1
|
Mantegazza C, Ferraro S, Biganzoli D, Destro F, Quitadamo P, Isoldi S, Torroni F, Malamisura M, Renzo S, Fioretti L, Gandullia P, Tantari G, Maino M, Fava G, Bramuzzo M, Zingarella S, Illiceto MT, Norsa L, Pellegrino M, Antoniello LM, Orizio P, Nanni A, Cisarò F, Felici E, Romano C, Oliva S. Foreign body ingestion in children: Definition of a nomogram to predict surgical or endoscopic intervention. Dig Liver Dis 2024; 56:312-321. [PMID: 37586909 DOI: 10.1016/j.dld.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND AIMS Foreign body ingestion (FBI) in children requires early identification to prevent adverse outcomes and may necessitate endoscopic or surgical intervention. This study aims to develop a nomogram that identifies children who require urgent surgical or endoscopic intervention by using the patient's medical history and clinical parameters collected at admission. METHODS This study is a retrospective review (01/2015-12/2020) of a multicenter case series of children admitted for FBI. Data from 5864 records from 24 hospitals in Italy were analyzed. Logistic regression models were used to establish the probability of requiring surgical or endoscopic intervention based on patient history and clinical characteristics. The nomogram representing the results from the multivariable model was reported to examine the propensity for surgery/endoscopy. RESULTS The study identified a significant association between intervention and various factors, including type of foreign body (blunt: reference category, disk battery (odds ratio OR:4.89), food bolus (OR:1.88), magnets (OR:2.61), sharp-pointed (OR:1.65), unknown (OR:1.02)), pre-existing diseases or conditions (OR 3.42), drooling (OR 10.91), dysphagia (OR 5.58), vomiting (OR 3.30), retrosternal pain (OR 5.59), abdominal pain (OR 1.58), hematemesis (OR 2.82), food refusal/poor feeding (OR 2.99), and unexplained crying (OR 2.01). The multivariable regression model showed good calibration and discrimination ability, with an area under the ROC curve of 0.77. CONCLUSIONS This study developed the first nomogram to predict the probability of the need for surgical or endoscopic intervention in children with FBI, based on the information collected at admission. The nomogram will aid clinicians in identifying children who require early intervention to prevent adverse outcomes.
Collapse
Affiliation(s)
| | - Simona Ferraro
- Center of Functional Genomics and Rare diseases Department of Pediatrics Buzzi Children's Hospital, Milan, Italy
| | - Davide Biganzoli
- Center of Functional Genomics and Rare Diseases, Buzzi Children's Hospital, Via Castelvetro 24, Milan, Italy
| | - Francesca Destro
- Department of Paediatric Surgery, Buzzi Children's Hospital, Milan, Italy
| | - Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy; Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Filippo Torroni
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Monica Malamisura
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Lorenzo Fioretti
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Paolo Gandullia
- Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giacomo Tantari
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Maino
- Digestive Endoscopy, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Bramuzzo
- Pediatric Gastroenterology, Digestive Endoscopy and Clinical Nutrition Unit, Department of Pediatric, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Silvia Zingarella
- Department of Pediatrics, Woman's and Child's University Hospital of Verona, Italy
| | - Maria Teresa Illiceto
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics, "Santo Spirito" Hospital of Pescara, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maristella Pellegrino
- Pediatric Surgery Unit, Maternal and Child Department, ASST GOM of Niguarda, Milan, Italy
| | - Luca Maria Antoniello
- Pediatric Surgery Unit, Division of Women's and Children's Health, Padova University Hospital
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Alessio Nanni
- Department of Paediatrics, Marche Polytechnic University, G.Salesi Hospital, Ancona, Via Corridoni 11, 60123 Ancona, Italy
| | - Fabio Cisarò
- Digestive Endoscopy Unit, San Giovanni Battista Molinette Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology and Pediatrics, University of Messina, Italy
| | - Salvatore Oliva
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy.
| |
Collapse
|
2
|
Fati F, Pulvirenti R, Longo G, Antoniello LM, Zambaiti E, Gamba P. Percutaneous endoscopic gastrostomy in children receiving peritoneal dialysis: A tertiary centre long-term experience and literature review. Perit Dial Int 2024:8968608231223812. [PMID: 38265012 DOI: 10.1177/08968608231223812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Children with severe chronic kidney disease receiving maintenance peritoneal dialysis (PD) are often malnourished and may require nutritional supplementation. Recent PD guidelines address laparoscopic and open surgical gastrostomy as safe approaches in children established on PD, while existing evidence on percutaneous endoscopic gastrostomy (PEG) is still lacking; as well as the role of perioperative antibiotic and antifungal prophylaxis. Hence, this study aimed to report our experience with PEG placement in patients on PD and compare it with the available literature. METHODS We retrospectively reviewed the medical records from patients on PD, who underwent PEG placement at a tertiary referral centre between 2000 and 2020. Data on perioperative management, complications and outcomes were retrieved. An extensive literature search was performed; studies describing PEG placement and perioperative prophylaxis in patients on PD were used as a comparison. Descriptive statistical analysis was conducted. RESULTS Seven patients (five males) were included. Perioperative antibiotic and antifungal prophylaxis were standard practice. At a median follow-up of 27 months (10-75), the peritonitis rate was 0.2 patient/years. No statistical significance was found between the peritonitis rate before and after PEG placement (p = 0.2). Patients' demographics and postoperative complications were comparable to the reported studies. CONCLUSIONS Based on our experience, our technique of PEG insertion with antimicrobial prophylaxis is feasible and associated with an acceptable complication risk in patients on PD. Further multicentric studies about surgical technique in patients on PD will be necessary to verify the feasibility of PEG and standardise the perioperative protocol.
Collapse
Affiliation(s)
- Federica Fati
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Rebecca Pulvirenti
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Germana Longo
- Pediatric Nephrology, Dialysis and Transplant Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Luca Maria Antoniello
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Elisa Zambaiti
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
- Pediatric Surgery Unit, Patologia e Cura del Bambino Department, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| |
Collapse
|
3
|
Pulvirenti R, Tognon C, Bisoffi S, Ghidini F, De Corti F, Fascetti Leon F, Antoniello LM, Gamba P. Innovative Techniques Associated with Traditional Abdominal Surgery in Complex Pediatric Cases: A Tertiary Center Experience. Children (Basel) 2021; 8:children8100898. [PMID: 34682163 PMCID: PMC8534733 DOI: 10.3390/children8100898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
Pediatric abdominal surgery is constantly evolving, alongside the advent of new surgical technologies. A combined use of new tools and traditional surgical approaches can be useful in the management of complex cases, allowing less invasive procedures and sometimes even avoiding multiple interventions. This combination of techniques has implications even from the anesthetic point of view, especially in post-operative pain control. Thereby, tertiary level centres, including highly-specialized professionals and advanced equipment, can maximize the effectiveness of treatments to improve the final outcomes. Our paper aims to present some possible combinations of techniques recently used at our institution to provide a one-session, minimally invasive treatment within different areas of abdominal surgery.
Collapse
Affiliation(s)
- Rebecca Pulvirenti
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
- Correspondence: ; Tel.: +39-347-369-6172
| | - Costanza Tognon
- Anesthesiology Pediatric Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy;
| | - Silvia Bisoffi
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Filippo Ghidini
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Federica De Corti
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Luca Maria Antoniello
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| |
Collapse
|
4
|
Bisoffi S, Leon FF, Zambaiti E, Sgrò A, Antoniello LM, Gamba P. Laparo-endoscopic combination for the safe extraction of an open safety pin in a 9-month-old child. Case report. Ann Med Surg (Lond) 2021; 69:102716. [PMID: 34429964 PMCID: PMC8368992 DOI: 10.1016/j.amsu.2021.102716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION and importance: Accidental ingestion of foreign bodies (FBs) is common among infants. In case of sharp FBs, the risk of accidental organ damage with potential life-threatening complications constitutes an absolute indication for removal. We present the case of a child, who, following the ingestion of an open safety pin, was successfully treated exclusively with minimally invasive techniques. CASE PRESENTATION A 9-month-old male patient was admitted for hematemesis. An anteroposterior and lateral X-ray of the thorax and abdomen revealed the presence of an open safety pin in the epi-mesogastric region, without a precise localization. Upper and lower gastrointestinal endoscopy, fluoroscopy, and laparoscopy were combined in the same intervention to localize and safely remove the foreign body. The patient was dismissed on a postoperative day 1. CLINICAL DISCUSSION AND CONCLUSION The two main pitfalls of this scenario were the initially uncertain location of the foreign body and the young age of the patient. A combination of different techniques was used to safely locate and remove the foreign body, reducing hospitalization and avoiding repeated radiological exposure. An experienced team in a tertiary paediatric surgical and endoscopic centre increases the chances of success and minimizes invasiveness and the risk of complications.
Collapse
Affiliation(s)
- Silvia Bisoffi
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padua, Padova, Italy
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padua, Padova, Italy
| | - Elisa Zambaiti
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padua, Padova, Italy
| | - Alberto Sgrò
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padua, Padova, Italy
| | - Luca Maria Antoniello
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padua, Padova, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padua, Padova, Italy
| |
Collapse
|
5
|
Ghidini F, De Corti F, Fascetti Leon F, Vidal E, Rancan A, Parolin M, Zadra N, Grazzini M, Maria Antoniello L, Ganarin A, Maita S, Tognon C, Mognato G, Castagnetti M, Benetti E, Gamba P, Dall'Igna P. Extraperitoneal kidney transplantation: a comparison between children weighting ≤15 kg and >15 kg. Experience of a single institution. Transpl Int 2021; 34:2394-2402. [PMID: 34411366 PMCID: PMC9292289 DOI: 10.1111/tri.14015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/05/2021] [Accepted: 08/15/2021] [Indexed: 12/20/2022]
Abstract
Extraperitoneal approach is sometimes recommended for kidney transplantation (KT) in children weighting <15 kg. We hypothesized that this approach might be as successful as in patients with normal weight. Data of all consecutive KTs performed between 2013 and 2019 were retrospectively reviewed. Early outcomes and surgical complications were compared between children weighing ≤15 kg (low‐weight (LW) group) and those weighing >15 kg (Normal‐weight (NW) group). All the 108 KTs were performed through an extraperitoneal approach. The LW group included 31 patients (mean age 3.5 ± 1.4 years), whose mean weight was 11.1 ± 2.0 kg. In the LW group,—a primary graft nonfunction (PNGF) occurred in one patient (3.2%), surgical complications occurred in nine (29%), with four venous thrombosis. In the NW group, PNGF occurred in one case (1.3%), delayed graft function (DGF) in eight (10%), surgical complications in 11 (14%) with only one case of venous thrombosis. In both groups, no need for patch during wound closure and no wound dehiscence were reported. The extraperitoneal approach can be effectively used in LW children. No differences were observed in the overall complication rate (P = 0.10), except for the occurrence of venous thrombosis (P = 0.02). This might be related to patients’ characteristics of the LW group.
Collapse
Affiliation(s)
- Filippo Ghidini
- Pediatric Urology, Department of Women's and Children's Health, University of Padua, Padua, Italy.,Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Federica De Corti
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Francesco Fascetti Leon
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Enrico Vidal
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Alessandra Rancan
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Mattia Parolin
- Pediatric Nephrology, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Nicola Zadra
- Department of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Maurizia Grazzini
- Department of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Luca Maria Antoniello
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Alba Ganarin
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Sonia Maita
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Costanza Tognon
- Department of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Guendalina Mognato
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marco Castagnetti
- Pediatric Urology, Department of Women's and Children's Health, University of Padua, Padua, Italy.,Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Elisa Benetti
- Pediatric Nephrology, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Patrizia Dall'Igna
- Pediatric Surgery, Department of Emergencies and Organ Transplantation, University of Bari, Bari, Italy
| |
Collapse
|
6
|
Duci M, Antoniello LM, Trovalusci E, Tognon C, Gamba P. Pediatric endoscopic procedures during the COVID-19 pandemic: an Italian center experience. Pediatr Surg Int 2020; 36:853-854. [PMID: 32474690 PMCID: PMC7261048 DOI: 10.1007/s00383-020-04678-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Miriam Duci
- Division of Pediatric Surgery, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Luca Maria Antoniello
- Division of Pediatric Surgery, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Emanuele Trovalusci
- Division of Pediatric Surgery, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Costanza Tognon
- Department of Anesthesia and Intensive Care, University Hospital, Padua, Italy
| | - Piergiorgio Gamba
- Division of Pediatric Surgery, Department of Women’s and Children’s Health, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| |
Collapse
|
7
|
Gamba PG, Messineo A, Antoniello LM, Boccato P, Blandamura S, Cecchetto G, Dall'Igna P, Guglielmi M. A simple exam to screen superficial masses: fine-needle aspiration cytology. Med Pediatr Oncol 1995; 24:97-9. [PMID: 7990771 DOI: 10.1002/mpo.2950240207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fine-needle aspiration cytology (FNAC) is now considered a useful tool in the evaluation of adult patients with mass lesions. We reviewed the experience with FNAC in our Paediatric Surgical Department. One hundred and eleven FNACs were performed in children with a superficial mass and no definite diagnosis. All the exams were done by the same physician using a fine needle and no anesthesia. We routinely used May-Grüwald-Giemsa and Papanicolaou staining. Patients age ranged from 20 days to 17 years, with a mean age of 6.5 years. A clinically benign pathology was cytologically confirmed in 90 cases (81%). All children did well at follow-up. Malignancy was diagnosed in eight cases (7.2%) and in all was confirmed with a surgical biopsy. In nine children (8.1%) the specimen was considered insufficient for definite diagnosis. In four cases (3.6%) the pathologist diagnosed a possible malignancy that was excluded at surgical biopsy. The sensitivity was 100% and the specificity was 96%. Our experience confirms that FNAC is a fast, cheap, simple, and accurate diagnostic method and should be used for screening in all children with doubtful superficial masses.
Collapse
Affiliation(s)
- P G Gamba
- Pediatric Surgical Department, University of Padua, Italy
| | | | | | | | | | | | | | | |
Collapse
|