Is there a role for routine preoperative endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in children?

Hypothesis: Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used preoperatively in adult patients with suspected choledocholithiasis. Cholelithiasis occurs much less often in children, and the indications for ERCP are not established. We hypothesized that the natural history of choledocholithiasis in children is spontaneous passage of stones through the papilla and that these children can be managed without routine preoperative ERCP.

Open and laparoscopic appendectomy are equally safe and acceptable in children.

Background: The aim of this study was to evaluate prospectively whether laparoscopic (LA) and open appendectomy (OA) are equally safe and feasible in the treatment of pediatric appendicitis.

Methods: A total of 517 children with acute appendicitis were randomly assigned to undergo LA or OA appendectomy, based on the schedule of the attending surgeon on call. Patient age, sex, postoperative diagnosis, operating time, level of training of surgical resident, length of postoperative hospitalization, and minor and major postoperative complications were recorded.

In-line image projection accelerates task performance in laparoscopic appendectomy.

Background: In laparoscopy, the monitor usually is placed at or above eye level across from the operating surgeon. Position of the endoscopic image at hand level has been shown in a laboratory model to facilitate task performance. The authors tested the hypothesis that in-line image projection reduced operating time for a standardized procedure.

Benefits of term delivery in infants with antenatally diagnosed gastroschisis.

Objective: To test the hypothesis that term gestation offers the best outcome. The relationship between gestational age and the extent of bowel injury in fetuses with gastroschisis is a matter of debate. Early delivery and cesarean delivery have been recommended to limit intestinal damage, but their benefits are unclear.

The unpredictable character of congenital cystic lung lesions.

Background: The spectrum of congenital cystic disease of the lung ranges from hydrops and neonatal respiratory distress to asymptomatic lesions. Surgical management is dictated by the presence of symptoms, recurrent infection, and the potential risk of malignant transformation.

Methods: Since 1995, all consecutive patients with congenital cystic lung lesions underwent follow-up for symptoms, treatment, and correlation of presumptive with pathological diagnosis.

Unsuspected splenic rupture in a neonate.

Serious intra-abdominal injuries in neonates are very rare. In addition, the signs and symptoms of hemoperitoneum caused by bleeding from solid viscera are vague and nonspecific and often are not recognized before the onset of hypovolemic shock or death. In this report, we describe a 2-day-old infant who presented with shock and pallor who had a ruptured spleen, presumably from birth.

Multiple spontaneous small bowel anastomosis in premature infants with multisegmental necrotizing enterocolitis.

Background/purpose: Fulminant necrotizing enterocolitis (NEC) may result in extensive bowel necrosis. Resection of involved segments may result in short bowel syndrome. Multiple stomas result in complications and further loss of intestinal length with closure.

Primary repair of long-gap esophageal atresia by mobilization of the distal esophagus.

Long-gap esophageal atresia remains a difficult problem for the pediatric surgeon. Several strategies for lengthening of the proximal esophageal segment have been used with relative success. Autogenous tissue conduits have resulted in less than optimal long-term results.

Primary laparoscopic placement of peritoneal dialysis catheters in children and young adults.

Background: Primary placement of peritoneal dialysis catheters in children often requires suturing of the catheter into the pelvis. We describe our experience with a gasless laparoscopy technique in children and young adults.

Methods: During an 18-month period, 12 patients (mean age, 14 years) underwent primary laparoscopic placement of peritoneal dialysis catheters.

Cost-effectiveness of laparoscopy in children.

Background: Laparoscopy may offer fast recovery and improved cosmesis, but its cost has been perceived as excessive.

Objective: To analyze the total hospital costs of laparoscopy vs open surgery.

Design: Retrospective cost-effectiveness analysis evaluating all cases performed in a 36-month period (September 1995 to August 1998).

Incidence of contralateral inguinal hernia: a prospective analysis.

Background/purpose: Contralateral groin exploration in children with unilateral inguinal hernia is still controversial, particularly in infants. The authors have attempted to determine the age- and gender-stratified incidence of contralateral hernia and the necessity of routine bilateral procedures.

Methods: This is a prospective study of 656 patients during a 34-month period at a single institution.

The changing presentation of pyloric stenosis.

Metabolic abnormalities described in pyloric stenosis are now rare, probably because of prompter recognition of the disease. This report reviews the trend in presentation over three decades. All infants treated for pyloric stenosis during three mid-decade target periods were reviewed.

Ureteral valves in children.

Objectives: Congenital ureteral valves are a rare cause of ureteral obstruction in children, with only 42 cases having been reported in peer-reviewed literature. Eight additional cases of ureteral valves are herein reported.

Methods: We report on the diagnosis and management of eight children with ureteral obstruction secondary to a ureteral valve.

Peritoneal drainage as definitive treatment for intestinal perforation in infants with extremely low birth weight (<750 g).

Background: Advances in neonatal intensive care have improved the survival of the extremely premature infant. However, survival at less than 25 weeks' gestational age remains tenuous, with intestinal perforation presenting a significant mortality.

Methods: During an 18-month period from 1995 to 1996, nine patients weighing less than 750 g (range, 485 to 740 g; mean, 615 g) presented with intestinal perforation.

Wandering spleen presenting as duodenal obstruction after repair of congenital diaphragmatic hernia.

The most common presentation of the wandering spleen in children is torsion with infarction. Duodenal obstruction by the spleen has not been reported previously. Wandering spleen can accompany congenital diaphragmatic hernia (CDH) because of its loss of retroperitoneal fixation.

A modified feeding Roux-en-Y jejunostomy in the neurologically damaged child.

Purpose: Feeding tube access with an antireflux procedure is frequently necessary in children with severe neurological deficits. Fundoplication in this particular group of patients has many complications and a reported failure rate of 40% to 50%. Recently, the use of a feeding Roux-en-Y jejunostomy has been advocated in this population.

Fetal lung growth after tracheal ligation is not solely a pressure phenomenon.

Fetal tracheal ligation increases lung growth in utero, making it potentially applicable for antenatal treatment of diaphragmatic hernia. This phenomenon has been ascribed to increased intratracheal pressure, which activates as yet unidentified pulmonary stretch receptors. The purpose of this study was to determine whether the composition of lung fluid has any effect on fetal lung development after tracheal obstruction.

Child abuse as a cause of traumatic chylothorax.

Chylothorax is an uncommon condition that may be associated with significant morbidity and mortality. The authors report a case of traumatic chylothorax attributed to child abuse and describe our management with tube thoracostomy and nutritional support with medium-chain triglycerides. Child abuse should be suspected in any case of chylothorax when no other etiology is evident and particularly when other signs of abuse are present.

Management of thoracolaryngopelvic dysplasia.

We report a family in which three members have thoracolaryngopelvic dysplasia (Barnes' syndrome). This family illustrates the phenotypic variability seen in this rare clinical entity and highlights the medical and surgical management necessary in such cases.

External compression as initial management of giant omphaloceles.

The authors describe a noninvasive technique for the management of giant omphaloceles. Two patients with giant omphaloceles were managed with external compression. Dry sterile dressings were used, buttressed by an Ace bandage in the first case and by a handcrafted Velcro abdominal binder in the second.

Pyloric stenosis in the age of ultrasonography: fading skills, better patients?

Hypertrophic pyloric stenosis can be diagnosed accurately by physical examination alone. However, ultrasonographic confirmation is obtained in the majority of cases, often before clinical evaluation by the surgeon. The present study examines whether the easy access to ultrasonography by the primary physician has affected the care of infants with pyloric stenosis.

Castleman's disease presenting as a pediatric surgical problem.

A 9-year-old girl presented with anemia, fever, and poor growth over a 2 1/2-year period. On physical examination, a right lower quadrant mass was palpated. Her signs and symptoms were consistent with Castleman's disease of the plasma cell type.

Blunt traumatic laceration of the suprahepatic inferior vena cava presenting as abdominal pain and shock in a child: a case report.

Objective: Report of management of blunt, intrapericardial inferior vena caval injury.

Design, Materials And Methods: A seven-year-old boy, after falling from the back of a motorcycle, had a laceration of the intrapericardial, inferior vena cava with cardiac tamponade. He presented with hypotension and a distended abdomen.

Prolapsed hyperplastic gastric polyp causing gastric outlet obstruction, hypergastrinemia, and hematemesis in an infant.

An infant presented with hematemesis and gastric outlet obstruction. Preoperative diagnosis of duodenal duplication cyst was based on a collaboration of radiological studies. At exploration the patient was found to have a gastric polyp that had intussuscepted into the duodenum leading to obstruction and hypergastrinemia secondary to gastric mucosa in the duodenal alkaline environment.

Chordoma presenting as a posterior mediastinal mass in a pediatric patient.

Chordomas are slow-growing malignant tumors that arise from fetal notochord cells. They are commonly found at the cranial or caudal ends of the spinal cord, but can be seen infrequently in other areas of the cord. Thoracic chordomas can present as either a posterior mediastinal mass or with cord compression symptoms.