Treatment of young patients with pilonidal sinus disease with the original (unmodified) Limberg flap standardized for the first time.

BACKGROUND: Pilonidal sinus disease (PSD) is commonly seen in young adults but may also affect adolescents. Our goal was to present results from operated patients, with a focus on the original Limberg flap, which we standardized for the first time. METHODS: This study was a retrospective review of 60 teenage patients who underwent surgery in a single pediatric surgery center over approximately 15 years. RESULTS: Of the 60 patients, 33 (55%) were male and the mean age was 14.20 ± 1.31 (9-17) years. After pilonidal sinus excision, primary repair and Limberg flap were performed in 45 (75%) and 15 (25%) patients respectively. There were no complications in the patients who underwent the Limberg flap technique, whereas 49% of the patients who underwent primary repair exhibited complications. The mean follow-up was 6.7 ± 4.8 years. CONCLUSION: We standardized the Limberg flap for the first time in children with measurements and consider that it meets expectations: it is not difficult to perform, it has low complication and recurrence rates, it requires an acceptable period to return to normal activities, and gives satisfactory cosmetic results. We did not identify any complications in patients treated with the Limberg flap excision and post-operative epilation. We consider that findings achieved by the treatment of original, standardized Limberg flap excision is comparable with all of the treatment methods reported in the literature related with children.

Management of traumatic bile duct injuries in children.

PURPOSE: Pediatric experience with biliary tract injuries (BTI) is limited and mostly consists of case presentations. The purpose of this study is to evaluate clinical and radiological findings of possible BTI, treatment strategies, and results. METHODS: The records of nine patients with the diagnosis of BTI between July 2009 and November 2017 were reviewed retrospectively. RESULTS: There were seven boys and two girls (mean 8.05 ± 4.39 years). The mechanisms were motor vehicle occupant, fall, crush and gunshot wound. Hepatic laceration routes that extended into the porta hepatis and contracted the gall bladder were demonstrated on computerized tomography (CT). Bile duct injury was diagnosed with bile leakage from the thoracic tube (n = 2), from the abdominal drain (n = 2) and by paracentesis (n = 5). Extrahepatic (n = 8) and intrahepatic (n = 1) bile duct injuries were diagnosed by cholangiography. Endoscopic retrograde cholangiography, sphincterotomy, and stent placement were successfully completed in five patients. Peritoneal drainage stopped after 3-17 days of procedure in four patients. The fifth patient was operated with the diagnosis of cystic duct avulsion. Cholecystectomies, primary repair of laceration, cystic duct ligation, and Roux-en-Y hepatoportoenterostomy were performed in the remaining four patients. All patients presented with clinically normal findings, normal liver functions, and normal ultrasonographic findings in the follow-up period. CONCLUSIONS: The presentation of the parenchymal injury extending to the porta hepatis with contracted gall bladder on CT and diffuse homogenous abdominal fluid should be considered as signs of BTI. We suggest a multi-disciplinary approach for the diagnosis and treatment of BTIs. Surgery may be indicated according to the patient's clinical condition, radiological findings and failure of non-operative treatment.

Intestinal malrotation needs immediate consideration and investigation.

BACKGROUND: The aim of this study was to evaluate clinical presentation, diagnostic studies, and volvulus rate and to describe the unusual clinical clues of intestinal malrotation. METHODS: A retrospective descriptive review was carried out of all patients diagnosed with intestinal malrotation between 2002 and 2014. Patients were divided into two groups: infants (≤1 year, n = 16; group 1); and children (>1 year, n = 12; group 2). Patient demographics, clinical history, symptoms, physical examination, diagnostic work-up, operative findings and early outcome were evaluated. RESULTS: Bilious vomiting was the cardinal complaint in both groups. Unusual symptoms such as respiratory insufficiency, dehydration, afebrile convulsion, and lethargy were prominent symptoms in six patients in group 1, whereas history of frequent hospitalization due to recurrent abdominal pain and feeding intolerance were prominent in six patients in group 2. Midgut volvulus was identified in 15 patients, four of whom were in group 2. Standard Ladd's procedure was done in addition to correction of volvulus. CONCLUSION: Malrotation with or without midgut volvulus is not a rare condition and should be kept in mind for any age group. Specific signs of diagnosis are not easily identified. In the case of unusual clinical presentation, diagnosis may be delayed and can result in catastrophic consequences if intestinal perfusion occurs. Although midgut volvulus is seen most frequently in infants, risk and complication rate are high beyond 1 year of age as well, and can manifest as failure to thrive, food intolerance, and abdominal pain needing recurrent hospitalization. Diagnostic suspicion and interdisciplinary coordination are essential for timely diagnosis and surgical treatment.

Mortality Factors in Crush Syndrome.

BACKGROUND: Crush Syndrome is a major cause of morbidity and mortality following large-scale catastrophic earthquakes. Since there are no randomized controlled studies on Crush Syndrome, knowledge on this subject is limited to expert experience. The primary objective is to analyze the epidemiological and demographic characteristics, clinical outcomes, and mortality factors of earthquake victims after the Pazarcik and Elbistan earthquakes on February 6, 2023. METHODS: This cross-sectional and observational retrospective study evaluated 610 earthquake victims who presented to our center between February 6 and April 30, 2023. Among these patients, 128 with Crush Syndrome were included in the study. Patient information was gathered from hospital records during their stay and from national registries upon referral. The primary outcome was to identify risk factors for mortality. Demographic and laboratory data were analyzed by acute kidney injury (AKI) stages; mortality-affecting factors were identified through regression analysis. RESULTS: Of the 128 Crush Syndrome patients (100 adults, 28 children), 64 were female. The AKI rate was 32.8%. Among patients with AKI, the frequency of hemodialysis requirement was 69%, and the mortality rate was 14.2%. The overall mortality rate for patients with Crush Syndrome was 4.6%, compared to 3.9% (19/482) in earthquake victims without Crush Syndrome (p=0.705). Notably, low systolic blood pressure at admission was the only factor significantly affecting mortality in Crush Syndrome patients (Hazard Ratio [HR]: 1.088, p=0.021, 95% Confidence Interval [CI]). CONCLUSION: Our study highlights low systolic blood pressure upon admission as a significant risk factor for increased mortality in Crush Syndrome patients. This finding may contribute to the literature by emphasizing the importance of monitoring blood pressure under rubble and administering more aggressive fluid therapy to patients with low systolic blood pressure.

Management of pyloric stricture in children: endoscopic balloon dilatation and surgery.

BACKGROUND: Surgical correction is the most preferred treatment modality in pyloric stricture (PS). Recently a few studies reported the experience of balloon dilation in children with PS. This study was designed to present our experiences of the management of the patients with PS with balloon dilation and corrective surgery. METHODS: The records of 14 patients who were treated with the diagnosis of PS between August 2003 and August 2011 were reviewed retrospectively. RESULTS: There were nine boys and five girls (mean age, 3.4 ± 1.7 years). The history of caustic ingestion was detected in eight patients; six of them were admitted on the day of ingestion. Two patients were admitted with nonbilious vomiting more than 2 weeks after ingestion. Four patients did not have a remarkable medical history, including caustic ingestion. They admitted with the complaint of nonbilious vomiting. PS was detected during endoscopy in two patients who had a diagnosis of peptic ulcer disease. PS was shown by barium meal study in all patients. Endoscopy was performed in all patients. Endoscopic balloon dilation was tried in 12 patients. Overall eight patients required surgical procedures for PS. The complaints were resolved by endoscopic balloon dilation of pylorus in the remaining six patients. CONCLUSIONS: Although endoscopic balloon dilatation for benign PS in adults is a generally accepted method of treatment, there is less experience with endoscopic balloon dilatation for PS in children. PS due to benign disorders can be effectively and successfully treated through endoscopic balloon dilatation in suitable patients. In patients with successful pyloric balloon dilatation, surgery can be avoided.

Hedgehog Signal Defect Leading to Familial Exudative Vitreoretinopathy-Like Disease and Gastrointestinal Malformation.

Objectives: The aim of the study was to present a new genetic association presenting with gastrointestinal tract malformations (GTMs) and familial exudative vitreoretinopathy (FEVR)-like disease and review the genetics of Hedgehog signaling. Materials and Methods: Three neonates were diagnosed with FEVR-like retinal vascular disease upon routine ophthalmological examination during hospitalization in the neonatal surgical intensive care unit for GTMs. Genetic analysis of the neonates was performed. Results: Gestational age of the neonates was 39, 38, and 39 weeks and birth weights were 3,500, 3,600, and 3,300 grams, respectively. All six eyes of the three infants were treated by laser photocoagulation. Recurrence was not seen in any of the eyes. Genetical analysis of all the neonates diagnosed with FEVR-like disease revealed defects in the Hedgehog pathway. Conclusion: FEVR is a genetically well-defined retinal vascular disease. The current study is the first to show an association between FEVR-like retinal vascular disease and GTMs. This study demonstrates the importance of the Hedgehog pathway in retinal vascular and gut development.

Foreign body aspiration in children: analysis of diagnostic criteria and accurate time for bronchoscopy.

OBJECTIVES: The aims of this study were to evaluate the predictive diagnostic value of history, clinical signs and symptoms, and radiological finding and to evaluate whether bronchoscopy is a safe procedure and whether it should be performed in urgent conditions. METHODS: The medical records of 191 children who underwent bronchoscopy for suspected foreign body aspiration (FBA) between 2001 and 2009 were reviewed for demographic data, radiological studies, and bronchoscopic findings retrospectively. RESULTS: There were 117 male and 74 female patients. Their ages ranged from 2 months to 14 years. The major complaints were paroxysmal cough and respiratory insufficiency. Foreign body aspiration was confirmed in 123 patients (65%). Of 106 patients who were admitted in the first 24 hours, FBA was confirmed in 75 patients. Of 116 patients with a definite history of witnessed FBA, 87 patients (75%) were found to have positive bronchoscopic findings. Of 46 patients who had prolonged history of recurrent pulmonary infections, allergic asthma, or bronchiolitis, 31 (67.4%) were found to have FBs. Foreign bodies were frequently organic. Nineteen patients required urgent bronchoscopic evaluation. Sensitivity and specificity for each diagnostic criterion were as follows: clinical history (63% and 32%); symptoms (68% and 53%); physical examination findings (70.5% and 63%); radiological findings (73% and 68%); and the triad of cough, wheezing, and diminished breath sound (88% and 51%), respectively. There was a positive correlation between the presence of wheezing and FB-positive patients. CONCLUSIONS: Although there are no specific symptoms and signs to make a clear-cut diagnosis, history of witnessed FBA, admittance within 24 hours from the beginning of respiratory symptoms, and wheezing are proper indications for bronchoscopy. Bronchoscopy is a safe procedure with few and confined complications.

An atypical bladder diverticulum presented with recurrent peritonitis: case report.

Bladder diverticula develop from congenital detrusor muscle defect and frequently present with urinary tract infection, which occurs as a result of urinary stasis in the diverticula. Different clinical presentations, such as bladder outlet obstruction, cyanosis of the lower extremities, intestinal obstruction, ureteral obstruction (which may occur due to direct diverticular compression), and peritonitis due to spontaneous rupture of the diverticula, were reported previously. Here, we report a case with the diagnosis of bladder diverticulum that caused recurrent generalized peritonitis without perforation and mimicked perforated appendicitis.

A rare cause of chronic rectal bleeding in children; solitary rectal ulcer: case report.

Solitary rectal ulcer causing lower gastrointestinal bleeding is extremely rare in children. Rare presentation, non-specific symptoms, insufficient experience, and characteristics mimicking other rectal diseases may cause misdiagnosis or delay of diagnosis in some pediatric patients. Here, we report a 10-year-old boy with solitary rectal ulcer diagnosed two years after onset of the symptoms who responded well to the conservative therapy, including high-fiber diet, laxatives, defecation training, and sucralfate enema.

Long-term management of corrosive esophageal stricture with balloon dilation in children.

BACKGROUND AND PURPOSE: There are only a few studies focused on efficacy and safety of balloon dilation in corrosive esophageal stricture in children. The aim of this study is to assess the long-term clinical results of balloon dilation in the treatment of corrosive esophageal stricture in children. MATERIALS AND METHODS: We retrospectively analyzed the management of 18 children (median age 3 years) who were treated with balloon dilation because of caustic esophageal stricture between January 2001 and December 2008. RESULTS: A total of 295 sessions of balloon dilation were performed in all patients over an 8-year period. Technical success was achieved in all patients, whereas clinical success was achieved only in eight (44.4%) patients after first dilation. Eight (44.4%) of all patients showed recovery within the first year and another six (33.3%) patients recovered within 2 years. Esophageal perforation occurred in one (5%) patient, during one dilation session (0.33%). The average number of dilation sessions was 12.7, 2.8, and 1, respectively, in the first, second, and third year. There was significant difference between the mean number of dilation sessions in the first and second year, and second and third year (p < 0.01 and p = 0.043). CONCLUSION: Short-segment esophageal strictures, improvement of food intake capacity, and increase in intervals of dilation sessions are good patient indicators. We suggest that esophageal balloon dilatation is a safe and effective method of treatment in caustic esophageal strictures and recommend that balloon dilation program be performed for at least 2 years before deciding that dilation has failed and preferring other treatment modalities which have higher risk of complications.

Diagnostic difficulties in esophageal atresia with proximal and distal tracheoesophageal fistula: a case report.

The authors report two patients with esophageal atresia and double fistula, one of whom was diagnosed intraoperatively and the other preoperatively through upper pouch contrast study. Patients with proximal and distal fistula do not present with excessive oral secretion and drooling because they can swallow the saliva/meals that reach the trachea from the proximal esophagus via the proximal fistula and then from the trachea to the distal esophagus via the distal fistula. Thus, since this clinical entity can be easily overlooked, some radiological and clinical signs that are helpful for preoperative and intraoperative diagnosis of a proximal fistula are discussed.

Evaluation of effects of s-methyl isothiourea and melatonin on intestinal ischemia/reperfusion injury in rats.

The present study was designed to evaluate whether the administration of s-methylisothiourea and melatonin has protective potential in intestinal ischemia/reperfusion injury. Forty male Sprague-Dawley rats were divided into five groups. Ileal specimens were obtained to determine the levels of malondialdehyde, protein carbonyl content, levels of antioxidant enzymes and evaluation of histologic changes. Combination of s-methylisothiourea and melatonin, led to a statistically significant increase in activities of antioxidant enzymes with a decrease in malondialdehyde and protein carbonyl content and intestinal mucosal injury scores. It was shown; combination of SMT and melatonin may exert more promised results.

Splenogonadal Fusion in Children: A Rare Entity Mimicking Inguinal Tumor.

Splenogonadal fusion (SGF) is a rare congenital malformation, which can be of a continuous or discontinuous type. It is characterized by splenic tissue fused with gonadal tissue. Because it lacks characteristic features, very few cases of SGF have been diagnosed preoperatively. Herein, we present a case with left side SGF who was diagnosed by Tc-nanocolloid spleen scintigraphy.

Ingested foreign bodies in children: Do they really pass spontaneously from the gastrointestinal tract? A single-centre experience with 1000 cases.

BACKGROUND: Foreign body (FB) ingestion is frequently encountered in all departments that treat children. FB may bring about significant anxiety for parents and physicians. The present study aims to determine the appropriate approach for FB ingestion in children. METHODS: The records of 1000 children with a history of FB ingestion between the years 2005 and 2017 were reviewed retrospectively in this study. RESULTS: Of 1000 children, 53.8% were male. The most common types of FBs were coins (35%). X-ray was negative in 49% of the patients, and 86% of these patients received no intervention. Of the 504 (51%) X-ray-positive patients, the oesophagus (68%) was the most common location. Life-threatening complications were tracheo-oesophageal fistula (1), Meckel's diverticulum perforation (1), and perforation due to rigid endoscopy (1). CONCLUSION: We demonstrated that coins, which are the most commonly ingested FBs, have various types and sizes according to their countries of origin, and this affects spontaneous passage. We found that only 48% (quite low compared to the literature) of the coins passed spontaneously. In asymptomatic patients with a gastric button battery, we suggest a "watchful waiting" approach. The patients should be observed and managed at home. In our study, we found that 85% of the button batteries that reached the stomach passed spontaneously.

Prenatal diagnosis of a mass in the adrenal region that proved to be a teratoma.

A prenatally detected suprarenal cystic mass measuring 2 cm was found to have enlarged upon postnatal ultrasonography at 6 weeks of age. Magnetic resonance imaging showed a 57 x 50 mm mass in the left adrenal region displacing the kidney inferiorly. The infant underwent an adrenalectomy with total resection of the tumor, which proved on histologic examination to be a mature teratoma. Prenatally detected suprarenal masses are likely to be neuroblastoma or adrenal hemorrhage, but may be rare benign lesions such as extralobar pulmonary sequestration, bronchogenic cyst, or renal dysplasia. Although teratoma in the adrenal region is extremely rare, it should be included in the clinical and radiologic differential diagnosis of prenatally detected suprarenal masses. Total excision of the mass for histologic diagnosis is indicated.

Boix-Ochoa (Partial Fundoplication) Treats Reflux, Even in Neurologically Impaired Patients. Can it Take the Title of "Gold Standard" from Total Fundoplication?

BACKGROUND: In 4-5% of cases of gastroesophageal reflux disease (GERD), surgical treatment is required. The aim of the study was to evaluate the success of Boix-Ochoa antireflux surgery, which is considered more physiologic with a higher failure rate (need for reoperation) than Nissen fundoplication, which is believed to be the gold standard operation. METHOD: In the 13 years from 2005 to 2018, the medical records of all children who underwent Boix-Ochoa in a single institution by pediatric surgeons were reviewed retrospectively. RESULTS: A total of 133 fundoplications were performed, of which patients were divided into four groups: neurologically impaired, structurally impaired, neurologically and structurally impaired, and neurologically and structurally normal; there were 64, 8, 34, and 27 patients in each group, respectively. Structural impairments included hiatal hernia and esophagus atresia, having previously had a gastrostomy and esophageal stenosis. The most common short-term complication was distal esophageal stenosis (13%), which caused vomiting and dysphagia, and was treated by dilatations. There were six (4.5%) recurrences of GER, one in the neurologically and structurally impaired group with a hiatal hernia and five in the structurally impaired group (three esophagus atresias, two caustic esophageal strictures). The mean follow-up period was 5.27 ± 3.43 years. Neurological impairment did not affect the success rate. CONCLUSION: Although there has not any literature demonstrating significant benefits of one procedure, we detected with this largest study in the pediatric literature about Boix-Ochoa fundoplication (more physiologic and easily performed) that it was successful (95%) in protecting reflux even in neurologically impaired patients (98%). We consider Boix-Ochoa (partial fundoplication) to be an alternative method to Nissen (complete fundoplication), and it can be done safely with a high success rate.

Effect of propolis on healing in experimental colon anastomosis in rats.

INTRODUCTION: Propolis is the generic name for the resinous substance collected by honeybees, which is known to have antioxidant, anti-inflammatory, apoptosis-inducible effects. Anastomotic dehiscence after colorectal surgery is an important cause of morbidity and mortality. We aimed to assess the effect of propolis on healing in an experimental colon anastomosis in rats. METHODS: Forty adult male Wistar albino rats were randomly assigned into 5 treatment groups with 8 rats in each: Group I, anastomosis+no treatment; Group II, anastomosis+oral propolis (600 mg/kg/d); Group III, anastomosis+oral ethyl alcohol (1 cc/d); Group IV, anastomosis+rectal propolis (600 mg/kg/d); Group V, anastomosis+rectal ethyl alcohol (1 cc/d). The bursting pressures, hydroxiproline levels and histopathological changes in each group were measured. RESULTS: When bursting pressures were compared between groups, we observed that they were increased in the groups treated with propolis in contrast to all other groups. Hydroxiproline levels in the propolis groups were also significantly increased in contrast to the other groups. There was also a statistically significant difference in histopathological changes between the treatment types. When propolis administration methods were compared, we did not observe a statistically significant difference. CONCLUSION: Propolis has a significantly favourable effect on healing in experimental colon anastomosis, independent from the method of administration.

Appendicitis within an umbilical hernia sac: previously unreported complication in children.

Umbilical hernia is one of the most common congenital pathologies of the anterior abdominal wall in children. Umbilical hernia in children has a high tendency for spontaneous closure. Surgical treatment is performed only for rarely occurring complications. Appendicitis within an umbilical hernia sac is a previously unreported complication for umbilical hernias. We report here the first case in the current English language literature.

Huge Neck Masses Causing Respiratory Distress in Neonates: Two Cases of Congenital Cervical Teratoma.

Congenital cervical teratomas are rare and usually large enough to cause respiratory distress in the neonatal period. We present two cases of congenital huge cystic neck masses in which distinguishing cervical cystic hygroma and congenital cystic teratoma was not possible through radiologic imaging techniques. Experience with the first case, which was initially diagnosed and treated as cystic hygroma by injection sclerotherapy, led to early suspicion and surgery in the second case. The masses were excised completely and histopathologic diagnoses were congenital teratoma in both patients. Our aim is to review congenital huge neck masses causing respiratory distress in early neonatal life to highlight this dilemma briefly with these interesting cases.