Iranian Journal of Pediatric Surgery

Introduction: Enterocolitis is a potentially fatal consequence of Hirschsprung’s disease, it is characterized by fever, abdominal pain, foul-smelling diarrhea, and sepsis. Most neonatal morbidity and mortality are caused by Hirschsprung-associated enterocolitis (HAEC). Harald Hirschsprung initially discovered Hirschsprung's related enterocolitis in the 19^th century and included it in his iconic description of megacolon. Trisomy 21, illness, familial history, and prior bouts of HAEC are risk factors for the condition. (3,4) According to Engun et al. patients who presented with a history of Hirschsprung's disease had a 35% incidence of HAEC, but those without such a history only had a 16% incidence. Similarly, HSD and trisomy 21 have a known association with 2.9 - 8.2% of HSD patients also having trisomy 21. This study aimed to evaluate HAEC as a postoperative complication in children who were admitted after pull-through surgery as regards the type of surgery, incidence, clinical presentation, sepsis workup, and management in Alexandria University Children’s Hospital.

Materials and Methods: This retrospective study included 30 patients with Hirschsprung disease who developed post-operative Hirschsprung-associated enterocolitis and were scheduled for surgical intervention from January 2021 to 2022.

Results:  In the studied group, the most commonly used pull-through procedure was the Soave (53.33%), followed by the Duhamel procedure (20%). Fewer subjects were operated using the Swenson and Rehbein methods, at 16.67% and 10% respectively. Most of our studied patients (26 patients) presented with signs and symptoms of Grade I HAEC, while 3 patients with Grade II and 1 patient with Grade III.

Conclusion:  Post-operative HAEC is a serious complication and needs to proper management to save the child either conservative treatment, repeated anal dilatation or surgical intervention in severe cases.

Introduction: Ankyloglossia characterized by mild to complete mucosal bands whereby the tongue is tied to the floor of the mouth. This oral anomaly can affect nutrition, speech and oral hygiene, and mechanical/social effects.

Materials and Methods: This study was a randomized clinical trial conducted in Tabriz Children's Hospital. All patients were randomly divided into two groups, group A and B, each of which included 20 patients. The electrocautery frenectomy under local anesthesia and simple frenuluplasty under general anesthesia was performed for the patients of A and B groups, respectively.

Results:  The patients were evaluated on the first day after the operation in terms of inflammatory signs and symptoms, on the seventh day after the operation in terms of wound healing and any complications, and one month after the operation in terms of scarring and wound contraction.

Nothing by mouth (NPO) time was only 1 hour for electrocautery frenectomy and no need for general anesthesia. There were no postoperative complications (e.g., erythema and eczema) in group A, and only one infant (i.e., 5% of the population) showed symptoms of fever in this group. In group B, on the other hand, 10% of the population showed signs of erythema, and 26% showed signs of eczema at the incision site after the surgery. Speech status was improved in all cases in the electrocautery group.    

Introduction: Purpose here, we included two groups of patients with inguinal hernia requiring surgical repair. We performed ultrasound-guided (US-guided) transversus abdominis plane (TAP) block on one group and US-guided Iliohypogastric/ilioinguinal (IN/IH) block on the other. We compared the results obtained from each group to compare the efficiency of each method in managing post-operative pain.

Materials and Methods: In this prospective blinded controlled clinical trial, after approval of local ethics committee and randomization of the patients, 25 patients were included in each group. Peripheral nerve blocks (TAP block or IH/IN) were performed under the US guide. Patient pain scores, additional analgesic requirements, and complication rates were documented and compared.

Results:  No statistical differences were found regarding demographic characteristics. Cardiopulmonary monitoring showed no complications in any of the groups. The IN/IH block group reported significantly lower pain scores than the TAP groups (immediately and 1 hour after; P: 0.02 and 0.03, respectively). Performing the TAP block took substantially longer (P= 0.04).

Conclusion: IN/IH block results in better pain management following pediatric inguinal hernia repair. 

Introduction: Posterior urethral valve (PUV) is one of the most common causes of obstructive uropathy in the children. Approximately one -third of such children end in chronic kidney disease (CKD) in future despite good management. There are some clinical parameters that are assumed poor renal outcome indicators.Many novel biomarkers are coming in limelight for early detection of chronic kidney disease. Increase of renin and aldosterone values in serum and urine as a result of tubulointerstitial damage can be marked as an early biomarker for prognosis.Therefore, this study focuses to assess the role of urinary and serum aldosterone and renin values in PUV patients before and after valve ablation.

Materials and Methods: This is a prospective observational study. It was conducted from September 2020 to August 2022 in the Department of pediatric surgery. The study group included 20 male babies with confirmed diagnosis of PUV. Clinical and radiological parameters were assessed. Plasma renin and aldosterone were measured using sandwich enzyme-linked Immunosorbent assay (ELISA) (ELK Biotechnology Co. LTD., Hubei, P.R.C.). Briefly, plasma samples or standard concentrations of the biomarker of interest were incubated in different 96-well ELISA plates coated with the appropriate antibodies. Statistical analyses were performed in Microsoft (MS) Excel using two-tailed Student’s t-test. The Pearson test was used for correlation.

Results:  Mean    age of PUV patients was 2.72 years, whilst in the control group it was 2.58 years. Deranged renal function like raised urea and creatinine were    significantly higher in the patient group than the control group. Median renin (82.89pg/ml) and aldosterone (71.76 pg./ml) in the patients with cases were significantly higher than the age-matched control group. In each age group, all levels of renin and aldosterone in urine and serum level were higher among patients than control. Levels of aldosterone level and renin correlated positively with serum and urea creatinine at presentation and follow-up.

Conclusion:     Prognostic biomarkers are needed for PUV patients. Aldosterone and renin can be considered as early prognostic marker which are easy to measure in serum and urine.

Introduction: Intestinal obstruction is a common disease encountered in pediatric population and among the most common causes of emergency admissions. Foreign bodies in the intestinal lumen are commonly seen in pediatric population and are mostly swallowed accidentally. Intestinal bezoars are a rare cause of intestinal obstruction in children. The aim of the study was to evaluate the patients of small intestinal obstruction due to a specific phytobezoar- persimmon seeds (date plum or amlook)- in pediatric age group in our region in terms of clinical presentation, management and complications.

Materials and Methods: Data of 100 patients of intestinal obstruction due to dry persimmon phytobezoar (date plum or amlook) were evaluated retrospectively by clinical presentation, clinical examination, radiological investigations and the management options, and intra-operative finding were noted from hospital records.

Results:  Out of 100 patients' records were evaluated, and the commonest presentations were abdominal pain in 92 patients, abdominal distension in 91, nausea and vomiting in 85 and constipation in 30 patients. 18 patients were managed conservatively, 56 patients underwent exploratory laparotomy with milking of food bolus, 20 patients underwent enterotomy with removal of food bolus and in 6 patients' resection with end to end anastomosis (REEA) was done.

Conclusion:     Intestinal obstruction due to dry persimmon phytobezoar (date plum or amlook) food bolus should be suspected in all patients where this fruit is commonly used as in our region and mass education of people in the region should be done.

Bartholin’s gland cyst and abscesses are exceedingly rare in females before puberty. Authors report a case of Bartholin’s gland abscess in a neonate.

we report the case of a 21-day-old infant  with Bartholin’s gland abscess . Spontaneous rupture of this abscess may occur, which progressed favourably under antibiotic therapy.

The diagnosis of Bartholin’s gland abscess should be considered in any child presenting with inflammatory swelling of the labia majora and confirmed by perineal ultrasound.

Intrauterine intussusception is a rare cause of intestinal atresia. Intrauterine intussusception was identified as etiological factor in only 0.6% of the cases. The pathophysiology of this correlation remains unclear. Antenatal intussusception leads to a partial intestinal necrosis and intestinal atresia in the concerned digestive segment. Here we report a case of ileal atresia consequent to intrauterine intussusception.
A full-term neonate presented with features of neonatal intestinal obstruction. Antenatal ultrasound was normal. Screening neonatal examination at birth was normal. At presentation, vital signs were normal, abdomen was distended with bilious residue in the nasogastric tube. Abdominal radiography showed dilated small intestine with multiple air-fluid levels. Pre-operative Ultrasound scan showed intussusception with dilated bowel loops. At surgical exploration the neonate had ileal atresia with ileo-ileal intussusception, just distal to the atretic ileal segment. The neonate was managed successfully by resection and end to back anastomosis.
The authors conclude that intrauterine intussusception is one of the rare causes of intestinal atresia and if an antenatal scan shows any target sign without any bowel dilatation, the baby should be delivered at a tertiary care center having neonatal intensive care facility, as it might lead to ischemia and atresia of the involved bowel.

Tissue deficiency accompanying failed hypospadias surgery makes further reconstruction difficult. Modified Cecil-Culp technique utilizes penile mobility to place the repair in a scrotal location for a short duration which helps to accomplish tension-free apposition using dartos and skin of the scrotum. A series of four cases is described where this technique proved beneficial despite adding a short subsequent procedure after a few months.