Intestinal Obstruction In Children Research Articles

Comparison of Long-term Outcomes between Hirschsprung's Disease Patients after Soave Procedure and Duhamel Procedure Based on the Paediatric Incontinence and Constipation Scoring System: A Retrospective Cohort Study

Introduction: Hirschprung's disease is a congenital disease that causes intestinal motility disorders. Hirschprung's disease is still the most common condition that causes intestinal obstruction in children. The incidence of Hirschprung's disease is 1:5000 live births. The incidence ratio of this disease is around 4:1 between men and women, with a higher percentage of men 1,3,4. Approximately 75% of cases of Hirschprung's disease occur in the rectosigmoid colon area, 17% in the splenic flexure or transverse colon and 8% along the colon and terminal ileum. The Duhamel technique still remains a popular procedure most surgeons especially for long segment treatment and redo procedures.28, 30 The advantage of the Duhamel Procedure is that it is easy to perform, reduces the risk of damage to surrounding structures such as genitourinary innervation, but has the possibility of complications of anastomotic leakage which causes fistulas and abscesses.
 Materials and Methods: Total subjects of this study was 441 patients with Hirschprung's disease who were treated with the Soave procedure and the Duhamel procedure at Dr. Moewardi General Hospital in Surakarta, Central Java, Indonesia for the period January 2017 - January 2022. This type of research is descriptive analytics with a retrospective cohort.
 Results: The results of the study can be concluded that patients with HAEC increases the risk of constipation. Congenital abnormalities predispose to fecal incontinence. Differences in surgical techniques do not significantly influence or increase the risk of constipation and fecal incontinence based on statistical tests. However, the increased risk of constipation and fecal incontinence is higher in patients undergoing the Duhamel surgical procedure.
 Conclusion: Conclusions that can be drawn from research regarding the comparison of long-term outcomes of Hirschsprung disease patients after Soave and Duhamel operations based on the Pediatric Incontinence and Constipation Scoring System at Dr. Moewardi General Hospital in Surakarta, Indonesia for period January 2017 – January 2022, it can be concluded that there is no significant difference in the outcome of patients who underwent the Soave or Duhamel procedures. The Duhamel procedure has a higher prevalence of complications of constipation and fecal incontinence compared to the Soave procedure. The presence of HAEC before the surgical procedure increases the risk of constipation, significantly in the Soave and Duhamel procedures.

Role of Ultrasound Guided Pneumatic Reduction of Intussusception in Children Under 3 Years with Early Presentation

Background: Intussusception remains the most common cause of intestinal obstruction in children under 3 years of age. Objective: To evaluate the role of ultrasound guided pneumatic reduction of intussusception in children under 3 years with early presentation. Methods: This prospective interventional study was carried out at the Department of Pediatric Surgery in Dhaka Medical College Hospital, Dhaka from July, 2020 to June, 2022 for a period of 24 months. A total number of 22 patients with intussusception scheduled for Ultrasound Guided Pneumatic Reduction procedure to reduce intussusception were enrolled for this study after fulfilling the selection criteria. After Ultrasound Guided Pneumatic Reduction, patients were evaluated with duration of reduction, hospital stay and mass existence. Results: The mean age of the patients was 1.28 ± 0.83 years, ranging from 4 months to 3 years. Of them, 54.5% were below or equal to 1 year and the rest, 45.5% were above 1 year. All patients had abdominal pain and 86.4% palpable abdominal mass. Most of the mass situated at right hypochondrium (59.1%). The mean duration of reduction was 6.45 ± 1.29 minutes, ranging from 4 to 8 minutes. The mean duration of hospitalization was 15.90 ± 1.57 hours, ranging from 14 to 18 hours. In 9.1% of cases, the mass remained after the procedure. Conclusion: Intussusception can be effectively treated using pneumatic reduction, which is also quicker, less messy, and risk-free.

Water-beads Ingestion with Intestinal Obstruction in Children: A Case Report

Background: Foreign body ingestion often occurs in the pediatric population and can cause no symptoms or even cause complications due to swallowing the foreign body. The aim of this case report is to increase clinician knowledge of cases of foreign body ingestion which can cause complications. Case: We report a case of foreign body ingestion water beads with complications of intestinal obstruction in a 1 year 2-month-old girl. The patient came with complaints of vomiting more than ten times containing fluid accompanied by decreased intake. The patient was suspected of swallowing water beads. The patient came to the emergency room with no signs of acute abdomen and the results of plain abdominal radiograph showed no foreign objects. The patient began to show symptoms of obstruction, not being able to defecate and not being able to pass gas. Physical examination revealed abdominal distention accompanied by inaudible bowel sounds. Abdominal CT scan results showed ileal obstruction. An exploratory laparotomy was performed, and two water beads were found intraoperative, which were the cause of the obstruction. The foreign body was removed. After surgery, the patient experienced gradual clinical improvement until he was discharged ten days after the procedure. Discussion: Foreign body ingestion in children is often not witnessed by anyone and may not cause symptoms until complications such as obstruction or peritonitis occur. Some foreign objects are radiolucent in plain radiographs. In emergency cases of foreign body ingestion, it is necessary to carry out emergency endoscopic procedures, even emergency surgical procedures in cases that cause complications. Conclusion: This case report increases clinician knowledge and awareness regarding the clinical approach in evaluating patients with suspected foreign body ingestion in children.

Лікування та профілактика спайкової кишкової непрохідності в дітей

Despite the achievements of modern pediatric surgery, to date there is no single comprehensive approach to the treatment and prevention of adhesive intestinal obstruction (AIO), both primary (prevention of adhesions formation after primary surgery) and secondary (prevention of recurrence). Purpose - to study the clinical effectiveness of treatment, primary and secondary prevention of postoperative intestinal adhesive obstruction in children. Materials and methods. An examination and analysis of medical records of 119 children aged 5 months to 17 years who were treated at the Pediatric Surgery Clinic of Ivano-Frankivsk National Medical University over the past 10 years for post-operative AIO was carried out. In 35 (29.41%) children a positive effect was achieved from conservative treatment. The remaining 84 (70.59%) children were operated on. Two groups of patients were formed: the comparison group - 38 (45.24%) children, who received traditional treatment, and the main group - 46 (54.76%) children, who were intraoperatively applied anti-adhesive gel to prevent recurrence of postoperative AIO. Results. It was established that postoperative AIO occurred in only 1 (1.19%) child after laparoscopic intervention, in the rest of the children primary surgical interventions were performed by an open method. In the comparative assessment of the postoperative course in two groups of patients, we drew attention to a more favorable course in the children of the main group, which was manifested by a faster recovery of peristalsis, a decrease in the duration of gastric stasis, a faster appearance of independent defecation, and a shorter period of inpatient treatment. When comparing the results of treatment between groups of patients, it was established that the frequency of recurrences of AIO in the main group of patients was 5.44 times lower than in children of the comparison group, and the frequency of relaparotomy for recurrent AIO was 7.28 times lower than in patients of comparison group. We did not observe complications associated with the use of anti-adhesive gel. We did not notice a significant difference in the results of treatment between patients who were treated with anti-adhesive gel of different composition (based on carboxymethylcellulose and sodium hyaluronate). Conclusions. The most effective method of primary prevention of postoperative adhesive intestinal obstruction is the use of laparoscopic primary surgical interventions. Intraoperative application of anti-adhesive gel is a highly effective and safe recurrence prevention method of adhesive intestinal obstruction in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Trichobezoar, An Unusual Cause of Small Bowel Obstruction in Pediatrics Age Group

Purpose: Trichobezoar, is a ball of swallowed hair, which is usually found in the stomach with a possibility of extension to the duodenum. As the tail can propagate to the small intestine, it is also given the name “Rapunzel syndrome”. The primary aim of this paper is to highlight an uncommon cause of intestinal obstruction in children and to share our experience of management in one of the youngest children reported in the literature. The secondary aim is to share a review of literature on this topic.
 Methodology: The hospital case notes of our patient were thoroughly reviewed and detailed history was confirmed with the family. Radiological imaging was discussed with a senior radiologist. We report a 3-year-old African child who presented to our emergency department with signs and symptoms of acute intestinal obstruction.
 Findings: After a thorough review of the literature, we document that ours is the second report of trichobezoar causing small intestinal obstruction in a 3-year-old child. At laparotomy, a 25 cm long trichobezoar was removed from the ileum with an enterotomy.
 Recommendations: Although it is a rare and unusual cause of isolated small bowel obstruction but with prompt diagnosis and timely intervention the outcome is excellent.

Analysis of the Causes of Intestinal Obstruction in Children to See the Impact of the Results on Healthy Life

Background: Intestinal obstruction, which affects patients of all ages, is described as a stoppage of the forward passage of contents inside the intestinal lumen. Aim: This paper aims to analysis of the causes of intestinal obstruction in children to see the impact of the results on healthy life. Patients and methods: This study was detected the causes of intestinal obstruction and how the effect on children as well as to see the impact of the results on healthy life conducted in different hospitals in Iraq from 14th January 2021 to 7th March 2022 with 42 cases for intestinal obstruction of children patients who under 14 years. The methodology outcomes were designed and analysed by the SPSS program. Results and discussion: Intestinal obstruction is a prevalent issue in the field of paediatric surgery, affecting children of various age groups. In contrast, previous studies have reported the highest incidence of intestinal obstruction to be under the age of one to two years old; however, our findings indicate that it is predominantly observed in children under the age of 14, with peak occurrence in infancy, consistent with similar reports documented in other regions of the country. Interestingly, only two patients, which accounted for a mere 1.54% of the sample, manifested obstructed umbilical hernia. In this study, a greater frequency of postoperative complications related to sepsis was observed. Predominantly, surgical infection was the most prevalent, followed by Septicemia and postoperative pyrexia as the other common occurrences. Conclusion: The study found that most impacted of intestinal obstructions are more common and that these acquired causes are mostly upper gastrointestinal in origin. In comparing with the last studies, the pattern and clinical presentation of intestinal obstruction are similar across Iraq. The negative outcomes of complications refer that Surgical infection (20%) and Postoperative fever (16%) got the high impact on children that occur with 36 % of patients after the operation was conducted.

A CASE SERIES ON THE MANAGEMENT OF INTUSSUSCEPTION IN INFANTS: CHALLENGING ENTITY WHILE DEPLOYED IN REMOTE SETTINGS DURING OVERSEAS DEPLOYMENT

Intussusception is a major cause of acute intestinal obstruction in children. Idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years. This paper reports three cases of infant intussusception, including one Ileo-ceaco-colic intussusception in an 8-month-old baby boy (an uncommon condition in small infants) treated at the peripheral hospital during deployment in remote settings. This case series highlights diverse signs and symptoms of intussusception, and very few cases present with a typical triad of intussusception (abdominal pain, vomiting, and red currant jelly stool). Strong clinical suspicion is required for the diagnosis of intussusception, especially in a remote peripheral setting where diagnostic facilities are scarce. Furthermore, the surgeon should be ready for a surprise challenge after opening Pandora’s box. Delay in diagnosis may result in complications such as perforation, necrosis, and death. An important lesson learned from these three different cases is that the postoperative behavior of surgically reduced intussusception differs from case by case, and we have to be careful and alert during the postoperative period.

A Case of Acute Intestinal Obstruction in an Infant during the COVID-19 Pandemic

Abstract Anomalous congenital bands are rare causes of intestinal obstruction in children, adults, and neonates. They are rarely reported, and their etiopathogenesis is unknown, without malrotation in children. Their presentation and radiographic features are similar to any acute intestinal obstruction. The author found approximately 50 similar cases in the literature; however, during and after COVID-19 pandemic, this is the first case of anomalous congenital obstructing band without mal rotation to be reported to date. This is a rare case of infantile intestinal obstruction managed during COVID-19 pandemic. Acute intestinal obstruction due to a congenital anomalous band is rare in infants and children, and if not treated promptly, can lead to morbidity and mortality. Various reasons, such as congenital, acquired, and extrinsic or intrinsic pathologies in children and adults, may be the cause for acute intestinal obstruction. Congenital anomalous bands account for 3% of the intestinal obstructions in infants and children. These bands may cause ischemia and gangrene of the bowel without timely intervention.

Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception

Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists. To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction. This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022. Reduction of ileocolic intussusception. The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception. We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P < .001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P = .002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P = .002) remained significant. This cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.

Ultrasound-guided hydrostatic reduction of intussusception: comparison of success rates between subspecialized pediatric radiologists and non-pediatric radiologists or radiology residents

Ileocolic intussusception is the most common cause of intestinal obstruction in children under two years of age. Treatment in most cases is radiologically guided reduction. In Slovenia, ultrasound (US)-guided hydrostatic reduction is currently the standard of care. The purpose of this study was to compare the success rate of US-guided hydrostatic reduction when performed by subspecialty-trained pediatric radiologists, non-pediatric radiologists, or radiology residents. We retrospectively analyzed medical records of patients with ileocolic intussusception who underwent US-guided hydrostatic intussusception reduction at University Medical Centre Ljubljana between January 2012 and December 2022 (n = 101). During regular daily working hours, the reduction was performed by pediatric radiologists. After hours (evenings and overnight), pediatric radiologists, non-pediatric radiologists, or radiology residents performed the reduction procedure. Patients were divided into three groups based on the operator performing the procedure. Data was analyzed using the chi-square test. Pediatric radiologists had thirty-seven (75.5%) successful first attempts, non-pediatric radiologists had nineteen (76.0%), and radiology residents had twenty (74.1%). There was no statistically significant difference in the success rate of ileocolic intussusception reduction depending on the operator who performed the procedure (p = 0.98). No perforation was observed in either group during the reduction attempts. Conclusion: Our results demonstrate that US-guided hydrostatic reduction is a reliable and safe procedure that achieves good results even in the hands of less experienced, however appropriately trained, radiologists. The results should encourage more medical centers to consider the implementation of US-guided hydrostatic reduction of ileocolic intussusception.What is Known:• US-guided hydrostatic reduction is a well-established method of treatment for ileocolic intussusception in children.• The results regarding the influence of operator’s experience with the procedure on its success rate are scarce and contradictory.What is New:• US-guided hydrostatic intussusception reduction is a reliable and safe technique that achieves similar success rates when performed by experienced subspecialized pediatric radiologists or less experienced but trained operators such as non-pediatric radiologists and radiology residents.• The implementation of US-guided hydrostatic reduction in general hospitals without subspecialized pediatric radiologists could improve patient care by increasing access to radiologically guided reduction and simultaneously decreasing the time to reduction attempts.

Intestinal Obstruction Due to Super Absorbent Polymer Bead Ingestion in Children.

Ingested foreign bodies (Fb) in children usually pass out in stools without any sequels. However, Fbs like open safety pins, button batteries, and super absorbent polymer (SAP) / jelly toys are associated with complications such as intestinal obstruction, and bowel perforation. Intestinal obstruction in children of uncertain nature should raise a suspicion of foreign body ingestion such as SAP, which may not be obvious at the initial presentation. The studyreports two such children, outlining the presentation and management. Key Words: Children, Intestinal obstruction, Foreign body, Health hazard, Bilious vomit, Super absorbent polymer beads.

The Role of the Multidisciplinary Approach in the Diagnosis and Treatment of Intussusception

Abstract Introduction: Intestinal intussusception, the most common cause of intestinal obstruction in children, is an intestinal obstruction that occurs by telescoping one intestinal segment into another, pulling also the mesentery which determine venous congestion phenomena and arterial insufficiency with intestinal wall necrosis. The cause of intussusception in children is frequently attributed to viral infections. Symptoms include abdominal pain, vomiting and hemorrhagic stools. Untreated, it is complicated by intestinal wall perforation and peritonitis. Currently, abdominal ultrasound is the gold standard method for confirming the diagnosis. Treatment should be started as soon as possible after the patient’s diagnosis. Methods: This is a 15 years retrospective study carried out in the “Sfântul Ioan” Clinical Emergency Hospital for Children in Galati. In this study we included 37 patients aged 0-18 years with the diagnosis of intussusception admitted between 2008 and 2022. We included in the study demographic data (age, sex, rural or urban origin), comorbidities, type of invagination, clinical data, laboratory and imaging examinations, therapeutic management, and complications. Results: Intestinal intussusception is more common in children between 1 and 12 months of age, predominantly affecting males (2/1). Symptomatic triad was present in 24% of cases and only in patients under 1 year of age, with onset of symptoms greater than 6 hours. The most common symptom was abdominal pain, which was observed in 92% of patients, followed by vomiting which had a frequency of 86%. In 84% of cases, the intussusception was primary, the most common anatomical form being ileocolic in 67.5%. The main operative technique was manual reduction of the intussusception, associated with cecopexy in 63% of cases, and circumstantial appendectomy in 100% of cases. Bowel resection was performed in only 7 (26%) of patients. There were 2 recurrences of intussusception, 1 case of evisceration and 1 case of secondary necrosis of the uninvaginated loop. Conclusions: Intussusception is a serious surgical pathology and treatment delays are common in our setting. Delayed presentation contribute to considerable morbidity and mortality. Training the family physicians and health staff of the local hospitals and raising awareness of the people to present early after the warning signs, will help to enhance early diagnosis of intussusception. In addition, the accessibility of the ultrasound and the training of specialists in the fields related to the pediatric pathology are also important. This information will contribute to the early diagnosis and non-operative treatment of intussusception.

A rare cause of intestinal obstruction in children trichobezoar: How to diagnose?

Trichobezoar is a rare clinical condition in children, which is caused by the accumulation of swallowed hair mass in the digestive tract. This condition is most common in young women with psychiatric histories who suffer from trichotillomania (TTM), where they have an irresistible urge to pull out their hair. Diagnosis and treatment of this pathology, which is already extremely rare, and its variable clinical presentations are challenging. The aim of this study was to increase awareness of trichobezoar in the differential diagnosis of signs of intestinal obstruction in children and to evaluate the diagnosis and management of this rare pathology. The clinical data of six patients who were treated for trichobezoars in the pediatric surgery department of our hospital between 2009 and 2022 were retrospectively analyzed. Six female patients were treated with the diagnosis of trichobezoar during this period. Patients were diagnosed with the help of anamnesis, physical examination, abdominal ultrasonography (USG), and finally, endoscopy. USG can predict the intestinal wall infiltration and the tail extended to the duodenum through pylorus in the series. All patients were evaluated with contrast-enhanced abdominal radiography. Five surgical interventions were performed in four of the cases. In a case who underwent surgery twice, the distal intestinal satellite bezoar was not noticed in the first operation. Two patients were diagnosed to have trichobezoar, but surgery was not required. These patients were younger and had early-onset TTM (before 10 years old). The patients were followed for an average of 10.8 years and no recurrence was detected. Trichobezoar is a rare cause of intestinal obstruction in children with fatal complications when diagnosed late. Failure to follow an algorithm for the management of the disease causes difficulties in the diagnosis and treatment. Especially in pa-tients with a known psychiatric history, whole abdominal USG and laparoscopy performed with awareness can prevent unnecessary examinations.

A rare cause of intestinal obstruction in children: signet-ring cell adenocarcinoma of the colon.

Signet-ring cell adenocarcinoma of the colon is well-recognized in adult patients who are extremely rare and not well-documented in children. Our study aims to raise awareness about this rare disease and its long-term outcomes. We retrospectively evaluated patients with signet-ring cell colon adenocarcinoma. Six patients, three boys and three girls, with a mean age of 14.83 (range, 13-17 years), presented with signs of intesti-nal obstruction and were diagnosed with signet-ring cell colon adenocarcinoma. All patients had air-fluid levels on abdominal X-ray. Abdominal ultrasonography of all patients revealed subileus. Abdominal computed tomography was performed in five patients, and pre-operative colonoscopy was conducted in two patients before the emergency intervention. All of the patients underwent emergent exploratory laparotomy with the preliminary diagnosis of acute abdomen. In two patients, debulking surgery followed by a stoma was performed. The remaining four patients were treated with anastomosis following intestinal resection. All girls had metastases on the ovary. One of the patients died due to the burden of multiple metastases in the early period, and three died in the sixth post-operative year. We have been following the remaining two patients since then. Although signet-ring cell carcinomas (SRCCs) are rare, they should be considered in the differential diagnosis of acute abdomen and intestinal obstruction in pediatric patients. Despite early diagnosis and treatment, SRCC has a poor prognosis in the pediatric population.

The Epidemiology of Various Intestinal Obstruction Causes in Children and Teenagers: A Multi-Center Study

Aim: to assess the Epidemiology of intestinal obstruction in children And Teenagers its causes. Study design: This is A Multicenter study. Place and duration of study: This study was conducted in lrh and hmc territory care hospital of kpk . Analysis was completed in 01 year, from Jan 2021 to Jan 2022. Methodology: This study included all children aged 13 to 18 years hospitalized in the pediatrics department who had an exploratory laparotomy for intestinal blockage and met the inclusion criteria. During an exploratory laparotomy, adhesions, intussusceptions, roundworms, and an obstructed hernia were identified as possible reasons for intestinal blockage. Software SPSS version 24 was used to analyze the data that was collected. We calculated percentages, means, and standard deviations. Results: 85 patients in all, including 30 cases (35% females) and 55 points (65% males), were analyzed. From [01] to [12] years was the range of ages, with a mean age of [04.3602.06] years. Adhesions were the most frequent cause of intestinal obstruction, followed by intussusception in 36 (42% of cases) and 27 (31% of cases), respectively. Conclusion: The prevalence of the etiological reasons for intestinal blockage in children And Teenagers varies by age group, although adhesions are the most frequent cause, with intussusception coming in second. Keywords: Children ,Teenagers, etiological causes, intestinal obstruction, adhesion, and intussusception

Chylolymphatic Cyst - Presenting as Acute Intestinal Obstruction – A Case Report

Chylolymphatic cyst is one of the rare variants of mesenteric cysts. These cysts are present within mesentery and contain chylous or lymphatic fluid. Chylolymphatic cysts are rare in paediatric age group. We present a case of a four years old boy who presented with features of acute intestinal obstruction. CECT abdomen revealed a hypodense cystic mass in the peritoneal cavity. Exploratory laparotomy of the abdomen revealed a solitary cyst measuring 10.7 cm x 9.4 cm x 10.5 cm which was adherent to the loops of small intestine and right kidney. Complete excision of cyst along with resection of the adjacent gut and end to end anastomosis was done. Histopathology of the excised cyst was suggestive of chylolymphatic cyst. It has been highlighted that chylolymphatic cyst can be a rare cause of intestinal obstruction in children.

Frequency of Various Etiological Causes of Intestinal Obstruction in Children

Aim: To determine the frequency of causes of intestinal obstruction among children. Study design: This is a cross sectional study. Place and duration of study: This study was conducted in Allama Iqbal Memorial Teaching Hospital Sialkot. Study was completed in six months duration from January 2022 to June 2022. Methodology: Children with age &lt;12 years admitted in the department of pediatrics and undergoing exploratory laparotomy for intestinal obstruction and fulfilling inclusion criteria were included in this study. On exploratory laparotomy causes of intestinal obstruction were noted like adhesions, intussusceptions, round worms and obstructed hernia. Collected data was analyzed using SPSS version 20 software. Percentages, means and standard deviations were determined. Results: Total 170 cases were studied including 107(62.9%) males and 63(37.1%) females. Range of the ages was one month to 12 years with mean age of 4.37±2.6 years. Most common cause of intestinal; obstruction was adhesions followed by intussusception found in 71(41.7%) and 55(32.3%) cases respectively. Conclusion: Frequency of etiological causes of intestinal obstruction varies in different age groups in children, however adhesions are most common cause of intestinal obstruction in children, while intussusception is second most common cause. Key words: Intestinal obstruction, Adhesion, Intussusception, Etiological causes, Children

Intussusception in a child with situs inversus totalis – A rare occurrence

Intussusception is when section of bowel is drawn into another. It is considered the commonest cause of intestinal obstruction in children. It is associated with a favorable outcome when diagnosis and management are prompt. Non-operative management techniques are employed in most cases with surgical reduction occurring in a third of cases. Situs anomalies are a rare spectrum of congenital anomalies involving malpositioning of the thoracoabdominal viscera. Situs inversus totalis is the commoner of the subdivision of the situs inversus spectrum. The condition is associated with several anomalies including, katagener's syndrome. Its association with intestinal obstruction is however extremely rare. There is no known reported case of intussusception occurring in a child with situs inversus totalis. Here, we report a case of seven (7) months old female diagnosed with intussusception and situs inversus totalis following clinical and radiological evaluation. She underwent open reduction and Ladd's procedure and made an uneventful recovery.

The spectrum of paediatric intestinal obstruction

Background: Acute intestinal obstruction is very common surgical emergency in paediatric age. The purpose of this study was to determine the aetiology, clinical presentation, management and outcome of intestinal obstruction in children in a tertiary care hospital. Material &amp; methods: This was a retrospective study of paediatric patients who presented with intestinal obstruction to the paediatric surgical unit. he study period was for one year. Data was extracted from the records. Statistical Package for Social Science (SPSS) version 23 was used for data entry and analysis. Data were expressed as percentages and mean. Results: There were 80 cases of paediatric intestinal obstruction seen during the study period. A total of 6200 children were admitted into the children’s ward of the hospital during the study period, out of which intestinal obstruction accounted for 1.20%. Most of the patients (43.75%) presented with abdominal pain. Most common etiology was Ascariasis. Conclusion: The present study concluded that most of the patients presented with abdominal pain. Most common etiology was Ascariasis followed by Adhesions. Only 2.5% were discharged against medical advice.

An unusual cluster of Waugh syndrome as a cause of intestinal obstruction in children - A case series.

Introduction and importanceThe association of intussusception with intestinal malrotation is a rare phenomenon named Waugh syndrome by Brereton et. It is a rare disease entity with less than 100 cases described so far. A cluster presentation is something unusual for rare diseases.Case presentationAll four patients have presented with features suggestive of bowel obstruction as all of them have had colicky abdominal pain. Three patients have vomiting as an additional complaint, so as the diarrhea. Fever has also been reported in one patient. Patients have presented in 6 months period, non-consecutively. Abdominal pain, diarrhea and vomiting are alarming in the pediatric population. When each case presented, an immediate resuscitation was performed including IV lines, nasogastric suctioning, electrolytes correction, and blood and FFP transfusion as necessary. Abdominal ultrasonography was performed revealing target sign. After optimization for surgery, manual reduction of the intussusception was done followed by a Ladd's procedure for the malrotation was performed for all 4 patients with excellent outcomes.Clinical discussionWith the surgery, after case optimization, remains the standard of care; the presence of cluster presentation for Waugh syndrome could suggest that some environmental factors might be implicated and further observations can be carried out to look more into such phenomenon.ConclusionWaugh syndrome, a combined presentation of intestinal malrotation and intussusception, is a rare syndrome that can present in children. Optimization for surgery followed by a 2-step surgical approach is the usual treatment with excellent outcomes described.