African Journal Of Paediatric Surgery[JOURNAL]
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200 papers
Preputial cyst in the newborn: A case report from Africa.
Elebute OA, Komolafe MD, Akinjo AO … +6 more , Alakaloko FM, Seyi-Olajide JO, Ladipo-Ajayi O, Abdulkareem FB, Ademuyiwa AO, Bode CO
Afr J Paediatr Surg · 2023 · PMID 36722576 · Full text
Cysts of the prepuce are rare, and documented reports from the English literature are mostly from Asia. Presentations in children are worrisome to the parents. We report a case of a preputial cyst occurring in a neonate...
Cysts of the prepuce are rare, and documented reports from the English literature are mostly from Asia. Presentations in children are worrisome to the parents. We report a case of a preputial cyst occurring in a neonate who was brought to our facility due to parental anxiety. After a thorough clinical evaluation, a freehand circumcision technique was performed which allowed exposure of the full extent of the cyst, the external urethral meatus and the glans, thus ensuring complete excision and minimising the risk of injury to the adjoining structures. We postulate that preputial cysts are rare in Africa due to the universality of circumcision, which is one of the options of treatment. Preputial cysts are benign foreskin cystic lesions that can be effectively treated with circumcision. This is probably the first reported case of a benign epithelioid preputial cyst from Africa. The paucity of reported cases may be due to the universal practice of circumcision in most of Africa.
Unexpected thoracic injury caused by a falling bullet in a metropolis.
Akman M
Afr J Paediatr Surg · 2023 · PMID 36722575 · Full text
The incident of being wounded by free-falling bullets is not usual in provinces where there is limited civilian armament in large metropolises. Cases that are wounded by falling bullet wounding apply to health-care insti...
The incident of being wounded by free-falling bullets is not usual in provinces where there is limited civilian armament in large metropolises. Cases that are wounded by falling bullet wounding apply to health-care institutions with major clinical manifestations. The patient was admitted with minor complaints, which manifested itself with mild back pain and spotting bleeding. An ovoid-style open wound was detected on the left scapula. Radiographic examination showed a semi-ovoid bullet-like radiodensity image inside the thoracic wall. In the evaluation performed under general anaesthesia, a bullet was found in the thoracic wall and was removed. In the standard follow-ups after the procedure, full recovery was achieved in the early period. Bullet wounds might be experienced outside of the battlefields without any direct fire, and these cases might not manifest the signs of gunshot injury. The cruciality of radiography in tackling diagnostic challenges was put forward.
A rare presentation of transverse testicular ectopia and role of laparoscopy.
Piplani R
Afr J Paediatr Surg · 2023 · PMID 36722574 · Full text
Transverse testicular ectopia (TTE) is an uncommon congenital anomaly, in which both the gonads migrate towards the same hemi-scrotum. We report a rare case of TTE discovered coincidentally during surgery in a 1-year-old...
Transverse testicular ectopia (TTE) is an uncommon congenital anomaly, in which both the gonads migrate towards the same hemi-scrotum. We report a rare case of TTE discovered coincidentally during surgery in a 1-year-old boy who presented with bilateral undescended testis and right inguinoscrotal swelling. The use of laparoscopy during evaluation for impalpable testis can aid in the diagnosis of TTE, before inguinal exploration. Findings such as the vascular supply and vas deferens of the crossed testis and the identification of Müllerian structures can be confirmed by laparoscopy. Diagnostic laparoscopy was suggestive of both the testes entering in the right-sided open deep inguinal ring, while left-sided deep inguinal ring was found to be closed. There was no evidence of persistent Müllerian structures. On exploration, both testes were present in the right inguinal region. A bilateral trans-septal orchidopexy along with right herniotomy was performed.
Rapunzel syndrome: An infrequent cause of paediatric mechanical occlusion.
Nasri S, Ammor A, Bendaoud M … +6 more , Diouri L, Tayeb B, Driss EA, Kamaoui I, Aichouni N, Skiker I
Afr J Paediatr Surg · 2023 · PMID 36722573 · Full text
Despite numerous cases of trichobezoars reported in the literature, few Rapunzel syndromes have been described. Rapunzel syndrome is a rare case of bowel obstruction resulting from hair ingestion (trichobezoar). The obst...
Despite numerous cases of trichobezoars reported in the literature, few Rapunzel syndromes have been described. Rapunzel syndrome is a rare case of bowel obstruction resulting from hair ingestion (trichobezoar). The obstruction can occur in any level of the intestinal tract. This syndrome is usually reported in patients affected by trichotillomania and trichophagia. We reported a case of Rapunzel syndrome in a 5-year-old girl diagnosed on an abdominal computed tomography scan and confirmed during surgery.
Recurrent non-bilious vomiting in a child: A case report of an uncommon diagnosis.
Ammor A, Nasri S, Haissoufi KE … +1 more , Benhaddou H
Afr J Paediatr Surg · 2023 · PMID 36722572 · Full text
Annular pancreas (AP) is a congenital anomaly and a recognised cause of duodenal obstruction which can affect all age groups. It may manifest early in the neonatal period, but it may also have varied and often delayed sy...
Annular pancreas (AP) is a congenital anomaly and a recognised cause of duodenal obstruction which can affect all age groups. It may manifest early in the neonatal period, but it may also have varied and often delayed symptoms. We report the case of AP in an 18-month-old girl with a long history of recurrent post-prandial non-bilious vomiting treated for a long time with the clinical diagnosis of gastroesophageal reflux. Upper gastrointestinal study was suggestive of partial duodenal obstruction and computed tomography revealed a complete ring of pancreatic parenchyma surrounding the second part of the duodenum. Diamond-shaped duodenoduodenostomy was achieved successfully and the post-operative period was uneventful. Although rare, AP must be kept in mind of any paediatric surgeon while confronted to symptoms of partial duodenal obstruction.
A review of necrotising enterocolitis in very low birth weight babies in a tertiary hospital in Johannesburg.
Motsisim S, Ballot DE
Afr J Paediatr Surg · 2023 · PMID 36722571 · Full text
INTRODUCTION: Necrotising enterocolitis (NEC) is the most common gastrointestinal complication in pre-mature infants. There are risk factors and modifying factors that have been identified and studied over the years, but...
INTRODUCTION: Necrotising enterocolitis (NEC) is the most common gastrointestinal complication in pre-mature infants. There are risk factors and modifying factors that have been identified and studied over the years, but not many studies have been conducted in middle-income countries. AIMS AND OBJECTIVES: This study aimed to describe the maternal, obstetric and neonatal characteristics in very low birth weight (VLBW) babies with NEC in a tertiary neonatal unit in South Africa. The survival to hospital discharge in VLBW babies with NEC was also determined. MATERIALS AND METHODS: This study was a retrospective, cross-sectional, observational study of VLBW babies admitted to a tertiary neonatal unit between January 2013 and December 2017. The population comprised babies <1500 g and <37 weeks gestation. Maternal and neonatal risk factors of NEC were compared in infants with and without NEC. RESULTS: In this study, 173 out of 2111 (8%) babies were diagnosed with NEC. HIV exposure, late-onset sepsis, respiratory support after initial resuscitation, administration of surfactant and blood transfusion were associated with NEC. Surgery was performed in 48/173 (27.7%) of babies with NEC. The mortality rate in babies with NEC was 49.1%. Death in babies with NEC was associated with surgery for NEC (P = 0.01), mechanical ventilation (P < 0.001) and late-onset sepsis (P = 0.018). CONCLUSION: Risk factors for NEC in our population are similar to other countries, with some variations such as HIV. Even though some prevention measures have been implemented, the mortality rate remains high.
Surgical management of complicated duplex kidney: A tertiary referral centre 10-year experience.
Paraboschi I, Farneti F, Mantica G … +5 more , Kalpana P, Tagizadeh A, Anu P, Pankaj M, Garriboli M
Afr J Paediatr Surg · 2023 · PMID 36722570 · Full text
AIM: The management of a complicated duplex kidney remains a challenge for paediatric urologists. The aim of this study is to report a 10-year experience of the surgical management of complicated duplex kidney in a singl...
AIM: The management of a complicated duplex kidney remains a challenge for paediatric urologists. The aim of this study is to report a 10-year experience of the surgical management of complicated duplex kidney in a single tertiary care paediatric referring hospital. MATERIALS AND METHODS: Clinical records of all children who undergone a surgical procedure for complicated duplex systems between January 2009 and March 2019 at our institution were retrospectively reviewed. Clinical manifestations, surgical procedures, complications and follow-up were collected and analysed. Logistic regression was performed to explore if any patient's characteristic or underlying associated comorbidity (ureterocoele, ectopic ureter, obstruction, etc.,) could be positively linked to the chance to develop recurrent urinary tract infections (UTIs). RESULTS: We have identified 95 children who received a surgical treatment for 102 complicated duplex kidneys. The presence of an ureterocoele was recorded in 41 (43.2%) patients, an ectopic ureter in 25 (26.3%), a vesicoureteral reflux (VUR) in 40 (42.1%), a vesicoureteric junction obstruction in 24 (25.3%) and an ureteropelvic junction obstruction in 3 (3.2%). An invasive approach such as an heminephrectomy (71.6%) was required in the majority of cases. Higher risk of developing a UTI has been demonstrated in children diagnosed postnatally (P < 0.001) and in those with an associated obstruction (P < 0.05). CONCLUSIONS: No standardised management could be recommended for the surgical treatment of complicated duplex kidney. Children without antenatal diagnosis and with either an upper tract obstruction or VUR are at greater risk to develop UTI and need to be looked after more closely.
Prevalence of gastroschisis and its neonatal mortality in the Eastern Cape Province tertiary institutions.
Machaea SS, Chitnis MR, Nongena P
Afr J Paediatr Surg · 2023 · PMID 36722569 · Full text
CONTEXT: Gastroschisis is a common abdominal wall defect faced by paediatric surgeons worldwide. Early gastroschisis detection, access to improved neonatal intensive care, parenteral nutrition and surgical techniques hav...
CONTEXT: Gastroschisis is a common abdominal wall defect faced by paediatric surgeons worldwide. Early gastroschisis detection, access to improved neonatal intensive care, parenteral nutrition and surgical techniques have led to a reported improvement in mortality of between 4% and 8% in high-income countries. In low to middle income countries, such as in Southern Africa, however, there is as much as 84% mortality among patients with gastroschisis. This is thought to be due to factors such as lack of antenatal screening, access to neonatal intensive care services and parenteral nutrition. AIMS: The purpose of this study was to calculate the prevalence of gastroschisis and report on its neonatal mortality in the Eastern Cape Province of South Africa. SETTINGS AND DESIGN: A retrospective observational study on all neonates with gastroschisis, presenting to a tertiary facility offering paediatric surgical services within the Eastern Cape Province from 1 January 2016 to 31 December 2018. SUBJECTS AND METHODS: A convenience sampling method was used in retrieving patient files for the study period. Statistical analysis used: Stata version 13. RESULTS: Thirty-seven neonates were included in the study. The prevalence of gastroschisis ranged from 0.07% to 0.18% throughout the 3-year study. The majority (81%) of the neonates were outborn and delivered by mode of caesarean section. Nearly 60% (n = 22) were female. 54% (n = 20) of neonates died within the neonatal period. CONCLUSIONS: The majority of the neonates in this study were outborn and female. Although their mortality rate was higher than reported in high-income countries, it was much improved from what is reported in the low to middle income countries.
Prospective study of laparoscopic management of appendicitis during the COVID pandemic in a single paediatric centre.
Dass D, Hotonu S, McHoney M … +1 more , Munro F
Afr J Paediatr Surg · 2023 · PMID 36722568 · Full text
BACKGROUND: The coronavirus (COVID-19) pandemic affected the presentation of many conditions. This study analyses and describes the impact of the COVID-19 pandemic on the management of appendicitis in children and the ro...
BACKGROUND: The coronavirus (COVID-19) pandemic affected the presentation of many conditions. This study analyses and describes the impact of the COVID-19 pandemic on the management of appendicitis in children and the role of laparoscopy. MATERIALS AND METHODS: We performed a prospective (during the pandemic) and retrospective (historic control) review of the management of appendicitis in a tertiary paediatric surgical unit. Preoperative data, operative findings and patient outcomes were compared between groups to identify differences between the study periods and to identify any factors predictive of outcomes. RESULTS: Sixty-two patients were identified in the pre-pandemic cohort, 72 in the pandemic cohort. There was no significant difference in patient demographics, length of admission or time between admission and surgery between groups. There was however a significantly longer time to presentation to hospital in the pandemic group. Clinical outcomes were comparable between the two groups, with no difference in the presence of surgical complications or histologically advanced appendicitis between the two groups. Laparoscopic surgery was safely used to manage appendicitis in the pandemic cohort through utilisation of a COVID-19 pathway that included guidance on testing, and use of personal protective equipment (PPE). Conservative management in the pandemic cohort was reserved for patients with appendicitis with the presence of mass formation. CONCLUSION: Despite a delayed presentation to hospital, there was no rise in the incidence of complicated appendicitis, complications of surgery or length of stay during the COVID-19 pandemic. Laparoscopic appendicectomy was also shown to be a safe and effective standard for the management of appendicitis during the pandemic. LEVEL OF EVIDENCE: III, treatment.
Neuroblastic tumours in children: Outcome from a referral centre in India.
Kumar B, Yadav R, Upadhyaya VD … +4 more , Mishra A, Yousuf, Mishra P, Lal P
Afr J Paediatr Surg · 2023 · PMID 36722567 · Full text
BACKGROUND: There is a paucity of uniform literature on the outcome of children with neuroblastic tumours from developing countries. This study aims to present the outcome in children having neuroblastic tumours. MATERIA...
BACKGROUND: There is a paucity of uniform literature on the outcome of children with neuroblastic tumours from developing countries. This study aims to present the outcome in children having neuroblastic tumours. MATERIALS AND METHODS: We retrospectively reviewed patients with neuroblastic tumours from January 2014 to March 2020. Data analysed were pertaining to the age, sex, presentation, site, stage, diagnostic evaluation performed, management and follow-up results, etc., The final outcomes were assessed as complete response; partial response (PR); no response (NR) and progressive disease. International Neuroblastoma Risk Group staging was used and patients were categorised on the basis of age, site and stage of tumour. Overall survival (OS) was calculated from the date of diagnosis to the date of last follow-up and event for OS was death. RESULTS: Forty-seven patients were included with median age of 60 months (ranges of 2-180; mean = 61.87 ± 47.56). About 72.3% (n = 34) patients were males. Out of total, 6.4% (n = 3), 53.2% (n = 25) and 38.3% (n = 18) were in stage L1, L2 and M, respectively, whereas 2.1% (n = 1) patients were in stage MS. Surgery was performed in 25 (53.19%) patients, but gross total excision was achieved in 48.90% (n = 23) patients. Onlu 10.60% (n = 5) patients were referred, whereas 14.89% (n = 7) patients reported recurrences. Mean and median follow-up time of the patients was 24.64 ± 16.04 and 18 months (range: 3-60 months). Out of total, 53.2% (n = 25) and 29.8% (n = 14) patients had complete and PRs, respectively, whereas 17% (n = 8) patients had NR. Out of the total 47 patients, 8 (17%) achieved events (deaths), whereas the rest, 39 (83%) patients, were censored. Mean event-free OS time was 50.04 months. CONCLUSION: There was a significant difference in patient deaths in recurrence and non-recurred patients (4/7, 57.1% vs. 4/40/, 10%, P = 0.011). Survival time was significantly higher in patients with stages L1-L2 as compared to Stage 4. Stage and age were found predictors of survival.
Are only a few hours adequate for hospitalisation following mini-incision open appendectomy in paediatric patients?
Sookpotarom P, Na Ayudhya VC, Tangsirapat V
Afr J Paediatr Surg · 2023 · PMID 36722566 · Full text
BACKGROUND: A very short hospital length of stay following an open appendectomy in children with acute simple appendicitis has never been mentioned yet in the literature. The authors reviewed the outcome of these paediat...
BACKGROUND: A very short hospital length of stay following an open appendectomy in children with acute simple appendicitis has never been mentioned yet in the literature. The authors reviewed the outcome of these paediatric patients who were treated with the open technique. MATERIALS AND METHODS: In this analytical cohort observational study, we retrospectively reviewed the medical records of the 115 consecutive patients who underwent open appendectomy from June 2017 to July 2021. RESULTS: There were 84 patients whose appendices were inflammatory or suppurative and appendectomies were done only through McBurney's point. Of these, the average age was 9.11 ± 2.67 years. The mean length of the incision was 1.95 ± 0.48 cm. Nearly one-third (25/85) were discharged within 3 h following surgery. Of the remaining cases, nine patients were discharged within the same day. There were increased percentages of patients who were eligible for early discharge in each consecutive year. CONCLUSION: The idea of immediate discharge within 3 h seems to be feasible for children with acute simple appendicitis who were treated with open appendectomy. We believe that the practice will be widely acknowledged and proceed to reduce the resources and the expenses in the hospital.
Presentation weight indices for patients with cleft and non-affected children: A two-centre study.
Okoli CM, Achionye E, Olaolu MO … +1 more , Onah II
Afr J Paediatr Surg · 2023 · PMID 36722565 · Full text
BACKGROUND: Children with cleft lip and/or palate (CL/P) face many challenges in the society. They tend to suffer malnutrition and therefore poor weight gain due to lack of standard care, especially from their parents an...
BACKGROUND: Children with cleft lip and/or palate (CL/P) face many challenges in the society. They tend to suffer malnutrition and therefore poor weight gain due to lack of standard care, especially from their parents and society at large. The poor weight gain leads to delayed surgical repair of the cleft abnormality leading to prolonged nutritional and psychological challenges for all concerned. OBJECTIVE: The aim of the study was to determine if children without cleft abnormalities presenting for routine immunisation and children with cleft abnormalities are both likely to be less than the 75 percentile of expected weight at the time of presentation, and if there is any difference in presenting weight amongst children with different cleft types. MATERIALS AND METHODS: This was a retrospective study. Data of children that attended the immunisation clinic of the Department of Primary Health of the National Orthopaedic Hospital, Enugu, and routine surgical clinic of the National Orthopaedic Hospital, Enugu, Nigeria, and the Good Shepherd Specialist Hospital, Enugu, Nigeria, between January 2010 and December 2014 with a diagnosis of CL/P, were obtained from the medical records. The data were analysed with SPSS and the confidence interval was 95%. RESULTS: A total of 923 medical records were reviewed for the study, out of which 363 were for children with cleft abnormalities. There was no significant difference in the weight of the children without cleft and presenting for routine immunisation compared with their expected 75 percentile, or children with cleft abnormality compared with their expected 75 percentile (either in their first or in their second visits). With the children that presented with CL/P, there was a significant difference noted amongst children with both CL/P deformity with the expected 75 percentile weight, irrespective of whether the combination was unilateral or bilateral, with P = 0.041. This difference was noted in their first visit. CONCLUSION: Children with combined CL/P are at risk of presenting with poor weight. Nutritional rehabilitation considered early with children with cleft and particularly those children with combined CL/P.
Is it reliable to make a decision based on visual changes in the patient's diaper in the evaluation of post circumcision bleeding?
Akman M
Afr J Paediatr Surg · 2023 · PMID 36722564 · Full text
BACKGROUND: The most common complication of circumcision is bleeding. Monitoring bleeding by visual assessment of the diaper can cause errors due to the high absorbency of diapers. The patient may have had significant pr...
BACKGROUND: The most common complication of circumcision is bleeding. Monitoring bleeding by visual assessment of the diaper can cause errors due to the high absorbency of diapers. The patient may have had significant problems before the visible changes. The amount of liquid that wets the cloth does not necessarily lead to a visual change consistent with the amount, and the nature of the liquid contaminating the diaper may cause difficulties in terms of visual evaluation. Making a decision based on the visual changes in the patient's diaper cannot be considered as reliable. METHODS: We planned to evaluate the visual changes that are caused by liquids of various volumes and contents that wet the diaper, according to measurable criteria. We aimed to emphasise the importance of the subject in circumcision practices of diapered children. Wetting of diapers with different volumes and variable blood load was performed utilising blood with different haematocrits and fluids. One hundred and sixty different diapers in four groups were moistened utilising the drip method. Visual changes in the soaked diapers were evaluated with the colorimetric method and five different colour criteria. The saturation and lightness values, which indicate the colour value, were obtained by using the numerical equivalents of the three main components, red, green and blue. Analysis was carried out by subjecting statistical evaluation within and between groups. RESULTS: There was a significant difference between the control group and the study group. It was observed that visual changes caused by the moistened cloths with linear increase did not make the same linear interaction. There was not a significant difference between Group II and Group IV, which were soaked with the same amount of blood and different volume of fluid. In Group III, colour saturation changes were found to have a parabolic effect instead of a linear change. In two different analyses of moistened diapers in terms of volume and blood load; it was not determined that the expected linear changes between the groups were not observed. CONCLUSION: Visual changes in diapers related to volume or blood load effects of fluids may not be compatible with the amount of bleeding. Mistakes may occur when super absorbent wipes are used when determining the amount of bleeding from the use of colour changes in the diaper. Visual changes should not be relied on in bleeding due to circumcision. Rather, vital signs follow-up and measurable laboratory tests should be used as a basis.
Bezoar types in children and aetiological factors affecting bezoar formation: A single-centre retrospective study.
Dorterler ME, Günendi T, Çakmak M … +1 more , Shermatova S
Afr J Paediatr Surg · 2023 · PMID 36722563 · Full text
BACKGROUND: Bezoar is formed as a result of the accumulation of undigested food or foreign substances in the gastrointestinal tract (GIS). The present study aims to investigate the bezoar types seen in children and the a...
BACKGROUND: Bezoar is formed as a result of the accumulation of undigested food or foreign substances in the gastrointestinal tract (GIS). The present study aims to investigate the bezoar types seen in children and the aetiological factors involved in bezoar formation. METHODS: A total of 16 patients who underwent an endoscopy and/or surgical treatment for bezoar at Harran University, Faculty of Medicine Pediatric Surgery Clinic between 2011 and 2019 were included in the study. The demographic information, laboratory and radiological findings were obtained from the patients' file records. RESULTS: A total of ten patients (62.5%) were female with a mean age of 7.8 ± 4.9 years. Phytobezoars were detected in ten patients, trichobezoars in two patients, lactobezoar in one patient, and other types in three patients. The aetiological factors were determined to be congenital GIS anomaly in 6 (37.5%) patients; trichotillomania in 2 (12.5%) patients; mental retardation in 2 (12.5%) patients; ingestion of a foreign body during infancy in 2 (12.5%) patients; high intake of high-fibre fruit in 3 (18.5%) patients; and postoperative dysmotility in 2 (12.5%) patients. CONCLUSIONS: Congenital GIS anomalies are mostly responsible for bezoar etiology in children and phytobezoar is the most common type of bezoar.
An audit of cancellation of elective surgery in paediatric patients at Chris Hani Baragwanath Academic Hospital.
Gamede N, Campbell R, Mogane P
Afr J Paediatr Surg · 2023 · PMID 36722562 · Full text
BACKGROUND: Cancellation of elective surgery is one of the quality indicators of theatre operation worldwide. The cancellation of elective surgery in paediatric patients is a worldwide problem with the rates ranging from...
BACKGROUND: Cancellation of elective surgery is one of the quality indicators of theatre operation worldwide. The cancellation of elective surgery in paediatric patients is a worldwide problem with the rates ranging from 0.21% to 44%. This study aimed to determine the rates and describe the reasons for cancellation of elective surgeries in paediatric patients at Chris Hani Baragwanath Academic Hospital (CHBAH). MATERIALS AND METHODS: A retrospective study was conducted using theatre records from 1 January to 31 December 2019. The numbers and reasons for elective paediatric surgeries were reviewed. Data were collected using the structured collection sheet and entered into Microsoft Excel. Statistical Package for the Social Sciences was also used to further analyse the data. Results were expressed as percentages in a graph and table forms. RESULTS: In the year 2019, a total of 3399 elective paediatric procedures were scheduled in 14 specialities at CHBAH. Of these, 634 (19%) were cancelled due to various reasons. The highest number of cases cancelled were from paediatric surgery and neonates (n = 204, 31%), followed by ear nose and throat (n = 99, 24%), burns (n = 80, 20%) and paediatric orthopaedics (n = 79, 16%). The most common reason for cancellation of elective surgery in paediatric patients at CHBAH was found to be time constraint (34%). The reasons for cancellation in our study were mostly due to avoidable factors at 68% and non-avoidable at 32%. CONCLUSION: The rate of cancellation in our study was high. Majority of the causes for cancellation were avoidable.
Change of guards at the AJPS: Opening new frontiers.
Ademuyiwa AO
Afr J Paediatr Surg · 2023 · PMID 36722561 · Full text
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Successful thoracoscopic excision of complex supracardiac middle mediastinal bronchogenic cyst in an infant.
Raut A, Parakh S, Parakh A … +1 more , Mukhi N
Afr J Paediatr Surg · 2022 · PMID 36018215 · Full text
INTRODUCTION: We report the first case of complex supracardiac middle mediastinal foregut duplication lesion compressing and adherent to the heart, managed successfully thoracoscopically in an infant, in an innovative wa...
INTRODUCTION: We report the first case of complex supracardiac middle mediastinal foregut duplication lesion compressing and adherent to the heart, managed successfully thoracoscopically in an infant, in an innovative way. MATERIALS AND SURGICAL TECHNIQUE: A 1-year-old girl was diagnosed as having supracardiac middle mediastinal foregut duplication lesion. It was completely overlying and adherent to her heart giving transmitted pulsations to the lesion, causing indentation over the left atrium and surrounded by all vital structures such as aorta, pulmonary artery, bronchi and phrenic nerve. After proper counselling of parents and relatives, the patient was posted for surgery. After proper positioning, thoracoscopic access was gained, difficulty here was neither bulge nor surface marking of the lesion was seen in thoracic cavity anywhere, considering the anatomical relations. The mediastinal pleura was opened, through a very narrow window for accessing the lesion, which was surrounded by vital structures in the middle mediastinum. A gentle dissection of the lesion was done to relieve it from adjacent adhered thoracic vitals structures successfully. Histopathological examination confirmed it as a bronchogenic cyst. DISCUSSION: Foregut duplication cyst, especially bronchogenic cysts, have been reported at various locations, however, supracardiac middle mediastinal bronchogenic cyst completely sitting on the heart, adherent to it causing compression of the left atrium and left bronchus and surrounded completely by the aorta, pulmonary artery and bronchus, has not been reported till date. Also, successful thoracoscopic excision of such rarely located lesion moving with heart, in a 1-year-old girl, has not been reported yet.
Giant juvenile fibroadenoma of the breast in a 12-year-old girl.
Dasgupta R, Rajak TK, Kaushal S … +1 more , Ritolia N
Afr J Paediatr Surg · 2022 · PMID 36018214 · Full text
Giant juvenile fibroadenomas, encountered usually in adolescents, are rapidly growing benign breast masses which lead to discomfort, anxiety and significant psychological stress. The breasts are in their early formative...
Giant juvenile fibroadenomas, encountered usually in adolescents, are rapidly growing benign breast masses which lead to discomfort, anxiety and significant psychological stress. The breasts are in their early formative years, and thus, it is important to rule out malignancy as well as plan treatment options to preserve as much breast tissue as is possible. This report highlights a case of giant juvenile fibroadenoma diagnosed in a 12-year-old female child and our endeavour to achieve a good aesthetic result.
The cleft Q as an outcome measure after palatoplasty.
Michael AI, Olusanya AA
Afr J Paediatr Surg · 2022 · PMID 36018213 · Full text
The Cleft Q, a patient-reported outcome measure, has been adopted by the International Consortium for Health Outcome measurement as a valid tool for the measurement of outcomes following intervention on a patient with a...
The Cleft Q, a patient-reported outcome measure, has been adopted by the International Consortium for Health Outcome measurement as a valid tool for the measurement of outcomes following intervention on a patient with a cleft. It is scarcely used in sub-Saharan Africa. We report our first experience with the Cleft Q in measuring the outcomes following palatoplasty in an African adult female with a Veau type II defect. The Cleft Q was able to demonstrate improved scores across all domains measured. There is however a need for further validation of the Cleft Q in our setting.
Delayed complication due to retained contrast following augmented pressure distal loop colostogram in anorectal malformation.
Jangid MK, Sharma J, Chanchlani R … +2 more , Malik R, Ahmad R
Afr J Paediatr Surg · 2022 · PMID 36018212 · Full text
Augmented-pressure distal loop colostogram (APDC) is the most important diagnostic investigation to delineate the detailed anatomy to plan the reparative management of anorectal malformations. APDC is generally considere...
Augmented-pressure distal loop colostogram (APDC) is the most important diagnostic investigation to delineate the detailed anatomy to plan the reparative management of anorectal malformations. APDC is generally considered safe, with a very low complication rate. Herein, we present an unreported complication of APDC, manifesting as acute abdomen, due to retained contrast in distal loop. The patient was managed with evacuation of retained contrast from distal loop. We recommend evacuating the contrast from the distal loop following APDC.
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