Endoscopic retrieval of 195 incidentally found ingested magnets in a pediatric patient: The limitations of radiography.

Ingestion of magnetic foreign bodies in children can present elusively on radiographs, requiring detailed history for accurate intervention guidance. Clustering and the weight of multiple magnets may indicate falsely distal positions in the GI tract.

Neonatal Testicular Torsion with Hydrocele: A Case Report Underscoring the Need for Early Recognition and Management.

Neonatal testicular torsion (NTT) is a rare but significant condition occurring within the first 30-day postbirth, leading to vascular compromise and potential testicular loss. This paper presents a case of NTT detected incidentally in a neonate with bilateral hydrocele, emphasizing the challenge of early diagnosis and management complexities. The infant underwent surgical intervention involving detorsion and bilateral orchiopexy but eventually required right orchiectomy due to necrosis. The paper highlights the prevalence of NTT in conjunction with hydrocele and stresses the importance of parent education and vigilant follow-up. Various diagnostic methods, primarily ultrasonography, and a range of management strategies are discussed, considering factors such as salvage potential, risk to the contralateral testicle, and surgical intervention's risks and benefits. The paper argues for individualized management, taking into account specific neonate conditions and parental preferences, underlining the essential role of informed and empathetic consultation. The case reinforces the urgent need for increased awareness, early detection, and carefully considered therapeutic approaches to prevent devastating outcomes like infertility and the necessity for lifelong hormone supplementation.

Intravesical gentamicin instillation in the prevention of recurrent urinary tract infections in children with neurogenic bladder- a single-center retrospective observational study.

BACKGROUND: Recurrent urinary tract infections (UTI) in children with neurogenic bladder (NGB) put them at high risk of morbidity and mortality from urosepsis and end-stage renal disease (ESRD). Since the efficacy of low-dose prophylactic antibiotics to prevent these recurrences has been declining since the emergence of extended-spectrum beta-lactamase (ESBL) organisms, intravesical gentamicin instillation has also been used, but only scarce data in children is available in the literature. OBJECTIVE: We evaluate the efficacy of intravesical gentamicin instillation to reduce UTIs in children with NGB, compare it with oral antibiotic prophylaxis and determine its effect on pathogens resistance to antibiotics. STUDY DESIGN: Retrospective observational study of 17 children with NGB managed in a tertiary center. Intravesical gentamicin instillation followed an initial period of oral antibiotic prophylaxis. In a conditional negative binomial regression model, a matched comparison of the rate of UTIs, the identified pathogens and their antibiotics susceptibility between the two therapies was performed for each individual child, RESULTS: When compared to antibiotic prophylaxis, intravesical gentamicin instillation showed no significant difference in the yearly rate of UTI, symptomatic UTI, or admissions for intravenous antibiotic therapy. However, it was associated with a 38% reduction in the incidence rate ratio of UTI (p = 0.04) and 75% of asymptomatic UTI (p = 0.006) After intravesical gentamicin instillation, five children (31%) had a gentamicin-resistant UTI, similar to before that treatment (p = 0.76). DISCUSSION: Although the overall rate of UTI and of asymptomatic infections were significantly lower with intravesical gentamicin instillation than during oral antibiotic therapy, there was no significant difference in the rate of symptomatic UTIs or UTIs requiring admissions, probably because of the small sample size. In addition, neither an emergence of ESBL pathogens nor the rate of pathogens resistance to gentamicin was observed with intravesical gentamicin instillation. As to the potential nephrotoxicity of aminoglycosides, the calculated GFR for all children remained normal. Strengths of our study include the use of a matched paired comparison of each participant with him/herself with each treatment modality, thus eliminating potential confounding by some individual characteristics. In addition, and unlike previous studies, we have also used a robust multivariate statistical analysis to compare counts and rates of outcomes. Limitations include the absence of gentamicin serum levels monitoring, of hearing testing, and also the small sample size. CONCLUSION: Intravesical gentamicin instillation decreases the overall rate of UTI and asymptomatic infections in children with NGB without increasing the rate of bacterial resistance to gentamicin.

Colonic adenocarcinoma as a secondary malignancy after treatment of embryonal rhabdomyosarcoma.

BACKGROUND: Survivors of childhood malignancies are known to be at an increased risk for developing a variety of secondary cancers. Primary adenocarcinoma of the colon is very rare in children and adenocarcinoma of the colon occurring as a secondary malignancy in children is much rarer. METHODS: A boy with a history of successfully treated embryonal rhabdomyosarcoma developed adenocarcinoma of the colon as a secondary cancer. RESULTS: The boy presented with a solid mass of the left cheek at 3 years of age. The mass was excised and histological examination showed embryonal rhabdomyosarcoma. He was treated with multi-agent chemotherapy and local radiotherapy, which resulted in complete remission. Four years later, he presented with recurrent colicky abdominal pain and bleeding per rectum and was found to have intussusceptions. Colonoscopy revealed a tumor in the transverse colon, which was biopsied and proved to be an adenocarcinoma. The boy underwent excision followed by chemotherapy using an adult colon cancer regimen. He is currently off chemotherapy for 2 years with no evidence of the disease. CONCLUSIONS: We report a rare case of colon cancer after treatment of rhabdomyosarcoma. Colorectal adenocarcinoma must be kept in mind as a secondary neoplasm following treatment for early childhood malignancies although it is extremely rare.

Lupus cystitis in an Omani girl.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple organs involvement. Bladder involvement (Lupus cystitis) is a rare manifestation of SLE, and occurs in association with gastrointestinal manifestations. We report a case of lupus interstitial cystitis with bladder irritation and bilateral hydroureteronephrosis in an adolescent female who was treated with intravenous methylprednisolone pulse therapy followed by oral prednisolone and mycofenolate mofetil (MMF). Her symptoms ameliorated, and the hydroureteronephrosis improved. She was presented again with systemic flare up of the disease together with hydrouretronephrosis, but without bladder irritation symptoms. The diagnosis of lupus cystitis was confirmed by radiographic abnormalities, cystoscopy and bladder biopsy.

Successful separation of pygopagus conjoined twins and primary skin closure using V-shaped flaps.

Pygopagus conjoined twins were born by caesarean section at 34 weeks of gestation. Initial evaluation revealed no other abnormalities apart from their attachment at lower back, buttocks and perineum. They had two separate anal and urogenital openings. Their investigations included roentgenograms, ultrasound, barium enema, cystourethrogram, CT scan and MRI. There were two separate spinal columns fused distally at the lower sacral level. Lower gastrointestinal studies showed two separate rectums and cystourethrogram showed normal and separate urinary tracts. MRI showed a single dural sac between two fused sacral bones with no other vertebral anomalies. They were successfully separated with primary skin closure using V-shaped flaps.

Successful separation of pygopagus conjoined twins.

Conjoined pygopagus twins are very rare. They represent about 17% of all conjoined twins and commonly share the gluteal region, terminal spine, and lower gastrointestinal, urological, and reproductive tracts. Meticulous preoperative investigations and planning as well as a multispecialty team approach contribute to the success of surgical separation. We report a case of successful surgical separation of pygopagus conjoined twins.

Camel-related injuries in the pediatric age group.

BACKGROUND: Road traffic accidents continue to be a major cause of morbidity and mortality among children. Domestic animal-related injuries in general, camel-related in particular, have not been given much attention, and very little is written about them. METHODS: The medical records of all children admitted to our hospital with camel-related injuries were retrospectively reviewed for age, sex, mechanism of injury, type of injuries, treatment, and outcome. RESULTS: Seventy-eight children with camel-related injuries were seen at our hospital. Most of them were camel jockeys. All were males, and their ages ranged from 4 to 15 years (mean, 8.6 years). In 74, the cause of injury was a fall from a racing camel, 2 were kicked by a camel, and 1 had a camel bite. Forty-four (56.4%) had head injury, which was moderate to severe in 17, and 6 of them had associated skull fractures, whereas 3 had intracranial hematomas. Twenty-five (32.1%) had fractures of various bones, and 14 of them had fracture of the tibia. One child had L2 and L3 dislocation, with displacement and compression fracture of L2. Two sustained thoracic injuries, whereas 9 had intraabdominal injuries, including liver injury (3), splenic injury (1), renal injury (3), and bowel injury (2). One had a camel bite leading to a fractured mandible, injury to his ear, and intimal tear of the left common carotid artery. CONCLUSIONS: Camels are a potential cause of serious injuries and a major public health problem for children in this part of the world. This is especially so for camel jockeys. Every effort should be made to prevent such injuries, including limiting camel racing to older children as well as providing adequate protective measures and public education about the proper and compassionate handling of domestic animals.

Situs inversus abdominus in association with congenital duodenal obstruction: a report of two cases and review of the literature.

This report describes two newborns with persistent bile-stained vomiting. Their radiological investigations revealed the existence of situs inversus and duodenal obstruction. In one, the duodenal obstruction was partial, secondary to a duodenal diaphragm with a central aperture, whereas the other child had complete duodenal atresia as well as Fallot's tetralogy. Such an association is extremely rare, with only 18 cases reported so far in the literature. Embryological aspects, investigations, and treatment are also discussed.

An unusual cause of pelvi-ureteric junction obstruction.

Congenital lumbar hernia is rare in the pediatric age group. This report describes an infant with a superior lumbar hernia with herniation of the kidney that resulted in pelvi-ureteric junction obstruction. Surgical repair of the hernia and reduction of the herniated kidney resulted in resolution of the pelvi-ureteric junction obstruction. The literature on the subject is also reviewed.

Congenital duodenal diaphragm in eight children.

BACKGROUND: Congenital duodenal obstruction (CDO) is a common and usually easy to diagnose cause of intestinal obstruction in the newborn, except when the cause of the obstruction is a duodenal diaphragm. We describe our experience with eight children who had intrinsic duodenal obstruction secondary to a duodenal diaphragm. METHODS: The medical records of 22 children with the diagnosis of congenital intrinsic duodenal obstruction were reviewed for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment and outcome. Operative findings and procedures were obtained from the operative notes. RESULTS: Eight of the 22 children (36.4%) had congenital duodenal diaphragm (CDD). In all children, the diagnosis was made from plain abdominal X-ray, which showed the classic double-bubble appearance, and barium meal, which showed duodenal obstruction. Four patients had associated anomalies, including two with Down's syndrome. Intraoperatively, five patients were found to have duodenal diaphragm with a central hole, while the other three had complete duodenal diaphragms. Postoperatively, all patients did well. Six required total parenteral nutrition. CONCLUSIONS: The 100% survival rate among these children is comparable to that in Western countries, and can be attributed to the lack of major associated abnormalities, good perioperative management, and the availability of total parenteral nutrition.

Congenital pyloric atresia: the spectrum.

Congenital pyloric atresia (CPA) is a very rare malformation. It can occur as an isolated lesion or in association with other genetically determined conditions such as epidermolysis bullosa or aplasia cutis congenital, or form part of the hereditary multiple intestinal atresias syndrome. Five newborns with CPA representing the spectrum are presented. The clinical features, diagnosis, and outcome are also discussed.

A rare association of urogenital duplication and anorectal malformation.

An unusual case of urogenital duplication in association with anorectal malformation is presented. A 3-year-old girl was referred to the authors' hospital with double vagina, double urethra, double sacrum, double ureters on the right side, multiple vertebral anomalies, together with anorectal malformation. Successful surgical reconstruction was performed.

Volvulus of the sigmoid colon in a child.

Sigmoid volvulus although a common cause of large bowel obstruction in the elderly, is considered rare in the pediatric age group. We report a case of sigmoid volvulus in a 10-year-old child with mental retardation and myopathy. The various predisposing factors for sigmoid volvulus in children are discussed, and the literature on the subject is also reviewed.

Herniation through the foramen of Morgagni: early diagnosis and treatment.

The majority of congenital diaphragmatic hernias (CDH) occur through the foramen of Bochdalek; herniation through the foramen of Morgagni (MH) is rare. Fifteen children (12 males and 3 females) with congenital MH (7 right, 3 left, 5 bilateral) were treated over a period of 15 years, comprising 11% of a total of 135 children with different types of CDH. The majority (12, 80%) had repeated chest infections. In 1 the hernia was discovered accidentally during evaluation of trauma, and another presented in the neonatal period with acute respiratory distress (ARD). The diagnosis was made on plain lateral chest radiograph when there was anterior herniation of bowel loops, and in these cases the diagnosis was confirmed by barium enema. Computed tomography was useful in preoperative diagnosis when the hernia contents were solid. All patients were operated upon transabdominally except 1, and in all cases there was a hernia sac. Associated anomalies were present in 10 (66.7%) patients: 4 (26.7%) had malrotation, 4 (26.7%) congenital heart disease, and 3 (20%) Down's syndrome. Our study shows a relatively high frequency of MH in our patients. MH rarely presents in the neonatal period, but when it does, it causes ARD. The majority of patients with MH present beyond the neonatal period with repeated attacks of chest infection, and although late-presenting MH is relatively benign, it nevertheless causes significant morbidity. Thus, clinical awareness and early diagnosis and surgical treatment are important factors.