Gastric volvulus in children.

Gastric volvulus (GV) is a rare disease in children that may not be recognized early in its course. We retrospectively analyzed 15 patients under 18 years of age who presented to our medical center with GV between January 1995 and June 2005. Patients with complete volvulus and acute obstruction requiring immediate intervention were defined as acute GV. Chronic GV was diagnosed in the presence of partial volvulus with chronic, nonspecific symptoms and signs. Chronic GV (12/ 15) was more common than acute GV (3/15). Organoaxial GV was the most common type (9/15), and there was a high incidence (6/15) of associated anomalies that predisposed to the condition. None of our patients had Borchardt's triad (acute localized epigastric distension, unproductive retching, and the inability to pass a nasogastric tube) which is described in adults with acute GV. Acute GV was immediately treated surgically, but conservative management was successful in patients with chronic idiopathic GV. When acute GV in children fails to exhibit the full gamut of Borchardt's triad, the diagnosis may be delayed. Immediate surgical reduction is recommended for acute GV. For chronic idiopathic GV, the treatment may be based on the age at diagnosis, the severity of symptoms, and how patients are expected to comply with conservative measures.

Meckel's Diverticulum: Factors Associated with Clinical Manifestations.

Objectives. The purpose of this study was to investigate the clinical features of Meckel's diverticula at different ages, genders, and pathology in order to serve as a reminder to clinicians when evaluating potential cases and to help obtain an early diagnosis. Methods. We collected information of patients with Meckel's diverticulum diagnosed at Mackay Memorial Hospital in Taiwan from 1984 to 2009. After performing a thorough review of their charts, the clinical features of the Meckel's diverticula were analyzed according to age groups, gender, and pathology. Result. A total of 126 patients, with 90 males and 36 females, were enrolled in this study. Seventy-five patients were symptomatic and 51 Meckel's diverticula were found incidentally during surgery for other diseases. Among symptomatic patients, 39% of pediatric patients and 5% of adult patients had intestinal hemorrhage. Twenty-eight percent of pediatric patients and 67% of adult patients had inflammation of Meckel's diverticulum. Forty-six percent of males and 16% of females had inflammation. Conversely, 27% of males and 58% percent of females had intestinal obstruction. When Meckel's diverticulum had ectopic gastric mucosa, it tended to cause intestinal hemorrhage when the patient is young. Conclusions. Age, gender, and pathology affect the clinical presentations of Meckel's diverticula.

Congenital central hypoventilation syndrome in a full-term baby presenting with repeated extubation failure.

Congenital central hypoventilation syndrome (CCHS) is a rare condition. The main characteristic is respiratory insufficiency during sleep. Patients who have CCHS need varying degrees of ventilation support during sleep, or even all day long, according to its severity. We report a term baby with repeated extubation failure, CCHS and Hirschsprung's disease diagnosed at 1 month of age. This patient was discharged at 5 months old with a home ventilator and reached normal developmental milestones.

Recurrent Intussusception: when Should Surgical Intervention be performed?

OBJECTIVE: To determine the optimal timing of surgery for recurrent intussusception. METHODS: We retrospectively reviewed medical records of patients aged from 0 to 18 years old with diagnosis of intussusception in the Pediatric Department at Mackay Memorial Hospital between January 1995 and May 2010. RESULTS: During the study period, there were 686 children (divided into three age groups: 367 < 2 years, 289 aged 2 to 5 years, 30 > 5 years) with diagnoses of intussusception. Eighty-five of the 686 patients had recurrent intussusception, of whom 56 had two, 16 had three, 11 had four, and 2 had five episodes. The recurrence rate after the first, second, third, and fourth barium enema reductions were 15.7%, 37.7%, 68.4%, and 100.0%, respectively. The incidence of recurrence and failure rate of barium enema reduction did not differ significantly among these three age groups. Surgery was performed in 177 children (146 during the first episode and 31 in recurrent cases). The probability of eventual surgery after first enema reduction was 21.8%, after the second 35.7%, and after the third 70.0%. Lead points were found in 15 children, and all of them were found during surgery for the first episode of intussusception. CONCLUSION: The probability of recurrence was 100% after the fourth episode of intussusception in our study. After the third episode of intussusception, the probability of recurrence and eventual surgery were 68% and 70%, respectively. From this study, surgical intervention should be considered at the third episode of intussusception.

A twenty-year review of early and late-presenting congenital Bochdalek diaphragmatic hernia: are they different clinical spectra?

BACKGROUND: Congenital Bochdalek diaphragmatic hernia (CDH) is easily recognized if it is present shortly after birth. However, cases of delayed CDH presentation are more subtle and therefore less easily diagnosed. METHODS: We retrospectively analyzed 85 patients who were under 18 and diagnosed with CDH between June 1987 and May 2007. Those diagnosed before 1 month of age were categorized as having early-presenting CDH and those diagnosed after 1 month were categorized as having late-presenting CDH. RESULTS: Of the 85 cases, 68 (80%) were early-presenting and 17 (20%) were late-presenting CDH. Respiratory symptoms were more common in early-presenting CDH, while gastrointestinal complaints were more dominant in the late-presenting group, particularly in patients with left diaphragmatic defects. Late-presenting CDH, which was more likely to be associated with chronic gastrointestinal symptoms, was associated with a lower mortality than acute early-presenting CDH with respiratory symptoms, despite the more prompt diagnosis of the latter. The small bowel was the organ most commonly herniated into the thorax. Congenital heart disease was the most commonly associated malformation, but the presence of associated anomalies did not increase mortality. CONCLUSION: Early-presenting CDH shows acute symptoms, is readily diagnosed, and requires prompt intervention to prevent death. In contrast, late-presenting CDH shows more subtle symptoms and is more difficult to diagnose. Although the late-presenting CHD has better prognosis, it still requires surgery intervention to alleviate the symptoms. Clinicians must maintain a high index of suspicion for CDH, regardless of its presentation.

Acute torsion of wandering spleen: report of one case.

Wandering spleen is a rare condition that can lead to splenic infarction or rupture if torsion persists. Early diagnosis and intervention are necessary, and abdominal ultrasonography and abdominal computed tomography are well accepted as the diagnostic imaging modalities. In this study, we present a boy with nic infarction due to acute torsion of a wandering spleen, after initial failure to demonstrate an ectopic spleen. Instead, acute torsion of the wandering spleen with spontaneous partial detorsion was incidentally found by multi-detector row CT with angiography. The patient was managed by splenectomy instead of splenopexy, because poor reperfusion after Laparoscopic detorsion.