Paediatric and adolescent traumatic gastrointestinal injuries: results of a European multicentre analysis.

AIM: Paediatric gastrointestinal injuries (GIIs) are rare, and the aim of this multicentre study was to evaluate their outcomes in a large cohort. METHODS: Hospital databases of 10 European paediatric surgical centres were reviewed for paediatric traumatic GIIs managed between 2000-2010. RESULTS: Ninety-seven patients with a median age of 9 years (0-17 years) were identified, with 72 blunt and 25 penetrating GIIs. Initial diagnostics in 90 patients led to correct diagnosis in 71%. Diagnostics were delayed in 26 patients (median 24 h). Eighty-two patients required surgery (67 laparotomy, 12 laparoscopy and three other approaches). There was a 50% conversion in the laparoscopic group. Median hospital stay was 10 days (range 1-137 days), with longer duration influenced by associated injuries (n = 41). Diagnosis <24 h was associated with significantly shorter hospital stay compared to more than 24 h (p = 0.011). In one-third of patients, morbidities were not related to a diagnostic delay or type of injury. There were five lethal outcomes, four due to associated injuries. CONCLUSION: Initial diagnostics in traumatic paediatric GIIs provide false negatives in one-third of patients. Diagnostic delay <24 h is associated with a significantly shorter hospital stay. Although laparoscopy is associated with a conversion rate of 50%, it can be used for diagnosis in suspected cases to avoid nontherapeutic laparotomy.

[Very severe hepatic trauma in childhood. The report of two cases with minimally invasive treatment]. / Traumatismo hepático muy grave en la infancia. A propósito de dos casos con tratamiento mínimamente invasivo.

Liver trauma in children is a pathology that has an increasing incidence mainly due to the implications of growing children in hazardous games and sports adventure, and the frequent car accidents. There has been a shift of management in haemodynamically stable patients towards non-operative management. This allows in most cases a patient's complete recovery without surgical aggression, preventing further damage derived from the handling of the injured liver. Herewith we report two cases of a 6 and 4 year old boys who suffered a very severe traumatic rupture of the liver. They were operated through minimally invasive surgical procedures, achieving complete resolution of the serious damages.

[Palmar hyperhidrosis in childhood: thoracoscopic sympathectomy]. / Hiperhidrosis palmar en la infancia: simpaticolisis toracoscópica y encuesta de satisfacción.

BACKGROUND: Excessive hand sweating, known as palmar hyperhidrosis, is a disabling disorder that starts during the childhood, and can have a strong negative impact on the quality of life of affected children, as they feel rejected by others due to their permanently damp hands, suffering during school activities, contact sports and daily games. MATERIAL AND METHODS: Thoracoscopic sympathicolysis is easy to perform and has proven to be safe, with a short operating time. A review was performed on 48 children who underwent surgical treatment of palmar hyperhidrosis and answered a follow-up questionnaire to evaluate their level of satisfaction. RESULTS: Considering the final surgical results, the 48 patients were completely satisfied with the outcome of the operation. Significant complications or adverse effects were not detected. CONCLUSIONS: The primary palmar hyperhidrosis is a pathology that entails an important reduction in the quality of life of those who suffer it. With the results of this technique in hand, we recommend the endoscopic thoracic sympathicolysis procedure for the treatment of this pathology in paediatrics. The level of patient satisfaction was high.

[Our experience with hydro-debridement in varied skin lesions. Technical and innovating advance in pediatric surgery]. / Nuestra experiencia con el hidro-desbridamiento en lesiones cutáneas variadas. Adelanto técnico e innovador en cirugía pediátrica.

We present our experience in the use of Hydrosurgery with debridement of necrotic tissues from skin wounds in children. The Hydrosurgery system uses a high velocity stream of sterile saline solution, which can be controlled according to the state of the lesion. We have used this system in 15 patients suffering from a wide range of pathologies (burns, severe traumatic wounds, skin necrosis etc), achieving its complete resolution in shorter period of time. This method is an innovative technique in the management of patients with acute o r chronic skin lesions that require periodic procedures.

Computed tomography diagnosis of symptomatic right paraduodenal hernia associated with enteric duplication cyst.

Paraduodenal hernias rarely present with symptoms in children. We report a case of a right paraduodenal hernia associated with enteric duplication cyst that caused intestinal suboclussion in a 9-month-old female infant. Paraduodenal hernia was detected by contrast-enhanced computed tomography. In a review of the English-published literature, we have not found other reports of the association of paraduodenal hernia and enteric duplication cyst. A high index of suspicion is required for detecting paraduodenal hernias in children, and abdominal computed tomography is the most specific imaging study for their preoperative diagnosis.

[Non-palpable testicle: joint review of pediatric endo-surgical group and its management by laparoscopy]. / El testículo no palpable y su tratamiento por laparoscopia. Revisión conjunta del Grupo Español de Endocirugía Pediátrica (GEEP).

We present the joint serie of 5 Pediatric Centers with 256 patients diagnosed of cryptorchidism with nonpalpable testis treated by laparoscopy. We have found that Ultrasound examination is not very useful. This entity affects more to the left side 60%. In near half of the cases 46% we have not found any testicle and in 54% it was carried out an orquidopexy by different methods. In 27% we made an orquidopexy by Fowler-Stephens technique with 86% of good results. We think that laparoscopy is the best way of diagnosis and treatment of this patients.

Bilateral and multilobar cystic adenomatoid malformation of the lung.

We report a case of bilateral and multilobar congenital cystic adenomatoid malformation (CCAM) in a four-months-old child with good clinical results after resections of the lesions. This is a relatively rare form of pulmonary disease. The final prognosis in these patients depends on the type of malformation, the presence or absence of fetal hydrops and on the extent of affected lung. Few cases of multiple involvement have been reported. We will consider the physiopathological aspects of the case, late clinical presentation and treatment and the positive surgical response based on the findings of the functional and anatomic imaging studies.

[Cantrell's pentalogy: complete treatment, step by step]. / Pentalogía de Cantrell: tratamiento completo, paso a paso.

Since MAYOR and CANTRELL described in 1953 and in 1958 the ectopia cordis associated to other four anomalies, few cases have been reported, and only a small part of them have survived. We report the case of a neonate who presented with the features of the pentalogy. On the 3rd day we found at operation the heart laying over the left hepatic lobe, no pericardium could be identified and diaphragm was absent at its anterior edge. We made an "isolating sac" with duramadre fixed to the anterior thoracic wall, to both sides and to the posterior diaphragmatic defect. The initial management of the ventral defect is described. At the age of two years we initiated the definitive treatment aiming to: 1. To protect the heart. 2. To correct the huge abdominal eventration following the closure of the omphalocele. We described in details the technic employed to cover the precordial defect, to reconstruct the diaphragm, and finally as we treated in three consecutives stages the huge abdominal eventration.

[Ectopic gastric mucosa in the proximal esophagus]. / Mucosa gástrica ectópica en esófago proximal.

Gastric mucosa is not found often in the proximal and medial esophagus. Hematemesis and dysphagia are the most frequent symptoms. We report a six year-old child who complained of difficulty in swallowing. A filling defect was detect in the esophagogram. We biopsied the suspected area, through an endoscopy and the pathological examination informed of ectopic gastric mucosa. We performed a 99Tc isotopic study. The child is on ambulatory controls and at the moment is asymptomatic.