Iranian Journal of Pediatric Surgery

Introduction: Gastrointestinal endoscopy is a prevalent diagnostic and therapeutic procedure employed for both children and adults. Since Etomidate is a short acting intravenous drug with hemodynamic stability and also it is the choice for sedation and anesthesia among patients afflicted with cardiovascular conditions, we decided to compare the benefits and drawbacks of the mentioned drugs in children undergoing endoscopy.

Materials and Methods: For conducting the research, 90 pediatric participants, aged from 1 to 15 years, with ASA I and II class requiring upper gastrointestinal endoscopy (admitted to Mofid Children Hospital) were randomly selected. For 45 patients, intravenous anesthetic drug Propofol (Group P) was administered for sedation required during endoscopy, while in the remaining 45 patients, Etomidate (Group E) was used, and hemodynamic fluctuations, apnea occurrence frequency, sedation recovery length, and nausea and vomiting after sedation were monitored and compared between the two groups. Finally, the data were analyzed using SPSS v.18 software, and t-test and chi-square statistical tests.

Results:   The average age of the patients was 7.8 ± 7.9 years. The recovery following anesthesia in Group P was 8.3 ± 4.3 minutes, while in Group E, it was 7 ± 3.2 minutes (p=0.373). The reduction in SPO₂ levels in Group P was 7.1 ± 3.9%, and in Group E, it was 1.4 ± 0.6% (p=0.01). The variations in heart rate (HR) were 3.9 ± 7.1 in Group P and 0.6 ± 1.4 in Group E (p=0.01). Changes in blood pressure (BP) were 10.1 ± 7.9 mmHg in Group P and 2.7 ± 1.3 mmHg in Group E (p = 0.235). The incidence of apnea was 26.7% (12 individuals) in Group P and 46.7% (21 individuals) in Group E (p=0.02). The occurrence of nausea and vomiting was 4.4% (2 individuals) in Group P and 20% (9 individuals) in Group E (p=0.01).

Conclusion:     The result of the findings suggests that the patients receiving Etomidate experienced lower saturation drop, and quicker awakening compared to the group of patients receiving Propofol, while the occurrence of apnea, nausea, and vomiting were higher

Introduction: Esophageal atresia (EA) is a relatively common congenital anomaly. Following the increase in the survival rate of neonates with appropriate surgical procedures, timely diagnosis and treatment of surgical complications are essential.

Materials and Methods: After getting ethical approval, all the patients who underwent surgery for EA at Tabriz Children's Hospital were contacted, and in case of any long-term complications, parents were invited to visit the hospital.

Results:   Fifty-five children, including 31 boys and 24 girls, with a mean birth weight of 2734.63±566.21 grams and an APGAR score of 8.75±0.96, participated in this study. The most common type of EA was type C (87.3%). Respiratory disorders (47.3%) and marked anastomotic stenosis (21.8%) are the most common complications following surgery. Anastomotic stenosis was associated with suture tension, tracheal intubation >5 days, and birth weight<2,500 grams.

Conclusion:    In the postoperative phase of EA surgery, respiratory disorders are a common complication. Anastomotic stenosis is the second most common complication. It is associated with suture tension, tracheal intubation for more than five days, birth weight less than 2,500 grams, Gastroesophageal reflux into the esophagus, and leakage from anastomosis. There is a need for future multi-center studies to provide more reliable evidence

Introduction: Testicular torsion (TT) necessitates emergent and proper intervention since it can affect sexual health and fertility. Ultrasonography is the gold standard modality for detecting TT. This study aimed to determine the long-term sonographic changes of the testicles in patients with a history of orchiopexy for testicular torsion in the pre-and post-operative stages who were referred to our tertiary pediatric referral emergency department in 2017-2018, northeast of Iran.

Methods: In this analytical cross-sectional study, we have collected patients referred to the urology department with acute scrotum complaints and followed up clinically and sonographically on the size of their testicles.

Results: The left testicle was found to be torsified in 24 (72.7%) cases. In the control ultrasound, 12 (38.7%) cases of involvement of the left side of the testicle were reduced in size. In the post-operative stage, the percentage of involvement in the right testicle (0.87%) was higher than in the left (0.50%). The percentage of parenchymal involvement frequency before and after the operation was compared using Fisher's exact test, which had a significant difference (P=0.001). The testicular blood supply frequency before surgery was impaired in 19 (57.6%) cases. In control ultrasound, 15 (45.5%) testicular tissues had normal blood supply. These results were compared using Fisher's exact test, which has no significant difference (P=0.154).

Conclusion: However, the sonographic changes of testicles in the patients suffering from TT were variable over time, and these changes can be widely different; they are also significantly related to testicular dimensions when the patient presents with testicular torsion.

Introduction

Congenital anomalies are main cause of intestinal obstruction that occur from neonates to adults. Frequently, obstruction is due to either incarcerated hernia, adhesive bands, volvulus and intussusception.

we illustrate all demographic & clinical data, imaging, surgical approach and outcome of unusual causes of pediatric intestinal obstruction. 

Methods

We document a retrospective review of ten pediatric cases of acute intestinal obstruction for whom surgery was indicated and showed rare causes and pathology between 2020 and 2023.

Results

On exploration, first and second patient had non-Hodgkin intestinal lymphoma. Third case had a large polyp of Peutz– Jeghers syndrome as a nidus for jejunojejunal intussusception. Fourth patient had jeujunogastric intussusception whereas fifth case had chylous cyst, in the sixth patient, cecal duplication cyst was a cause of intussusception. Seventh case had volvulus of small gut due to entrapment through a mesenteric defect was detected whereas eighth case had ileal gel ball, ninth case had volvulus on top of mesenteric lymphangioma and tenth case had huge mesenteric chylous cyst. All causes of obstruction are rare either as a pathology or its age or presentation.

Conclusion

Suspicion, careful evaluation, and tailoring of appropriate treatment are corner stone for precise management of these unusual cases. 

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