Paediatric perineal injury following explosive blast: A Case Report

Perineal injury in children is uncommon. Injuries range from minor perineal skin laceration to severe injury to the genitourinary tract, anorectal region and the pelvic bone. The mechanisms of injury are usually attributed to blunt trauma, penetrating injuries like impalement injury, or sexual abuse. Perineal injury resulting from explosive blast in children is rare. The management depends on the time and mode of presentation and examination findings. Early presentation (a few hours after injury) with 1st or 2nd-degree perineal injury may benefit from debridement with primary repair of soft tissues and/or sphincters. Late presentation (days after injury) with 3rd or 4th-degree injury will require diverting colostomy or urinary diversion and wound drainage. This is a report of an unusual case of severe perineal injury in a child following explosive blast sustained while squatting close to packed explosives that got detonated. The perineal injury was initially managed with colostomy and wound drainage. The colostomy was closed after the wound had healed with good faecal continence achieved and without perineal soft tissue or anal sphincteric repair. It is concluded that severe isolated paediatric explosive blast perineal injury is rare but is amenable to surgical care.

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Examining the effectiveness of examination at 6–8 weeks for developmental dysplasia: testing the safety net

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-316520 ◽

2018 ◽

Vol 104 (10) ◽

pp. 953-955 ◽

Cited By ~ 3

Author(s):

Mike Reidy ◽

Caitlin Collins ◽

Jamie G B MacLean ◽

Donald Campbell

Keyword(s):

Safety Net ◽

Late Presentation ◽

Developmental Dysplasia ◽

Positive Finding ◽

Invasive Treatment ◽

Early Presentation ◽

Current Form ◽

Non Invasive ◽

The Uk ◽

Dysplasia Of The Hip

ObjectiveThe ‘GP check’ at 6–8 weeks forms part of the selective surveillance system for developmental dysplasia of the hip (DDH) in the UK. It is imperative to pick up DDH within the first months of life to allow for non-invasive treatment and the avoidance of surgery. We aim to investigate the effectiveness of hip examination at 6–8 weeks.MethodsThis is a longitudinal observational study including all infants born in our region in the 5 years following 2006. Early presentation was defined as diagnosis within 14 weeks of birth and late presentation after 14 weeks. Treatment records for early and late DDH as well as referrals for ultrasound (US) following examination at 6–8 weeks were analysed. Attendance of the examination at 6–8 weeks in those patients who went on to present with a late DDH was also analysed.Results23 112 live births occurred during the study period. There were 141 confirmed cases of DDH. 400 referrals for US were received following examination at 6–8 weeks; 6 of these had a positive finding of DDH. 27 patients presented after 14 weeks and were classified as late presentations. 25 of these patients had attended examination at 6–8 weeks and no abnormality had been identified.ConclusionsThe sensitivity of examination at 6–8 weeks was only 19.4%, its specificity was 98% and it had a positive predictive value of 1.5%. For many years the check at 6–8 weeks has been thought of as a means to identify those children not identified as neonates; however, we found that four out of five children with DDH were not identified by the check at 6–8 weeks. Unfortunately, we conclude that the presumed safety net of the examination in its current form is not reliable.

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Neonatal gastric perforation: is prematurity the only cause?

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20203500 ◽

2020 ◽

Vol 7 (9) ◽

pp. 1318

Author(s):

Manas R. Dash ◽

S. K. Barma ◽

Pranay Panigrahi ◽

P. Parida ◽

P. K. Mohanty ◽

...

Keyword(s):

Early Detection ◽

Early Diagnosis ◽

Gastric Perforation ◽

Primary Repair ◽

Surgical Care ◽

Abdominal Distension ◽

Anterior Wall ◽

Care Hospital ◽

Neonatal Gastric Perforation ◽

Gastric Ischemia

Background: Neonatal Gastric Perforation (NGP) is a serious and life-threatening emergency and challenging in terms of diagnosis and management. The precise aetiology remains obscure in most cases. Published literatures provide theories of gastric ischemia, aerophagia & trauma with or without definite inciting pathology. Owing to its high mortality rate, it requires early detection & urgent intervention to bring out the newborn from this catastrophe.Methods: We report five cases of neonatal gastric perforation over period of 2013-2019 admitted to a tertiary paediatric surgical care hospital managed by early detection, prompt resuscitation along with exploration and primary repair of the defect in gastric wall.Results: The common feature in these five cases were preterm age, low birth weight, hypoxic event and marked abdominal distension causing respiratory distress. Features of imminent or complete septic shock were present in all cases. Perforation was found on anterior wall along greater curvature of stomach in all babies. Four babies out of five survived except in one case of jejunoileal Artesia that developed gastric perforation in post operative period.Conclusions: Neonatal gastric perforation should be suspected in cases of rapidly deteriorating premature newborn with gross abdominal distension and pneumoperitoneum. In our opinion, etiology of NGP is multifactorial. Prematurity, low APGAR score with vigorous resuscitation could be a clue for early diagnosis. Good outcome in our series was due to early diagnosis and prompt pre and postoperative measures. Additionally, sterile gastric content in peritoneum might lead to survival from this catastrophic event.

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DOZ047.13: Prophylactic endoscopic esophageal vacuum (EVAC) therapy of high-risk esophageal anastomoses in pediatric surgical patients

Diseases of the Esophagus ◽

10.1093/dote/doz047.13 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

J L Yasuda ◽

W J Svetanoff ◽

S J Staffa ◽

P D Ngo ◽

S J Clark ◽

...

Keyword(s):

High Risk ◽

Esophageal Atresia ◽

Surgical Procedures ◽

Primary Repair ◽

Surgical Care ◽

Technical Failure ◽

Exact Test ◽

Anastomotic Complications ◽

Increased Risk ◽

Long Gap Esophageal Atresia

Abstract Summary Esophageal anastomotic leak (EAL) is a potentially severe complication of surgical procedures of the esophagus. Vacuum-assisted closure (VAC) therapy is increasingly used in the treatment of EAL, with observational studies suggesting it is a highly effective method for esophageal defect closure.1–3 It was hypothesized that prophylactic esophageal VAC (EVAC) placement at the time of new anastomosis creation may improve blood flow and healing, potentially leading to fewer EALs. Methods Between July 2015 and November 2018, patients who underwent surgery that resulted in a new esophageal anastomosis and were deemed to be high risk for anastomotic complications had a prophylactic EVAC placed at the time of surgery. Retrospective review of similar surgical procedures without prophylactic EVAC placement from January 2014 to November 2018 was performed for comparison. Results Thirteen pediatric patients had prophylactic EVAC placement at the time of esophageal repair. Procedures prompting EVAC placement included primary repair of long-gap esophageal atresia (LGEA) by the Foker technique (N = 7), stricture resection after repaired LGEA (N = 3) or type C esophageal atresia (N = 1), and stricture resection after delayed identification of a retained esophageal foreign body (N = 2). Three of 13 patients who had prophylactic EVAC placement (23.1%) experienced EAL in the post-operative period. Two patients were found to have technical failure of their EVAC leading to absence of suction, and one patient experienced delayed EAL 12 days after removal of the EVAC. In comparison, post-surgical EAL occurred in 13 of 58 patients who had the Foker procedure for LGEA and in 8 of 31 patients who had esophageal stricture resection without prophylactic EVAC placement. The rates of EAL in the prophylactic EVAC group were not significantly different from rates of EAL in either the post-surgical Foker (23.1% vs 22.4%, P = 0.999), post-stricture resection (23.1% vs 25.8%, P = 0.999), or combined post-Foker and stricture resection (23.1% vs 23.6%, P = 0.999) groups by Fisher's exact test. Conclusions Prophylactic EVAC placement does not carry increased risk of EAL compared to standard post-surgical care; however, further device refinement is needed to reduce technical failure.

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Histopathological Patterns of Breast Lesions - A Hospital-Based Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/111 ◽

2021 ◽

Vol 8 (10) ◽

pp. 567-574

Author(s):

Dharmakanta Kumbhakar ◽

Partha Pratim Talukdar

Keyword(s):

Lobular Carcinoma ◽

Late Presentation ◽

Breast Diseases ◽

Histopathological Study ◽

Breast Lesions ◽

Breast Cancers ◽

Duct Carcinoma ◽

Early Presentation ◽

Wide Range

BACKGROUND The breast tissue consists of both specialised epithelial cells and stroma. It is a site of a broad array of pathological alterations. Both benign and malignant lesions can occur in the breast. Breast cancer is the most commonly diagnosed female cancer accounting for 20 % of female malignancies globally. METHODS The study was carried out to evaluate the histopathological patterns of 589 breast lesions whose biopsied breast tissues were presented at the Pathology department of Tezpur Medical College and Hospital, Tezpur, Assam, for a period of three (03) years from January 01, 2017 to December 31, 2019. RESULTS Out of 589 cases of breast lesions, 418 were benign breast lesions (70.97 %) and 171 were malignant (29.03 %) with a benign and malignant ratio of 2.44:1. Fibroadenoma breast was the most common benign breast disease were 264 out of 418 (63.15 %) and infiltrating duct carcinoma was the commonest malignant breast lesions, in this study there were 123 out of 171 (71.93 %). Among 123 cases of infiltrating duct carcinoma, 93 (75.61 %) were grade III ;27 (21.95 %) were grade II and 03 (2.44 %) were grade I as per Nottingham histologic score system in the study group. Metastatic lymph nodes were 89 (52.05 %) were seen in the malignant cases. Early presentation (stage 0, I and II) constituted 77 (45.45 %) while late presentation (stage III and VI) accounted for 94 (54.97 %) in the breast malignancy in the study. CONCLUSIONS Histopathological study plays very important role in the diagnosis, treatment and prognosis of breast lesions. This study highlighted the distinct incidences and pathological characteristics of wide range of breast diseases and affirmed that breast cancers in developing countries like India are characterised by late presentation. KEYWORDS Fibroadenoma, Duct Papilloma, Lipoma, Infiltrating Duct Carcinoma, Ductal Ca in Situ, Invasive Lobular Carcinoma, Lobular Carcinoma in situ, Medullary Carcinoma, Mucinous Carcinoma, Malignant Phyllodes

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The Evaluation, Management and Outcome about an Experience with Sharp Force Abdominal Injury

BioMedica ◽

10.51441/biomedica/5-283 ◽

2021 ◽

Vol 37 (2) ◽

pp. 130-133

Author(s):

Zhou Xu ◽

Yunsong Lu ◽

Heng Li ◽

Dailiang Peng ◽

Xuwei Jiang ◽

...

Keyword(s):

Primary Repair ◽

Demographic Data ◽

Internal Organs ◽

Early Presentation ◽

Penetrating Abdominal Trauma ◽

Negative Laparotomy ◽

Sharp Force ◽

Time Of Presentation ◽

Complications And Mortality ◽

Sharp Force Injury

Background and Objective: Sharp force injuries (SFI), inflicted by cutting or stabbing, result in variable outcome depending upon the nature and site of the injury. This study evaluated the cases of SFIs and their outcome with reference to the time of presentation, demographic data, wounded organs, and surgical procedure performed. Methods: This retrospective study analyzed the clinical data of 20 patients who presented with sharp force injury (knife stabbing and penetrating abdominal trauma) and were admitted between April 2015 and November 2016. The management and outcome of patients were recorded. Results: All patients in this study were male and aged between 21 and 30 years. Knife stabbing was the only mechanism of injury in all cases. Colon (50%) was the commonest organ injured followed by intestine (40%) and liver (30%). Mortality rate was 10%. There were two cases with negative laparotomy (10%). Wound sepsis (10%) was the commonest complication. Conclusions: SFI involving abdominal area are managed either conservatively or with primary repair and laparotomy to save internal organs. Early presentation and prompt management leads to reduced chances of complications and mortality.

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Motor disorders and hip joint dysplasia in newborns and infants

Kazan medical journal ◽

10.17816/kmj1587 ◽

2013 ◽

Vol 94 (2) ◽

pp. 193-198 ◽

Cited By ~ 1

Author(s):

E Y Zharova

Keyword(s):

Hip Joint ◽

Soft Tissues ◽

External Rotation ◽

Clinical Analysis ◽

Joint Hypermobility ◽

Pelvic Bone ◽

Motor Disorders ◽

Hip Abduction ◽

Common Pathogenesis ◽

Vascular Accidents

Aim. To detect the neurogenic motor disorders in children with hip joint dysplasia. Methods. Clinical analysis of hip joint dysplasia and neurogenic motor disorders symptoms in newborns and infants was performed. Children were distributed into two groups: the first group included children with hypertonic muscles of the lower extremities and restrictions of hip abduction, the second group included children with diffuse hypotonia and hip and knee bent in a specific position («frog» symptom). Results. Analysis of perinatal life of children included in the study showed that in 100% of cases diseases of mother and fetus were observed in these children. All children with hip dysplasia were also present with clinical features of nervous system disorders. Patients with central motor lesions have symptoms of pyramidal insufficiency such as hip adductors hypertonia, often treated as restrictions of hip abduction by orthopedists. Patients with the segmental motor lesions presented with flaccid paresis accompanied by hip joint hypermobility, which leads to excessive external rotation of the hip. A similar clinical picture is observed in diffuse muscle weakness caused by neonatal posterior cerebral circulation vascular accidents. In both cases soft tissues and pelvic bone nutrition is impaired. Conclusion. The common pathogenesis of hip joint dysplasia and motor disorders implies that children with these diseases should be treated jointly by neurologist and orthopedist.

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ORGANIZATION OF DIAGNOSTIC AND DYNAMIC OBSERVATION DURING RECONSTRUCTIVE RESTORATION OF GUNSHIRTING SOFT TISSUES

Kharkiv Surgical School ◽

10.37699/2308-7005.2.2020.24 ◽

2020 ◽

pp. 119-126

Author(s):

I. P. Khomenko ◽

Ye. V. Tsema ◽

К. V. Gumenuk ◽

S. V. Tertyshnyi ◽

V. Yu. Shapovalov

Keyword(s):

Soft Tissue ◽

Soft Tissues ◽

Surgical Care ◽

Diagnostic Procedures ◽

Gunshot Wounds ◽

Front Line ◽

Medical Evacuation ◽

Material Resources ◽

Dynamic Observation

Summary. Damage to the soft tissues of the human body is found both in peacetime and during the war, but the firearms nature has become relevant for Ukraine. Despite the experience gained surgery from previous wars in the treatment of gunshot injuries, there is still no generally accepted diagnostic scheme and classification for reconstructive closure of such specific injuries. The aim. Demonstrate the features of various methods for diagnosing gunshot wounds of soft tissues proposed for reconstruction of a damaged area. Results. In order to improve the quality of surgical care at the stages of medical evacuation, it is always necessary to carry out diagnostic procedures and treatment together. Sometimes it is impossible to implement medical care — it is on the front line, sometimes there is a lack of material resources — in the CDL, but it must be understood that the amount of diagnosis and treatment of a gunshot wound with soft tissue damage is always a difficult process. Conclusions. A multimodal approach to diagnostics and dynamic observation in the reconstruction of soft tissue gunshot injury not only restores the integrity of the damaged anatomical structure but also increases the percentage of functional capacity.

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Anatomical derangements after failed PSARP: correlating MRI and operative findings

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00094-8 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Amr Abdelhamid AbouZeid ◽

Shaimaa Abdelsattar Mohammad

Keyword(s):

Primary Repair ◽

Levator Ani ◽

Colostomy Closure ◽

Redo Surgery ◽

Anorectal Angle ◽

Pelvic Mri ◽

Group A ◽

Faecal Continence ◽

Group B ◽

Operative Findings

Abstract Background Redo surgery for anorectal anomalies (ARA) may be considered a special category of reconstructive surgery with less predictable outcomes. In this report, we studied anatomical derangements in a group of boys following a previously complicated PSARP procedure, in addition to the effect of reoperation on rectifying this distorted anatomy. Results The study included 27 boys who were re-operated after a previous complicated PSARP. Included cases were divided into two groups: group A (14 cases) was referred before colostomy closure with an obviously complicated primary operation, and group B (13 cases) was referred with delayed complications after colostomy closure. Pelvic MRI examinations were performed before reoperation in 19 cases. In nine of these cases, a repeat MRI examination was performed at follow-up after reoperation to study the effect of redo surgery on rectifying the distorted anatomy. Abnormal wide anorectal angle and wide pelvic hiatus were common anatomical derangements after a previously complicated PSARP. An important goal of reoperation was reconstruction of the levator ani behind the anorectum trying to create a more acute anorectal angle and a narrower pelvic hiatus. The success of this corrective step was evaluated by MRI comparing pre- and postoperative measurements that showed a favourable decrease in the values of anorectal angle and hiatal/PC ratio. Improvement of faecal continence was documented after reoperation in 8 out of 10 cases in group B. Conclusion A wide pelvic hiatus was a frequently encountered postsurgical complication after failed PSARP that has most probably resulted from poor reconstruction of the pelvic floor at time of the primary repair. Re-approximation of the split halves of levator ani in the midline behind the anorectum at reoperation can help to correct the distorted internal anatomy and improve bowel control in these cases.

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Arthroscopic Reinsertion of Acute Injuries of the Scapholunate Ligament Technique and Results

Journal of Wrist Surgery ◽

10.1055/s-0040-1710502 ◽

2020 ◽

Vol 09 (04) ◽

pp. 328-337

Author(s):

Vicente Carratalá ◽

Francisco Javier Lucas ◽

Ignacio Miranda ◽

Alfonso Prada ◽

Eva Guisasola ◽

...

Keyword(s):

Grip Strength ◽

Soft Tissues ◽

Primary Repair ◽

Acute Injury ◽

Prospective Clinical Study ◽

Scapholunate Ligament ◽

Dorsal Approach ◽

Perilunate Dislocation ◽

Acute Injuries ◽

Aggressive Interventions

Abstract Objective To describe a technique for treating acute injuries of the scapholunate ligament (SLL) by performing an arthroscopic reinsertion of the SLL and dorsal capsulodesis and to present the results obtained. Methods The study deals with an analytical, prospective clinical study that included 19 consecutive patients with acute injury of the SLL. The range of joint motion, grip strength, pain according to the visual analog scale, functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were studied preoperatively and 6 and 12 months postoperatively. The complications and necessary reinterventions were recorded. Results Nineteen patients with acute injury of the SLL were studied; mean age was 44 ± 2 years, 74% males, 58% complete rupture, and 42% partial rupture, treated with the above-mentioned technique. Thirty-seven percent also had a distal radius fracture and there was one case of perilunate dislocation. Improvement in pain, grip strength, joint balance, and functionality was observed 6 and 12 months postoperatively, with 79% of the cases with good or excellent results Conclusion The arthroscopic reinsertion and dorsal capsular reinforcement of the SLL, allow a reliable and stable primary repair of the dorsal aspect of the ligament in acute or subacute SL injuries where there is tissue that can potentially be repaired, thus achieving an anatomical repair similar to that obtained with open surgery, but without the complications and stiffness secondary to aggressive interventions on the soft tissues that are inherent to the open dorsal approach.

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Mo1414 Late Presentation of Acute Pancreatitis (Beyond 72 Hours) Is Associated With Worse Outcomes in Comparison to Early Presentation (< 72 Hours)

Gastroenterology ◽

10.1016/s0016-5085(16)32405-2 ◽

2016 ◽

Vol 150 (4) ◽

pp. S705-S706

Author(s):

Naresh Bhat ◽

Pradeep Kakkadasam Ramaswamy ◽

Amit Yelsangikar ◽

Kayalvizhi Nagarajan ◽

Anupama Nagar

Keyword(s):

Acute Pancreatitis ◽

Late Presentation ◽

Early Presentation

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