Journal of Indian Association of Pediatric Surgeons最新文献

An adolescent boy presented with a history of penetrating trauma from a bicycle handlebar injury to the left lower abdomen. A computed tomography (CT) scan and a diagnostic laparoscopy showed extraperitoneal bladder rupture, which was repaired. In the postoperative period, a micturating cystourethrogram revealed a rectovesical fistula (RVF), which was managed conservatively with a Foley catheter. This case depicts a rare complication of RVF in a case of penetrating trauma abdomen managed conservatively with a unique mechanism of injury.

Umbilical hernia is one of the most common congenital anomalies. We document an unusual event of abscess of umbilical hernia in a 5-month-old female which was associated with rupture of the hernia followed by evisceration. Immediate reduction and surgical repair were done. The case reports an uncommon trilogy of rupture of umbilical hernia, abscess, and spontaneous evisceration.

Aim: This study aims to compare the pediatric trauma score (PTS) and shock index pediatric age adjusted (SIPA) score for predicting the outcome in children presenting with trauma mainly abdomen.

Methodology: Prospective study of 18 months with recruitment of trauma patients admitted to a tertiary centre with mainly abdominal trauma. After immediate resuscitation, SIPA and PTS scores were computed and reassessed 24 h later. The outcomes of injured subjects were analyzed using an indigenous morbidity scoring system and compared with SIPA and PTS scores. Statistical methods were used for demographic details, uni/multivariate analysis, and for calculating predictive values.

Results: Male (aged 5-8 years) was identified as most commonly injured. Fall was noted as most frequent mechanism and maximally contributed to high morbidity. Liver was most frequently injured, whereas hollow viscous injuries (pneumoperitoneum) were associated with the poorest outcome. SIPA and PTS, both at admission and 24 h later, significantly correlated with morbidity, with 82% predictive accuracy (P < 0.001 for SIPA; P = 0.003 for PTS). This association weakened at 24 h with normalization of SIPA after resuscitation in 70% of cases, whereas PTS maintained uniformity with consistency across 24 h. Multivariate regression analysis identified that among significant factors, pneumoperitoneum, low PTS, and infant subjects had the highest odds ratios for poor outcome following trauma to the abdomen.

Conclusion: Pediatric trauma victims with abdominal injuries can be triaged using SIPA soon after injury, whereas for delayed presenters, PTS is a better alternative, albeit with suggested age-based value correction for its components.

Airway foreign body aspiration, particularly in the pediatric population, poses a critical and time-sensitive emergency due to the potential for rapid decompensation. We report a rare and challenging case of a Y-shaped fish bone lodged in the subglottic airway of a 3-year-old child, and a novel, innovative endoscopic retrieval technique was conceptualized on the table and employed to retrieve it. This case underscores the importance of individualized airway management strategies in complex pediatric airway foreign body cases.

Background: Inflammation and malignancy studies in choledochal cystic malformations (CDC) are scarce. This research explores the role of inflammation, bile composition, and markers like cyclooxygenase-2 (COX-2), phosphorylated ribosomal protein S6 (PS6), matrix metallopeptidase-9 (MMP9), and mammalian target of rapamycin (mTOR) in CDC.

Materials and methods: This is a cross-sectional observational study. The study was conducted between January 2021 and December 2023. Bile samples from children being operated for CDC were collected and analyzed for biochemical and enzymatic constituents, while excised specimens underwent histopathological and immunohistochemistry (IHC) COX-2, mTOR, PS6, and MMP9. Statistical analysis evaluated data relationships, including descriptive statistics, Chi-square tests, and linear regression. Results aimed to enhance understanding of CDC pathogenesis and identify potential biomarkers and therapeutic targets, with P ≤ 0.05 considered statistically significant.

Results: Bile and histopathology samples from 30 children (median age: 72 months; 13 males, 17 females) with type 1 choledochal malformation were analyzed. All underwent surgery with uneventful recoveries. Significant findings included bile composition differences by age and abnormal pancreaticobiliary junction (APBJ) length. Histopathology and IHC showed COX-2, MMP9, and PS6 positivity, correlating with bile components and APBJ length.

Conclusion: This study highlights a potential association between APBJ length, inflammatory markers (COX-2 and MMP9), and cellular proliferation (PS6) in children with type I choledochal malformation. The significant expression of these markers suggests that pancreatic reflux might initiate chronic inflammation and epithelial injury.

Introduction: Biliary atresia (BA) is a major cause of neonatal cholestasis and the leading indication for pediatric liver transplantation. Timely and accurate diagnosis is critical to enable early surgical intervention and improve native liver survival. Percutaneous transhepatic cholecysto-cholangiography (PTCC) has emerged as a minimally invasive alternative to intraoperative cholangiography (IOC) for diagnosing BA. This prospective study aimed to evaluate the feasibility, safety, and diagnostic accuracy of PTCC in differentiating BA from other causes of neonatal cholestasis.

Materials and methods: Conducted between October 2023 and March 2025, this study enrolled infants under 6 months of age with clinical suspicion of BA. All patients underwent ultrasonography and PTCC. PTCC feasibility, diagnostic accuracy, and safety were assessed in comparison with IOC. Gallbladder (GB) parameters and laboratory findings were also analyzed.

Results: Of the 45 enrolled patients, PTCC was feasible in 62.2% (28/45), diagnosing BA in 71.4% (20/28) and excluding it in 28.6% (8/28). PTCC was not feasible in 37.8% (17/45). Overall, BA was confirmed in 77.8% (35/45). Gallbladder parameters were evaluated as predictors of PTCC feasibility. Receiver operating characteristic analysis identified fasting GB volume, length, and width as significant predictors (P < 0.05) for PTCC feasibility (area under the curve 0.789, 0.716, 0.727, respectively). GB width demonstrated the highest sensitivity (82.1%) for predicting PTCC feasibility. No procedural complications were observed.

Conclusion: PTCC is a safe, feasible, and reliable diagnostic modality for preoperative assessment of BA. GB parameters on ultrasound are significant predictors of PTCC feasibility, reinforcing its integration into the diagnostic workup for neonatal cholestasis.

Objectives: To study the ratio of surface area of bladder converted into bladder-plate, after it has been laid-open, and infra-umbilical anterior-abdominal-wall surface-area in cadavers, and its comparison with clinical cases of bladder exstrophy using same ratio.

Methods: The study was conducted in ten fresh cadavers, available in the department of anatomy for dissection and 20 bladder exstrophy undergoing repair in the department of pediatric surgery. In cadavers, surface area of infraumbilical anterior-abdominal-wall was calculated after placing horizontal and midline vertical measuring tapes and by counting the number of squares (1 cm²) and mini squares (1 mm²). Bladder was accessed up to verumontanum, taken out and was laid-open via vertical midline cut like a book on graph paper. Bladder-plate surface area was calculated by counting the number of squares and mini-squares. Ratio of infra-umbilical anterior-abdominal-wall surface-area and bladder-plate surface-area was calculated. In exstrophy cases, bladder-plate surface-area and infra-umbilical anterior-abdominal-wall surface-area was calculated after placing vertical and horizontal measuring strips across the bladder-plate and infraumbilical anterior-abdominal-wall as in cadavers and ratio was calculated. The findings of clinical cases were compared with findings found in the cadaveric study.

Results: In cadavers, the ratio of laid-open bladder-plate surface-area and infra-umbilical anterior-abdominal-wall surface-area ranged from 33.4% to 50.5%. In clinical cases, ratio ranged from 7.5% to 12.5% in patients with small bladder-plate (n = 11), 16.7%-19.7% in patients with moderate bladder-plate (n = 3), and 23.8%-37.2% in patient with good bladder-plate (n = 6).

Conclusion: In exstrophy cases, bladder-plate surface-area being 24%-37% of infra-umbilical anterior-abdominal-wall (nearer to findings in cadaver control) is the objective criteria of good bladder-plate which is likely to be predictor of good outcome after repair.