Atropine as an Adjunct in the Management of Pediatric Patients With Hypertrophic Pyloric Stenosis: A Single Institution Experience and Review of the Literature.

Infantile hypertrophic pyloric stenosis (IHPS) is a condition whereby there is a thickening of the pyloric muscle, leading to obstruction of the gastric outflow. Typically present within three to five weeks of life, it presents as postprandial non-bilious projectile vomiting. Commonly, a pyloromyotomy is the gold standard to relieve the obstruction. However, in a subset of patients not amenable to undergo surgery or anesthesia, or for postoperative persistent or recurrent obstruction, atropine may offer an alternative treatment. A retrospective review was performed on pediatric patients with hypertrophic pyloric stenosis utilizing the electronic medical record. Data included were demographics, workup data, treatment, outcomes, and symptom resolution. Approval was obtained by the institutional review board of the host institution. Five pediatric patients, with an average age of 2.1 months, received atropine treatment for IHPS. The average time to reach full feeds since the initiation of atropine was approximately four days. Three of the five patients were successfully managed with IV atropine, which was then transitioned to oral atropine and tapered off as outpatients, leading to the resolution of symptoms. The remaining two patients were considered failures of medical management and subsequently required surgery. Atropine use as an alternative treatment for IHPS may be considered when patients are not able to undergo surgery or anesthesia or have recurrent or persistent obstructive symptoms postoperatively. In this limited study, atropine was found to be safe and effective. Randomized controlled studies may lend additional merit to this therapy in the future.

Gastrointestinal Perforation with Blunt Abdominal Trauma in Children.

Gastrointestinal tract perforation is uncommon in children, accounting for <10% of cases of blunt abdominal trauma. Diagnosis of bowel perforation in children can be challenging due to poor diagnostic imaging accuracy. Intra-abdominal free air is found only in half of the children with bowel perforation. Ultrasound findings are nonspecific and suspicious for perforation in only two-thirds of cases. A computer tomography (CT) scan has a sensitivity and specificity of 50% and 95%, respectively. Surgical decisions should be made based on clinical examination despite normal CT results. Management of bowel perforation in children includes primary repair in 50-70% and resection with anastomosis in 20-40% of cases.

Congenital absence of the left external iliac vein with anomalous venous connection in a pediatric patient.

We report an interesting case of a 2-year-old boy with congenital absence of the left external iliac vein and an anomalous lower extremity venous connection. Magnetic resonance imaging was used to identify aplasia of the vessel and aid in the diagnostic algorithm. In the present report, we have discussed the relevant literature associated with congenital venous anomalies and their clinical presentations and treatment options. Our patient did not undergo surgical intervention for his vascular malformation.

Fibrin Glue Repair of a Traumatic Rectovaginal Fistula in a Pediatric Patient.

BACKGROUND: Rectovaginal fistulas are often associated with obstetric trauma and present with leakage of stool or flatus from the vagina. They are often repaired via fistulaectomy, but sometimes more complex repairs are needed. There are limited data regarding success using fibrin glue to close the tract. CASE: A developmentally delayed pediatric patient presented with right hip pain. Imaging studies identified a hairpin penetrating the rectovaginal space. The hairpin was removed during an exam under anesthesia, and the subsequent rectovaginal fistula was closed with fibrin glue. Closure of the tract has persisted for more than 1 year without need for further intervention. SUMMARY AND CONCLUSION: Fibrin glue may be a minimally invasive and safe approach for rectovaginal fistulas in the pediatric patient.

Health Inequities in Pediatric Trauma.

This review article highlights the disparities evident in pediatric trauma care in the United States. Social determinants of health play a significant role in key aspects of trauma care including access to care, gun violence, child abuse, head trauma, burn injuries, and orthopedic trauma. We review the recent literature as it relates to these topics. The findings from these recent studies emphasize the important principle that trauma care for children should be designed with a focus on equity for all children.

Management of Abdominal Wall Defects.

Congenital abdominal wall defects vary from abdominal wall hernias to severe congenital structural anomalies that include gastroschisis, omphalocele, and prune belly syndrome. The conditions often carry various associated anomalies and require multidisciplinary treatment approaches. Complex surgical reconstructive techniques are frequently required and prenatal, perioperative, and long-term follow-up is critical to ensuring the best possible outcomes.