T2-based magnetic resonance genitography in children with complex anorectal malformations: experience at a tertiary pediatric hospital in Latin America.

In children with anorectal malformations (ARMs), it is essential to have a diagnostic imaging method that helps with the evaluation of the internal anatomy. In patients with a persistent cloaca, an ARM variant, in which the measurement of the urethral channel and common channel determines surgical management, there are multiple options for imaging. Magnetic resonance imaging (MRI) is an excellent method for this purpose, from which accurate measurements of channel length can be obtained. Additionally, the use of volumetric/isotropic sequences allows multiplanar reformatting. We present our experience with pelvic MRI and intracavitary non-paramagnetic contrast (MR genitography). This method uses volumetric T2-weighted images and the instillation of saline solution as a contrast agent to distinguish the common channel, length of the urethra, anatomy of the vagina, and presence and location of the rectal fistula. We believe this technique to be particularly useful for those working in settings with limited MRI resources.

Contact Burn with Blister Formation in Children Treated with Sennosides.

Eight children treated for severe constipation with sennosides unexpectedly developed contact burns with blisters secondary to the use of these laxatives. All patients wore diapers, and the injuries occurred overnight. To avoid this side effect, we recommend that patients treated with sennosides, especially those in diapers, receive the medication at a time that allows for bowel movements to occur during the day and not overnight.

Unexpected megarectum: A potential hidden source of complications in patients with anorectal malformation.

BACKGROUND: Primary posterior sagittal anorectoplasty is recommended to repair anorectal malformations with rectoperineal or rectovestibular fistula. The aim of this study was to identify the impact of the presence of megarectum on the relative frequency of complications related to posterior sagittal anorectoplasty. METHODS: We performed a cross-sectional retrospective study including patients with anorectal malformation, preoperative rectogram and surgically treated with primary or staged posterior sagittal anorectoplasty. Only complications related to anorectoplasty were analyzed and compared with the presence of megarectum. RESULTS: Thirty patients aged 1 day to 7 years were included, 60% had megarectum. Sixteen patients had primary repair: 6 with megarectum and 10 without megarectum; complications occurred in four of the six with megarectum, 66.7%, and no complication were observed in the 10 patients without megarectum (F p=0.008). Fourteen patients had staged repair and no complications related to posterior sagittal anorectoplasty occurred in these patients. CONCLUSIONS: Comprehensive preoperative evaluation in patients with anorectal malformation with rectoperineal or rectovestibular fistula could include a rectogram. Awareness of the presence of megarectum could be useful information in the decision to create a colostomy or perform a primary posterior sagittal anorectoplasty.

Juvenile polyposis of infancy associated with paracentric inversion and deletion of chromosome 10 in a Hispanic patient: a case report.

Juvenile polyposis of infancy is a rare genetic disorder, involving multiple hamartomatous polyps of the gastrointestinal tract, which usually has a very aggressive clinical course and is often fatal. It is characterized by early onset (during the 1st months of life) and by diffuse juvenile polyposis with anemia, recurrent gastrointestinal bleeding, diarrhea, rectal prolapse, intussusception, protein-losing enteropathy, starvation, and malnutrition. There is a hypothesis that mutation of the tumor-suppressor genes BMPR1A and PTEN, located on the long arm of chromosome 10, is associated with the development of this disease. Medical treatment for this disorder is challenging and should be conservative whenever possible. We present the case of a 3-year-old girl with juvenile polyposis of infancy who eventually died from mesenteric artery thrombosis during surgical colectomy. Karyotype of the patient showed a paracentric inversion in 10q and a deletion in 10p. We will briefly comment on some genetic considerations of this disease.

[Medico-surgical consensus for management of children with gastroesophageal reflux Acapulco, Mexico 2002]. / Consenso médico quirúrgico para el manejo de niños con reflujo gastroesofágico--Acapulco, México 2002.

UNLABELLED: Gastroesophageal reflux (GER) is a common disease in children less one year old. It is present around 10% of unselected infant population. 40-50% have abnormal 24 h pH monitoring. An early diagnosis and treatment should be done in order to avoid complications. AIM: To establish the consensus for the diagnosis and treatment of children with GER, to rule out similar diseases avoid the use of unnecessary drugs and the secondary side effects as well as unnecessary surgery. METHOD: The consensus was done with the participation of general pediatricians, pediatrics gastroenterologist, pediatric surgeons, radiologist and endoscopist. An initial paper was done by pediatric surgeon and pediatric gastroenterologist who submitted to the rest of participants. Second stage: the paper was review through E-mail for all participants who send their suggestions and modifications. A new paper was done and discussed by medical and surgery area. During the Congress of Pediatric Surgery, in an open session was discuss again with the participation of the main authors and all the audience present. Finally, a paper was done and review for the main authors.

Descenso endorrectal: Acceso anal y laparoscópico. Modelo experimental en conejos / Endorectal descent: Anal and laparoscopic approach. Experimental model in rabbits

Objetivo. Describir una nueva técnica quirúrgica para descensos abdominoperineales endorrectales en una sola operación, usando laparoscopía y disección endorrectal por vía transanal. Diseño. Estudio se llevó a cabo en el Departamento de Cirugía de la Facultad de Medicina, UNAM. Material y método. Se operaron 25 conejos. Por laparoscopía se disecta el mesenterio del sigmoides y la reflexión peritoneal, y por vía transanal se realiza la mucosectomía, el descenso y las anastomosis. Resultados. La técnica permite realizar la colectomía, descender cualquier longitud de colon y tomar biopsias transoperatorias sin contaminar la cavidad abdominal. Puede ser utilizada para enseñanza o invetigación, y en la clínica, encuentra su aplicación en pacientes con enfermedad de Hirschsprung, colitis ulcerativa crónica inespecífica y poliposis familiar

Malformaciones del sistema nervioso enteral ¿Constipación funcional, enfermedad de Hirschsprung o displasia neuronal intestinal? / Malformations of the enteric nervous system. Functional constipation, Hirschsprung's disease or neuronal intestinal dysplasia?

Hasta hace unos años, la Enfermedad de Hirschsprung (EH) era el diagnóstico diferencial más común de la constipación crónica y la única alteración del sistema nervioso enteral conocida. Hoy sabemos que existe un grupo de malformaciones de la invervación colorrectal que puede causar síntomas indistinguibles de la EH; más aún, que pueden coexistir con ésta. Es por ello importante reconocer estas alteraciones para ofrecer un diagnóstico y tratamiento más adecuado a los pacientes con estos trastornos de la motilidad gastrointestinal

Ileocecocistoplastia continente en niños con incontinencia irreversible / Continent ileocecocystoplasty in children with intractable urinary incontinence

En un estudio clínico, descriptivo y observacional, se analizaron la continencia urinaria, el impacto sobre la función renal y las complicaciones postoperatorias en niños operados de ileocecositoplastia continente en el servicio de Urología del Instituto Nacional de Pediatría, de agosto de 1992 a diciembre de 1993. Se analizaron las características clínicas más importantes al momento de la cirugía, el cuadro clínico, las pruebas de laboratorio y la continecia urinaria, preoperatoria y a los seis meses de la operación. También se analizaron, la longitud del segemento ileocecal utilizado y las complicaciones postoperatorias. Esta serie, que es la más numerosa descrita en niños, es de 13 pacientes entre tres y 17 años de edad, con alteración irreversible de la continencia urinaria. Las complicaciones postoperatorias fueron formación de cálculos en el reservorio en un caso, dehiscencia de la plicatura del ileon en otro y acidosis metabólica hiperclorémica en un caso. Consideramos que de las derivaciones urinarias continentes, la indicación más apropiada de la ileocecositoplastia es en niños con padecimiento congénitos que comprometen la continencia y cuya vejiga urinaria no necesita ser extirpada