International Journal of Surgery Open最新文献

Introduction

Surgical abdominal emergencies in children are responsible for high morbidity and mortality. They are numerous and their management in Africa is difficult. The management of non-traumatic abdominal emergencies in children in a regional hospital in Togo is described.

Method

and study setting: This was a single-center, retrospective and descriptive study conducted over a 12-month period. It included all children aged 0–15 years treated at the hospital for non-traumatic abdominal surgical emergencies.

Results

We reported 217 cases of non-traumatic abdominal surgical emergencies in children. We noted a male predominance with a sex ratio of 1.57. Similarly, grandchildren were predominant (44.70 %). A low school attendance rate was noted (21.20 %) and the children were mostly from poor families (32.72 %). The average consultation time was 5.3 ± 1.03 days. Pain was the main symptom and was present in all children. An unprepared abdominal X-ray was the main imaging procedure performed (77.18 %). These conditions were dominated by peritonitis (56.68 %). These were mainly ileal perforations. All the children received surgical treatment. The postoperative course was marked by complications in 104 children (47,93 %) and 14 deaths (6,45 %).

Conclusion

Non-traumatic abdominal surgical emergencies in children are dominated by peritonitis in rural Togo. They could be related to poverty. An effective policy of universal access to health care is essential.

Introduction

and Importance: Trauma, particularly from motor vehicle accidents, causes significant morbidity and mortality worldwide. Isolated jejunal perforation resulting from blunt abdominal trauma is rare but challenging to diagnose. This article sheds light on this infrequent condition, emphasizing the need for early recognition for optimal outcomes.

Case presentation

A 30-year-old male presented with abdominal pain after a motor vehicle accident. Examination and tests showed signs of jejunal perforation. Urgent surgery revealed a 2 cm perforation, contusions, and deserosalizations. The perforation was repaired, and the patient recovered well postoperatively.

Clinical discussion

Blunt abdominal trauma is a major cause of injury, with motor vehicle accidents being prominent. Hollow visceral injuries, though rare, pose diagnostic and management challenges. In this context, recognizing the indications for surgical intervention is complex. Imaging, especially CT scans, plays a critical role in diagnosis. This case underscores the importance of CT findings in diagnosing and deciding the need for surgical exploration.

Conclusion

Isolated jejunal perforation from blunt abdominal trauma is rare but demands clinical attention. Timely diagnosis through CT scans and immediate surgical intervention are crucial for successful outcomes. Surgery involves careful exploration, repairing the perforation and associated injuries, and meticulous postoperative care. Research and knowledge sharing are vital for improving approaches and reducing complications and mortality in these cases.

Introduction and Importance

Congenital bronchopulmonary foregut malformation (CBPFM) is a rare anomaly in which either a lung, a lung lobe or a segment has a patent congenital communication to the upper gastrointestinal tract. In esophageal lung, an anomalous main bronchus arises from the esophagus rather than the trachea.

Case presentation

A male neonate was admitted with respiratory distress immediately following birth. Radiographic evaluation included chest radiograph, chest Ultrasound, chest CT and an upper gastrointestinal (GI) contrast study. A completely opaque right hemithorax was initially visualized and identified as esophageal lung with associated anomalous partial systemic arterial supply and venous drainage. A right posterolateral thoracotomy with pneumonectomy of the hypoplastic lung was performed. However, the patient died of respiratory failure on the first postoperative day.

Clinical discussion

Esophageal lung is an extremely rare form of CBPFM in which a main stem bronchus, usually the right one, is abnormally connected to the esophagus. The diagnosis is suggested by chest x-ray and confirmed by upper GI contrast study, which is also available in resource-poor settings. A CT scan with 3D volume rendered images can make a diagnosis, although difficulties remain. Pneumonectomy is the preferred treatment for most patients.

Conclusion

Esophageal lung is a rare congenital abnormality with few reported cases. Radiologists and pediatricians should have a high index of suspicion for this anomaly in cases of neonatal respiratory distress and a persistently opacified lung with focal air bronchogram(s) and pursue a timely confirmatory contrast study.

Introduction

Endoscopic retrograde appendicitis therapy (ERAT) is a new colonoscopy-based, non-invasive procedure used in the management of acute appendicitis. The results and future prospects of ERAT seem promising. In this study, we aim to study and compare the outcomes of the management of acute appendicitis done through ERAT and laparoscopic appendectomy.

Methods

The protocol for this study was prospectively registered. Electronic databases were searched for relevant articles, and all the comparative studies that compared the results of ERAT and laparoscopic appendectomy published in English were included. The mean difference was used as an effect measure for continuous variables, and the odds ratio was used for dichotomous data.

Results

Compared to laparoscopic appendectomy, ERAT had 10.93 min lesser procedural time (MD: 10.93; 95% CI: (−14.46) – (−7.40); n = 404; I² = 92%, p-value= < 0.00001), 5.46 times lesser odds of achieving technical success (OR: 5.46; 95% CI: 1.17–25.53; n = 329; I² = 0%, p-value = 0.03), 14.25 times more odds of developing recurrence (OR: 14.25; 95% CI: 2.67–76.12; n = 327; I² = 0%, p-value = 0.002), and cost of care was 611.99 USD lesser (MD: 611.99; 95% CI: (−940.48) – (−283.51); n = 204; I² = 98%, p-value = 0.0003). Analysis of length of hospital stay and adverse events did not show a significant difference between the two groups.

Conclusion

ERAT is a safe and appendix-conserving procedure that has a lesser procedural time compared to laparoscopic appendectomy; however, recurrence and therapeutic failure remain higher in the ERAT group.

Background

Continuous positive airway pressure (CPAP) is a simple, inexpensive, and gentle mode of respiratory support for neonates.This is beneficial for spontaneously breathing neonates by maintaining functional residual capacity in the alveoli to prevent atelectasis and improve oxygen exchange. The aim of this study was to assess the practice of continuous positive airway pressure application in neonatal intensive care.

Methods

A hospital based prospective observational descriptive study was conducted on 60 neonates from March 15, 2022 to July 30, 2022 at NICU Unit at XXX Comprehensive Specialized Hospital, July 2022, North-west Ethiopia.

Descriptive statistical analysis with SPSS version 25 was used.

Results

The overall practice of CPAP use were (73.4%), with assessment of parameters such as initial nursing care before initiation of CPAP (82.2%), Setting up of CPAP (94.1%), preparing the Baby for CPAP (65.3%), Connecting the nasal prong system to the neonate (50%), Methods of Securing CPAP device (96.7%), Performing safety check for Troubleshooting in CPAP (78.3%) and Monitor of CPAP and On-going assessments (46.6%).

Conclusion

The practice of CPAP application was good at Initial nursing care before initiation of CPAP, Setting up of CPAP, and Methods of Securing CPAP device. However, there was poor practice in connecting the nasal prong system to the neonate, preparing the Baby for CPAP, performing safety checks for troubleshooting in CPAP, Monitoring of CPAP and On-going assessments.

Background

Anal fistulas are relatively common. Despite diverse treatment modalities and tremendous advance and optimization of surgical approaches, considerable recurrence and high failure rates are not uncommon especially after surgery for complex anal fistulas. Therefore, autologous adipose-derived stem cell therapy for the treatment of complex perianal fistula can be an innovative and promising option with potential high cure rate and long-term healing.

Aim

To assess the efficacy and feasibility intralesional administration of stromal vascular fraction containing autologous, adipose-derived stem cells prepared from fresh lipoaspirate for management of complex and recurrent anal fistula.

Methods

Totally, 28 patients with complex perianal fistulas were enrolled in this prospective case-series study from March 2018 and August 2022. They were 22 male and 6 females patient) with 38.8 years average ages (ranges from 26 to 54 years). All patients were assigned to receive intralesional injection with autologous freshly prepared adipose-derived stem cells from lipoaspirate suction in a concentration of 1 × 10⁷ cell/ml. The healing of fistulas, confirmed by clinical assessment and magnetic resonance imaging was evaluated at week 6 weeks, 12 weeks and 6 months after treatment. If no evidence of healing was not seen at 6 weeks, a second dose of same concentration was administered. In addition to fistula healing, adverse effect (functional outcomes), complications and procedure safety were also evaluated.

Results

The overall healing rate of fistulas treated by injection of ADSCs was 60.7% (17/28), while healing rate after first injection was 50% (14/28) and after second injection was 30% (3/10).Three patients were lost after first injection. During the follow up period of 6 months none of the patients who showed complete healing, recorded relapse of their fistulas (recurrence 0%). Further, none of the patients recorded complications or adverse reactions related to stem cell therapy during the study and none of them had worsening fecal incontinence during follow-up period. Postoperative pain assessed by.

VAS score was significantly low (>3). Fecal continence assessed by Wexner score of all patients was not changed or affected.

Conclusions

Injection of complex perianal fistulas by freshly prepared autologous ADSCs could be a valid and effective treatment modality. It is safe, feasible and minimally invasive procedure that lacks the risk of injury to anal sphincter complex, unlike other surgical procedures that endanger the anal continence.Further, second dose of ADSCs injection could improve the rate of healing, without adding adverse effects.