Postnatal Treatment in Antenatally Diagnosed Meconium Peritonitis.

Meconium peritonitis is a rare prenatal disease with an increased rate of morbidity and mortality in the neonatal period. Distinctive features revealed by prenatal and postnatal ultrasoundmay be present: abdominal calcifications, ascites, polyhydramnios, meconium pseudocyst, echogenic mass and dilated bowel or intestinal obstruction. Establishing clear postnatal treatment and prognosis is difficult because of the heterogeneity of the results obtained by ultrasound. The aim of the study is to determine how prenatal diagnosis of meconium peritonitis is associated with perinatal management and further evolution. Clinical results are different depending on the presence of antenatal diagnosis of meconium peritonitis and its form, which can be mild or severe. Surgical treatment and management of meconium peritonitis depend on the clinical presentation of the newborn. Meconium peritonitis diagnosed prenatally differs from that of the newborn, not only concerning the mortality rates but also through reduced morbidity and overall better prognosis.

Laparoscopic treatment for complicated acute appendicitis in children, junior athletes.

BACKGROUND: We present our experience in the first 20 cases of complicated acute appendicitis in children, junior athletes, managed laparoscopically. MATERIALS AND METHOD: We selected our first 20 patients, aged between 3 and 17 (median age 10), with complicated acute appendicitis treated laparoscopically. We analysed the intra and postoperative complications, operative time, length of hospitalization and their return period to previous training.Four cases were excluded from the study because they were converted to open appendectomy (OA). RESULTS: One case developed a parietal abscess at the place of insertion of the suprapubic trocar and was treated locally.There were no cases with intraabdominal abscesses to require drainage. Fever on the 3rd postoperative day appeared in one patient which required reassessment of the antibiotic treatment. Length of hospitalization was between 4 and 8 days.The athletes resumed their sports activity after 10 - 12 days. CONCLUSION: Complicated acute appendicitis (generalized peritonitis, localized abscess, perforated abscess), was once a contraindication for laparoscopic appendectomy (LA). Today LA is the first choice of surgical treatment for most of the surgeons. Due to the limited number of patients we have operated on laparoscopically up to this present paper we cannot draw a statistically significant conclusion, but the good results are encouraging us to continue using this approach as the first line treatment in children and more over for those who need a rapid return to intense physical activity.

Differential diagnosis of abdominal wall defects - omphalocele versus gastroschisis.

A newborn with abdominal wall defect is one of the most dramatic cases in neonatology, but also a challenge for pediatric surgeons. This article describes the fundamental concepts of two major abdominal wall defects - gastroschisis and omphalocele - including options and principles of prenatal and postnatal care. Although these birth defects of the abdominal wall are always grouped together, they are two separate and distinct entities, with many differences in terms of pathology and associated anomalies; this explains the different therapeutic approach and results. For a correct management of the newborn with this anomaly, it is essential to understand the similarities and differences between gastroschisis and omphalocele. This article emphasises the similarities between these two parietal defects, highlighting the differences as well.

Considerations on gastroschisis repair.

BACKGROUND: Although primary closure of the gastroschisis is possible in many cases, there have been various strategies published and materials used to cover the eviscerated bowel when the abdominal wall defect cannot be closed in one step, providing bowel protection and reduction of heat and fluid loss. There have been suggestions of coverage materials such as skin graft, lyophilized dura mater graft, free flap corium and meshed skin graft (1,2). PURPOSE: We highlight an alternative repair method of gastroschisis in those cases where there is a disproportion between the amount of eviscerated organs and the hypoplastic abdominal cavity. If in this case primary closure of the abdominal wall is chosen, the difference in volume can cause a significant increase in intraabdominal pressure. METHOD: In some cases, when complete primary closure was not possible, we used an alternative method to repair the parietal defect using umbilical cord patch. RESULTS: This technique creates a mesothelial surface in contact with the bowel. Remote tracking of these patients showed excellent results. CONCLUSIONS: This technique is easy to apply and very useful for infants with gastroschisis especially when primary closure is not possible. The use of autologous material, in this case as the umbilical cord, has several advantages, including wide availability, a lower rate of infection and significantly reduced costs.