Pediatric intussusception in a Saudi Arabian tertiary hospital.

UNLABELLED: There are various methods of diagnosing and treating pediatric intussusception. This is an indication that no single method is acceptable to all and no single method is ideal for all cases. Because of this, we reviewed the cases and management of intussusception, seen at Aseer Central Hospital over a 7-year period. MATERIALS AND METHODS: Thirty four pediatric patients admitted at Aseer Central Hospital over a 7-year period (from 1993 to 2000) at Aseer Central Hospital, Southwestern region of Saudi Arabia were reviewed. These are by no means all the cases of intussusception seen during this period. Adult cases and incomplete records of pediatric cases were not included in this series. The 34 cases that met the objectives of this paper were analyzed with regards to the age group distribution, sex, nationality, type and site of intussusception, the cause of intussusception, the method of diagnosis and the treatment given, were also reviewed. Their case files were reviewed and used for the analysis. RESULTS: The age range was 2 months to 8 years (Mean = 10.86 months). There were 21 boys and 13 girls, a male: female ratio of 1.6:1.0. All (100%) presented with vomiting, 91% with bloody stools and 82% with colicky abdominal pain. Twenty-eight patients (82.3%) had diagnostic barium enema, and 8 of these were successfully reduced. Exploratory laparotomy was performed for 26 patients and 6 of this required surgical resection. There was no mortality in this series, but one patient had a wound dehiscence which was treated conservatively. CONCLUSION: The management of pediatric intussusception depends on the presentation, the available facilities and the expertise of the treating surgeons.

Primary locally infiltrative gastrointestinal aspergilloma in a non-neutropaenic child.

A 21-month-old male child presented with malnutrition and painless abdominal masses. The masses were provisionally diagnosed as being abdominal lymphoma. Pre-operative investigations did not establish any other cause. The diagnosis of primary gastrointestinal aspergilloma was obtained only post-operatively by histopathology and tissue culture. Following surgery, the tumour grew rapidly and massively despite intravenous amphotericin-B, in the recommended doses. The tumour caused recurrent intestinal obstruction which necessitated multiple extensive surgical excisions. The patient finally died due to sepsis and gastrointestinal bleeding. We believe this to be the first description of a primary gastrointestinal aspergilloma with aggressive local infiltration in a non-neutropenic child.

Lung resections in bronchiectasis due to lipoid pneumonia: a custom-design approach.

OBJECTIVE: To see the effect of "custom-designed" surgical resection of some severely damaged parts of the lungs in children with bronchiectasis caused by forced feeding of children early in their lives with animal fat "ghee". DESIGN: All children with bronchiectasis--post lipoid pneumonia--who failed to respond to medical treatment had surgical removal of most affected parts of their lungs. SETTINGS: Asir Central Hospital Abha, a referral hospital in Asir region of Saudi Arabia and a Teaching Hospital for College of Medicine and Health Sciences, King Khalid University, Saudi Arabia. SUBJECTS: Six children aged between seven and 12 years with lipoid bronchiectasis were referred to paediatric surgical service for surgical treatment. RESULTS: There was no surgical mortality. Apart from mild cough, all the pre-operative symptoms of the children disappeared. Two children died more than six months post-operatively due to the extent of the original disease. CONCLUSION: Surgical resection designed to remove the most affected parts of the lungs in diffuse-type bronchiectasis is recommended when there is failure of medical treatment.

Swallowed foreign body: Is interventional management always required?

A retrospective study of 20 cases diagnosed as "swallowed foreign body" seen over a five-year period (July 1993-June 1998) at Asir Central Hospital was performed. Six (30%) were children and 14 (70%) adults. In the children, five were boys and one was a girl. Objects swallowed included metal nails. coins, hair pins and a chain pendant. In the adult group, eight (57%) were males and six (43%) females. Objects swallowed included sewing needles, sharp blades, pieces of glass, paper clips and gravel. The swallowed foreign body in all the patients passed innocuously through the gastrointestinal tract in two to ten (average 4.7) days. Our method of treatment consisted of giving high fiber diet, Metamucil or lactulose and liquid paraffin. There was no mortality.