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Davenport M. Commentary on early management of meconium ileus in infants with cystic fibrosis: A prospective population cohort study. J Pediatr Surg 2021; 56:1293. [PMID: 33745742 DOI: 10.1016/j.jpedsurg.2021.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/23/2022]
Abstract
This is a commentary on the manuscript titled "Early Management of Meconium Ileus in Infants with Cystic Fibrosis: A Prospective Population Cohort Study" by Long A-M, et al.
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Golriz F, Cassady CI, Bales B, Herrejon C, Hicks MJ, Zhang W, Orth RC, Guillerman RP. Comparative safety and efficacy of balloon use in air enema reduction for pediatric intussusception. Pediatr Radiol 2018; 48:1423-31. [PMID: 29797036 DOI: 10.1007/s00247-018-4156-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 04/11/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Intussusception, a common cause of bowel obstruction in young children, is primarily treated with air enema reduction. There is little literature comparing the safety and efficacy of air reduction without or with a rectal balloon. OBJECTIVE To determine the safety and efficacy of a rectal balloon seal in air enema reduction. MATERIALS AND METHODS We retrospectively reviewed the records of children who underwent air reduction for ileocolic or ileo-ileocolic intussusception over an 8-year period. We sorted data from 566 children according to whether a rectal balloon was used in the reduction, and further sorted them by type and experience level of the practitioner. Using logistic regression analyses, we identified risk factors for iatrogenic bowel perforation or failed reduction. RESULTS Significant associations with bowel perforation included balloon use (P=0.038), age <1 year (P<0.0001), and attending physician's level of experience <5 years (P=0.043). Younger age was associated with both perforation (P<0.0001) and procedural failure (P=0.001). The risk-adjusted predicted probability of perforation decreased with age, approaching zero by 10 months regardless of balloon use. For cases without bowel resection, the risk-adjusted predicted probability of failure decreased toward zero by 30 months with balloon use, while remaining constant at 3-12% regardless of age when not using a balloon. CONCLUSION The likelihood of a successful air reduction might be safely increased by using an inflated rectal balloon in children older than 9 months. Use of a balloon in younger infants is associated with a higher risk of iatrogenic bowel injury.
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Shin J, Jeon GW. Successful Ultrasound-Guided Gastrografin Enema for Very Low Birth Weight Infants with Meconium-Related Ileus. Neonatal Med 2018. [DOI: 10.5385/nm.2018.25.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jaeho Shin
- Division of Pediatric Surgery, Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Callahan MJ, Talmadge JM, MacDougall RD, Kleinman PL, Taylor GA, Buonomo C. Selecting appropriate gastroenteric contrast media for diagnostic fluoroscopic imaging in infants and children: a practical approach. Pediatr Radiol 2017; 47:372-381. [PMID: 27725991 DOI: 10.1007/s00247-016-3709-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/28/2016] [Accepted: 09/13/2016] [Indexed: 11/30/2022]
Abstract
In our experience, questions about the appropriate use of enteric contrast media for pediatric fluoroscopic studies are common. The purpose of this article is to provide a comprehensive review of enteric contrast media used for pediatric fluoroscopy, highlighting the routine use of these media at a large tertiary care pediatric teaching hospital.
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Affiliation(s)
- Michael J Callahan
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Jennifer M Talmadge
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.,Spectrum Medical Group, Radiology, 324 Gannett Drive, South Portland, Maine, 04106, USA
| | - Robert D MacDougall
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Patricia L Kleinman
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - George A Taylor
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Carlo Buonomo
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
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Abstract
Gastrointestinal tract perforation can arise from various underlying etiologies ranging from congenital causes to ingested foreign bodies in the pediatric patient population. Imaging assessment in patients with suspected gastrointestinal tract perforation plays a central role in making the diagnosis and follow-up evaluation. This article reviews the more common etiologies of gastrointestinal tract perforation in pediatric patients, their imaging manifestations, and strategies for imaging assessment to assist the radiologist in arriving at a timely and accurate diagnosis.
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Affiliation(s)
- Gary R Schooler
- Department of Radiology, Duke University Medical Center, 1905 Children׳s Health Center, Durham, NC
| | - Joseph T Davis
- Department of Radiology, Duke University Medical Center, 1905 Children׳s Health Center, Durham, NC
| | - Edward Y Lee
- Department of Radiology, Boston Children׳s Hospital and Harvard Medical School, Boston, MA.
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Cho HH, Cheon JE, Choi YH, Lee SM, Kim WS, Kim IO, Shin SM, Kim EK, Kim HS, Choi JH, You SK. Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success. Eur J Radiol 2015; 84:2024-31. [PMID: 26159485 DOI: 10.1016/j.ejrad.2015.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/27/2015] [Accepted: 06/04/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study aimed to assess the therapeutic results of ultrasound (US)-guided water-soluble contrast enema in very low birth weight (VLBW) preterm infants (<1,500 g) with meconium obstruction and to study factors that affect therapeutic results. METHODS This study included a total of 33 consecutive VLBW infants with clinically diagnosed meconium obstruction underwent US-guided water-soluble contrast enema, from April 2007 to March 2014. Patients were classified into two groups based on to procedure outcome: the success group (evacuation of the meconium plug resolution followed by improved bowel distention within 2 days of the procedure, without additional interventions), and the failure group (the contrast enema failed to relieve the obstruction, or other procedure-related complications occurred). Patient- and mother-related clinical factors and procedure-related factors were compared between both groups. RESULTS Overall success rate was 54.5%, with 18 successful (M:F=10:8), and 15 failure (M:F=7:8) cases. When compared with the failure group, the success group patients showed statistically significant older gestational age (29(+1) vs. 27 weeks; p=0.028), larger birth weight (1023.1g vs. 790.3g; p=0.048), and higher body weight on the day of the procedure (1036.2g vs. 801.6g, p=0.049). However, no statistically significant differences were seen between other patient and maternal factors. Among the procedure-related factors, retrial of contrast injection during the procedure was associated with significantly higher success than the single trial (p=0.027). The presence of refluxed contrast into the distal ileum was the statistically significant predictor for success of the procedure (p=0.038). There were three cases of bowel perforation (9.1% per person). CONCLUSION US-guided water-soluble contrast enema in VLBW infants with meconium obstruction showed a 54.5% success rate and a 9.1% perforation rate per person. Among the procedure-related factors, retrial of contrast injection during the procedure and the presence of refluxed contrast into the distal ileum were related to the success of the procedure.
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Affiliation(s)
- Hyun-Hae Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea.
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea
| | - So Mi Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - In-One Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - Su-Mi Shin
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun Kyoung You
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
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Kim HS, Je BK, Cha SH, Choi BM, Lee KY, Lee SH. Renal excretion of water-soluble contrast media after enema in the neonatal period. Pediatr Neonatol 2014; 55:256-61. [PMID: 24295782 DOI: 10.1016/j.pedneo.2013.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 12/07/2012] [Accepted: 07/29/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND When abdominal distention occurs or bowel obstruction is suspected in the neonatal period, a water-soluble contrast enema is helpful for diagnostic and therapeutic purposes. The water-soluble contrast medium is evacuated through the anus as well as excreted via the kidneys in some babies. This study was designed to evaluate the incidence of renal excretion after enemas using water-soluble contrast media and presume the causes. METHODS Contrast enemas using diluted water-soluble contrast media were performed in 23 patients under 2 months of age. After the enema, patients were followed with simple abdominal radiographs to assess the improvement in bowel distention, and we could also detect the presence of renal excretion of contrast media on the radiographs. Reviewing the medical records and imaging studies, including enemas and consecutive abdominal radiographs, we evaluated the incidence of renal excretion of water-soluble contrast media and counted the stay duration of contrast media in urinary tract, bladder, and colon. RESULTS Among 23 patients, 12 patients (52%) experienced the renal excretion of water-soluble contrast media. In these patients, stay-in-bladder durations of contrast media were 1-3 days and stay-in-colon durations of contrast media were 1-10 days, while stay-in-colon durations of contrast media were 1-3 days in the patients not showing renal excretion of contrast media. The Mann-Whitney test for stay-in-colon durations demonstrated the later evacuation of contrast media in the patients with renal excretion of contrast media (p = 0.07). The review of the medical records showed that 19 patients were finally diagnosed as intestinal diseases, including Hirschsprung's disease, meconium ileum, meconium plug syndrome, and small bowel atresia or stenosis. Fisher's exact test between the presence of urinary excretion and intestinal diseases indicated a statistically significant difference (p = 0.04). CONCLUSION The intestinal diseases causing bowel obstruction may increase the water-soluble contrast media's dwell time in the bowel and also increase urinary excretion.
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Affiliation(s)
- Hee Sun Kim
- Department of Radiology, Korea University Hospital, Ansan, Gyeonggido, Republic of Korea
| | - Bo-Kyung Je
- Department of Radiology, Korea University Hospital, Ansan, Gyeonggido, Republic of Korea.
| | - Sang Hoon Cha
- Department of Radiology, Korea University Hospital, Ansan, Gyeonggido, Republic of Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University Hospital, Ansan, Gyeonggido, Republic of Korea
| | - Ki Yeol Lee
- Department of Radiology, Korea University Hospital, Ansan, Gyeonggido, Republic of Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University Hospital, Ansan, Gyeonggido, Republic of Korea
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Watanabe T, Takahashi M, Amari S, Ohno M, Sato K, Tanaka H, Miyasaka M, Fuchimoto Y, Ito Y, Kanamori Y. Olive oil enema in a pre-term infant with milk curd syndrome. Pediatr Int 2013; 55:e93-5. [PMID: 23910816 DOI: 10.1111/ped.12082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/26/2012] [Accepted: 02/19/2013] [Indexed: 11/28/2022]
Abstract
Milk curd syndrome was first reported in the 1960s, but was gradually forgotten because of its low incidence thereafter. This condition in pre-term infants has been reported over the last decade and has again attracted neonatologists' attention. The present report describes a pre-term infant with milk curd syndrome. Abdominal distension was evident 14 days after the start of feeding with fortified expressed milk. Abdominal X-ray showed multiple intraluminal masses surrounded by a halo of air, and ultrasound indicated hyperechoic masses. Along with that history and the appearance of fecal impaction, the diagnosis of milk curd syndrome was confirmed. This baby was treated with olive oil enemas and successive colonic lavage for 3 days, and the symptoms were relieved. Olive oil enema, which softens hard stools and induces smooth movement of these stools, may be an effective and safe first-line treatment in pre-term infants with milk curd syndrome.
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Affiliation(s)
- Toshihiko Watanabe
- Division of Surgery, National Center for Child Health and Development, Tokyo, Japan.
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Abstract
BACKGROUND Meconium obstruction without cystic fibrosis in low-birthweight neonates is a distinct clinical entity. We aimed to determine what therapeutic strategies work best in very-low-birthweight neonates with meconium obstruction of the small bowel under varied clinical conditions caused by the associated diseases of prematurity. METHODS Medical records of very-low-birthweight neonates with meconium obstruction of the small bowel treated from 1998 to 2008 were retrospectively reviewed. Pre- and postnatal data, treatments, and clinical outcomes were assessed. RESULTS Nine patients with perinatal complications were identified. Mean gestational age and birthweight were 26.9 weeks and 863 g, respectively. Abdominal distension developed from 1 to 7 days of life. Five patients were initially treated with Gastrografin enema, three of whom had successful outcomes. Two hemodynamically unstable patients failed to respond to Gastrografin treatment; they ultimately died of sepsis. The remaining four without Gastrografin treatment underwent enterostomy to resolve the obstructions with good results. CONCLUSIONS Gastrografin and surgical treatments should be appropriately selected based on the underlying pathologies of meconium obstruction of the small bowel. Therapeutic Gastrografin enema is effective, safe and repeatable; however, it is not recommended for hemodynamically unstable patients. Surgical intervention is reserved for those who develop rapid abdominal distension that risks perforation.
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Affiliation(s)
- Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan.
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Copeland DR, St Peter SD, Sharp SW, Islam S, Cuenca A, Tolleson JS, Dassinger MS, Little DC, Jackson RJ, Kokoska ER, Smith SD. Diminishing role of contrast enema in simple meconium ileus. J Pediatr Surg 2009; 44:2130-2. [PMID: 19944221 DOI: 10.1016/j.jpedsurg.2009.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 05/28/2009] [Accepted: 06/01/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE Contrast enema is the initial study of choice for simple meconium ileus to confirm diagnosis and to relieve obstruction. Despite favorable historically published results, our clinical impression suggests decreased effectiveness of the contrast enema resulting in more surgical interventions in contemporary practice. METHODS A retrospective multiinstitutional review for a 12-year period was conducted for neonates diagnosed with meconium ileus by contrast enema. The neonates were divided into 2 groups-historic group (HG = before 2002) and contemporary group (CG = after 2002). T test was used for comparison of continuous variables and chi(2) for categorical data. RESULTS Thirty-seven total patients were identified (21 females and 16 males). Obstruction was relieved in 8 neonates (22% overall success rate). Average enema attempt per patient was decreased in the CG group compared to HG (1.4 vs 1.9). The success rate in the CG group was 5.5% (1/18) compared to 39% (7/18) in HG. CONCLUSIONS In this review, success of contrast enema for relief of meconium ileus has significantly decreased over time. These findings may be because of reluctance to repeat enemas, change in radiologist experience, or use of contrast agent. As a result, higher rates of operative intervention are now observed. In stable patients, surgeons should recommend repeat enemas before exploration.
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Nakaoka T, Shiokawa C, Nishihara M, Tamai H, Funato M, Uemura S. Iopamidol enema treatment for meconium obstruction of prematurity in extremely low-birth weight infants: a safe and effective method. Pediatr Surg Int 2009; 25:273-6. [PMID: 19184049 DOI: 10.1007/s00383-009-2334-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE Meconium obstruction of prematurity (MO) often occurs in extremely low-birth weight (ELBW) infants, and its treatment is quite a challenge for neonatologists. We attempted to establish a method of primary treatment for MO of prematurity in ELBW infants. METHODS An iopamidol enema with 50 cm H(2)O static pressure was performed as the primary treatment. This procedure is safe and effective and we recommend this as the first treatment for MO in ELBW infants. RESULTS The procedure was performed 50 times in 23 infants and no complications occurred. Out of 23 patients, 20 (88%) improved, but the other 3 did not. In the failure group, the procedure was performed on a significantly later date and the mortality rate was higher (12.5 vs. 67%). CONCLUSIONS This procedure is safe and effective. We recommend this as the first treatment for MO in ELBW infants.
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Abstract
We discuss an infant with MI secondary to cystic fibrosis, who was managed surgically by a double barrel ileostomy for mid - small bowel atresia and developed severe faecal impaction in the post - operative period. The faecal impaction was treated successfully with oral NAC and 0.2% NAC contrast enemas. The patient's liver function tests revealed a dramatic increase in transaminases and bilirubin contemporaneous with the administration of the enemas. The levels showed a spontaneous improvement after discontinuation. This is only the second reported case of hepatotoxicity secondary to NAC enemas in the literature. While our experience offers modest support for the use of NAC, its efficacy is not yet proven and paediatric surgeons using NAC in the enema form need to closely monitor liver function contemporaneous with this agent's administration and adjust their treatment accordingly.
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Affiliation(s)
- Andrew Cooke
- Department of Paediatric Surgery, The Children's Hospital at Westmead, New South Wales, Australia.
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Tawil MI. Pediatric Emergencies: Non-traumatic Abdominal Emergencies. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Providing care to neonates with bowel obstruction requires a basic understanding of gastrointestinal (GI) anatomy and functional landmarks as well as knowledge of the pathophysiology associated with intestinal blockage. Early recognition and prompt diagnosis necessitate astute assessment of common presenting symptoms and accurate interpretation of diagnostic investigations. Initial medical management is focused primarily on gastric decompression and maintenance of fluid and electrolyte balance. This article describes features of the neonatal GI tract and discusses common causes of neonatal bowel obstruction.
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Abstract
PURPOSE OF REVIEW Cystic fibrosis is a common disorder, affecting as many as 1:2500 Caucasian live births. Despite improved medical management, disease-specific complications are common and are responsible for substantial morbidity and ultimately mortality. Both pulmonary and gastrointestinal complications of cystic fibrosis are well known; however, the complications requiring surgical intervention in the pediatric population are infrequent. We provide a detailed review of the cystic fibrosis-associated pulmonary and gastrointestinal complications and potential surgical options for management in children with cystic fibrosis. RECENT FINDINGS Recent operative approaches are described that include application of minimally invasive surgical techniques primarily for intrathoracic disease. Novel medical therapies are also presented. Finally an attempt is made to put in perspective those surgical care advances that have had a benefit on disease outcomes. SUMMARY This report will provide the physician caring for the child with cystic fibrosis an understanding of those disease complications that will require surgical consultation and potential operative intervention.
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Abstract
The presence of dilated bowel loops antenatally suggests fetal bowel obstruction. Neonatal intestinal obstruction can have different variations in presentation depending on the level and extent of obstruction. Some of these conditions can be diagnosed antenatally. Antenatal detection of surgically correctable anomalies would ideally reduce perinatal morbidity and mortality by allowing a planned delivery with early resuscitation and prompt surgical intervention. Duodenal atresia is the most common intestinal atresia diagnosed in a fetus. Presently there are no significant abnormalities of the fetal gastrointestinal tract that benefit from fetal intervention. However a thorough understanding of the disease processes is necessary for diagnosis and treatment of intestinal obstruction. With advances in neonatal intensive care and management there has been a significant decrease in mortality rates of neonates with intestinal obstruction.
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Affiliation(s)
- Rang Shawis
- Paediatric Surgical Unit, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, United Kingdom.
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Abstract
BACKGROUND Guidelines for diagnosis and therapy of meconium obstruction in extremely low birth weight neonates are still not well established. METHODS All low-birth-weight infants presenting with meconium obstruction over a 5-year period were reviewed retrospectively. Patients with meconium plug syndrome or cystic fibrosis were excluded. RESULTS Seven patients were identified. Average birth weight and gestational age were 874 g and 27.7 weeks, respectively. All were products of high-risk pregnancies, and 6 (86%) were delivered by cesarean section. All patients presented with distended abdomens without peritonitis. Abdominal films showed multiple distended intestinal loops without air-fluid levels in all cases. Three patients (43%) had contrast enemas, all showing microcolon. Nonoperative therapy, consisting of rectal irrigations and N-acetylcysteine per orogastric tube, succeeded in 3 patients who were obstructed for less than 10 days and failed in 1 patient obstructed for 12 days. Four patients, all obstructed for more than 10 days, underwent enterotomy and lavage (2), bowel resection and ileostomy (1), and initial peritoneal drainage for perforation followed by bowel resection (1). All patients survived with intact bowel function. CONCLUSIONS Extremely low-birth-weight infants with meconium obstruction can be diagnosed based on their typical clinical and plain radiographic characteristics, without need for a contrast enema. Nonoperative treatment is successful early in the course of the obstruction. In the absence of an intestinal complication, simple enterotomy and meconium evacuation effectively treats long-standing obstruction.
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Affiliation(s)
- Sherif Emil
- Division of Pediatric Surgery, University of California, Irvine Medical Center, Orange 92868, USA
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Abstract
Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma are tumors of the sympathetic nervous system that arise from primitive sympathogonia and are referred to collectively as neuroblastic tumors. They arise wherever sympathetic tissue exists and may be seen in the neck, posterior mediastinum, adrenal gland, retroperitoneum, and pelvis. The three tumors differ in their degree of cellular and extracellular maturation; immature tumors tend to be aggressive and occur in younger patients (median age, just under 2 years), whereas mature tumors occur in older children (median age, approximately 7 years) and tend to behave in a benign fashion. The most benign tumor is the ganglioneuroma, which is composed of gangliocytes and mature stroma. Ganglioneuroblastoma is composed of both mature gangliocytes and immature neuroblasts and has intermediate malignant potential. Neuroblastoma is the most immature, undifferentiated, and malignant tumor of the three. Neuroblastoma, however, may have a relatively benign course, even when metastatic. Thus, these neuroblastic tumors vary widely in their biologic behavior. Features such as DNA content, tumor proto-oncogenes, and catecholamine synthesis influence prognosis, and their presence or absence aids in categorizing patients as high, intermediate, or low risk. Treatment consists of surgery and, usually, chemotherapy. Despite recent advances in treatment, including bone marrow transplantation, neuroblastoma remains a relatively lethal tumor, accounting for 10% of pediatric cancers but 15% of cancer deaths in children.
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Affiliation(s)
- Gael J Lonergan
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 14th and Alaska Sts, NW, Bldg 54, Rm M-121, Washington, DC 20306-6000, USA.
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Albert D, Hartley B, Roebuck D. Contemporary concepts in the evaluation and management of tracheobronchomalacia in children: . Curr Opin Otolaryngol Head Neck Surg 2001; 9:346-51. [DOI: 10.1097/00020840-200112000-00002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hein E, Rogalla P, Hentschel C, Taupitz M, Hamm B. Dynamic and quantitative assessment of tracheomalacia by electron beam tomography: correlation with clinical symptoms and bronchoscopy. J Comput Assist Tomogr 2000; 24:247-52. [PMID: 10752886 DOI: 10.1097/00004728-200003000-00011] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the performance of electron beam tomography (EBT) in the dynamic and quantitative assessment of tracheal collapse in tracheomalacia. METHOD Eight patients with suspected tracheomalacia were evaluated by EBT, and the results were correlated with both clinical symptoms and bronchoscopy. To validate this technique, an EBT phantom study preceded the patients' examination. A dynamic imaging sequence consisting of 20 50-ms scans obtained at 0.5 s intervals during a 10 s period was performed while the patient followed an instructed breathing maneuver. RESULTS Good correlation between EBT data and clinical symptoms was found in all patients. In comparison to bronchoscopic findings, EBT results correlated well in three, showed limited correlation in three patients, and no correlation in one case. CONCLUSION EBT with its short scanning time may be regarded as an accurate noninvasive method to dynamically evaluate tracheomalacia.
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Affiliation(s)
- E Hein
- Department of Radiology, Charité Hospital, Humboldt-Universität zu Berlin, Germany
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Abstract
This article discusses the various origins of gastrointestinal obstruction in the newborn infant in a progressive fashion, from the gastric outlet to the colon. The various entities are considered within the paradigm of high or low obstruction, with particular emphasis on the contribution of the radiologist in diagnosis and non-surgical treatment, outlining the role of plain films, sonography, and contrast studies.
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Affiliation(s)
- M Hernanz-Schulman
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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González-Spínola J, Del Pozo G, Tejedor D, Blanco A. Intussusception: the accuracy of ultrasound-guided saline enema and the usefulness of a delayed attempt at reduction. J Pediatr Surg 1999; 34:1016-20. [PMID: 10392926 DOI: 10.1016/s0022-3468(99)90781-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to evaluate the therapeutic value of ultrasound (US)-guided saline enema for intussusception and the usefulness of a delayed attempt after at least 30 minutes when reduction has not been complete. METHODS One hundred ninety-five cases of intussusception were diagnosed with ultrasonography. US-guided saline hydrostatic reduction was performed in 194 with an additional attempt after at least 30 minutes in those cases in which only partial resolution had been achieved. The method was changed (the volume of the reservoir bag and the caliber of the catheter were increased) so we analyze two different periods; 85 cases are included in the first period and 110 in the second. RESULTS The global rate of successful reduction was 81.9% (159 of 194 cases), and it raised to 88.2% (97 of 110 cases) in the second period. In 15.5% cases (30 of 194) reduction was achieved in a delayed attempt at least 30 minutes after the initial partial resolution. The rate of recurrence was 9.7%. No perforation was seen. CONCLUSIONS The accuracy of US-guided saline enema in achieving intussusception reduction is high, similar to other methods, avoiding radiation exposure. A delayed attempt after a period of rest increases the rate of reductions.
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Affiliation(s)
- J González-Spínola
- Department of Radiology, University Hospital 12 de Octubre, Madrid, Spain
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Buonomo C. NEONATAL GASTROINTESTINAL EMERGENCIES. Radiol Clin North Am 1997. [DOI: 10.1016/s0033-8389(22)00437-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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