Severity assessment to guide empiric antibiotic therapy for cholangitis in children after Kasai portoenterostomy: a multicenter prospective randomized control trial in China.

BACKGROUND: Cholangitis is common in patients with biliary atresia following Kasai portoenterostomy (KPE). The prompt use of empiric antibiotics is essential due to the lack of identified microorganisms. The authors aimed to validate a severity grading system to guide empiric antibiotic therapy in the management of post-KPE cholangitis. MATERIALS AND METHODS: This multicenter, prospective, randomized, open-label study recruited patients with post-KPE cholangitis and was conducted from January 2018 to December 2019. On admission, patients were categorized into mild, moderate, and severe cholangitis according to the severity grading system. Patients in the mild cholangitis group were randomized to receive cefoperazone sodium tazobactam sodium (CSTS) or meropenem (MEPM). Patients with severe cholangitis were randomized to treatment with MEPM or a combination of MEPM plus immunoglobulin (MEPM+IVIG). Patients with moderate cholangitis received MEPM. RESULTS: The primary endpoint was duration of fever (DOF). Secondary outcomes included blood culture, length of hospital stay, incidence of recurrent cholangitis, jaundice clearance rate, and native liver survival (NLS). For mild cholangitis, DOF, and length of hospital stay were similar between those treated with CSTS or MEPM (all P >0.05). In addition, no significant difference in recurrence rate, jaundice clearance rate, and NLS was observed between patients treated with CSTS and MEPM at 1-month, 3-month, and 6-month follow-up. In patients with moderate cholangitis, the DOF was 36.00 (interquartile range: 24.00-48.00) h. In severe cholangitis, compared with MEPM, MEPM+IVIG decreased DOF and improved liver function by reducing alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and direct bilirubin at 1-month follow-up. However, recurrence rate, jaundice clearance rate, and NLS did not differ significantly between MEPM+IVIG and MEPM at 1-month, 3-month, and 6-month follow-up. CONCLUSIONS: In patients with post-KPE cholangitis, MEPM is not superior to CSTS for the treatment of mild cholangitis. However, MEPM+IVIG treatment was associated with better short-term clinical outcomes in patients with severe cholangitis.

Diagnosis and treatment of solid pseudopapillary neoplasm of the pancreas in children: A report of 18 cases.

Purpose: To explore the incidence, imaging and treatment of solid pseudopapillary tumor of pancreas in children, and Summarize the experience of treatment. Methods: The clinical data of 18 children with a solid pseudopapillary tumor of the pancreas treated in our hospital from January 2012 to June 2021 were analyzed retrospectively. The age range was 8-16 years old, the average age was 11.67 years old, and the median age was 11.5 years old, namely, three boys with an average age of 10 years old and 15 girls with an average age of 12 years old. In total, two cases were admitted to the hospital because of trauma, seven cases were found in physical examination, and nine cases were admitted with the abdominal pain as the main complaint. Enhanced CT examination was performed before operation, nuclear magnetic resonance examination and abdominal ultrasound examination were performed in some children, and plain CT scan was performed after operation. Results: Solid pseudopapillary tumor of the pancreas can occur in all parts of the pancreas, especially in the body and tail of the pancreas. Among the 18 cases, SPN occurred in the head of pancreas in 5 cases (27.78%), the neck of pancreas in 2 cases (11.11%), and the body and tail of pancreas in 11 cases (61.11%). All the 18 children were treated by operation. among them, 4 cases underwent choledochal pancreatico duodenectomy (1 case), 4 cases underwent pancreaticoduodenectomy combined with splenectomy (3 cases), 6 cases underwent spleen-preserving pancreatectomy / tail pancreatectomy (1 case), 3 cases underwent enucleation of pancreatic tumor due to exogenous growth, 1 case underwent laparoscopic partial pancreatectomy and pancreaticoenterostomy. Laparotomy was performed in 12 cases and endoscopic surgery in 6 cases. Postoperative pathology confirmed solid pseudopapillary tumor of the pancreas. None of the patients received radiotherapy and chemotherapy after operation and were followed up for 6 months to 2 years. There was no recurrence, metastasis or pancreatic dysfunction. Conclusion: Solid pseudopapillary tumor of pancreas in children is a rare, low-grade malignant solid tumor with no specific clinical manifestations and laboratory examinations. Preoperative diagnosis mainly depends on enhanced CT. Surgical resection of tumor is a reliable treatment, and the specific operation is mainly based on the experience of the chief surgeon, the location of the tumor and the invasion of surrounding tissue. At present, there is no evidence of the effectiveness of other treatment options, and surgical resection of the tumor has a good prognosis.

Surgical Procedure Choice for Removing Hepatic Cysts of Echinococcus granulosus in Children.

Aim This study aims to evaluate the effectiveness of radical and conservative surgical procedures for removal of hydatid cysts in the liver of children. Methods A total of 112 pediatric patients had surgical treatment of hepatic cystic echinococcosis (CE) between January 2002 and December 2012 at the First Affiliated Hospital of Xinjiang Medical University were retrospectively evaluated. The patients were divided into two groups receiving either radical (n = 26) or conservative surgery (CS) (n = 86). Patient age, gender, symptoms, preoperative radiologic investigations, type of cyst, involvement of other organs, surgical procedure performed, postoperative complications, and mean hospital stay after surgery were recorded. Results The mean surgical procedure time for radical surgery (RS) was significantly longer than CS (126.4 ± 37 vs. 90.4 ± 22.9 minutes, p < 0.001], and the days for hospitalization showed no difference (11.0 ± 2.1 vs. 11.5 ± 3.1 days, p > 0.05]. Seven patients in the CS group had 20-300 mL of bile drainage 2-4 days post-operation and two patients developed a postoperative cavitary abscess; five patients in the RS group and one patient in the CS group developed a hydrothorax on the fifth day postoperatively. Follow-up of all patients showed that the majority had recovered well except for 3 cases who developed recurrences due to cysts ruptured accidently before surgery. There were no recurrences or biliary complications in the RS group. Conclusion CS is an effective method for liver CE cyst removal and RS is suitable for hepatic cysts in less risk position in pediatric patients.

Splenogonadal fusion: Report of four cases and review of the literature.

Splenogonadal fusion (SGF) is a rare congenital abnormality that affects children of both genders. Very few cases of SGF have been diagnosed preoperatively. In this study, the surgical findings and laparoscopic treatment of four children with SGF associated with intra-abdominal cryptorchidism are described. Laparoscopy was demonstrated to be the only accurate exploratory procedure for the diagnosis and surgical treatment of SGF with non-palpable testis.