Closure of the ventral hernia in the management of giant exomphalos: a word of caution

Giant exomphalos containing liver as its major component and with visceroabdominal disproportion presents difficult management options to a paediatric surgeon. At Starship Children's Hospital, we deal with these with primary skin closure, if possible, followed by staged repair of the ventral hernia beginning in the 2nd year of life. During the closure of a ventral hernia, we encountered major hepatic venous bleeding resulting from the inadvertent injury to the right hepatic vein, resulting in the death of the child. An autopsy report showed the position of the hepatic veins superficially just beneath the skin. Subsequently, we performed magnetic resonance imaging (MRI) of the abdomen to look at the hepatic venous and caval anatomy in two children before closure of the ventral hernia. This was of immense help in limiting the dissection in the area and thus avoiding catastrophe. We recommend routine imaging with MRI before closure of a ventral hernia in children with giant exomphalos.

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) in siblings: case report and review of the literature

PURPOSE

Report of MMIHS in siblings with emphasis on diagnostic aspects in antenatal scanning and genetics.

METHOD

Two case reports and review of the literature

RESULTS

The firstborn child of this family was a female infant with a postnatal diagnosis of MMIHS. In the consecutive pregnancy frequent antenatal scans were performed, which showed normal fetal anatomy until 19 weeks' gestation. The pregnancy was carried on and at 36 weeks' gestation dilatation of the renal collecting system and dilated loops of bowel were seen, suggestive of MMIHS.

CONCLUSION

Prenatal diagnosis of MMIHS remains difficult. Further research into the genetics of this condition is necessary and would be an important tool in counselling parents with an affected child in view of the chances having an affected child at subsequent pregnancies. A multi-centre collection of a genetic pool from parents may be helpful for future research.

Long-term dilatation of caustic strictures of the oesophagus

Caustic strictures of the oesophagus (CSO) in children are managed in different ways. Our study looks into the results of long-term dilatation of such strictures. Of 109 children admitted to our hospital with caustic ingestion, 10 developed strictures. The dilatations were carried out for periods varying from 9 months to 4 years. While 3 patients needed surgical treatment, 7 did not and did well. The oesophageal perforation rate with dilatations was only 0.47% (2 perforations from a total of 424 dilatations). Long-term dilatations are successful in managing a majority of CSO in children and are associated with minimal complications.