Sarkhan Elbayiyev, Esra Beşer, G. Kadıoğlu Şimşek, Bengu Karacaglar, H. G. Kanmaz Kutman, F. Canpolat
Background: Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. We aimed to investigate the relationship between survival and oxygenation index calculated in the first 12 hours of life in neonates with CDH. Methods: Various scoring systems have been developed to predict and determine the course of the disease in this disease group with a high mortality rate. In our study, we planned to investigate the use of APGAR scores, Neonatal acute physiological perinatal spread score-II, and oxygenation index in predicting survival. Patients born in Ankara City Hospital between March 2019 and November 2021 and followed up due to congenital diaphragmatic hernia were included in the study. Preductal oxygen saturation (sPO2) was manipulated to be 80-95% and postductal >70%. Target PaCO2 values were set to be 50-70 mmHg. Oxygenation index scores were calculated using the formula mean airway pressure (MAP) (cmH2O) x fraction of inspired oxygen (FiO2) (%) / partial pressure of arterial oxygen (PaO2) (mmHg). Results: The 5th-minute APGAR scores of the patients with the congenital diaphragmatic hernia in our study were lower in the non-survivors group than the survivors group (p=0.010). SNAPPE-II and OI scores were statistically significantly higher in the nonsurvivors group (p=0.003 and p=0.002). Conclusion: The oxygenation index was determined to be an independent predictive parameter in mortality (OR: 4.519 CI: 1.301-654.645, p=0.034). The results of our study show that the oxygenation index is a reliable parameter in predicting survival.
{"title":"Prognostic value of the oxygenation index to predict survival in infants with congenital diaphragmatic hernia","authors":"Sarkhan Elbayiyev, Esra Beşer, G. Kadıoğlu Şimşek, Bengu Karacaglar, H. G. Kanmaz Kutman, F. Canpolat","doi":"10.47338/jns.v11.1107","DOIUrl":"https://doi.org/10.47338/jns.v11.1107","url":null,"abstract":"Background: Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. We aimed to investigate the relationship between survival and oxygenation index calculated in the first 12 hours of life in neonates with CDH. \u0000Methods: Various scoring systems have been developed to predict and determine the course of the disease in this disease group with a high mortality rate. In our study, we planned to investigate the use of APGAR scores, Neonatal acute physiological perinatal spread score-II, and oxygenation index in predicting survival. Patients born in Ankara City Hospital between March 2019 and November 2021 and followed up due to congenital diaphragmatic hernia were included in the study. Preductal oxygen saturation (sPO2) was manipulated to be 80-95% and postductal >70%. Target PaCO2 values were set to be 50-70 mmHg. Oxygenation index scores were calculated using the formula mean airway pressure (MAP) (cmH2O) x fraction of inspired oxygen (FiO2) (%) / partial pressure of arterial oxygen (PaO2) (mmHg).\u0000Results: The 5th-minute APGAR scores of the patients with the congenital diaphragmatic hernia in our study were lower in the non-survivors group than the survivors group (p=0.010). SNAPPE-II and OI scores were statistically significantly higher in the nonsurvivors group (p=0.003 and p=0.002).\u0000Conclusion: The oxygenation index was determined to be an independent predictive parameter in mortality (OR: 4.519 CI: 1.301-654.645, p=0.034). The results of our study show that the oxygenation index is a reliable parameter in predicting survival.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48960194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Esophageal atresia (EA) with distal trachea-esophageal fistula (TEF), the most common variety of EA, is managed by primary end-to-end anastomosis. Recurrent TEF constitutes the most difficult-to-manage complication of the primary repair and has an incidence of 2% to15%. Case Presentation: We present a case of rare recurrent TEF after primary repair of EA. The difficulties faced in view of the COVID pandemic and difficult diagnosis are discussed. We share our experience in the successful management of acquired TEF and lessons learned. Conclusion: Recurrent trachea-esophageal fistula is one of the rare and challenging complications to manage. The surgical option carries the best overall prognosis.
{"title":"A complicated tale of an acquired tracheoesophageal fistula: A case report","authors":"V. Manchanda, M. Sengar, Parveen Kumar","doi":"10.47338/jns.v11.1108","DOIUrl":"https://doi.org/10.47338/jns.v11.1108","url":null,"abstract":"Background: Esophageal atresia (EA) with distal trachea-esophageal fistula (TEF), the most common variety of EA, is managed by primary end-to-end anastomosis. Recurrent TEF constitutes the most difficult-to-manage complication of the primary repair and has an incidence of 2% to15%.\u0000Case Presentation: We present a case of rare recurrent TEF after primary repair of EA. The difficulties faced in view of the COVID pandemic and difficult diagnosis are discussed. We share our experience in the successful management of acquired TEF and lessons learned.\u0000Conclusion: Recurrent trachea-esophageal fistula is one of the rare and challenging complications to manage. The surgical option carries the best overall prognosis.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46033032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shishir Kumar, V. Manchanda, Parveen Kumar, R. Bhandari
Background: Carmi syndrome is the name given to the association of congenital pyloric atresia and epidermolysis bullosa. It has a high mortality. Case series: We report 3 neonates with features of multiple skin blisters and a classical X-ray picture of a single bubble appearance. Two of them underwent surgery while 1 succumbed to sepsis in the pre-operative period. One baby had delayed mortality and the other is doing well in follow-up. Conclusions: Carmi syndrome should be kept as a differential diagnosis in neonates with skin blisters and feed intolerance. Early recognition with prompt medical and surgical management may contribute to a successful outcome.
{"title":"Congenital pyloric atresia with epidermolysis bullosa: A case series","authors":"Shishir Kumar, V. Manchanda, Parveen Kumar, R. Bhandari","doi":"10.47338/jns.v11.1071","DOIUrl":"https://doi.org/10.47338/jns.v11.1071","url":null,"abstract":"Background: Carmi syndrome is the name given to the association of congenital pyloric atresia and epidermolysis bullosa. It has a high mortality.\u0000Case series: We report 3 neonates with features of multiple skin blisters and a classical X-ray picture of a single bubble appearance. Two of them underwent surgery while 1 succumbed to sepsis in the pre-operative period. One baby had delayed mortality and the other is doing well in follow-up.\u0000Conclusions: Carmi syndrome should be kept as a differential diagnosis in neonates with skin blisters and feed intolerance. Early recognition with prompt medical and surgical management may contribute to a successful outcome.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48167877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vicente Salinas-Salinas, Daniel Acosta-Farina, Romel Oviedo-Vargas, J. Oliveros-Rivero, Daniel Acosta-Bowen
Background: Congenital diaphragmatic hernia is the total or partial absence of the diaphragm, which can be unilateral or bilateral. Becmeur et al. in 2001 mentioned the thoracoscopic management approach for the first time. Methods: The medical record of neonatal CDH thoracoscopic management (using the Reverdin Needle) from January to May 2021 at Dr. Roberto Gilberto Elizalde Children's Hospital located in Guayaquil, Ecuador was retrieved. Various parameters and characteristics were studied. Results: Four patients were included in this study. M:F ratio was 3:1 with all having a type B left sided defect. The average duration of surgery was 157.5 minutes and 2 of them developed pulmonary hypertension in post-op period. All had good outcomes. Conclusion: We propose that the possibility of a successful thoracoscopic surgery in congenital diaphragmatic hernia is increased with use of the Reverdin needle.
{"title":"Experience with the use of Reverdin needle in neonatal thoracoscopic congenital diaphragmatic hernia repair","authors":"Vicente Salinas-Salinas, Daniel Acosta-Farina, Romel Oviedo-Vargas, J. Oliveros-Rivero, Daniel Acosta-Bowen","doi":"10.47338/jns.v11.1081","DOIUrl":"https://doi.org/10.47338/jns.v11.1081","url":null,"abstract":"Background: Congenital diaphragmatic hernia is the total or partial absence of the diaphragm, which can be unilateral or bilateral. Becmeur et al. in 2001 mentioned the thoracoscopic management approach for the first time.\u0000Methods: The medical record of neonatal CDH thoracoscopic management (using the Reverdin Needle) from January to May 2021 at Dr. Roberto Gilberto Elizalde Children's Hospital located in Guayaquil, Ecuador was retrieved. Various parameters and characteristics were studied.\u0000Results: Four patients were included in this study. M:F ratio was 3:1 with all having a type B left sided defect. The average duration of surgery was 157.5 minutes and 2 of them developed pulmonary hypertension in post-op period. All had good outcomes.\u0000Conclusion: We propose that the possibility of a successful thoracoscopic surgery in congenital diaphragmatic hernia is increased with use of the Reverdin needle.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49405606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Rectal atresia (RA) is a unique and rare congenital malformation contributing to about 1% of anorectal malformations. It may be associated with an abnormal sacrum and a presacral mass. The sphincter mechanism in these cases is well developed. Different surgical procedures have been described for correction of this anomaly, with variable outcomes. Case Presentation: We present three cases of rectal atresia with their management. All the patients presented in early neonatal life with failure to pass meconium. All the patients underwent colostomy in neonatal life as initial management. Definitive surgery was performed later in all patients. All the patients are doing fine on follow-up with good continence. Conclusion: The Posterior Sagittal Approach with the division of septum/tissue between the rectum and anal canal and end-end anastomosis gives excellent results.
{"title":"Rectal Atresia an uncommon entity: Experience of three cases","authors":"R. Hamid, S. Ahmad, N. Bhat","doi":"10.47338/jns.v11.1067","DOIUrl":"https://doi.org/10.47338/jns.v11.1067","url":null,"abstract":"Background: Rectal atresia (RA) is a unique and rare congenital malformation contributing to about 1% of anorectal malformations. It may be associated with an abnormal sacrum and a presacral mass. The sphincter mechanism in these cases is well developed. Different surgical procedures have been described for correction of this anomaly, with variable outcomes.\u0000Case Presentation: We present three cases of rectal atresia with their management. All the patients presented in early neonatal life with failure to pass meconium. All the patients underwent colostomy in neonatal life as initial management. Definitive surgery was performed later in all patients. All the patients are doing fine on follow-up with good continence.\u0000Conclusion: The Posterior Sagittal Approach with the division of septum/tissue between the rectum and anal canal and end-end anastomosis gives excellent results.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47978856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manel Kammoun, A. Jarraya, H. Ketata, S. Ammar, M. Zouari, Chiraz Regaieg, Nadia Hentati, M. Ben Dhaou, R. Mhiri
Background: Hickman-Broviac catheters have improved the care of young children needing frequent and prolonged venous access, but at the same times it has substantial morbidity, particularly in a resource-constrained setup. Our study aims to describe the experience of a Tunisian hospital and investigate the main risk factors for complications. Methods: In this study, we included all the neonates and infants who underwent Broviac catheter insertion in the pediatric surgery department. The patients were divided into 2 groups according to the presence of complications. We compared these two groups and univariate logistic regression analyses were used to determine the risk factors for complications. Results: Forty-three children were included in the study. The incidence of complicated catheters was 60.4%. The following factors were significantly associated with an increased risk of complications: age 6 months [OR 3.5, 95% CI: 0.6-19.3], weight 6 kg [OR 1.54, 95% CI: 0.46-5.2], emergency circumstances [OR 1.62, 95% CI: 0.8-5.4], and antibiotic-therapy as an indication for Broviac catheter insertion [OR 1.8, 95% CI: 0.5-6.2]. Conclusion: Complications seem to be more frequent in patients younger than 6 months and those with a weight of less than 6Kg. To reduce the morbidity related to the catheters, the indications should be carefully chosen.
{"title":"Risk factors for Hickman-Broviac catheter complications: An experience from a Tunisian hospital","authors":"Manel Kammoun, A. Jarraya, H. Ketata, S. Ammar, M. Zouari, Chiraz Regaieg, Nadia Hentati, M. Ben Dhaou, R. Mhiri","doi":"10.47338/jns.v11.1120","DOIUrl":"https://doi.org/10.47338/jns.v11.1120","url":null,"abstract":"Background: Hickman-Broviac catheters have improved the care of young children needing frequent and prolonged venous access, but at the same times it has substantial morbidity, particularly in a resource-constrained setup. Our study aims to describe the experience of a Tunisian hospital and investigate the main risk factors for complications.\u0000Methods: In this study, we included all the neonates and infants who underwent Broviac catheter insertion in the pediatric surgery department. The patients were divided into 2 groups according to the presence of complications. We compared these two groups and univariate logistic regression analyses were used to determine the risk factors for complications.\u0000Results: Forty-three children were included in the study. The incidence of complicated catheters was 60.4%. The following factors were significantly associated with an increased risk of complications: age 6 months [OR 3.5, 95% CI: 0.6-19.3], weight 6 kg [OR 1.54, 95% CI: 0.46-5.2], emergency circumstances [OR 1.62, 95% CI: 0.8-5.4], and antibiotic-therapy as an indication for Broviac catheter insertion [OR 1.8, 95% CI: 0.5-6.2].\u0000Conclusion: Complications seem to be more frequent in patients younger than 6 months and those with a weight of less than 6Kg. To reduce the morbidity related to the catheters, the indications should be carefully chosen.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45368026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Neonatal tumors comprise about 2% of all pediatric malignancies, with neuroblastoma having the highest incidence. Neuroblastoma involving the adrenal medulla and sympathetic ganglia is the most typical scenario in infancy, while the pelvic variant is rare. We report this case because of the unusual and rare presentation of neuroblastoma in a newborn baby mimicking sacrococcygeal teratoma. Case Presentation: A newborn male baby presented with a firm sacral mass, about 5 x 7 cm, with normal overlying skin. MRI revealed an intrapelvic mass extending to the sacral region encasing the coccyx. After preparation, complete tumor excision was performed, and the diagnosis of neuroblastoma was confirmed by histological and immunohistochemical study. Conclusion: Primary neonatal neuroblastoma presenting as a sacrococcygeal mass is a rare and atypical clinical finding of neuroblastoma. It is hard to diagnose this sort of tumor preoperatively unless the mass is subjected to histological and immunohistochemical analysis after tumor excision.
背景：新生儿肿瘤约占所有儿科恶性肿瘤的2%，其中神经母细胞瘤的发病率最高。累及肾上腺髓质和交感神经节的神经母细胞瘤是婴儿期最典型的情况，而盆腔变异则很罕见。我们报告这一病例是因为在一个模仿骶尾部畸胎瘤的新生儿中出现了罕见的神经母细胞瘤。病例介绍：一名新生男婴出现一个约5 x 7厘米的坚固骶骨肿块，其上覆皮肤正常。核磁共振成像显示一个骨盆内肿块延伸到包围尾骨的骶骨区域。准备好后，进行了完整的肿瘤切除，并通过组织学和免疫组织化学研究证实了神经母细胞瘤的诊断。结论：新生儿原发性神经母细胞瘤表现为骶尾部肿块，是一种罕见且非典型的神经母细胞癌临床表现。除非在肿瘤切除后对肿块进行组织学和免疫组织化学分析，否则很难在术前诊断出这种肿瘤。
{"title":"Primary neonatal sacrococcygeal neuroblastoma masquerading as a teratoma: A case report","authors":"O. A. Edan, Nazar MT Jawhar","doi":"10.47338/jns.v11.1113","DOIUrl":"https://doi.org/10.47338/jns.v11.1113","url":null,"abstract":"Background: Neonatal tumors comprise about 2% of all pediatric malignancies, with neuroblastoma having the highest incidence. Neuroblastoma involving the adrenal medulla and sympathetic ganglia is the most typical scenario in infancy, while the pelvic variant is rare. We report this case because of the unusual and rare presentation of neuroblastoma in a newborn baby mimicking sacrococcygeal teratoma.\u0000Case Presentation: A newborn male baby presented with a firm sacral mass, about 5 x 7 cm, with normal overlying skin. MRI revealed an intrapelvic mass extending to the sacral region encasing the coccyx. After preparation, complete tumor excision was performed, and the diagnosis of neuroblastoma was confirmed by histological and immunohistochemical study.\u0000Conclusion: Primary neonatal neuroblastoma presenting as a sacrococcygeal mass is a rare and atypical clinical finding of neuroblastoma. It is hard to diagnose this sort of tumor preoperatively unless the mass is subjected to histological and immunohistochemical analysis after tumor excision.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48661051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Assouto, A. S. C. R. Houegban, B. R. Assan, N. Tchiakpe, M. Fiogbe, A. Gbénou
Background: Gastroschisis often has a fatal outcome in developing countries. Its outcome is taken as an indicator of the level of healthcare in a particular healthcare facility. The aim was to study the outcome of the management of gastroschisis and to identify the main challenges of its treatment in a country with limited resources. Methods: This is a prospective and descriptive study conducted over a period of 4 years (2016-2020). It included all the neonates admitted to the two referral hospitals of our country with the diagnosis of gastroschisis. Each of the university hospitals had a neonatology unit. Parenteral nutrition and assisted ventilation were not available. Results: Twenty patients were admitted to our hospitals with an annual frequency of five cases. The sex ratio (M:F) was 1.5. Only one of the 20 mothers (5%) of the patients had an antenatal diagnosis and was the only one born in a university hospital. The remaining (19-95%) were referred to a university hospital after their birth. None of the 20 patients had received parenteral nutrition. Surgically, seven babies (35%) had benefited from the placement of a silo with progressive reduction of the bowels. The mortality of gastroschisis was 100% and the average life span of the patients was 4.5 days [1-20 days]. Conclusion: It is important to act appropriately on the whole chain of management of gastroschisis from antenatal diagnosis to treatment so that this pathology is no longer fatal for newborns in countries with limited resources.
{"title":"Dismal outcome of gastroschisis in a resource-limited country in West Africa: Relevant issues and what to expect?","authors":"C. Assouto, A. S. C. R. Houegban, B. R. Assan, N. Tchiakpe, M. Fiogbe, A. Gbénou","doi":"10.47338/jns.v11.1077","DOIUrl":"https://doi.org/10.47338/jns.v11.1077","url":null,"abstract":"Background: Gastroschisis often has a fatal outcome in developing countries. Its outcome is taken as an indicator of the level of healthcare in a particular healthcare facility. The aim was to study the outcome of the management of gastroschisis and to identify the main challenges of its treatment in a country with limited resources.\u0000Methods: This is a prospective and descriptive study conducted over a period of 4 years (2016-2020). It included all the neonates admitted to the two referral hospitals of our country with the diagnosis of gastroschisis. Each of the university hospitals had a neonatology unit. Parenteral nutrition and assisted ventilation were not available.\u0000Results: Twenty patients were admitted to our hospitals with an annual frequency of five cases. The sex ratio (M:F) was 1.5. Only one of the 20 mothers (5%) of the patients had an antenatal diagnosis and was the only one born in a university hospital. The remaining (19-95%) were referred to a university hospital after their birth. None of the 20 patients had received parenteral nutrition. Surgically, seven babies (35%) had benefited from the placement of a silo with progressive reduction of the bowels. The mortality of gastroschisis was 100% and the average life span of the patients was 4.5 days [1-20 days].\u0000Conclusion: It is important to act appropriately on the whole chain of management of gastroschisis from antenatal diagnosis to treatment so that this pathology is no longer fatal for newborns in countries with limited resources.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46544375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 10-day-old, male baby born to a primigravida of 23year at 36 weeks of gestation via emergency Caesarian section for oligohydramnios, was referred to us for abdominal distension and respiratory distress for 3 days. He had not passed stools for 3 days. He was small for gestational age weighing 1.5 kg and had Apgar scores of 4 and 8 at 1 and 5 minutes and had to be put on continuous positive airway pressure (CPAP) soon after delivery. At presentation, the patient’s general condition was poor was on inotropic support for septicemic shock. The nasogastric tube was in situ draining a significant amount of bilious aspirate. On abdominal examination, the abdomen was distended with generalized tenderness and guarding with absent bowel sounds on auscultation. Preliminary lab investigation results were: TLC=40,000 cells/cumm; Platelets=40,000 cells/cumm; CRP=64mg/L. The patient was intubated and taken on hand ventilation and a bolus of intravenous fluid was given along with broad-spectrum antibiotics. X-ray abdomen showed few dilated gut loops with the paucity of air in the intestine. On abdominal ultrasonography, there was minimal inter-gut free fluid with air and fluid-filled dilated gut loops. After hemodynamic stabilization, the patient was taken up for exploratory laparotomy that showed 15ml of sero-feco-purulent peritoneal fluid and a 5 cm gangrenous and perforated segment of the proximal sigmoid colon with thick meconium/fecal matter in the left iliac fossa. A segment of the proximal ileum was found stuck to the involved sigmoid colon segment leading to kinking and perforation at its apex. Therefore, resection of involved gangrenous sigmoid colon and perforation bearing segment of proximal ileum was done with end-to-end colo-colic and ileo-ileal anastomoses. The histopathological examination showed sigmoid colon had the aggregate of Langhans and foreign body giant cells with areas of necrotic exudates and serositis and the detection of many wide, ribbon-like, sparsely septate fungal hyphae with wide angle branching (approximately 90 degrees) characteristic of mucormycosis without any angioinvasion (Fig. 1). The postoperative period was uneventful and the patient was discharged on the seventh postoperative day after he had started accepting orally and passing flatus and stools normally. He is on regular follow-up, thriving well with a weight appropriate for his age.
{"title":"Mucormycosis of the colon in a premature neonate","authors":"Pradeep Kajal, Namita Bhutani, Kirti Saini, Anjali Sindhu","doi":"10.47338/jns.v11.1085","DOIUrl":"https://doi.org/10.47338/jns.v11.1085","url":null,"abstract":"A 10-day-old, male baby born to a primigravida of 23year at 36 weeks of gestation via emergency Caesarian section for oligohydramnios, was referred to us for abdominal distension and respiratory distress for 3 days. He had not passed stools for 3 days. He was small for gestational age weighing 1.5 kg and had Apgar scores of 4 and 8 at 1 and 5 minutes and had to be put on continuous positive airway pressure (CPAP) soon after delivery. At presentation, the patient’s general condition was poor was on inotropic support for septicemic shock. The nasogastric tube was in situ draining a significant amount of bilious aspirate. On abdominal examination, the abdomen was distended with generalized tenderness and guarding with absent bowel sounds on auscultation. Preliminary lab investigation results were: TLC=40,000 cells/cumm; Platelets=40,000 cells/cumm; CRP=64mg/L. The patient was intubated and taken on hand ventilation and a bolus of intravenous fluid was given along with broad-spectrum antibiotics. X-ray abdomen showed few dilated gut loops with the paucity of air in the intestine. On abdominal ultrasonography, there was minimal inter-gut free fluid with air and fluid-filled dilated gut loops. After hemodynamic stabilization, the patient was taken up for exploratory laparotomy that showed 15ml of sero-feco-purulent peritoneal fluid and a 5 cm gangrenous and perforated segment of the proximal sigmoid colon with thick meconium/fecal matter in the left iliac fossa. A segment of the proximal ileum was found stuck to the involved sigmoid colon segment leading to kinking and perforation at its apex. Therefore, resection of involved gangrenous sigmoid colon and perforation bearing segment of proximal ileum was done with end-to-end colo-colic and ileo-ileal anastomoses. The histopathological examination showed sigmoid colon had the aggregate of Langhans and foreign body giant cells with areas of necrotic exudates and serositis and the detection of many wide, ribbon-like, sparsely septate fungal hyphae with wide angle branching (approximately 90 degrees) characteristic of mucormycosis without any angioinvasion (Fig. 1). The postoperative period was uneventful and the patient was discharged on the seventh postoperative day after he had started accepting orally and passing flatus and stools normally. He is on regular follow-up, thriving well with a weight appropriate for his age.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49010423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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