Surgery For Intestinal Perforation Research Articles

Micro-CT of tracheal stenosis in trisomy 21

A male infant with trisomy 21, born at 36 weeks' gestation, had care withdrawn at 2 months of age and was referred for postmortem investigations. The child had been ventilator...

Gallbladder sludge associated with ceftriaxone therapy for typhoid fever in Nigerian children: A case series

Ceftriaxone is a third-generation cephalosporin with a wide spectrum of activity against both gram-negative and gram-positive organisms. Ceftriaxone has proven efficacy against severe and difficult-to-treat community-acquired infections including typhoid fever and other sepsis syndromes caused by multi-drug resistant organisms. Several studies including prospective studies exist in the literature that described the accumulation of sonographically demonstrable sludge (or precipitates) in the gallbladder and sometimes in the urinary tract. The accumulation of sludge occurs during therapy for severe infections in some children identified with certain predisposing factors. The condition is often asymptomatic but might be associated with clinical features that could mimic disease progression in patients with intra-abdominal manifestations of infection such as typhoid fever. Five Nigerian children aged between 4 and 11 years developed demonstrable gallbladder sludge (precipitate) while on treatment for typhoid fever with ceftriaxone. Three of the children manifested clinical features suggestive of gallbladder precipitate accumulation following commencement of the antibiotic, while the other two did not. Ceftriaxone therapy was continued to completion in all the cases along with conservative management. Four of the children recovered and had resolution of the sludge, while the fifth died of multi-organ failure after surgery for intestinal perforation. Although several studies exist in the literature regarding this condition, our search using Medline and Google Scholar did not identify such reports from children in Nigeria or sub-Saharan Africa. The cases are presented to create awareness on the possibility of occurrence of a drug-induced biliary precipitate formation in children.

R-006 What is the prognostic factor and best surgery for intestinal perforation in ELBW infants?(Requested Theme Session 1 Surgery for low-birth-weight infants,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

R-006 What is the prognostic factor and best surgery for intestinal perforation in ELBW infants?(Requested Theme Session 1 Surgery for low-birth-weight infants,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Surgery for intestinal perforation in preterm neonates: anastomosis vs stoma

Background Traditionally, a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC). We compared the outcome of resection and anastomosis (RA) with stoma formation (RS). Methods Sixty-eight neonates undergoing laparotomy for IIP (n = 20), NEC (n = 43), and indeterminate cause (n = 5) were reviewed retrospectively. Intestinal resection was followed by either anastomosis or stoma. The primary outcome measure was the frequency of anastomosis- and stoma-related complications. Results The median gestational age (GA) was 28.5 weeks and birth weight (BW) was 940 g. Thirty-seven neonates had RA (NEC 22, IIP 14, 1 unknown), 28 RS (NEC 21, IIP 6, 1 unknown), and 3 laparotomy only. Twenty-five neonates died postoperatively. The mean ± SD GA of those who survived was 30 ± 4.5 weeks and those who died was 27.2 ± 3.5 weeks ( P = .008). The mean BW for those that survived was 1440.5 ± 865.1 g and those who died was 827.7 ± 385.1 g ( P = .002). There was no statistically significant difference between the RA and RS groups for GA ( P = .93), BW ( P = .4), general complications ( P = .96), anastomosis and stoma complications ( P = .48), and deaths ( P = .42). Conclusions RA, rather than stoma, is an acceptable option in the surgical management of preterm neonates with IIP or NEC.

Peritoneal Dialysis in Neonates after Major Abdominal Surgery

Three newborn babies with acute renal failure were started on peritoneal dialysis 3, 4 and 3 days after abdominal surgery for intestinal perforation, intestinal malrotation with volvulus and hepatic laceration, respectively. Peritoneal access was achieved by Trocath catheters in the first two and via a Jackson-Pratt peritoneal drain inserted during surgery in the third baby. Two babies survived after dialysis for 9 and 6 days. The third baby was dialysed for 16 days, had partial recovery in renal function and died of multisystem failure at the age of 35 days. Peritoneal dialysis is possible in neonates with recent major abdominal surgery. Occasionally, a peritoneal drain inserted during surgery may provide an easy access for the procedure.