC may also play a role in primary obstructive megaureter (POM). An immunohistochemical study was conducted to investigate the density of ICC in ureterovesical junction (UVJ) segments resected from patients with POM and from control autopsy specimens. MATERIALS AND METHODS: Resected UVJ segments from 11 patients operated for POM comprised the study group. Control UVJs were obtained from autopsy specimens of 7 children who died from causes other than urogenital pathology. The UVJs including the narrowest parts were studied using immunohistochemical staining for C-kit positive cells. RESULTS: The number of ICC was significantly lower in the UVJs of the POM compared to the control group. The UVJs of the POM group had 1.75 ± 1.14 ICC (mean ± 1SD), whereas the control group had 5.76 ± 2.99 ICC (mean ± 1SD). CONCLUSION: The number of ICC was decreased in the UVJs of the patients with POM compared to the normal control group. As dilation of the ureter during fetal life is a common condition and ureteral dilation is often self limiting, we hypothesize that ureteral peristalsis is a maturational event including the maturational development of ICC.

The diagnosis of yo-yo reflux with dynamic renal scintigraphy in a patient with incomplete ureteral duplication.

UNLABELLED: The diagnosis of yo-yo reflux in patients with incomplete upper collecting system duplications is difficult. We report a case with recurrent urinary tract infections and ultrasonographically detected duplication in the left collecting system in which the presence of yo-yo reflux is demonstrated with dynamic renal scintigraphy. CONFLICT OF INTEREST: None declared.

The effect of dilated ganglionic segment on anorectal and urinary functions during 1-stage transanal endorectal pull through for Hirschsprung's disease.

BACKGROUND/PURPOSE: During a 1-stage transanal endorectal pull through (OS-TERP) for Hirschsprung's disease (HD), dilated ganglionic segment (DGS) may pose a problem during coloanal anastomosis. Apart from the anorectal problems occurring after the HD operations, lower urinary tract problems may also be encountered. The anorectal and lower urinary tract system functions of the patients that underwent OS-TERP in the presence of DGS were evaluated. METHOD: From 2000 to 2005, 15 patients (14 boys and 1 girl) underwent OS-TERP for HD. During the presence of DGS, the coloanal anastomosis of the DGS was completed without any tapering or excision. Hospital and digital video records of all the patients who underwent OS-TERP were evaluated, and the operation time, complications, and follow-up periods of the patients were compared. Standard urodynamic studies were performed after at least 6 months. Bladder capacity; mean bladder capacity ratio; maximum filling pressure; the number of contractions during the filling phase; intraabdominal, intravesical, and detrusor pressures; residual urinary volume; and electromyography activities of the pelvic floor muscles were evaluated. RESULTS: Six patients had ganglionic segment of normal caliber, whereas 9 patients had DGS. Duration of the operation was significantly longer in the DGS group. One patient in DGS group experienced a single episode of enterocolitis in the postoperative period. Transient urinary retention occurred in another patient in DGS group. In ganglionic segment of normal caliber group, one patient experienced 2 episodes of enterocolitis in the postoperative period. Urodynamic study of the 7 patients in the DGS group had postvoiding urine volume of less than 20 mL. The detrusor activities of all the patients were found to be normal. None of the patients had developed urinary tract problems during the follow-up period. CONCLUSION: With the coloanal anastomosis technique, we have described that narrowing the DGS to anal caliber step by step without any excision or tapering enables DGS to fit to the anus easily. Although further clinical studies with larger sample sizes are necessary, present study may imply that OS-TERP performed in the presence of a DGS may not increase morbidity and affect anorectal functions. The normal urodynamic study results obtained in this study may imply that OS-TERP procedure may be performed safely in the presence of DGS.

The contribution of elevated gastric pressure to prevention of gastroesophageal reflux in several different antireflux procedures.

Although there are many studies evaluating the effect of elevated gastric pressure in total wrap and partial anterior and posterior wrap fundoplications, there are no ex vivo manometric studies evaluating the contribution of elevated gastric pressure to prevention of gastroesophageal reflux (GER) in Collis and uncut Collis procedures without fundoplication. An experimental study has been designed to determine the contribution of elevated intragastric pressure in the absence of in vivo anatomic and functional factors to the prevention of GER in Collis and uncut Collis without fundoplication procedures. The study was conducted on adult male New Zealand rabbits' esophagus and stomachs. The stomachs were divided into four groups: total wrap fundoplication group, partial wrap anterior fundoplication group, Collis without fundoplication group, and uncut Collis without fundoplication group. The minimum intragastric pressure (MIP) causing GER of each stomach before and after the procedure were measured with a two-way catheter introduced through the pylorus. The MIP values causing GER of the total wrap and partial anterior wrap fundoplication groups were found to be significantly higher compared with the basal intragastric pressures (P < 0.01). The MIP values causing GER of the Collis and uncut Collis without fundoplication groups were not significantly different compared with basal intragastric pressures (P > 0.05). The elevated gastric pressure is found to be insufficient to prevent GER in Collis and uncut Collis without fundoplication procedures. The efficacy of these procedures in preventing GER seems to be related to the anatomic and functional factors affecting in vivo circumstances.