Search

Abstract Over the past 15 years, there has been a noticeable uptick in incidents involving children ingesting multiple magnetic foreign bodies which can cause injuries and gastrointestinal complications including death. The current study aimed to identify the prevalence, clinical presentation, and management of single or multiple magnet ingestions. A retrospective multi-central cross-sectional study was conducted to include all pediatric patients

Background: Inguinal hernia (IH) is a prevalent condition in children necessitating surgical repair. However, determining the optimal timing (early or delayed) of inguinal herniotomy in neonates and preterm infants remains debatable. While open herniotomy traditionally serves as the standard inguinal hernia repair (IHR) procedure, laparoscopic repair has gained traction in recent decades. Our study aims to scrutinize both the optimal timing and approach to inguinal hernia repair in neonates and preterm infants. Methods: We conducted a literature review on surgical repair of IH in neonates and preterm infants published between 1999 and 2024. Results: Twenty studies met the inclusion criteria for this review. All studies were retrospective, predominantly originating from Europe and the United States. Thirteen out of the 20 studies focused solely on preterm infants. Patient sample sizes ranged from 30 to 8037, totaling 14533 patients. Most studies indicate that delaying inguinal hernia repair in newborns and preterm infants does not increase the risk of incarceration or recurrence. Moreover, postponing repair until after discharge from the NICU correlates with a shorter postoperative hospital stay and notably diminishes the risk of long-term postoperative ventilator dependence, thereby mitigating potential perioperative complications. Hence, this approach seems safe for certain patients whose families can reliably access appropriate surgical care. Conclusion: Significant disparities exist in the timing of inguinal hernia repair for newborns and preterm infants across various pediatric surgery centers. Current evidence suggests delayed inguinal hernia repair may be a viable option for selected patients. Regarding the optimal approach in this population, laparoscopy appears safe and effective.

Abstract Aim Necrotizing enterocolitis (NEC) is the most lethal disease of the gastrointestinal tract of preterm infants. New and existing management strategies need clinical evaluation. Large heterogeneity exists in the selection, measurement, and reporting of outcome measures in NEC intervention studies. This hampers meta-analyses and the development of evidence-based management guidelines. We aim to develop a Core Outcome Set (COS) for NEC that includes the most relevant outcomes for patients and physicians, from moment of diagnosis into adulthood. This COS is designed for use in NEC treatment trials, in infants with confirmed NEC. Methods This study is designed according to COS-STAD (Core Outcome Set-STAndards for Development) recommendations and the COMET (Core Outcome Measures in Effectiveness Trials) Initiative Handbook. We obtained a waiver from the Ethics Review Board and prospectively registered this study with COMET (Study 1920). We will approach 125 clinicians and/or researchers from low-middle and high-income countries based on their scientific output (using SCIVAL, a bibliometric tool). Patients and parents will be approached through local patient organisations. Participants will be separated into three panels, to assess differences in priorities between former patients and parents (1. lay panel), clinicians and researchers involved in the neonatal period (2. neonatal panel) and after the neonatal period (3. post-neonatal panel). They will be presented with outcomes currently used in NEC research, identified through a systematic review, in a Delphi process. Eligible outcome domains are also identified from the patients and parents’ perspectives. Using a consensus process, including three online Delphi rounds and a final face-to-face consensus meeting, the COS will be finalised and include outcomes deemed essential to all stakeholders: health care professionals, parents and patients’ representatives. The final COS will be reported in accordance with the COS-Standards for reporting (COS-STAR) statement. Conclusions Development of an international COS will help to improve homogeneity of outcome measure reporting in NEC, will enable adequate and efficient comparison of treatment strategies, and will help the interpretation and implementation of clinical trial results. This will contribute to high-quality evidence regarding the best treatment strategy for NEC in preterm infants.

Background: Transanal pull-through for the treatment of Hirschsprung disease in the neonatal period remains debatable. This study reported our experience with transanal pull-through in neonates. Methods: We reviewed medical records of neonates with Hirschsprung disease treated in our department with transanal pull-through between the years 2010 and 2016. Results: Of the 40 included patients, 31 were male neonates, and 9 were female. The mean age at the time of surgery was 13 days. The mean operative time was 136 minutes. The level of aganglionosis was rectal in 8 cases, rectosigmoid in 19 cases, descending colon in 7 cases, splenic flexure in 3 cases, transverse colon in 2 cases, and ascending colon in one case. A combined abdominal approach was used in 11 patients. There were no intraoperative complications. Major complications were noted in 4 cases: anastomotic leakage in 3 cases of whom one succumbed 3 days postoperatively; and bowel perforation in one case. The most common late postoperative complication was fecal soiling encountered in 25% of cases. Two among 29 patients who reached the age of continence remain incontinent. Conclusion: Transanal pull-through in neonates has similar outcomes and complications to those of infants and children. Therefore this procedure can be safely employed in neonates however we recommend that the treating team should have an ample learning curve for this procedure in infants.

Background: Trichobezoar is an uncommon clinical entity in which ingested hair mass accumulates within the digestive tract. It is generally observed in children and young females with psychological disorders. It can either be found as an isolated mass in the stomach or may extend into the intestine. Untreated cases may lead to grave complications. Material and Methods: We retrospectively analyzed the clinical data of six patients treated for trichobezoar in Monastir pediatric surgery department during 16-year-period between 2004 and 2019. Imaging (abdominal computed tomography and upper gastroduodenal opacification) and gastroduodenal endoscopy were tools of diagnosis. Results: Our study involved 6 girls aged 4 to 12. Symptoms were epigastric pain associated with vomiting of recently ingested food in 3 cases and weight loss in one case. Physical examination found a hard epigastric mass in all cases. The trichobezoar was confined to the stomach in 4 cases. An extension into the jejunum was observed in 2 cases. Surgery was indicated in all patients. In two cases, the attempt of endoscopic extraction failed and patients were then operated on. All patients had gastrotomy to extract the whole bezoar even those with jejunal extension. Psychiatric follow-up was indicated in all cases. The six girls have evolved well and did not present any recurrence. Conclusion: open surgery still plays a crucial role in Trichobezoard management . After successful treatment, psychiatric consultation is imperative to prevent reccurrence and improve long term prognosis

Background: Femoral hernias are an uncommon groin pathology among pediatric patients. Therefore, they are frequently misdiagnosed. In the present study, we review our experience with this rare surgical entity during the past 25 years. Methods: The medical records of 19 patients who underwent 22 femoral hernia repairs between January 1994 and December 2019 were retrospectively analysed. Results: Patients' age ranged from 2 to 12 years (mean age was 5. 5 years) with an approximately equal sex ratio (10 girls/9 boys). There were three bilateral cases identified separately. They were discovered and managed at different times. All the children were referred with a groin lump, but the correct pre-operative diagnosis was made in only 13 cases (59%). In the remaining cases, four were identified intraoperatively following negative exploration for a supposed inguinal hernia. The other five were found to have a femoral hernia 1 month to 12 months after ipsilateral inguinal hernia repair. All patients underwent elective surgery. The femoral canal was closed using either Lytle or McVay procedure. Recurrence occurred in only one patient 2 months after initial repair. Conclusion: Femoral hernias are often misdiagnosed. Pre-operative diagnosis can be obtained through careful clinical assessment. In equivocal cases, ultrasonography and laparoscopy could be useful. A correct pre-operative diagnosis will lead to suitable treatment, thus avoiding unnecessary reoperations and their related complications.

Splenogonadal fusion, which is adherence of splenic tissue to gonads, is an uncommon congenital anomaly which mainly affects males. Herein, we report a case of splenogonadal fusion in a 20-month-old boy presenting with acute scrotal pain and inflammation. With the suspicion of left testicular torsion, an emergent left scrotal exploration was carried out. It revealed a necrotic left testicle along with a 360° rotation of the spermatic cord and three accessory structures in the lower pole of the testicle. Histology showed the presence of a splenic tissue. Splenogonadal fusion can present as an acute condition mimicking a testicular torsion. But, one should always bear in mind the possibility of this association. Splenogonadal fusion should be included in differential diagnosis of testicular mass to avoid unnecessary orchidectomy.

Foreign bodies ingestion is considered as a common pediatric problem, it is mostly encountred in infants between 6months and 2 years. Ingestion of magnets was documented in only few reports. We report two uncommon cases of bowel perforations owing to magnets ingestion. Patients were respectively aged of 10 months and 20 months .they were successfully managed. Once ingested, magnetic objects would attach each other through intestinal wall leading subsequently to intestinal necrosis. Thus their surgical removal is unavoidable.

Sternal cleft is a rare congenital anomaly which is generally observed at birth. The aetiology remains obscure. Superior clefts are more frequent than inferior ones, and isolated central clefts are extremely rare. Surgery is recommended to protect the heart and other mediastinal contents from trauma and also to improve respiratory dynamics. We present the case of a newborn with isolated central clefts and we will give a review of the literature.

This is the case of a 6 month-old boy victim of an attempted infanticide by means of sharp long needles inserted through the abdominal wall. He was successfully managed by laparoscopic approach.

Surgical management of long-gap esophageal atresia (LGEA) remains challenging. Yet, there is a consensus among pediatric surgeons to preserve native esophagus. We used a new surgical technique to successfully manage three children diagnosed with LGEA. This technique consists of a combined thoracic and cervical approach to the EA repair using the patient's native esophagus. All patients initially had had gastrostomy and continuous upper pouch suction while awaiting surgery. This new technique has the potential to become the choice method in LGEA management.

Objectives: The purpose of this study was to document clinical features of inguinal hernia (IH) in the pediatric population. It provides data to evaluate associated risk factors of incarcerated hernia, its recurrence as well as the occurrence of contralateral metachronous hernia. Materials and Methods: We report a retrospective analytic study including 922 children presenting with IH and operated from 2010 to 2013 in our pediatric surgery department. Results: We managed 143 girls (16%) and 779 boys (84%). The mean age was 2 years; the right side was predominantly affected (66.8%, n = 616). Incarcerated hernia was documented in 16% of cases with an incidence of 33% in neonates. The incarceration occurrence was 15.5% in males versus 2.09% in females. The surgical repair was done according to Forgue technique. Postoperatively, four cases of hernia recurrence were documented, and contralateral metachronous hernia was reported in 33 children with 7.7% females versus 2.8% males. Forty-five percent of them were infants. The mean follow-up period was 4 years. We think that incarceration can be related to several risk factors such as feminine gender, prematurity, and the initial left side surgical repair of the hernia. Conclusion: IH occurs mainly in male infants. Prematurity and male gender were identified as risk factors of incarceration. Contralateral metachronous hernia was reported, especially in female infants and after a left side surgical repair of the hernia.

Introduction: We report the case of a 4 years old girl who present a cervico-thoracic ganglioneuroblastome with none response to chemotherapy and radiotherapy Case presentation: The girl was operated using the Cormier Dartevelle-Grünenwald incision which helped to remove the tumor completely with optimal control of noble elements. The follow up was uneventful. Conclusion: The Cormier Dartevelle-Grünenwald incision can be a good option in case of big cervico-thoracic malignant tumors.

Congenital esophageal web is a rare disorder that presents a diagnostic and management challenge. In a female infant born at 31 weeks of gestation, significant secretions and respiratory distress were noted at birth. Chest X-ray demonstrated the nasogastric tube in the esogastric junction with no distal bowel gas. Esophagogram showed a congenital web near the esogastric junction. An endoscopic examination under general anesthesia showed a complete, thick membrane on the distal esophageal lumen. Endoscopic incision and cauterization of the web through the midline were performed, improving the clinical symptoms and esophageal stenosis.

Background: Congenital epidermolysis bullosa (CEB) is a rare genodermatosis. The digestive system is very frequently associated with skin manifestations. Pyloric atresia (PA) and oesophageal stenosis (OS) are considered the most serious digestive lesions to occur.The aim of this work is to study the management and the outcome of digestive lesions associated to CEB in four children and to compare our results to the literature. Patients and Methods: A retrospective study of four observations: Two cases of PA and two cases of OS associated to CEB managed in the Paediatric Surgery Department of Fattouma Bourguiba Teaching Hospital in Monastir, Tunisia. Results: Four patients, two of them are 11 and 8 years old, diagnosed as having a dystrophic epidermolysis bullosa since the neonatal period. They were admitted for the investigation of progressive dysphagia. Oesophageal stenosis was confirmed by an upper contrast study. Pneumatic dilation was the advocated therapeutic method for both patients with afavourable outcome. The two other patients are newborns, diagnosed to have a CEB because of association of PA with bullous skin lesions with erosive scars. Both patients had a complete diaphragm excision with pyloroplasty. They died at the age of 4 and 3 months of severe diarrhoea resistant to medical treatment. Conclusion: Digestive lesions associated to CEB represent an aggravating factor of a serious disease. OS complicating CEB is severe with difficult management. Pneumatic dilatation is the gold standard treatment method. However, the mortality rate in PA with CEB is high. Prenatal diagnosis of PA is possible, and it can help avoiding lethal forms.

Please see Fulltext

Background: The definitive treatment of Hirschsprung′s disease is the removal of the aganglionic bowel by a pull-through surgery. In most cases, this surgery is performed in infancy or in the neonatal period as presentation in older children and adulthood is uncommon. Materials and Methods: It is a retrospective study of 20 patients above two-year-old who underwent a transanal Soave one-stage endorectal pull-through procedure for Hirschsprung′s disease between January 2002 and December 2010. Results: Twenty patients were recruited in this study. Fourteen were males and six were females. Patient ages ranged from 2 to 14 years (median age: five years and three months). All patients presented with persistent constipation and abdominal distension. Two of them had an intestinal obstruction that required colostomy. Ten patients (50%) had a recto-sigmoid Hirschsprung′s disease. All patients were operated on using a Soave one-stage endorectal pull-through procedure. The laparoscopy was necessary during the pull-through in three cases. The average duration of the intervention was 240 minutes. That represents almost the double of the duration of the same procedure in newborns and infants in our department (130 minutes). Early postoperative complications included one case of anastomosis leakage and one case of intussusception. Late postoperative complications were perineum irritation in five cases (25%), anal stenosis in four cases (20%) and enterocolitis in one case (5%). None of our patients developed fecal incontinence. Soiling was reported in four cases (20%). There was no death. Conclusion: Soave transanal one-stage endorectal pull-through is safely feasible in children of more than two years of age. Laparoscopy may be necessary whenever there are difficulties in the pull-through.

We present a case of male newborn presented with respiratory distress at 21 hours of life. The patient was operated for right congenital diaphragmatic hernia (CDH). Hepatic pulmonary fusion (HPF) was found at surgery.

Background: Wound infection is the most frequent complication in burn patients. There is a lack of guidelines on the use of systemic antibiotics in children to prevent this complication. Patients and Methods: A prospective study is carried out on 80 patients to evaluate the role of antibiotic prophylaxis in the control of infections. Results: The mean age was 34 months (9 months to 8 years). There was a male predominance with sex ratio of 1.66. The mean burn surface size burn was 26.5% with total burn surface area ranging from 5% to 33%, respectively. According to American Burn Association 37% (30/80) were severe burns with second and third degree burns >10% of the total surface body area in children aged

Background: Lipoblastoma is a rare benign mesenchymal tumour of embryonal fat that occurs almost exclusively in infants and children. This determined the epidemiological, clinical and therapeutic aspect of this disease. Materials and Methods: A total of 10 cases of pathologically proven lipoblastoma from 2003 to 2012 were reviewed. Results: There were six boys and four girls ranging in age from 7 months to 9 years. A soft-tissue mass was the main complain in nine patients. The various locations of the mass were mediastinal, thigh, buttock, inguino-scrotal, the greater omentum and the Latissimus dorsi. Lesions measured 5-15 cm. complete excision was done. The median time of follow-up was 42 months (ranges between 18 and 84 months). There were no recurrences. Conclusion: It is important to consider lipoblastoma in the diagnosis of a rapidly enlarging fatty mass in children. Complete resection is the only definitive treatment and should not be delayed when impingement on surrounding structures is imminent. There is a tendency for these lesions to recur despite presumed complete excision. Therefore, follow-up for a minimum of 5 years is recommended.

Background: Recurrent intussusceptions in child and infants are problematic and there are controversies about its management. The aim of this study is to determine the details of the clinical diagnosis of recurrent intussusception and to determine the aetiology of recurrent intussusceptions. Patients and Methods: It′s a retrospective study of 28 cases of recurrent intussusception treated in the paediatric surgery department of Monastir (Tunisia) between January 1998 and December 2011. Results: During the study period, 505 patients were treated for 544 episodes of intussusception; there were 39 episodes of recurrent intussusceptions in 28 patients; the rate of patients with recurrence was 5.5%. With comparison to the initial episode, clinical features were similar to the recurrent episode, except bloody stool that was absent in the recurrent group (P = 0,016). Only one patient had a pathologic local point. Conclusion: In recurrent intussusception, patients are less symptomatic and consult quickly. Systematic surgical exploration is not needed as recurrent intussusceptions are easily reduced by air or hydrostatic enema and are not associated with a high rate of pathologic leading points.

Pyloric atresia (PA) is uncommon. It occurs in 1:100000 live births. Neonates usually present soon after birth with copious non-bilious vomiting. The treatment is surgical and its prognosis is poor, especially, when it is associated with epidermolysis bullosa (EB). The aim of this study was to evaluate the clinical presentation, diagnosis, operative management, post-operative courses, and outcome in infant with PA, based in our cases and literature review. Charts of 10 patients who underwent surgery for PA in the department of paediatric surgery in a Teaching Hospital in Tunisia (Monastir) between 1990 and 2012 were reviewed. Data were analysed for demographic, clinical, therapeutic, and prognostic characteristics. The average of age at presentation was 2 days and there were six males and four females. The main presenting symptoms were non-bilious vomiting in 90% of cases. Abdominal X-ray showed gastric dilatation with an absence of gas in the rest of the intestinal tract in 90%, and a pneumoperitoneum in one. The surgical approach was laparotomy in all cases. Gastric perforation was observed in one patient and was completely repaired. The distribution of the anatomic variations was type A in nine cases and type B in one. Five patients underwent excision of the diaphragm and Heineke-Mikulicz pyloroplasty and gastroduodenostomy in the other five cases. Identified associated anomalies were Down′s syndrome in one and EB in 2 (20%), one family has three affected sibling. Post-operative mortality rate was 70%. No standard surgical approach can be adopted a better management of PA or the associated anomalies depends on an early diagnosis and the availability of neonatal intensive care unit.

See Fulltext

Introduction The abdomen is the most prevalent site of primarily unidentified fatal injury after blunt trauma, and represents the third major affected part. However, follow-up strategies of intra-abdominal injuries remain controversial. The aim of this study is to describe the characteristics of children with blunt abdominal trauma (BAT) and who presented radiographic amendments in re-imaging studies and predict factors that could identify patients group requiring control in this population. Methods A retrospective study was conducted in the department of pediatric surgery and the intensive care unit of Monastir involving all patients under the age of 14 years old who were admitted for blunt abdominal trauma between January 2010 and December 2021.An analysis of epidemiological, clinical, radiological and therapeutic management characteristics were performed. Results A total of 151 patients were included in this study with a mean age of six years. The sex ratio (m/f) was 2.7. Most trauma circumstances were related to road accidents (43.7%) and falls (32.4%). The liver, the spleen, and the kidneys were the most frequently affected organs. A combination of intra-abdominal lesions was recorded in 32 cases. 84% of the cases (110/131) of the reimaged patients had no complications, compared to 16% (21/131) who developed intra-abdominal complications. The complicated reimaging findings were significantly associated with high grade hepatic and renal injuries (p=0.019 and 0.002, respectively), and patient symptom persistence or development (p=0.001). Conclusion It is safe to avoid performing reimaging studies if clinical progression remains uneventful in children with low-grade hepatic, splenic, and renal lesions. However, the clinical assessment is the most crucial consideration during BAT management in children.

Introduction: The abdomen is the most prevalent site of primarily unidentified fatal injury after blunt trauma, and represents the third major affected part. However, follow-up strategies of intra-abdominal injuries remain controversial. The aim of this study is to describe the characteristics of children with blunt abdominal trauma (BAT) and who presented radiographic amendments in re-imaging studies and predict factors that could identify patients group requiring control in this population. Methods: A retrospective study was conducted in the department of pediatric surgery and the intensive care unit of Monastir involving all patients under the age of 14 years old who were admitted for blunt abdominal trauma between January 2010 and December 2021.An analysis of epidemiological, clinical, radiological and therapeutic management characteristics were performed. Results: A total of 151 patients were included in this study with a mean age of six years. The sex ratio (m/f) was 2.7. Most trauma circumstances were related to road accidents (43.7%) and falls (32.4%). The liver, the spleen, and the kidneys were the most frequently affected organs. A combination of intra-abdominal lesions was recorded in 32 cases. 84% of the cases (110/131) of the reimaged patients had no complications, compared to 16% (21/131) who developed intra-abdominal complications. The complicated reimaging findings were significantly associated with high grade hepatic and renal injuries (p=0.019 and 0.002, respectively), and patient symptom persistence or development (p=0.001). Conclusion: It is safe to avoid performing reimaging studies if clinical progression remains uneventful in children with low-grade hepatic, splenic, and renal lesions. However, the clinical assessment is the most crucial consideration during BAT management in children.

Abstract Background we aim to discuss the origin and the differences of the phenotypic features and the management care of rare form of disorder of sex development due to Mosaic monosomy X and Y chromosome materiel. Methods We report our experience with patients harboring mosaic monosomy X and Y chromosome material diagnosed by blood cells karyotypes and cared for in our department from 2005 to 2022. Results We have included five infants in our study. The current average age was 8 years. In four cases, the diagnosis was still after born and it was at the age of 15 years in one case. Physical examination revealed a variable degree of virilization, ranging from a normal male phallus with unilateral ectopic gonad to ambiguous with a genital tubercle and bilateral not palpable gonads in four cases and normal female external genitalia in patient 5. Karyotype found 45, X/46, XY mosaicism in patient 1 and 2 and 45, X/46, X, der (Y) mosaicism in patient 3, 4 and 5. Three cases were assigned to male gender and two cases were assigned to female. After radiologic and histologic exploration, four patients had been explored by laparoscopy to perform gonadectomy in two cases and Mullerian derivative resection in the other. Urethroplasty was done in two cases of posterior hypospadias. Gender identity was concordant with the sex of assignment at birth in only 3 cases. Conclusion Because of the phenotypic heterogeneity of this sexual disorders and the variability of its management care, then the decision should rely on a multidisciplinary team approach.

Abstract Introduction Canceling pediatric elective surgery leads to multiple disturbances regarding the inefficient operating room (OR) management, the financial repercussions, and the psychological impact on the patient and his family. This study aims to identify the reasons for cancellations among the pediatric population in our setting and suggest some convenient solutions. Methods We carried out a prospective and descriptive study over 12 months in the pediatric surgery department of Fattouma Bourguiba University Hospital. Results One thousand four hundred twenty-six patients were scheduled for surgery at the pediatric surgery department, of whom 131 (9.2%) were canceled. Medical and anesthesia-related reasons accounted for 62.5% of all cancellations, followed by surgical reasons at 16%, organizational or administrative issues at 11.5%, and patient-related reasons at 10%. The most significant causes were upper respiratory tract infections (URTIs) in 36.6%, abnormal blood test results in 16%, and non-adherence to preoperative fasting in 9.2%. Conclusions The rate of pediatric elective surgery cancellations at Fattouma Bourguiba University Hospital was higher than the accepted average rate (5%). Therefore, to prevent these cancellations as much as possible, efforts should be made to promote children’s medical care, operation scheduling, and efficient institution resource utilization.