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BACKGROUND: Gastroschisis is a common developmental anomaly of the abdominal front wall. The aim of surgical management is to restore the integrity of the abdominal wall and to insert the bowel into the abdominal cavity with the use of the primary or staged closure technique. The objective of this paper is to analyze our 20-year experience with surgical treatment of gastroschisis with primary and staged closure, to compare the postoperative course for the said techniques as well as to identify factors influencing the course and early results of treatment. METHODS: The research materials consist of a retrospective analysis of medical history of patients treated at the Pediatric Surgery Clinic in Poznan over 20 years period from 2000 to 2019. 59 patients were operated on: 30 girls and 29 boys. RESULTS: Surgical treatment was performed in all the cases. Primary closure was performed in 32% of the cases, whereas staged silo closure was performed in 68% of the cases. Postoperative analgosedation was used for 6 days on average after primary closures, and 13 days on average after staged closures. Generalized bacterial infection was present in 21% of patients treated with primary closures and 37% for staged closures. Infants treated with staged closure began enteral feeding considerably later (day 22) than those treated with primary closure (day 12). CONCLUSIONS: It is not possible to indicate clearly which surgical technique is superior to the other based on the results obtained. When choosing the treatment method, the patient's clinical condition, associated anomalies, and the medical team's experience must be taken into consideration.

Introduction: Liver biopsy is a safe and helpful diagnostic tool for many liver disorders. It can be performed using various techniques. Regardless of the technique, the liver biopsy is considered to be a safe procedure. Aim of the study: We aimed to analyze the indications, techniques, results, and complications of liver biopsies in the paediatric age group.Material and methods: We retrospectively obtained the data from the medical history records of 63 paediatric patients who underwent the liver biopsy. The data were analyzed statistically.Results: The most often performed type of biopsy was core needle biopsy (tru-cut), followed by core needle aspiration biopsy, fine-needle aspiration biopsy, open biopsy, and laparoscopic biopsy. Complications in the form of hematoma occurred only in 2 cases. The most common indications for the procedure were viral hepatitis monitoring/diagnosis, focal lesions, and autoimmune hepatitis. The histopathological results were predominantly hepatitis (viral and non-viral) and neoplasm.Conclusions: Liver biopsy is a safe procedure regardless of the technique used to obtain a tissue sample. Therefore, it should not be avoided when it is indicated.

The guidelines Thyroid Cancer 2022 are prepared based on previous Polish recommendations updated in 2018. They consider international guidelines - American Thyroid Association (ATA) 2015 and National Comprehensive Cancer Network (NCCN); however, they are adapted according to the ADAPTE process. The strength of the recommendations and the quality of the scientific evidence are assessed according to the GRADE system and the ATA 2015 and NCCN recommendations. The core of the changes made in the Polish recommendations is the inclusion of international guidelines and the results of those scientific studies that have already proven themselves prospectively. These extensions allow de-escalation of the therapeutic management in low-risk thyroid carcinoma, i.e., enabling active surveillance in papillary microcarcinoma to be chosen alternatively to minimally invasive techniques after agreeing on such management with the patient. Further extensions allow the use of thyroid lobectomy with the isthmus (hemithyroidectomy) in low-risk cancer up to 2 cm in diameter, modification of the indications for postoperative radioiodine treatment toward personalized approach, and clarification of the criteria used during postoperative L-thyroxine treatment. At the same time, the criteria for the preoperative differential diagnosis of nodular goiter in terms of ultrasonography and fine-needle aspiration biopsy have been clarified, and the rules for the histopathological examination of postoperative thyroid material have been updated. New, updated rules for monitoring patients after treatment are also presented. The updated recommendations focus on ensuring the best possible quality of life after thyroid cancer treatment while maintaining the good efficacy of this treatment.

Introduction: The aim of the work is to present the possible struggles that a doctor of the Hospital Emergency Department for adults may encounter when admitting a pediatric patient with a head injury. Head trauma is the most common cause of death or permanent injury in the pediatric population. The lack of experience in dealing with a minor patient, as well as the lack of knowledge of anatomical and physiological differences make it necessary to introduce simple algorithms. It helps to facilitate decision-making proces while facing this challange. Methods: The paper discusses the recommended management of a pediatric patient with the head injury treated by a team with limited experience in the field, based on a review of the literature - available studies and publications from the last 15 years - as well as the authors’ own experience. Result: In case of the pediatric head trauma there is a need to develop a patient examination scheme, paying attention to the specific anatomical and physiological differences resulting from the patient's age. It i salso recommended to introduce an algorithm that allows to limit and reasonably use imagining – mostly CT scan – in pediatric patients ( CHALICE, CATCH and PECARN algorithms). The article also recommends methods of management in the case of particular types of craniocerebral trauma.

Introduction: Laparoscopic adrenalectomy is more widely recognized as a valuable treatment method for benign and malignant tumours. Aim: This study reviews over 20-year experience with laparoscopic adrenalectomy in children in Central-West Poland. Materials and methods: During the last 21 years, 5041 laparoscopic procedures were performed, among them 39 adrenalectomies in children aged from 2 days to 17 years. The following data were analysed: patient's age at diagnosis and surgery, lesion volume in CT/MRI examination, duration of surgery, the incidence of complication after surgery, and length of hospitalization. Results: The volume of adrenal lesion visualized by CT or MRI before surgery varied from 0.5 cm3 up to 490 cm3, with a median of 14 cm3. As many as 80% of adrenalectomies allowed radical removal of the lesion and 92% of those procedures were performed without any complications. From all data analysed, only age, both at diagnosis and at surgery, was significantly lower in patients with a malignant lesion. Conclusions: Laparoscopic adrenalectomy is a valuable method to use in paediatric patients for both benign and malignant adrenal lesions. However, in patients with malignant adrenal lesions it may be expected that the procedure will be more difficult due to the lower age and larger lesion size.

Introduction: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a procedure which enables reconstruction of the continuity of the gastrointestinal track after resection of the large intestine and rectum. The most common diseases that require this type of resection include: ulcerative colitis and familial adenomatous polyposis. Aim: The study aimed to determine the effectiveness of IPAA in the surgical treatment of the paediatric age group. Material and methods: The research material was collected based on medical records of 21 patients who underwent proctocolectomy at the Department of Pediatric Surgery, Traumatology, and Urology of the Medical University of Poznan in 2000–2021. Results: In a group of 21 patients, 11 children were qualified for proctocolectomy due to ulcerative colitis (UC), 6 due to familial adenomatous polyposis (FAP), 3 due to Hirschsprung’s disease (HD), and one child due to Crohn’s disease (CD). Early complications in treated patients included dehiscence of the postoperative wound, bleeding from the lower gastrointestinal tract and anastomotic leakage. Late complications included pouchitis, stenosis of the ileostomy, narrowing of the anastomotic site and soiling. Quality of life was rated at an average of 9–10 by 16 patients on a scale of 1–10. Conclusions: IPAA is a proven method of reconstruction for the paediatric age group requiring proctocolectomy. Complications are common, most often related to the underlying disease and the clinical condition of the patients. Despite possible complications, patients rate their quality of life high on the scale. Each qualification for surgery should be carried out in a multidisciplinary team.

Summary Background The aim of this study was to evaluate the incidence and histological type of lesions affecting the ovaries and to analyze employed methods of invasive treatment. Materials & Methods Medical records of patients who were treated surgically for ovarian tumors in the years 2015–2019 were reviewed. The study group was comprised of 31 female patients. Results During 5 years time, there were 31 girls in the age from 3 months to 17 years hospitalized in the department. The mean age was 11 years. Histopathological examination was performed in all of these cases. 12 patients were diagnosed with malignant lesion, 19 with benign lesion. The most commonly diagnosed malignant tumors were a dysgerminoma and a mixed germ cell tumor. In the group of benign lesions, the most frequent tumor type was mature teratoma. The first occurring symptom was abdominal pain. Some of the lesions were diagnosed accidentally during ultrasonography. The diagnostics was expanded depending on the size of the tumor, staging and clinical condition of the patient. All the patients were treated surgically, 16 of them underwent laparoscopic surgery. Torsion of the ovary or oviduct was observed in 3 cases. Chemotherapy was introduced in 8 cases as complementary treatment. Conclusions The most commonly diagnosed tumor was mature teratoma. Ultrasonography is the most frequent method of the ovaries’ examination. Ovarian lesions are characterized by non-specific clinical symptoms, which is associated with prevalent incidental detection during ultrasonography.

Down syndrome (DS) is a common genetic disorder and is associated with an increased likelihood of many diseases, including defects of the heart, genitourinary system, gastrointestinal tract, and oncological diseases. The aim of this study was to analyze medical problems occurring in newborns with DS and to create a basic diagnostic and therapeutic algorithm intended primarily for neonatologists, pediatricians, family physicians, and physicians of other specialties caring for children with DS. Over a 5-year period, the medical records of 161 neonates with Down syndrome from four neonatology departments in Poznan, Poland, were examined. After applying exclusion criteria, 111 patients were analyzed. Data obtained from medical history included sex, week of gestation, birth weight, APGAR score, clinical symptoms, peripheral blood count with smear, and clinical features such as jaundice, hemorrhagic diathesis, ascites, hepato- or splenomegaly, pericardial or pleural effusion, respiratory failure, and other rare transient signs of abnormal myelopoiesis: fetal edema, hepatic fibrosis, renal failure, and rush. In the study group, 8% of children with Down syndrome were diagnosed with a heart and 1.8% with a genitourinary defect. Transient abnormal myelopoiesis syndrome (Transient abnormal myelopoiesis (TAM)) was found in 10% of newborns with DS. A blood count with blood smear, cardiology consultation with echocardiography, and an abdominal ultrasound should be performed in the first few days after birth in all newborns with Down syndrome. If this is not possible and the child’s condition is stable, these tests can be performed within 2–3 months after birth.

lt;bgt; Introduction:lt;/bgt; Pediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS) is a new disease, the first cases of which were observed in the spring of 2020. It affects children who have been infected with SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) and children who have been in direct contact with patients suffering from COVID-19 (coronavirus disease 2019). The disease is characterized by a wide spectrum of symptoms and the development of generalized inflammation of different organs and systems. One of the numerous symptoms may be severe abdominal pain.lt;/brgt;lt;/brgt;lt;bgt;Aim:lt;/bgt; The aim of this study was to review the available literature and analyze the results of patients treated at the Department of Pediatric Surgery, Traumatology and Urology in Poznań in whom PIMS-TS imitated acute surgical abdominal disease.lt;/brgt;lt;/brgt;lt;bgt;Materials and methods:lt;/bgt; material for the study was collected on the basis of medical records of patients treated at the Department of Pediatric Surgery, Traumatology and Urology of the Poznań University of Medical Sciences in the period between March 2020 and February 2021.lt;/brgt;lt;/brgt;lt;bgt;Results:lt;/bgt; TDuring this period, seven patients met the PIMS-TS criteria and three children were qualified for surgical treatment. Only one patient had an acute surgical cause of abdominal pain.lt;/brgt;lt;/brgt;lt;bgt;Discussions:lt;/bgt; The guidelines of the expert group at the Polish Pediatric Society and the National Consultant in the field of Pediatrics indicate the need to exclude acute surgical abdominal disease as a criterion for the diagnosis of PIMS-TS syndrome. In patients with acute abdominal pain, imaging and laboratory tests are sometimes diagnostically inconclusive, therefore exploratory laparoscopy is worth considering in order to differentiate PIMS-TS from acute surgical abdominal disease.

The familial occurrence of childhood cancers has been proven for a long time. Wilms’ tumors often do not have a clear germline genetic cause. However, approximately 2% of all nephroblastoma cases are familial. Descriptions of twins with the same cancer are extremely rare, so our aim was to present the background of the available literature of the occurrence of Wilms’ tumor in a pair of monozygotic twin girls with detailed clinical, histological, and molecular analysis. Two twins were born of unrelated Caucasian parents. Family history revealed no known chronic diseases or malformations. At the age of 3.5 years, the first twin was admitted to the emergency department due to hematuria and abdominal pain. Ultrasound examination revealed an enlarged right kidney, 12.8 cm, with a mass in the upper pole measuring 56 × 69 × 78 mm. The second girl was referred for an abdominal ultrasound, which revealed a right kidney measuring 8.6 cm with a central mass measuring 54 × 45 × 41 mm. Both children underwent surgical resection, and the histopathological result showed a mixed form of nephroblastoma, predominantly epithelioid with residual blastemal compartment. Detailed clinical, histological, cytogenetic, and molecular analyses were performed on both sisters. It was also decided to identify environmental factors. Information was obtained that the girls’ parents run a farm and regularly use pesticides and chemical rodenticides. Based on our observations and the available literature, Wilms tumor in monozygotic twins may be present. Both genetic and environmental factors may be involved in the development of tumors. After excluding methylation abnormalities and mutations in the genes studied, we questioned whether the onset of Wilms tumor in both sisters could be the result of exposure of the twins’ parents to pesticides.

The golden standard of infantile digital fibromatosis treatment has not been established. This publication aims to present the process of sustained treatment of a 4-month-old boy with a red, firm, swollen, painless tumor of the third and fourth right toes and syndactyly of these. The lesion was surgically resected due to continued growth, but after 1 year of observation, local recurrence was noticed and an observational approach was implemented with satisfactory effect.

In newborns and infants, ovarian lesions can be detected during ultrasound examination before or after birth. Malignant ovarian lesions account for1% of malignancies in newborns. However, in case of doubt about the nature of the lesion, surgery with tissue collection for histopathologic evaluation should be considered with the absolute condition of fertility preservation.The aim of this publication was to describe a case report of a 3-day-old infant who presented an ovarian lesion on postnatal ultrasound, with features suggesting a malignant nature of the ovary. In the described case, laparoscopy and mini-laparotomy were performed, torsion was excluded. The ovary was preserved, and histopathologic examination excluded the malignant nature of the lesion.A detailed analysis of the clinical status, laboratory tests, and imaging studies is necessary before making a final decision on further therapeutic, especially surgical management of a newborn with an ovarian lesion.

Juvenile xanthogranuloma (JXG) is a rare non-Langerhans cell tumour usually diagnosed during infancy. The lesion is typically located in the skin; however, extracutaneous lesions have been described. The symptoms vary depending on the location and size of the lesion. Presented here is a case of 13-year-old girl with this type of tumour located within the bronchus. She reported chest discomfort, difficulty breathing, and cough. A month prior to admission she had suffered from a respiratory tract infection. Prolonged surgical treatment was required due to the tumour’s atypical location and recurrence of the tumour following initial resection. Isolated pulmonary JXG is an extremely rare finding, which requires accurate diagnosis and careful planning of therapeutic treatment. Severe pulmonary symptoms, inconclusive histopathological examination, malignancy risk, and large tumour size are indications for radical surgical resection of the tumour. Non-surgical treatment with chemotherapy is useful in cases of inoperable tumours.

Background: Each year, nearly 1% of population suffers from burn injuries. The main cause of complications and death after thermal injury is infections. Excessive use of antibiotics affects however the children treated for burns and can have negative effects. Therefore, specifying the recommendations for antibiotic therapy in patients after thermal injury seems to be of importance. Materials and methods: An evaluation of 310 paediatric patients hospitalised for burn injuries was performed. In the first part of evaluation, a retrospective analysis of treatment with particular focus on infection complications and administered antibiotics was performed. This was followed by a prospective evaluation of effectiveness of the principles of antibiotic therapy specified at the earlier stage. Results: In 2010-2016, an antibiotic was systemically administered to 53.4% of children treated for thermal injury, provided that in 87.1% of cases it was introduced as a prophylactic measure. Infection of a burn wound was recorded in 4.7% of cases. The most frequently isolated bacterium (57.1%) was Staphylococcus aureus MSSA. Supply of antibiotics failed to reduce the number of infection complications or burn wound infections. The studies formed the basis for specification of the internal antibiotic therapy criteria, effectiveness of which was then evaluated. In 2017, an antibiotic was administered to 37.1% of patients. Reducing antibiotic therapy did not increase the risk of infection complications or frequency of wound infections. Conclusion: Routine antibiotic prophylaxis in burn injuries has no effect on the risk of infection complications and does not reduce the treatment time. It should be limited to perioperative prophylaxis in the case of skin grafts and to the patients with progressing symptoms of burn disease or with concomitant infections.

BACKGROUND: Gastroschisis belongs to common developmental anomalies. The aim of surgical management is to restore the integrity of the abdominal wall and to insert the bowel into the abdominal cavity with the use of the primary or staged closure technique.The objective of this paper is to analyze our 20-year experience with surgical treatment of gastroschisis with primary and staged closure, to compare the postoperative course for the said techniques as well as to identify factors influencing the course and early results of treatment.METHODS: The research materials comprise of a retrospective analysis of medical history of patients treated at the Surgery Clinic in Poznan in the years 2000-2019. 59 patients were operated on: 30 girls and 29 boys.Surgical treatment was performed with the use of primary closure in 33% of the cases, whereas the staged silo closure was performed in 67% of the cases. RESULTS: Postoperative analgosedation was used for 6 days on average after primary closures, and for 13 days on average after staged closures. Incidence frequency of generalized bacterial infection was 21% for primary closures and 37% for staged closures. Infants treated with staged closure began enteral feeding considerably later (day 22) than those treated with primary closure (day 12). CONCLUSIONS: It is not possible to indicate clearly which surgical technique is superior to the other on the basis of the results obtained. When choosing the treatment method, the patient's clinical condition, associated anomalies and the medical team's experience must be taken into consideration.

The International Neuroblastoma Risk Group Staging System (INRGSS) is based on the age of patients and preoperative imaging, with attention paid to whether the primary tumor is affected by one or more of specific image-defined risk factors (IDRFs). This publication presents a 2.5-year-old boy with neuroblastoma who had an accidental ligation of the celiac trunk during tumor resection. The consequences of this complication were pancreatic and spleen ischemia and necrosis, ischemia, and perforation of the common bile duct, gallbladder, stomach, and duodenum. The aim of this publication was to highlight the great role of the radiologist in determining the indications for neuroblastoma tumor removal, especially with current vascular IDRFs, and to show how the radiologist’s insightful approach can save the patient from irreversible complications.

Patients with a Wilms tumor are often admitted to the hospital accidentally, with an abdominal mass causing asymmetry of the abdominal wall. Hypertension accompanying a Wilms tumor occurs in about 10–27% of children, but cardiomyopathy associated with a Wilms tumor is very rarely described. This publication presents a case of a 9-month-old girl with a bilateral Wilms tumor accompanied by dilated cardiomyopathy since her initial cancer diagnosis, as well as her off-protocol treatment. The severe condition of the child forced the application of off-protocol treatment, i.e., accelerated resection of a larger tumor, which enabled the improvement of heart performance and made subsequent therapy possible. In the course of the presented treatment, a gradual normalization of cardiac ventricular function and contractility was observed. In conclusion, a massive abdominal tumor associated with abdominal compartment syndrome compromised the functioning of the cardiovascular system in the young child. Therefore, earlier removal of Wilms tumors in patients with heart failure should be considered. This may result in the improvement of cardiovascular function and the possibility of further therapy.

Aim To correlate the age of definitive surgery to the long-term results and the prevalence of long-term complications after definitive operation of Hirschsprung's disease. Background Long-term outcomes after definitive surgery of Hirschsprung's disease seem to be satisfactory for the children, their parents and also for the surgeons. Children's and parents’ perspectives of the overall outcome tend to differ from that of the surgeons, because they learn to cope with minor and major functional disturbances during the entire period of childhood. Because they adapt, their perspective of the overall outcome can be overestimated and are more satisfied than expected. Materials and methods Parents and patients were interviewed, asked to answer a standardized questionnaire, and examined. Patients’ hospital records were reviewed. Children were treated with the one-stage or multistage method. Duhamel-Martin and Transanal Endorectal Pull-Through (TEPT) techniques were used. Statistical analyses were performed using STATISTICA 10. Results Thirty-one patients took part in the study. Duhamel-Martin technique was used on 12 children operated in stages. The one-stage TEPT method was used on 19 children. The most common complication was fecal incontinence, which occurred in 39% of the operated patients. Children who were operated on radically under 4 months of age had a higher prevalence of complications. Conclusions In children with Hirschsprung's disease the definitive surgery should be considered no sooner than in the 4 months of age. Intestine ought to be exteriorized previously. Further studies in large cohorts are warranted in order to identify independent outcome-associated factors.

The aim of this study was to analyse the long-term outcome after surgical correction of Hirschsprung’s disease using a standardised questionnaire designed specifically to address the long-term results, in correlation to the physical examination of each patient. The data was collected from the medical records of patients treated over a 15 year period (2000–2014). Sixty-two patients were treated, 33 using one-stage and 29 using multistage surgical procedures. Twenty-seven children took part in the whole study, which consisted of personal interview, completing the questionnaire and physical examination. The Duhamel-Martin and transanal endorectal pull through techniques were used. Statistical analysis was performed using STATISTICA 10. The statistical significance was set at p

Background/purpose Neuroblastic tumors are the most common pediatric extracranial solid tumors in infants and very young children. Although, especially in newborns, there is an increasing number of situations in which observation alone is used, surgery remains an important step in the treatment of neuroblastoma but can be complicated by arterial vasospasm in the surgical field. The aim of this two-center retrospective study was to analyze the occurrence of arterial constriction as a complication of neuroblastic tumors resection. Methods Medical records of patients who were treated surgically for neuroblastic tumors in the years 2012–2019 were reviewed. Results For 8 years, 113 children were treated for neuroblastic tumors. The treatment included both primary and delayed surgery after initial chemotherapy carried out according to SIOPEN protocols. In 11 out of 113 cases (9.7%) local arterial constriction was observed. In 6 out of 11 cases an attempt was made to save the organ, however, two patients suffered from kidney atrophy, two other partial kidney infarctions, one child suffered from partial limb paresis, and another from brain ischemia and death. Conclusions Local arterial constriction constitutes a relatively common (10% of cases) and severe complication of neuroblastic tumors resection. Efficacy of local application of papaverine based on our experience remains unproven hence further research is warranted.

Patients with pediatric cancer face an increased risk of infections. In most cases, these infections are associated with the use of a long-term central venous catheter. This study describes the epidemiology of a port-associated bacteremia as well as a profile of microorganisms responsible for port-associated bloodstream infections (PABSIs) in pediatric patients with cancer treated in a single center. The retrospective analysis included patients with cancer who had implanted a port, hospitalized between 2010 and 2015 at the Department of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences. The medical records of patients were reviewed for demographic characteristics, diagnosis, port-related complications, and their management. Data were collected from patients’ electronic medical records containing complete information on medical examinations and supplementary tests, diagnosis, timing, and type of port-associated complications. In a study period, 277 ports were inserted to 241 patients. A total of 183 094 catheter days were analyzed. Sixteen patients had more than 1 insertion of a port. The commonest observed complication was PABSI (40.07%) and the incidence density was 0.6 per 1000 port-days. Staphylococcus was the most commonly isolated organisms from patients with PABSI. From all port-associated complications, bloodstream infections and mechanical complications were the most often observed complications. The commonest pathogens responsible for PABSI were coagulase-negative staphylococci. Pathogens resistant to standard antibiotic treatment play an important role in PABSI, with methicillin-resistant Staphylococcus epidermidis being the predominant pathogen. Port-associated bloodstream infections are a common reason for preterm removal of a port.

Infantile choriocarcinoma is an extremely rare disease. We present a case study of a 1-month-old male with choriocarcinoma diagnosed simultaneously with his mother. On admission to hospital, the disease was very advanced and massive progression and multi-organ failure caused the death of the patient despite the implemented treatment. It was too late to save the child’s life, but early enough to save his mother. The authors believe that the serum levels of hCG should be determined in every newborn with anemia and liver tumor, especially when the mother has a positive history of miscarriage.