Abdominal Emergency In Children Research Articles

Non-traumatic abdominal surgical emergencies in children in Dapaong (TOGO)

IntroductionSurgical abdominal emergencies in children are responsible for high morbidity and mortality. They are numerous and their management in Africa is difficult. The management of non-traumatic abdominal emergencies in children in a regional hospital in Togo is described. Methodand study setting: This was a single-center, retrospective and descriptive study conducted over a 12-month period. It included all children aged 0–15 years treated at the hospital for non-traumatic abdominal surgical emergencies. ResultsWe reported 217 cases of non-traumatic abdominal surgical emergencies in children. We noted a male predominance with a sex ratio of 1.57. Similarly, grandchildren were predominant (44.70 %). A low school attendance rate was noted (21.20 %) and the children were mostly from poor families (32.72 %). The average consultation time was 5.3 ± 1.03 days. Pain was the main symptom and was present in all children. An unprepared abdominal X-ray was the main imaging procedure performed (77.18 %). These conditions were dominated by peritonitis (56.68 %). These were mainly ileal perforations. All the children received surgical treatment. The postoperative course was marked by complications in 104 children (47,93 %) and 14 deaths (6,45 %). ConclusionNon-traumatic abdominal surgical emergencies in children are dominated by peritonitis in rural Togo. They could be related to poverty. An effective policy of universal access to health care is essential.

Lollipop stick en-route cecum: Mimic of appendicitis

Acute appendicitis is commonly encountered abdominal emergency in children which present clinically with acute onset right iliac fossa pain. We present a case by a 5-year-old child which presented in a similar manner, however, was subsequently diagnosed with perforation in cecum secondary to foreign body ingestion on contrast-enhanced computed tomography.

Role of Dexamethasone as an adjuvant in the treatment of intussusception: A prospective study

Background: Intussusception is one of the most commonly encountered abdominal emergencies in children for which the preferred treatment modality has always been non operative hydrostatic reduction. Recurrence is a common concern after a successful hydrostatic reduction. Adjuvant treatment with pharmacological agents have been considered to reduce chances of recurrence. Aim: The study was conducted to examine the role of dexamethasone in decreasing early recurrent intussusception. Materials and methods: A prospective cohort study was conducted in a tertiary care center from June 2018- June 2022 on 51 pediatric patients, admitted with intussusception and divided into a dexamethasone and non-dexamethasone group. Data was collected regarding demography, rate of recurrences, duration of hospital stay, surgery performed if any including the intraoperative findings and associated complications. The level of significance was set at 5%. SPSS version 27 was used to perform the statistical analysis. Result: After ultrasound-guided hydrostatic reduction, the dexamethasone group showed significant reduction in recurrence, compared to the non-dexamethasone group. In this study, 7 cases showed recurrence despite three attempts of hydrostatic reduction and intraoperatively noted to have a pathological lead point. Conclusion: Dexamethasone is one of the greatest discoveries of the 20th century with its vast use in multiple diseases. The use of dexamethasone during hydrostatic reduction of intussusception in a pediatric population makes it a wonderful drug with remarkable results and patient outcome.

Surgically proven small bowel intussusception in children: Analysis of 36 cases

Background: Intussusception is one of the most common abdominal emergencies in children. While the majority of childhood intussusceptions are ilecolic and idiopathic, small bowel intussusceptions are rare and a pathological trigger is often blamed for the etiology. Ultrasonography is the most commonly used diagnostic tool in the diagnosis of intussusception.
 Objectives: To determine auxiliary diagnostic criteria for ultrasonography in the differentiation of small bowel intussusceptions based on ultrasonography, reduction and surgical findings of surgically confirmed small bowel intussusceptions and to contribute to the diagnosis and treatment algorithm of small bowel intussusceptions based on our clinical experience.
 Methods: The records of patients who underwent surgery for small bowel intussusception at the Faculty of Medicine, Department of Pediatric Surgery between January 2008 and December 2020 were retrospectively reviewed. Demographic characteristics, ultrasonographic findings, onset and duration of symptoms, treatment method, intraoperative findings and histopathological results of the patients were recorded.
 Results: Thirty-six pediatric patients with small bowel intussusception were operated. The average age of these patients was 59 ± 49.7 months and %78 was male. The location of the small bowel intussusception detected by ultrasound scan was the paraumbilical area and left quadrant in 19 (53%) patients and the right quadrant in 15 (42%) patients. In ultrasonography, the mean diameter of the invaginated segment was 3 (1.2-6.5) cm and the mean length was 6.7 (3-15) cm. Pathological lead points were detected in the etiology of nineteen (53%) patients. Thirteen (36%) patients underwent segmental resection and anastomosis due to necrosis.
 Conclusions: Small bowel intussusceptions are often localized in the paraumbilical and left upper quadrant. However, it should be kept in mind that it may be localized in the right lower quadrant like ileocolic invaginations. Enema reduction can be used as an adjunctive diagnostic method to exclude ileocolic invaginations rather than treatment in these patients. The diameter and length of the invaginated segment may be decisive in the surgical decision of the small bowel intussusception.

Intestinal obstruction due to appendicitis in a 3-month-old child

Appendicitis is the most common surgical abdominal emergency in children, but it is uncommon in infants. We present a 3-month-old boy with intestinal obstruction caused by appendicitis. The radiography image revealed multiple air fluid levels and dilated bowls. Appendicitis was discovered during laparotomy exploration and was surgically removed. The patient was discharged home in good health 3 days after surgery.

Volvulus with sigmoid necrosis in children: Two cases observed at Ignace Deen Hospital

Introduction: We report the clinical observation of 2 cases of volvulus with sigmoid necrosis in children. Observation: Two male patients, aged 12 and 15, were hospitalized with acute mechanical bowel obstruction. There was an asymmetric, motionless meteorism and rectal emptiness. X-rays of the abdomen revealed an arch. Laparotomy found volvulus with necrosis of the sigmoid colon. The Hartmann-type colostomy and the ideal colectomy were the surgical procedures. Conclusion: Sigmoid volvulus is a rare abdominal emergency in children and severe in the necrosis stage.

Simultaneous Antegrade and Retrograde Intussusceptions in a Child: A Rare Condition and Literature Review:

Intussusception is one of the major abdominal emergencies in children under two years of age. Double intussusceptions are rare, and the simultaneous ante grade and retrograde occurrence is even rarer. Fewer than 10 such cases have been reported in the pediatric population. An 8-month-old girl was presented to a peripheral health center with paroxysmal abdominal pain for two days, as well as postprandial vomiting and four mucous stools. She was diagnosed with amoebic dysentery. Faced with the appearance of glairy-bloody stools, she was admitted to our pediatric emergency unit. After examination and abdominal ultrasound, the diagnosis of intussusceptions was made. On the fourth day, operative findings showed a double ante grade and retrograde pattern. A manual reduction followed by an appendectomy was performed. The postoperative course was uneventful. Continuing education of peripheral practitioners will allow early diagnosis and appropriate treatment as this misdiagnosis could have compromised the vascular reserve of the bowel, resulting in intestinal ischemia and possibly perforation.

Serum Soluble CD40 Ligand in Predicting Simple Appendicitis and Complicated Appendicitis at Different Time Points in Children.

Objectives: Appendicitis is a common abdominal emergency in children. It is difficult for clinicians to distinguish between simple appendicitis (SA), gangrenous appendicitis (GA), and ruptured appendicitis (RA) in children based on physical and current laboratory tests. Abdominal computed tomography with the disadvantage of excess radiation exposure is usually used in the emergency room for appendicitis surveys. Serum soluble CD40 ligand (sCD40L) is an inflammatory biomarker. This study aimed to use sCD40L to distinguish SA, GA, and RA.Methods: All patients aged <18 years old with suspected appendicitis were tested once for serum sCD40L within 72 h of appendicitis symptoms. We compared sCD40L levels of SA, GA, and RA individually on days 1, 2, and 3 in patients with normal appendix (NA), a total of nine subgroups. Thereafter, the diagnostic performance of sCD40L in predicting appendicitis and the receiver operating characteristic curves were carried out.Results: Of 116 patients, 42 patients had SA, 20 GA, 44 RA, and 10 NA. We found six subgroups with significant p-values of sCD40L predicting appendicitis as follows: SA on day 2, GA on days 2 and 3, and RA on days 1–3. The sensitivity and specificity of sCD40L at the best cutoff point with 178 pg/mL in these six subgroups range from 0.75 to 1.00 and 0.90, respectively.Conclusions: SCD40L is a good predictor of pediatric appendicitis. Clinicians can use sCD40L to distinguish from SA, GA, and RA in children with suspected appendicitis.

Geographic influence on postoperative complications in children with complicated appendicitis: a single center study

BackgroundAcute appendicitis is one of the most common abdominal emergencies in children. Complicated appendicitis is much more common in pediatric age group than in adults due to probability of delay in diagnosis or misdiagnosis. Geographic status has an influence on the clinical course of such surgical cases. This prospective comparative study was conducted at the pediatric surgery department in our hospital in Egypt during the period from December 2018 to August 2019, aiming to find the relation between residence of patients and occurrence of post-operative complications among patients in Sharkia Governorate, Egypt. Patients were divided into two groups: rural and urban. Data recorded included demographic data, preoperative assessment, operative findings, postoperative course, postoperative complications, and follow-up.ResultsSixty patients were included in the study, 32 of them were from rural areas, and 28 were from urban areas. There was no significant difference between them regarding demographics. Duration of symptoms was significantly longer with rural group (3.7 ± 1.4 vs. 3.07 ± 0.92 days). Length of hospital stay was significantly longer with the rural group (4.7 ± 1.7 vs. 4.7 ± 1.7 days). The rate of wound infection was significantly higher with the rural group (34.37% vs. 10.7%), while other postoperative complications were increased with rural group, but that was not statistically significant. The regularity of follow-up was higher with the urban group.ConclusionsChildren with complicated appendicitis from rural areas are at higher risk for occurrence of postoperative complications and poor outcome, with less regularity in follow-up. This is because of many obstacles they faced, including difficulties of transportation, insufficient medical services, and low socioeconomic and educational statuses.

Ultrasound-guided hydrostatic reduction versus fluoroscopy-guided air reduction for pediatric intussusception: a multi-center, prospective, cohort study

BackgroundIntussusception is the most common abdominal emergency in children. The first line treatment of uncomplicated pediatric intussusception is enema reduction. Until now, there have been no multi-center studies comparing the effectiveness and safety of UGHR and FGAR in the treatment of pediatric intussusception. The aim of this study was to compare the effectiveness and safety of the two most commonly used enema methods of pediatric intussusception: ultrasound-guided hydrostatic reduction (UGHR) and fluoroscopy-guided air reduction (FGAR).MethodsFrom November 1, 2017 to October 31, 2018, we conducted a multi-center, prospective, cohort study. Children diagnosed with intussusception in four large Children’s Medical Centers in China were divided into UGHR and FGAR groups. Stratified analysis and subgroup analysis were used for further comparison. The success and recurrence rates were used to evaluate the effectiveness of enema reduction. The perforation rate was used to evaluate the safety of enema reduction.ResultsA total of 2124 cases met the inclusion criteria (UGHR group: 1119 cases; FGAR group: 1005 cases). The success and recurrence rates in the UGHR group were higher than in the FGAR group (95.80%, 9.28% vs. 93.13%, 10.65%) (P < 0.05, P > 0.05), respectively. The perforation rate in the UGHR group was 0.36% compared with 0.30% in the FGAR group (P > 0.05). Subgroup analysis showed the success rates in the UGHR group were higher than in the FGAR group of patients with onset time between 12 and 24 h (95.56% vs. 90.57%) (P < 0.05). Of patients aged 4 to 24 months, the success rates in the UGHR group were also higher than in the FGAR group (95.77% vs. 91.60%) (P < 0.05). Stratified analysis showed the success rates in the UGHR group were higher than in the FGAR group in patients with the symptom of bloody stool (91.91% vs 85.38%) (P < 0.05).ConclusionsUGHR and FGAR are safe, nonsurgical treatment methods for acute pediatric intussusception. UGHR is superior to FGAR, no radiation risk, its success rate is higher, without a difference in perforation rate, especially for patients aged 4–24 months.Level of evidenceLevel II.

Clinical profile of patients with intussusception in a tertiary care institution in South India

Background: Intussusception is a common abdominal emergency in children. It is the most common cause of intestinal obstruction in children less than 2 years. Awareness about the clinical presentation vomiting, abdominal pain, blood in stools, abdominal mass helps in early diagnosis. This study describes the demographics and clinical profile of patients with intussusception in a tertiary care institute in South India.Methods: This was a prospective case series study conducted in the pediatric surgery department in a tertiary care hospital in South India. Children upto 12 years with clinically and radiologically confirmed intussusception were enrolled over 12 months study period. Demographic and clinical data was collected and recorded.Results: Eighty two children with clinical and radiological picture suggestive of intussusception were studied. 57 patients (75%) were below 1 year of age. Male:female ratio was 1.7:1. The classical triad of abdominal colic, palpable abdominal mass and rectal bleeding was seen in 39 patients (50%). Most common signs were rectal bleed and abdominal mass.Conclusions: Awareness about the clinical presentation of intussusception helps in early diagnosis and prompt treatment of this common pediatric emergency and helps to prevent mortality.

Laparoscopic versus open appendectomy in complicated appendicitis in children: a single center study

BackgroundAcute complicated appendicitis is a common abdominal emergency in children. Unlike simple appendicitis, laparoscopic appendectomy has not been considered yet the first choice in management of complicated appendicitis. This prospective randomized controlled clinical trial was conducted at Pediatric Surgery Department, Zagazig University Hospitals, Egypt, during the period from December 2018 to August 2019. The aim of the study was to evaluate the role of laparoscopic appendectomy in such cases compared to open appendectomy.ResultsSixty patients were included in the study, divided randomly into 2 equal groups: laparoscopic and open appendectomy groups. The mean operative time was significantly longer with laparoscopic appendectomy than open appendectomy, 85 vs. 61 min, respectively (p < 0.001**). The time taken to start oral intake was significantly shorter with laparoscopic appendectomy than open appendectomy, 1.9 vs. 2.73 days, respectively (p = 0.025*). The mean hospital stay was significantly lower with laparoscopic appendectomy than open appendectomy, 4.23 vs. 5.13, respectively (p = 0.044*). There were no statistical differences between the two groups regarding wound infection, occurrence of postoperative ileus, intraperitoneal collection, or readmission.ConclusionsLaparoscopic appendectomy is safe, feasible, and effective procedure in the management of complicated appendicitis in children, with no evidence of any increase in the postoperative complications.

A gyermekkori invaginatio modern értelmezése és kezelése

Intussusception is one of the most common abdominal emergencies in children. The understanding of its aetiology and management has changed significantly over the last decades. Earlier, the hypertrophic Peyer's patches and polyps were considered responsible, but with the knowledge obtained from the lipopolysaccharide-induced animal model of intussusception, the rotavirus vaccination, the seasonality and the postnatal changes of the enteric nervous system it became clear that the intestinal motility plays a key role in the aetiology. The efficacy of non-operative management is continuously improving. The radiologists initially moved from the hydrostatic X-ray-controlled reduction towards the air enema (pneumatic reduction), however, nowadays, there is a shift back to hydrostatic procedures but under ultrasound guidance to reduce radiation exposure. In many institutions, intussusception is managed as day-case rather than as an inpatient case. The role of medications like glucagon and cyclo-oxygenase inhibitors used during reduction manoeuvres and prevention of recurrence is still controversial. Surgical management is shifting towards laparoscopy. The authors herein reviewed the current literature to present recent insights into understanding the pathogenesis and management updates. Orv Hetil. 2020; 161(32): 1331-1338.

Sedated ultrasound guided saline reduction (SUR) of ileocolic intussusception: 20 year experience

BackgroundIleocolic intussusception is a common abdominal emergency in children, diagnosed routinely with ultrasound and treated most frequently with fluoroscopic pneumatic reduction without sedation. Alternatively, ultrasound can also be used to obviate ionizing radiation and sedation can be used to avoid discomfort from the procedure. The purpose of this study was to present our experience with sedation using saline enema under ultrasound guided control to reduce ileocolic intussusception. Materials and methodsThis is a retrospective study of patients with ileocolic intussusception presenting to a tertiary care hospital between 1998 and 2018. We excluded the data of patients that underwent either fluoroscopic guided reduction with barium enema or primary surgery. All patients received sedation with propofol and subsequently underwent our sedated ultrasound guided saline reduction (SUR) protocol until reduction was confirmed. Results414 total reductions were performed in the 338 children who underwent our SUR protocol, of which 86.0% were successful. Zero perforations occurred during attempted reduction. 58 patients required surgery after a failed reduction (14.0%). There were 76 recurrent episodes that underwent our SUR protocol, of which 93.4% had a successful reduction. ConclusionThe success rate of reduction was high and compared similarly to techniques that either use pneumatic reduction under radiation or refrain from administering a sedative prior to enema. Level of evidenceTreatment study level III.

Adenovirus-associated intussusception in a child

Intestinal intussusception is one of the most common causes of acute abdominal emergencies in children under 2 years of age. We herein describe a case of adenovirus associated small intestinal intussusception in a 5-month-old boy. A brief review on triggers of intussusception in children is provided. Thorough gross and microscopic inspections of resected intussusception specimens are recommended to diagnose subtle predisposing triggers such as viral infections.

Fatal Intussusception in a 2-month-old Infant: A Post Mortem Experience

Introduction: Intussusception, the invagination or telescoping of a proximal segment of bowel into an adjacent distal segment of bowel is the second commonest cause of abdominal emergency in children after appendicitis. It is important to note that intussusception though a relatively benign condition, can cause unexpected death due to misdiagnosis or delayed referral resulting in intestinal perforation.

Assessment of a modified technique for air delivery during fluoroscopic-monitored pneumatic intussusception reduction

Intussusception is one of the most common causes of acute abdominal emergency in children. Image-monitored pressure reduction is the first line of treatment. We report on a modified technique of air delivery during fluoroscopic-monitored pneumatic intussusception reductions, and compare it with an established technique. We modified the Shiels intussusception reduction device so that the air used for intussusception reduction is delivered not by the device's insufflator bulb, but rather by the hospital medical air supply system, eliminating the need for continuous pumping of the insufflator bulb during the procedure. Subsequently, we retrospectively compared sequential fluoroscopy-monitored pneumatic intussusception reduction procedures performed in patients younger than 18years using either the standard or modified devices, evaluating technical procedure parameters (i.e. median procedure time length, fluoroscopy time length and radiation dose) and patient outcomes (i.e. number of complete intussusception reductions, number of incomplete intussusception reductions, number of intussusception recurrences within 3days of the procedure, number of procedures followed by surgery). We found no statistically significant differences between procedures performed with the standard and modified techniques. The device modification allows for increased operator comfort. Evaluated procedure parameters and patient outcomes appear similar to those of the standard technique.

Management for intussusception in children.

Management for intussusception in children.

Sonography of acute appendicitis and its mimics in children.

The diagnosis of acute right lower quadrant pain in a pediatric population is challenging. Acute appendicitis is the most common cause of an acute surgical abdomen. The common mimics of acute appendicitis are acute gastrointestinal and gynecologic diseases. This article reviews the sonographic findings of the spectrum of common acute abdominal emergencies in children with a focus on imaging clues to a specific diagnosis. This awareness can impact on diagnostic accuracy and impact patient management.

Pneumoperitoneum

Pneumoperitoneum is rarely encountered as a radiographic finding in association with perforated appendicitis in children, and may lead to diagnostic errors. In this paper, we present pneumoperitoneum as a presenting finding of perforated appendicitis in a 2-year-old boy. The term pneumoperitoneum frequently indicates perforation of an intra-abdominal hollow viscus. However, it is rarely encountered as a radiographic finding in association with perforated appendicitis. The cases reported in the literature are mostly adult patients, but the relevant data in children are limited. Here, we present a case of a 2-year-old boy with perforated appendicitis who presented with pneumoperitoneum. The patient was taken into the operation theater with an initial diagnosis of gastrointestinal perforation. Surgical exploration indicated a perforated appendix and an appendectomy was performed. Appendicitis is one of the most common surgical abdominal emergencies in children. However, very young children often pose a diagnostic dilemma for the clinician. Pneumoperitoneum is a confusing finding in perforated appendicitis, and may lead to diagnostic errors. However, it may be considered as a favorable sign because it will result in the patient’s immediate surgical exploration and cure. Keywords : appendicitis, children, pneumoperitoneum