Impact of a Standardized Clinical Pathway for Suspected and Confirmed Ileocolic Intussusception.

Introduction: Clinical pathways for specific diagnoses may improve patient outcomes, decrease resource utilization, and diminish costs. This study examines the impact of a clinical pathway for emergency department (ED) care of suspected and confirmed pediatric ileocolic intussusception.

Methods: Our multidisciplinary team designed an intussusception clinical pathway and implemented it in a tertiary children's hospital ED in October 2016.

Unusual ultrasound appearance of small bowel intussusception and secondary bowel obstruction in a child with Peutz-Jeghers syndrome.

Small bowel intussusception (SBI) in pediatric patients resolves spontaneously in the majority of cases. Pathologic small bowel intussusception with a lead point is rare in children. Ultrasound (US) is the preferred initial imaging study for the diagnosis of intussusception.

Factors associated with 30-day unplanned pediatric surgical readmission.

Background: Unplanned readmissions are costly to family satisfaction and negatively associated with quality of care. We hypothesized that patient, operative, and hospital factors would be associated with pediatric readmission.

Methods: All patients with an inpatient operation from 10/1/2008 to 7/28/2014 at a freestanding children's hospital were included.

Pediatric magnet ingestions: the dark side of the force.

Background: Pediatric magnet ingestions are increasing. Commercial availability of rare-earth magnets poses a serious health risk. This study defines incidence, characteristics, and management of ingestions over time.

Too attractive: the growing problem of magnet ingestions in children.

Background: Small, powerful magnets are increasingly available in toys and other products and pose a health risk. Small spherical neodymium magnets marketed since 2008 are of particular concern.

Objective: The objective of this study was to determine the incidence, characteristics, and management of single and multiple-magnet ingestions over time.

Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review.

Importance: Analyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear.

Objective: To review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery.

Iatrogenic arteriovenous fistula in the arm in an infant: diagnostic and therapeutic considerations.

Iatrogenic arteriovenous fistulas (AVF) are well described in adults; however, this complication is rarely described and reported in infants. We report the case of a 3-month-old infant with complicated gastroschisis requiring multiple venipunctures who presented with signs and symptoms suggestive of traumatic arteriovenous fistula. Ultrasound imaging confirmed the presence of a wide-necked AVF between the brachial artery and vein.

Implementation of a standardized procedural checklist in a children's hospital.

Background: The aim of this study was to examine the implementation and sustainability of checklist use among procedural-based specialties in a pediatric hospital and to survey perceptions of checklist efficacy among staff members and physicians.

Methods: A modified World Health Organization procedural checklist was implemented. Percentage daily compliance was collected for all procedures over a 12-month period.

Laparoscopic management of neonatal paraesophageal hernia with intrathoracic gastric volvulus.

Intrathoracic gastric volvulus associated with neonatal paraesophageal hernia is very rare in the newborn period. We report a case of a 3-week-old term infant who presented to the hospital with a history of non-bilious vomiting. Workup for hypertrophic pyloric stenosis eventually revealed the presence of a congenital hiatal hernia and intrathoracic gastric volvulus requiring urgent surgical management.

Mesothelial cyst presenting as an irreducible inguinal mass.

Inguinal hernias are common in the pediatric population. We describe a 10-year-old child who presented with signs and symptoms suggestive of an incarcerated inguinal hernia. Ultrasound examination demonstrated an aperistaltic multicystic inguinal mass of uncertain origin.

Optimizing your operating room: or, why large, traditional hospitals don't work.

Introduction: Caring for patients in traditionally designed, large teaching hospitals is often frustrating. Attempts at decreasing internal costs and inpatient length of stay are universally undertaken in order to address dwindling reimbursement, and patient care becomes more specialized and fractionated. These attempts have proven to be myopic, at best, and injurious to patient care and professional job satisfaction, at worst.

Simultaneous gastric and small intestinal trichobezoars.

Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. A trichobezoar represents a mass of accumulated hair. Trichobezoars may present as an isolated gastric mass, as an extension into the small intestine, or as an independent fragmented mass in the small intestine.

Isolated torsion of the fallopian tube in a menarchal 11-year-old girl.

Isolated torsion of the fallopian tube is a rare cause of an acute lower abdominopelvic pain in adolescent females that is difficult to recognize preoperatively. This is a case report of an 11-year-old girl who presented with a right lower quadrant abdominal pain, nausea, and vomiting secondary to isolated torsion of the right fallopian tube 2 days after the onset of her first menses. In this report, the patient's clinical course is discussed with special emphasis on diagnostic imaging and management strategy of adnexal torsion in pubertal and adolescent girls.

Temporary occlusion of the gastroesophageal junction: a modified technique for stabilization of the neonate with esophageal atresia and tracheoesophageal fistula requiring mechanical ventilation.

Management of newborn infants with esophageal atresia and tracheoesophageal fistula that require mechanical ventilation is challenging. Without rapid control of the fistula, these patients develop profound respiratory failure and massive distention of the gastrointestinal tract. We present the case of a newborn who upon intubation exhibited respiratory failure and cardiovascular collapse, and in whom traditional intra-operative techniques to gain control of the tracheoesophageal fistula were unsuccessful.

Intraoperative colonic lavage in a premature infant: a case report.

Left-sided colonic obstruction in the neonate traditionally is managed with a multistaged defunctioning colostomy and resection. In adults, one-stage primary anastomosis has become increasingly popular with the use of on-table antegrade colonic lavage. In infants, and especially in premature neonates, enterostomies pose significant morbidity.