Evaluation and Management of Achalasia Cardia in Children: A Retrospective Observational Study.

Background: Achalasia cardia is a neuromuscular disorder of unknown etiology characterized by aperistalsis of the body of the esophagus and failure of relaxation of the lower esophageal sphincter. The diagnosis of achalasia cardia is delayed due to the rarity and the ability to mimic other common conditions in children. Hence, a study was conducted to evaluate the clinical presentation and the management of achalasia cardia in children. Materials and Methods: A retrospective observational study was conducted in the department of pediatric surgery at a tertiary center. The children with achalasia cardia who presented between January 2014 and December 2021 were included. Results: A total of 12 patients were treated for achalasia cardia during the study period. All children presented with recurrent episodes of vomiting, whereas dysphagia was seen in six (50%) children. Eighty-three percent of the children presented with a history of weight loss, whereas failure to thrive was seen in nine (75%) children. Five (42%) children were managed as gastroesophageal reflux disease (GERD) for more than a year before presenting to us. Three (25%) children underwent open cardiomyotomy with Thal fundoplication and the rest nine (75%) underwent laparoscopic cardiomyotomy. All are thriving well. Conclusion: Achalasia is an important differential diagnosis in children with suspected GERD. The most common symptom of achalasia cardia is vomiting followed by dysphagia. Weight loss and failure to thrive are important presenting features in children with achalasia which are uncommon in adults. Cardiomyotomy without fundoplication is safe and effective to treat achalasia cardia in children without having any extra complications.

Factors contributing to mortality in neonates with congenital diaphragmatic hernia and eventration.

Introduction: Despite all the advances, the mortality rate of congenital diaphragmatic hernia (CDH) ranges from 30% to 60% for isolated CDH and as high as 89% when they are associated with additional structural or chromosomal anomalies. Hence, a study was conducted to evaluate the factors contributing to the mortality of neonates treated for CDH or the eventration of diaphragm. Materials and Methods: A retrospective study was conducted in the department of paediatric surgery at a tertiary centre. The neonates admitted with a diagnosis of CDH or eventration requiring surgery, between March 2013 and March 2021, were included in the study. Results: A total of 123 neonates were included in the study. The variables, earlier median age at presentation (1 [1-23] vs. 3 [1-28]; P < 0.001; Mann-Whitney U-test), preterm birth (10/79 vs. 0/44; P = 0.01; Fischer's exact test), inborn (68/79 vs. 27/44; P = 0.002; Chi-square test), weight ≤2 kg (18/79 vs. 1/44; P = 0.003; Chi-square test), central cyanosis at presentation (21/79 vs. 1/44; P < 0.001; Chi-square test), antenatal detection (47/79 vs. 14/44; P = 0.003; Chi-square test) and earlier mean age at surgery (3.66 ± 1.47 vs. 7.66 ± 6.88; P < 0.001; Independent sample t-test) were associated with increased mortality. On multinominal logistic regression analysis, the factors preterm (odd's Ratio [OR] =4.735; P = 0.03), weight ≤2 kg (OR = 5.081; P = 0.02), central cyanosis at presentation (OR = 6.969; P = 0.008) and antenatal detection (OR = 7.471; P = 0.006) were found to be independently associated with increased mortality in CDH/eventration. Conclusion: The factors: prematurity, weight <2 kg, cyanosis at presentation and antenatal diagnosis were independently associated with increased mortality in neonates with CDH/eventration requiring surgery.

Sequelae of Corrosive Injury in Children: An Observational Study.

Aim: This study aims to determine the sequelae of corrosive ingestion in children. Methods: A retrospective study was conducted in the Department of Pediatric Surgery at a Tertiary Center. The children presenting between January 2015 and December 2020 with a history of ingestion of caustic agents were included in the study. Results: A total of 26 children were included in the study. The children with suicidal attempts were significantly older than those who ingested the corrosive agents accidentally (14.2 ± 1.9 years vs. 6 ± 3.3 years; P < 0.01; Student's t-test). Sixteen (62%) children had esophageal strictures, 8 (31%) had pyloric strictures, and a child (4%) had both esophageal and gastric strictures. Eight (31%) children required an initial feeding jejunostomy and 6 (23%) required a feeding gastrostomy as they had significant weight loss on presentation. Eleven (65%) esophageal strictures responded to the dilatation regimen and are symptom-free on follow-up. Three (18%) children with esophageal stricture underwent esophageal replacement. Eight (31%) children had a pyloric stricture and all of them were treated with a modified Billroth I gastro-duodenostomy. The children who presented after 2 months were found to have a significantly increased need for esophageal replacement (3/9 vs. 0/17; P = 0.03; Fischer's exact test). Conclusion: The corrosive ingestion in children is associated with higher morbidity. The sequelae include esophageal and antro-pyloric strictures. A feeding gastrostomy or jejunostomy was required in more than half of the patients. The children presenting after 2 months of ingestion were associated with an increased need for esophageal replacement.