ABSTRACT
Perforated bowel and adhesive intestinal obstruction are common indications for emergency surgical intervention in a preterm neonate. The initial approach to managing perforation involves either peritoneal drain insertion or formal laparotomy. Once a neonate presents with complete bowel obstruction, prompt abdominal exploration becomes crucial. One prevalent cause of bowel obstruction in this population is adhesions resulting from previous surgeries. This report details the case of a preterm, extremely low birth weight neonate experiencing pneumoperitoneum, initially managed with an intraperitoneal drain. Despite temporary improvement, the infant developed recurrent pneumoperitoneum, necessitating formal exploratory laparotomy. Approximately one month post-surgery, the baby encountered complete bowel obstruction due to adhesive intestinal obstruction, requiring a second exploratory laparotomy. The child survived both surgical interventions and is thriving at follow-up. Our findings suggest that in select cases, intraperitoneal drain placement may suffice. However, there is a need for further research to improve the suspicion and diagnosis of Meckel's diverticulum perforations in neonates. Additionally, vigilant assessment and timely intervention for adhesive intestinal obstruction can enhance bowel salvage outcomes.
ABSTRACT
Introduction: Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum, and its incidence is poorly understood due to its rarity. Gastrointestinal Basidiobolomycosis (GIB) is an uncommon presentation with limited reports in Saudi Arabia. This retrospective study aims to describe risk factors, clinical findings, diagnosis, and management of GIB in the pediatric population. Methods: We conducted a retrospective analysis of all pediatric patients diagnosed with GIB at a tertiary hospital between 2010 and 2022. Patients were identified based on their diagnosis of GIB. A self-administered questionnaire was distributed to assess risk factors associated with GIB. Results: We analyzed 25 cases of pediatric GIB, with approximately half of the cases (56%) occurring during the COVID-19 pandemic. The mean age of affected patients was 6.6 years, with a male predominance (60%, n=15). About 100% of parents acknowledged gecko existence in their residence, and their children were exposed to insect bites. Poor appetite was reported in all patients, and high counts of eosinophils and erythrocyte sedimentation rate were observed. Thrombocytosis was present in approximately 90% of patients, and 87% had anemia. Abdominal computerized tomography scans and ultrasound-guided biopsies were the most used diagnostic tools, with cases being diagnosed based on histopathological findings and confirmed via fungal culture. Conclusion: Our study provides valuable information on the potential risk factors, clinical features, diagnosis, and management of pediatric GIB in the Jazan region. The observed increase in cases during the COVID-19 pandemic highlights the need for continued surveillance and research to understand better the epidemiology and associated risk factors with this rare fungal infection. These findings emphasize the need for heightened awareness, early detection, and effective prevention strategies to mitigate the impact of pediatric GIB.
ABSTRACT
Acute appendicitis (AA) is cited as the leading cause of surgical acute abdomen in pediatrics and the most frequent urgent surgical pathology worldwide. For a long time, surgical appendectomy has been effectively used as the first-line treatment for AA. Other conservative management practices, such as the use of antibiotics, have been applied in the treatment of appendicitis. COVID-19 has had a significant impact on the surgical treatment strategies of AA in pediatrics, with many pediatric surgeons having to shift from upfront surgical appendectomy to conservative management involving the use of antibiotics as a treatment strategy. This meta-analysis compares the outcomes between appendectomy and conservative therapy in the management of AA during COVID-19 in pediatrics. Twenty-one articles fully met the inclusion criteria. Articles that were published more than five years ago were excluded from the analysis. Also, articles that included studies on the adult population were excluded. Results from various retrospective studies, prospective clinical controlled trials, correlational studies, and randomized clinical trials were analyzed. This study reveals that the use of antibiotics has been demonstrated to be safe and effective in the treatment of uncomplicated appendicitis. However, antibiotics have been shown to have some complications. Despite this being the case, the studies identified the potential of using antibiotics as a definitive treatment of uncomplicated AA in pediatrics. Further studies are required to evaluate the cost-effectiveness and recurrence of AA of this alternative treatment method.