Iranian Journal of Pediatric Surgery

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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Background: The term of undescended testis refers to the cessation of the natural descending of the testis into the scrotum. Due to the advantages of the scrotal orchiopexy method over inguinal orchiopexy in some studies, we decided to conduct a similar study on children in Hazrat Masoumeh Hospital in Qom in 2016-2019 and we evaluated the effect of scrotal surgery in the treatment of UDT.

Material and methods: In this study, among the files of children with palpable UDT between 2016-2019 who were undergone scrotal or inguinal surgery in Hazrat Masoumeh Hospital in Qom, the number of sample files from these files is selected and divided into two groups. One group was undergone traditional inguinal surgery and the other group were under scrotal surgery.

Results: The mean operation time for type of incision above the scrotum and in the inguinal region were 8.27 ± 2.51 and 3.14 ± 12.08 minutes, respectively. The highest location in scrotal surgery was 70 (52.67%) in the external ring area and 101 (60.47%) was inguinal canal in inguinal surgery. In the scrotal method in no case and in the inguinal method only one case of secondary UDT was observed. In the scrotal method in no case and in the inguinal method only one case of wound infection was observed.

Conclusion: Finally, our study showed that the scrotal method has more advantages than the inguinal method, the only limitation in this method is the location of the testis.

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: Post-operative pain relief is one of the major practices in anesthesiology. The different pharmacokinetic and sensitivity of children to different classes of anesthetics drugs, especially opioids, make the clinical judgment of pediatric anesthesiologist harder.

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

Results: The average duration of analgesia in the X, M and P group were 18.48± 2.45, 17.62± 2.96, and 17.56± 3.16 hours, respectively. The duration of analgesia in the group X was superior to the other groups; however, there was not any meaningful different between the duration of analgesia between the 3 groups (p>0.05).  

Conclusion: the present double-blind clinical trial disclosed that the preoperative bilateral infraorbital nerve block induced an anesthetic effect prolonged as the duration induced by the opioid infusion.

Splenic abscesses are rare in children. Mostly, they present in immunocompromised children or in children with hematological malignancies. In most of the cases these are smaller, isolated or multiple abscesses and are being successfully treated with broad spectrum antibiotics and percutaneous drainage. However, large abscesses pose a management challenge and require a careful decision to go for either total or partial splenectomy. Ultrasound and CT scan both play a crucial role to decide on these larger abscesses which are prone to rupture and can cause septicemia and death. Different organisms have been isolated from these abscesses as bacteria, fungi and atypical bacteria. We report a case of a massive splenic abscess with septicemia managed successfully by timely operative intervention.

Epigastric hernia (EH) is hernia of linea alba above umbilicus. An uncommon surgical condition & account for 3-5% of the population with male predominance. EH have high risk of incarceration & strangulation because of tight fascial defect of linea alba. Congenital epigastric hernia refers to herniation of intra- abdominal organs from the xiphoid process to the umbilicus due to failure of proper attachment of the rectus muscle during development and a hernia is called strangulated when its blood supply of its contents is compromised. A congenital strangulated and gangrenous epigastric hernia is very rare & is associated with significant morbidity and mortality.

Double intussusception in children is an extremely rare entity with only 15 cases reported in medical literature till present.

An 18-month-old male child presented with features of intestinal obstruction. Evaluation showed an ileocolic intussusception on ultrasound. Initially, hydrostatic pressure reduction was attempted but was unsuccessful. Exploratory laparotomy revealed a double intussusception of ileo-ileal intussusception over colon and Meckel’s diverticulum as the lead point. The histopathology of the excised specimen revealed normal ileum and hypertrophic pancreatic tissue in the Meckel’s diverticulum. 

The significance of early diagnosis and suspicion of double intussusception intraoperatively and the surgical management is emphasized in this case report. 

Congenital bifid tongue is a rare malformation, which is usually present in association with other oral findings such as cleft palate and tongue mass. The authors have found a rare case of congenital bifid tongue together with absence of lingual frenulum, and a hamartomas mass in a 9-month-old female infant. Mother complains of difficulties in sucking breast milk and dribbling milk during breast feeding, as well as some episodes of positional dyspnea and choking with cyanosis during feeding. The mass was excised, along with an excess portion of the left tongue, and the bifid tongue was surgically repaired in layers after excision. The histopathological report was used to confirm the diagnosis of hamartoma. The review of literature, description of the lesion, diagnosis, and management of this finding are all outlined.

In this study, we presented a 14-year-old patient who referred to a pediatric cardiology clinic with chest pain and tachycardia, whose electrocardiography examinations determined Wolf-Parkinson-White Syndrome, and in the anteroposterior chest radiography, a left-sided para-cardiac mass was detected. A lesion originating from the middle mediastinum and measuring 55×56 mm at its widest point was observed in the Computed Tomography scan. During surgery, the thorax was entered via a left muscle-sparing mini-thoracotomy, and the mass was excised completely. The histopathological examination result was evaluated as mature cystic teratoma. We presented this case because there has been no co-incidence between mature cystic teratoma and WPW syndrome in the literature before.