Total intestinal obstruction due to traumatic submucosal jejunal hematoma: A case report.

INTRODUCTION AND IMPORTANCE: Blunt abdominal trauma can result in various injuries, including intestinal hematomas causing obstruction. Traumatic submucosal jejunal hematomas are rare, especially in children, with bicycle handlebar injuries being a potential cause. Prompt recognition and appropriate imaging are crucial for accurate diagnosis and management. CASE PRESENTATION: A 10-year-old boy presented with delayed abdominal pain, vomiting, and absence of bowel movements following blunt abdominal trauma from a bicycle handlebar injury. Abdominal CT scan confirmed a submucosal jejunal hematoma, leading to exploratory laparotomy and duodenojejunostomy. CLINICAL DISCUSSION: Bicycle handlebar injuries, although seemingly minor, can cause significant internal damage, especially in children. Delayed symptoms pose a diagnostic challenge, necessitating a high index of suspicion and imaging modalities like CT scans for timely intervention. CONCLUSION: This case underscores the importance of considering traumatic submucosal jejunal hematomas in children with blunt abdominal trauma, particularly from bicycle handlebar injuries. Surgical intervention may be necessary in cases of complete intestinal obstruction, emphasizing the need for prompt diagnosis and treatment.

The Multidisciplinary Perioperative Management of Conjoined Twin Separation Surgery During the Pandemic.

Background: Conjoined twin management, especially separation surgery, is a complex procedure which requires multidisciplinary work in the perioperative period. This complexity further increased with the COVID-19 pandemic, where social distancing protocols and the general reduction in non-COVID-19-related health-care services added a new dimension to the modern form of teamwork. Methods: This study focused on the process of preparation for conjoined twin separation surgery during the pandemic from March 2020 to May 2022 with pre-pandemic era comparison. We described the decision-making process and the available facilities in terms of equipment, human resources, and the inclusion of information and technology. Results: Among the essential requirements for separation surgery are doctors from various disciplines, pediatric anesthesiologists, nurses from different specialties, radiologists, rehabilitation specialists, nutritionists, pharmacists, psychologists, social workers, public relations, and information and technology staff. The team composition may change depending on the patient's clinical characteristics and social needs. Surgery preparation consists of a prognostication period, preoperative management, surgery, and discharge. Conclusion: Complex surgery such as conjoined twin separation can be managed effectively by a team of multidisciplinary experts. The application of information technology, to manage changes in multidisciplinary work pre- and post-pandemic, can reduce pandemic-related social restrictions while maintaining effectiveness and increasing efficiency.

Transfer factor treatment in management of peritonitis condition: An experimental study in rat.

BACKGROUND: There is a role for the immune system in improving the outcome of peritonitis cases in children. Transfer factors are one immunomodulatory treatment that can increase the activity of natural killer (NK) cells to produce interferon-gamma (IFN-γ), which is thought to increase the phagocytic activity of macrophages. This study analyzed the effects of transfer factors on the phagocytic activity of macrophages in the intraperitoneal fluid of a Wistar rat model of peritonitis. METHODS: This experimental study had a post-test-only control group design and was carried out at the Laboratory of Pharmacology and Microbiology of Padjadjaran University, Bandung, Indonesia. It analyzed the effect of transfer factors on the phagocytic activity of macrophages in the intraperitoneal fluid of Wistar rats experiencing peritonitis after being injected with Escherichia coli. An unpaired comparative t-test was performed using the SPSS program to analyze the difference between transfer factor administration and macrophage phagocytic activity levels. RESULTS: There was a statistically significant difference between the phagocytosis index values of macrophages in samples treated with transfer factors and those that were untreated (p = 0.005). CONCLUSIONS: Transfer factors increased the phagocytic activity of macrophages in a Wistar rat model of peritonitis. This suggests that transfer factors could have a role as an immunomodulatory treatment for peritonitis.

Unusual esophageal foreign body in neonates: A case report.

INTRODUCTION AND IMPORTANCE: Esophageal foreign body mostly occurs in children aged 6 months to 5 years old. In neonates (babies less than 28 days old), such report is extremely rare. In this case, we report the first esophageal foreign body in neonates without any symptoms. CASE PRESENTATION: A 28-day-old baby boy, with normal body weight, from a low socio-economic status family, came to us with a history of ingested foreign body. No sign of unconsciousness, excessive saliva, dysphagia, and respiratory distress. The chest X-ray revealed a radiopaque foreign body in the upper third of the esophagus. The patient underwent extraction of the foreign body using a flexible endoscope under general anesthesia. We found a 1.9 cm in diameter pendant with no sign of bleeding nor inflammation in the esophageal lumen. After the foreign body removal, the patient is in good condition and recovered uneventfully. CLINICAL DISCUSSION: Foreign body in children under 6 months old is very rare. A high index of suspicion for foreign body ingestion must be considered in unattended children from lower socio-economic status, primarily if witness statements are present and confirmed with radiological examination. Most common impaction site is at the level of the cricopharyngeus muscle. Currently, flexible endoscopy is the standard for foreign body removal in children. CONCLUSION: High index suspiciousness, witness statements and radiological examination are the important points in diagnosing ingested foreign body in neonates. Clinicians are required to provide education to parents to supervise their children when playing together.

Ensnaring the upward migration of double-J stent through nephrostomy route using a wire lasso.

Insertion of double-J (DJ) stent is common in pediatric urology practice as an internal urinary diversion. The DJ stent may migrate proximally into the renal pelvis which is a rare complication. We used a wire lasso to ensnare DJ stent ste through the nephrostomy route using a rigid cystoscope to retrieve the upward migration of DJ stent in 7 years old boy with right vesico-ureteric junction obstruction that previously had a re-implantation of the right ureter. As a result, the DJ stent were safely retrieved with slightly hematuria that improved before 24 hours.

Secondary infection of amoeba and typhoid fever in severe malnourished pediatric patient with Type I choledocal cyst: a case report.

Amebiasis is caused by the protozoan Entamoeba histolytica. Extraintestinal amebiasis manifestation includes liver abscess and other rare manifestations involving the lungs, heart and brain. Liver abscess is the most common extraintestinal manifestation. Only few cases of amebic splenic abscess and two cases of gall bladder abscess have been reported. Typhoid fever is an infection caused by Salmonella typhi. It can cause extraintestinal complications such as myocarditis, endocarditis, pneumonia, empyema, osteomyelitis, arthritis, cholecystitis, spleen abscess and liver abscess. Choledocal cyst is a congenital dilation of the biliary branch. If left untreated, it can cause morbidity from cholangitis, cyst perforation, liver failure and malignancy. Until now, there is no publication about double infection of amebic and salmonella infection in a child with choledocal cyst.

The influence of topical mitomycin-C on total fibroblasts, epithelialization, and collagenization in anoplasty wound healing in Wistar rats.

PURPOSE: The purpose of this study is to analyze the influence of topical mitomycin-C on total fibroblasts, epithelialization, and collagenization in anoplasty wound healing in Wistar rats. METHODS: In this experimental study, anoplasty procedures were performed on twelve Wistar rats that were subsequently randomly placed into two groups; i.e., control and treated groups. In the treated group, topical mitomycin-C was applied to the wound following the anoplasty procedure. All rats were sacrificed on the seventh day, and tissue samples of the wounds were obtained for histopathological evaluations. The total fibroblasts, epithelialization, and collagenization were evaluated by scoring methods. The Mann-Whitney test was used to analyze the statistical significance of differences, and p values below 0.05 were considered to be significant. RESULTS: The mean fibroblast scores for the treated and control groups were 1.5 and 3.0. The mean epithelialization scores for the treated and control groups were 5 and 3.33. The mean collagenization scores for the treated and control groups were 5 and 3.5. Statistical evaluations revealed significant differences between the groups in total fibroblasts (p=0.006), epithelialization (p=0.022), and collagenization (p=0.022). CONCLUSIONS: Topical mitomycin-C reduced the fibroblasts; however, the treatment did not suppress epithelialization or collagenization during anoplasty wound healing in Wistar rats.