Pub Date : 2020-02-12DOI: 10.15406/jpnc.2020.10.00407
Julien IE Hoffman
Pulse oximetry is used as a screening test for critical congenital heart disease. Current algorithms involve one or to re-screenings for some patients. That may take 2-8 hours before a diagnosis is made. I propose that after the initial screen, patients who do not pass the test be given a short exposure to high oxygen concentration in order to eliminate lung disease as a cause of the desaturation.
{"title":"Accelerated pulse oximetry in the neonate: a proposal","authors":"Julien IE Hoffman","doi":"10.15406/jpnc.2020.10.00407","DOIUrl":"https://doi.org/10.15406/jpnc.2020.10.00407","url":null,"abstract":"Pulse oximetry is used as a screening test for critical congenital heart disease. Current algorithms involve one or to re-screenings for some patients. That may take 2-8 hours before a diagnosis is made. I propose that after the initial screen, patients who do not pass the test be given a short exposure to high oxygen concentration in order to eliminate lung disease as a cause of the desaturation.","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"105 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125597394","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}
Pub Date : 2020-01-28DOI: 10.15406/jpnc.2020.10.00405
It presents the clinical case of a pediatric patient of 9 years old male, of urban origin who underwent surgery for acute abdomen box with preoperative diagnosis of complicated appendicitis, finding the findings transquirúrgicos a primary omental torsion greater, performed a case report and a review of existing literature.
{"title":"Primary torsion of epliplon major as a cause of acute abdomen","authors":"","doi":"10.15406/jpnc.2020.10.00405","DOIUrl":"https://doi.org/10.15406/jpnc.2020.10.00405","url":null,"abstract":"It presents the clinical case of a pediatric patient of 9 years old male, of urban origin who underwent surgery for acute abdomen box with preoperative diagnosis of complicated appendicitis, finding the findings transquirúrgicos a primary omental torsion greater, performed a case report and a review of existing literature.","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134175059","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}
Pub Date : 2020-01-03DOI: 10.15406/jpnc.2020.10.00404
Abdurhaman Mustefa, Amarch Abera, Asegedech Aseffa, Tsigereda Abathun, Nega, Degefa, H. Tadesse, Tomas Yeheyis
Background: There are an estimated 2.9 million deaths worldwide from sepsis every year (44% of them in children under 5 years of age) and one quarter of these are due to neonatal sepsis. According to global burden of neonatal sepsis about 6.9 million neonates were diagnosed with possible serious bacterial infection needing treatment from these 2.9 million cases of neonates needing treatment occur in sub-Saharan Africa. Method: An institution based cross sectional study with retrospective document review was conducted among neonates admitted to neonatal intensive care unit from December 2017 to December 2018 in arbaminch general hospital. Sample size was calculated by using single population proportion sample formula with a final sample size of 351. Data were collected a checklist. Using SPSS version 21 Binary and multiple logistic regressions have been used to observe the association between independent variables and dependent variable. Result: The magnitude of neonatal sepsis was 78.3%. APGAR<6,PROM> 18 hours and duration of labour>12 hours were positively associated with neonatal sepsis where as gestational age > 37 weeks and birth weight >2500 grams were protective factors as evidenced by statistical result of 2.33(0.205-0.33), 1.32(0.71-0.84), 1.20(0.70-0.95), 0.85(0.34-0.815) and 0.12(0.04-030) respectively. Conclusion and recommendation: The finding of this study shows that neonatal sepsis accounts the highest proportion cases amongst neonates admitted in the hospital. Gestational age, birth weight, APGAR score, PROM and duration of labour were found to be determinants of neonatal sepsis. Therefore, service utilization of mothers, early detection of risky situations and appropriate practice of newborn care can halt the problem.
{"title":"Prevalence of neonatal sepsis and associated factors amongst neonates admitted in arbaminch general hospital, arbaminch, southern Ethiopia, 2019","authors":"Abdurhaman Mustefa, Amarch Abera, Asegedech Aseffa, Tsigereda Abathun, Nega, Degefa, H. Tadesse, Tomas Yeheyis","doi":"10.15406/jpnc.2020.10.00404","DOIUrl":"https://doi.org/10.15406/jpnc.2020.10.00404","url":null,"abstract":"Background: There are an estimated 2.9 million deaths worldwide from sepsis every year (44% of them in children under 5 years of age) and one quarter of these are due to neonatal sepsis. According to global burden of neonatal sepsis about 6.9 million neonates were diagnosed with possible serious bacterial infection needing treatment from these 2.9 million cases of neonates needing treatment occur in sub-Saharan Africa. Method: An institution based cross sectional study with retrospective document review was conducted among neonates admitted to neonatal intensive care unit from December 2017 to December 2018 in arbaminch general hospital. Sample size was calculated by using single population proportion sample formula with a final sample size of 351. Data were collected a checklist. Using SPSS version 21 Binary and multiple logistic regressions have been used to observe the association between independent variables and dependent variable. Result: The magnitude of neonatal sepsis was 78.3%. APGAR<6,PROM> 18 hours and duration of labour>12 hours were positively associated with neonatal sepsis where as gestational age > 37 weeks and birth weight >2500 grams were protective factors as evidenced by statistical result of 2.33(0.205-0.33), 1.32(0.71-0.84), 1.20(0.70-0.95), 0.85(0.34-0.815) and 0.12(0.04-030) respectively. Conclusion and recommendation: The finding of this study shows that neonatal sepsis accounts the highest proportion cases amongst neonates admitted in the hospital. Gestational age, birth weight, APGAR score, PROM and duration of labour were found to be determinants of neonatal sepsis. Therefore, service utilization of mothers, early detection of risky situations and appropriate practice of newborn care can halt the problem.","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123270803","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}
Pub Date : 2019-12-24DOI: 10.15406/jpnc.2019.09.00402
M. Tawfique
{"title":"Evolution of cancer genomics and its clinical implications","authors":"M. Tawfique","doi":"10.15406/jpnc.2019.09.00402","DOIUrl":"https://doi.org/10.15406/jpnc.2019.09.00402","url":null,"abstract":"","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125282984","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}
Pub Date : 2019-12-14DOI: 10.15406/jpnc.2020.10.00431
M. Elmetwally, Mohamed H Koura, M. Mahmoud, Madhavan P Nayar, Mohammed Jaffer Sajwani
{"title":"Unilateral pulmonary agenesis, with esophageal atresia long term results","authors":"M. Elmetwally, Mohamed H Koura, M. Mahmoud, Madhavan P Nayar, Mohammed Jaffer Sajwani","doi":"10.15406/jpnc.2020.10.00431","DOIUrl":"https://doi.org/10.15406/jpnc.2020.10.00431","url":null,"abstract":"","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134264669","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}
Pub Date : 2019-12-03DOI: 10.15406/jpnc.2019.09.00400
Askerov Aa, Satybaldieva Aj
The article presents the results of a study on noninvasive early diagnosis of the endometriosis ovarian cyst via ultrasound and on-markers CA-125. The effectiveness of using antimulyler hormone in predicting the reserve capacity of the ovary after surgical treatment of endometriosis cyst.
{"title":"Non-invasive research in ovarian endometriosis","authors":"Askerov Aa, Satybaldieva Aj","doi":"10.15406/jpnc.2019.09.00400","DOIUrl":"https://doi.org/10.15406/jpnc.2019.09.00400","url":null,"abstract":"The article presents the results of a study on noninvasive early diagnosis of the endometriosis ovarian cyst via ultrasound and on-markers CA-125. The effectiveness of using antimulyler hormone in predicting the reserve capacity of the ovary after surgical treatment of endometriosis cyst.","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129502068","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}
Pub Date : 2019-11-22DOI: 10.15406/jpnc.2019.09.00399
Marianne Touma Boulos, S. Abou Jaoudé, Z. Saliba, Samah Fattah, S. Saadé, N. Hanna
Junctional ectopic tachycardia (JET) is the most common tachyarrhythmia that appears mostly during the immediate postoperative period of congenital heart surgery. Patients who develop JET have increased mortality and morbidity. Despite the availability of different antiarrhythmic treatments, management of JET is still challenging. We report a case of reversing of malignant JET following congenital heart surgery with the use of oral Ivabradine, after the failure of all the others treatment options of JET. Ivabradine is a drug used in adult practice to lower heart rate in heart failure and angina. Our case report may provide hope that Ivabradine may be a new therapeutic option for JET in infants following congenital heart surgery.
{"title":"New therapeutic option for junctional ectopic tachycardia in infants following congenital heart surgery: ivabradine, a case report","authors":"Marianne Touma Boulos, S. Abou Jaoudé, Z. Saliba, Samah Fattah, S. Saadé, N. Hanna","doi":"10.15406/jpnc.2019.09.00399","DOIUrl":"https://doi.org/10.15406/jpnc.2019.09.00399","url":null,"abstract":"Junctional ectopic tachycardia (JET) is the most common tachyarrhythmia that appears mostly during the immediate postoperative period of congenital heart surgery. Patients who develop JET have increased mortality and morbidity. Despite the availability of different antiarrhythmic treatments, management of JET is still challenging. We report a case of reversing of malignant JET following congenital heart surgery with the use of oral Ivabradine, after the failure of all the others treatment options of JET. Ivabradine is a drug used in adult practice to lower heart rate in heart failure and angina. Our case report may provide hope that Ivabradine may be a new therapeutic option for JET in infants following congenital heart surgery.","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115887829","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}
Pub Date : 2019-11-01DOI: 10.15406/jpnc.2019.09.00397
D. Bharti, I. Patel
We are reporting an infant delivered at 23 weeks of gestation who presented with subcutaneous fat necrosis (SCFN).
我们报告一例妊娠23周分娩的婴儿出现皮下脂肪坏死(SCFN)。
{"title":"Subcutaneous fat necrosis in an extremely low birth weight infant","authors":"D. Bharti, I. Patel","doi":"10.15406/jpnc.2019.09.00397","DOIUrl":"https://doi.org/10.15406/jpnc.2019.09.00397","url":null,"abstract":"We are reporting an infant delivered at 23 weeks of gestation who presented with subcutaneous fat necrosis (SCFN).","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126019331","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}
Pub Date : 2019-10-16DOI: 10.15406/jpnc.2019.09.00396
S. Saadé, N. Hanna, C. Mourani
Introduction: Neonates and infants having surgical repair for congenital heart disease are at risk of developing acute kidney injury (AKI). Our objectives were to determine surgeries most associated with AKI, to compare effect of peritoneal dialysis (PD) and conventional treatment, and to study the risk factors associated with PD mortality. Materials and methods: Records of Children who underwent cardiac surgery from November 2016 until December 2017 were reviewed. Clinical and biological effects of PD and conventional treatment were compared. In PD group, subgroups of survivors and non-survivors were compared to study risk factors for mortality associated with PD. We compared mortality between early and late PD (more than 24 hours after surgery). Results: 134 children were operated during the study period. 27 (20%) developed AKI and 9 of those (33%) received PD. Arterial switch was most associated with AKI (71.4%). PD had better effect in decreasing creatinine and blood urea nitrogen (BUN) levels after 48 hours treatment than conventional treatment (creatinine: 28.8±14.5 vs 7.5±12.1micromol/L, p=0.003) (BUN: 3.08±2.1 vs 0.91±1.5mmol/L, p=0.017). In PD group, survivors (n=5) had higher mean arterial pressure in the 6 hours prior to PD that non-survivors (n=4) (55.3±9.6 vs 40.0±3.6 mmHg, p=0.019). Survivors had also higher pH 24 hours after PD (7.37±0.03 vs 7.31±0.02, p=0.014), better creatinine variation (-3.6±5.8 vs 29.0±13.0micromol/L, p=0.02), and better diuresis improvement (4.4±3.2 vs 0.23±1.1ml/kg/h, p=0.039). There was no mortality difference between early and late PD. There were no major complications with PD. Conclusion: PD is safe for AKI after heart surgery. It has better outcome on BUN and creatinine levels. PD mortality is higher with low cardiac output, persistence of acidosis and absence of creatinine or diuresis improvement.
新生儿和接受先天性心脏病手术修复的婴儿有发生急性肾损伤(AKI)的风险。我们的目的是确定与AKI最相关的手术，比较腹膜透析(PD)和常规治疗的效果，并研究与PD死亡率相关的危险因素。材料和方法:回顾2016年11月至2017年12月接受心脏手术的儿童的记录。比较PD治疗与常规治疗的临床及生物学效果。在PD组中，将幸存者和非幸存者亚组进行比较，研究PD相关死亡率的危险因素。我们比较了早期和晚期PD(术后24小时以上)的死亡率。结果:研究期间共手术134例。27例(20%)发生AKI，其中9例(33%)接受PD治疗。动脉切换与AKI的相关性最高(71.4%)。PD治疗48h后肌酐和尿素氮(BUN)水平较常规治疗有较好的降低效果(肌酐:28.8±14.5 vs 7.5±12.1 μ mol/L, p=0.003) (BUN: 3.08±2.1 vs 0.91±1.5mmol/L, p=0.017)。PD组幸存者(n=5)在PD前6小时的平均动脉压高于非幸存者(n=4)(55.3±9.6 vs 40.0±3.6 mmHg, p=0.019)。幸存者PD后24小时pH值也较高(7.37±0.03 vs 7.31±0.02,p=0.014)，肌酐变化较好(-3.6±5.8 vs 29.0±13.0微mol/L, p=0.02)，利尿改善较好(4.4±3.2 vs 0.23±1.1ml/kg/h, p=0.039)。早期和晚期PD患者的死亡率没有差异。PD无重大并发症。结论:PD治疗心脏手术后AKI是安全的。对BUN和肌酐水平有较好的疗效。低心排血量、持续酸中毒和没有肌酐或利尿改善的PD死亡率较高。
{"title":"Peritoneal dialysis after pediatric cardiac surgery: benefits and risks","authors":"S. Saadé, N. Hanna, C. Mourani","doi":"10.15406/jpnc.2019.09.00396","DOIUrl":"https://doi.org/10.15406/jpnc.2019.09.00396","url":null,"abstract":"Introduction: Neonates and infants having surgical repair for congenital heart disease are at risk of developing acute kidney injury (AKI). Our objectives were to determine surgeries most associated with AKI, to compare effect of peritoneal dialysis (PD) and conventional treatment, and to study the risk factors associated with PD mortality. Materials and methods: Records of Children who underwent cardiac surgery from November 2016 until December 2017 were reviewed. Clinical and biological effects of PD and conventional treatment were compared. In PD group, subgroups of survivors and non-survivors were compared to study risk factors for mortality associated with PD. We compared mortality between early and late PD (more than 24 hours after surgery). Results: 134 children were operated during the study period. 27 (20%) developed AKI and 9 of those (33%) received PD. Arterial switch was most associated with AKI (71.4%). PD had better effect in decreasing creatinine and blood urea nitrogen (BUN) levels after 48 hours treatment than conventional treatment (creatinine: 28.8±14.5 vs 7.5±12.1micromol/L, p=0.003) (BUN: 3.08±2.1 vs 0.91±1.5mmol/L, p=0.017). In PD group, survivors (n=5) had higher mean arterial pressure in the 6 hours prior to PD that non-survivors (n=4) (55.3±9.6 vs 40.0±3.6 mmHg, p=0.019). Survivors had also higher pH 24 hours after PD (7.37±0.03 vs 7.31±0.02, p=0.014), better creatinine variation (-3.6±5.8 vs 29.0±13.0micromol/L, p=0.02), and better diuresis improvement (4.4±3.2 vs 0.23±1.1ml/kg/h, p=0.039). There was no mortality difference between early and late PD. There were no major complications with PD. Conclusion: PD is safe for AKI after heart surgery. It has better outcome on BUN and creatinine levels. PD mortality is higher with low cardiac output, persistence of acidosis and absence of creatinine or diuresis improvement.","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121164147","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}
Pub Date : 2019-10-14DOI: 10.15406/jpnc.2019.09.00395
D. Codrich, E. Guida, Scarpa Maria Grazia, F. Pederiva, D. Sanabor, J. Schleef
A five years old girl was taken to our emergency department with a history of few hours of acute abdominal pain in the upper quadrants and non biliary vomiting, followed by retching. The patient was afebrile, with a huge distended abdomen, without tenderness. The rest of the physical examination was unremarkable. A nasogastric tube was passed with some difficulty, a venous access was secured and blood tests were taken: WBC were 12.050U/uL, RCP was 8,8mg/L, pancreatic amylase were elevated at 430U/L. Serum electrolytes, liver and renal function, haemostasis were normal. An abdominal ultrasound (US) revealed a spleen localized in the right flank, below the liver and an abdominal computed tomography (CT) scan was performed (Figures 1-2). The exam showed a well vascularised spleen in the right flank below the liver, a dislocation to the right of the pancreatic tail and body and a huge distended stomach with a the nasogastric tube inside. The diagnosis was gastric volvolus associated with wandering spleen and pancreatic torsion. Fluid resuscitation and antibiotic therapy were started. The girl spontaneously lied on the left flank as her preferred decubitus and after a while the spleen was palpated not in the right flank but in mesogastrium. She was taken to the operatory theatre as soon as fluid resuscitation was secured an emergency and an open laparotomy was performed. A gastric mesenteroaxial volvolus was found associated to uncomplete torsion of the spleen and pancreatic tail. There were no legaments of fixation between spleen and stomach, nor between spleen and kidney, nor between spleen and abdominal wall. There were no signs of severe gastric ischemia. The stomach was derotated and the spleen restored to its normal position since the tissue was completely viable. An omental patch associated to splenopexy was performed to keep the spleen in place and a diaphragmatic and anterior gastropexy was performed. The recovery was uneventful, the amylases returned to normal values within two days and the girl was discharged on postoperative day 4th. At 24months the girl is asymptomatic and a follow-up ultrasound revealed a spleen and stomach in its normal position.
{"title":"Gastric volvolus with wandering spleen and pancreatic torsion in a 5years old girl","authors":"D. Codrich, E. Guida, Scarpa Maria Grazia, F. Pederiva, D. Sanabor, J. Schleef","doi":"10.15406/jpnc.2019.09.00395","DOIUrl":"https://doi.org/10.15406/jpnc.2019.09.00395","url":null,"abstract":"A five years old girl was taken to our emergency department with a history of few hours of acute abdominal pain in the upper quadrants and non biliary vomiting, followed by retching. The patient was afebrile, with a huge distended abdomen, without tenderness. The rest of the physical examination was unremarkable. A nasogastric tube was passed with some difficulty, a venous access was secured and blood tests were taken: WBC were 12.050U/uL, RCP was 8,8mg/L, pancreatic amylase were elevated at 430U/L. Serum electrolytes, liver and renal function, haemostasis were normal. An abdominal ultrasound (US) revealed a spleen localized in the right flank, below the liver and an abdominal computed tomography (CT) scan was performed (Figures 1-2). The exam showed a well vascularised spleen in the right flank below the liver, a dislocation to the right of the pancreatic tail and body and a huge distended stomach with a the nasogastric tube inside. The diagnosis was gastric volvolus associated with wandering spleen and pancreatic torsion. Fluid resuscitation and antibiotic therapy were started. The girl spontaneously lied on the left flank as her preferred decubitus and after a while the spleen was palpated not in the right flank but in mesogastrium. She was taken to the operatory theatre as soon as fluid resuscitation was secured an emergency and an open laparotomy was performed. A gastric mesenteroaxial volvolus was found associated to uncomplete torsion of the spleen and pancreatic tail. There were no legaments of fixation between spleen and stomach, nor between spleen and kidney, nor between spleen and abdominal wall. There were no signs of severe gastric ischemia. The stomach was derotated and the spleen restored to its normal position since the tissue was completely viable. An omental patch associated to splenopexy was performed to keep the spleen in place and a diaphragmatic and anterior gastropexy was performed. The recovery was uneventful, the amylases returned to normal values within two days and the girl was discharged on postoperative day 4th. At 24months the girl is asymptomatic and a follow-up ultrasound revealed a spleen and stomach in its normal position.","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126230288","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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