Annals of Pediatric Surgery

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EISSN : 2090-5394
Total articles ≅ 86
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Aakanksha Agarwal, , Saurya, Niladri Sekhar Bhunia, Dipesh Kumar Dhoot
Published: 14 July 2021
Annals of Pediatric Surgery, Volume 17, pp 1-5; doi:10.1186/s43159-021-00095-7

Background Urinary bladder masses are uncommon in the pediatric age group and pose a diagnostic challenge, often necessitating histopathological differentiation and confirmation. An unusual mimic of neoplastic bladder mass is inflammatory pseudotumor, and timely identification and diagnosis of which prevents undue patient stress and radical treatment. Case presentation We present a case of a 7-year-old female child who presented with hematuria, and a urinary bladder mass was detected on ultrasound which was further characterized by magnetic resonance imaging (MRI) and diagnosed as an inflammatory pseudotumor (IPT) on histopathology. Conclusions This case report describes the imaging features of IPT along with a list of differential diagnoses emphasizing the need for radiologists to be aware of this surprising and rare entity.
, Shaimaa Abdelsattar Mohammad
Annals of Pediatric Surgery, Volume 17, pp 1-7; doi:10.1186/s43159-021-00094-8

Background Redo surgery for anorectal anomalies (ARA) may be considered a special category of reconstructive surgery with less predictable outcomes. In this report, we studied anatomical derangements in a group of boys following a previously complicated PSARP procedure, in addition to the effect of reoperation on rectifying this distorted anatomy. Results The study included 27 boys who were re-operated after a previous complicated PSARP. Included cases were divided into two groups: group A (14 cases) was referred before colostomy closure with an obviously complicated primary operation, and group B (13 cases) was referred with delayed complications after colostomy closure. Pelvic MRI examinations were performed before reoperation in 19 cases. In nine of these cases, a repeat MRI examination was performed at follow-up after reoperation to study the effect of redo surgery on rectifying the distorted anatomy. Abnormal wide anorectal angle and wide pelvic hiatus were common anatomical derangements after a previously complicated PSARP. An important goal of reoperation was reconstruction of the levator ani behind the anorectum trying to create a more acute anorectal angle and a narrower pelvic hiatus. The success of this corrective step was evaluated by MRI comparing pre- and postoperative measurements that showed a favourable decrease in the values of anorectal angle and hiatal/PC ratio. Improvement of faecal continence was documented after reoperation in 8 out of 10 cases in group B. Conclusion A wide pelvic hiatus was a frequently encountered postsurgical complication after failed PSARP that has most probably resulted from poor reconstruction of the pelvic floor at time of the primary repair. Re-approximation of the split halves of levator ani in the midline behind the anorectum at reoperation can help to correct the distorted internal anatomy and improve bowel control in these cases.
Yasir S. Jamal, Sabah S. Moshref, Abeer M. Baamir, Mazin O. Kurdi, Doaa Y. Jamal
Annals of Pediatric Surgery, Volume 17; doi:10.1186/s43159-021-00093-9

Background Submucous cleft palate (SMCP) is a congenital abnormality with various clinical and anatomical features. Submucous cleft pathologies may be unrecognized during routine examinations. Current diagnostic techniques are constrained and unrevealing in presurgical patients. This prospective study aimed to evaluate transnasal palatal transillumination technique in diagnosis of SMCP at our institute hospital, during period from 2005-2020. Patients and methods Twenty-one cases with SMCP were recruited with age range from 2-60 months. Transnasal palatal transillumination with controllable light intensity endoscope used to evaluate SMCP and cases were photo and video recorded. Results In this study, 21 cases (13 males and 8 females) with SMCP were detected or confirmed by intranasal transnasal palatal transillumination. Frequency of SMCP patients at our institute was 3.39%. All patients presented with symptomatic complaints at diagnosis time, apart from 5 patients (23.8%) were diagnosed during cleft lip repair operations. Presenting symptoms were hypernasality (23.8%), delayed speech (23.8%), perforated palate with nasal escape of milk and food (14.3%), feeding difficulties (14.3%), and otitis media (4.8%). During intra-oral examination, all cases had a bifid uvula accompanied SMCP. Submucous cleft palate appeared as thin palate with central lucency. According to operative findings, operations done for repair were mostly two long palatal flaps (n = 13, 61.9%), von Langenbeck (n = 5, 23.8%), simple repair with lateral release incisions (n = 2, 9.6%), and simple repair without lateral release incision (n = 1, 4.8%). Conclusions Intraoperative assessment of submucous cleft palate with transnasal palatal transillumination is easy and cheap method to avoid missing cases of SMCP.
Ismael Essam Elhalaby, Mohamed Awad Mansour, Ahmed Mohamed Ismail Tawfik, Hisham Fayad Aly
Published: 1 July 2021
by 10.1186
Annals of Pediatric Surgery, Volume 17, pp 1-8; doi:10.1186/s43159-021-00092-w

Background Controversy exists regarding the appropriate level of sympathectomy for primary palmar hyperhidrosis (PH) as different levels are associated with variable postoperative patients’ satisfaction and potential complications. The aim of this study was to investigate the safety, efficacy, and outcome of T2-T3 thoracoscopic sympathectomy (TS) versus T4 TS in this age group. Results This prospective study included 32 patients (17 males and 15 females) with primary PH treated at the department of pediatric surgery, in our institution during the period from February 2019 to February 2020. Inclusion criteria included moderate and/or severe degrees of PH not responding to conservative measures. The patients were divided randomly into two groups: group I treated by T2-T3 TS and group II underwent only T4 TS. All patients were evaluated regarding operative details and postoperative outcome. Follow-up ranged from 6 to 24 months. Group I included 18 patients (14 operated on both sides and 4 operated on one side), and group II included 14 patients (11 operated on both sides and 3 operated on one side). The ages ranged between 5 and 18 years (mean 14.25 ± 3.14 years). The difference in mean age among both groups (14.5 versus 13.9 years) was not statistically significant. The mean operative time was significantly longer in group I (22.4 versus 17.2 min, p value 0.046). The hospital stay (1 day) was similar for both groups. Postoperative compensatory hyperhidrosis (CH) was more frequent in group I (n=7, 50% versus n=5, 45.5%), but the difference was not statistically significant. Postoperative over dryness occurred in 5 patients in group I (28.6%) and temporary Horner’s syndrome in one patient (7.14%). No over dryness or Horner’s syndrome occurred in any patient in group II. The QOL score has improved in both groups; the degree of improvements was better in group II. Conclusion Both T2-T3 TS and T4 TS are effective in treating primary palmar hyperhidrosis in children and adolescents. T4 TS is preferred than T2-3 TS due to less frequent postoperative complications and better patients’ satisfaction.
Faysal Tabbara, Karim Wehby Ataya, Youssef Annous, Kawsar Alamiddine,
Published: 17 June 2021
Annals of Pediatric Surgery, Volume 17, pp 1-4; doi:10.1186/s43159-021-00091-x

Background Heterotaxy syndrome is a rare clinical entity that is characterized by abnormal visceral organ arrangement in the chest and abdomen. Left atrial isomerism is a subcategory of heterotaxy syndrome characterized by the presence of multiple spleens with or without cardiac anomalies. Patients may remain asymptomatic their whole lives until they are diagnosed incidentally. Given that patients with left atrial isomerism might demonstrate atypical presentations of acute intrabdominal pathologies, it is important to keep a high index of suspicion when encountering such cases. Case presentation In this report, we present a case of a 9-year-old boy with a known history of left atrial isomersim who presented with left lower quadrant pain and positive McBurney, psoas, and obturator signs on the left side. A computed tomography scan of the abdomen confirmed the diagnosis of perforated acute appendicitis on the left, which prompted an emergent laparoscopic appendectomy. Conclusion Our case highlights the importance of keeping a high index of suspicion for a heterotaxy syndrome that is complicated by acute appendicitis in pediatric patients presenting with vague abdominal pain. Planning the location of trocar placement in patients with situs anomalies is of paramount importance to avoid technical difficulties in laparoscopic procedures.
, Debapriya Bandyopadhyay, Bikasha Bihary Tripathy, Akash Bihari Pati, Manoj Kumar Mohanty
Published: 15 June 2021
Annals of Pediatric Surgery, Volume 17, pp 1-6; doi:10.1186/s43159-021-00090-y

Background Recently, several serum and urinary biomarkers have been investigated for diagnosis of acute appendicitis. Urinary biomarkers seem to be advantageous in children as it is non-invasive, painless, and easy to perform. Leucine-rich α-2-glycoprotein (LRG) is regarded as a reliable urinary biomarker for the diagnosis of pediatric appendicitis. A prospective observational pilot study was conducted in children presenting with abdominal pain. Assessment of pediatric appendicitis score (PAS), routine blood tests, and measurements of urinary LRG was done. The present study aimed to evaluate the diagnostic accuracy of urine LRG in appendicitis in Indian children and to assess the concentration of urine LRG at which it will guide the management. Results LRG had a receiver operating characteristic (ROC) area under the curve (AUC) of 0.586 (95% CI 0.407–0.766). There was no specific cut-off identified using Youden’s index. ROC analysis of the PAS score resulted in an AUC of 0.821 (95% CI 0.691–0.952). Using Youden’s index, the cut-off for PAS scoring was identified as 6.5 with the sensitivity of 80%, the specificity of 76.2%, positive predictive value 76.19%, negative predictive value as 80%, and diagnostic accuracy of 78%. Conclusions LRG could not show better diagnostic performance compared to routine blood tests and PAS scores. There was no specific cut-off value at which it will differentiate mesenteric adenitis and acute appendicitis and guide their management. With 78% diagnostic accuracy, PAS score (> 6) is still a better tool for the diagnosis of acute appendicitis. Trial registration Clinical Trials Registry Government of India, CTRI/2018/01/011182, Registered on: 08 Jan 2018.
Adewale Olaotan Oyinloye, Nasiru Raheem, Aminu M. C. Dahiru, Christopher Uruku Rikin, Auwal Mohammed Abubakar
Annals of Pediatric Surgery, Volume 17, pp 1-3; doi:10.1186/s43159-021-00089-5

Background Lipoblastoma is a rare benign neoplasm of the adipose tissue occurring most commonly in infants and young children. This tumor can present as a localized, well-circumscribed lesion (lipoblastoma) or as a multi-centric lesion (lipoblastomatosis). Case presentation This is a case report of lipoblastoma in a 19-month-old male with 9 months history of rapidly progressing axillary mass. Examination revealed a well-circumscribed right axillary mass measuring 25 cm × 20 cm with normal overlying skin and prominent, visibly distended superficial veins. He had surgical excision of the mass. Histologic examination revealed lipoblastoma. There has been no recurrence in the last 21 months of follow-up. Conclusion The report is presented for its rarity and also for its potential to pose diagnostic difficulty to surgeons. Surgical excision offers the best chance of cure. Long-term follow-up is also important to detect recurrence.
, Yoshikazu Toyoki, Aika Ichisawa, Takahiro Yamada, Yusuke Wakasa, Hiroyuki Jin, Makoto Nakai, Kazunori Aoki, Hiroaki Kawashima, Masaaki Endo
Annals of Pediatric Surgery, Volume 17, pp 1-8; doi:10.1186/s43159-021-00088-6

Background Appendicitis is the most common cause of acute abdomen. Although emergency surgery used to be the standard treatment for both simple and complex appendicitis, there are now options for interval surgery, laparoscopic surgery, and even non-surgical treatment. In this study, we aimed to establish better treatment strategies for pediatric acute appendicitis and to find out whether minimally invasive treatment is superior to the traditional open approach. We retrospectively reviewed the cases of acute appendicitis treated in our hospital during the period from 2013 to 2018. The patients who underwent appendectomy were divided into four groups. Group 1 underwent early appendectomy with open approach, group2 underwent interval appendectomy with open approach, group 3 underwent early appendectomy with laparoscopic approach, and group 4 underwent interval appendectomy with laparoscopic approach. In addition to the above groups, the non-surgical treatment group was also studied. Clinical presentation, laboratory findings, imaging results, operative time, morbidity, and length of hospital stay were reviewed. Results One hundred six children’s records were reviewed. Thirty-five of them were selected for non-surgery as they were cases with no fecal stone and first onset appendicitis, and 15 of these 35 patients (42.9%) relapsed after antibiotic treatment. As for the appendix diameter, the relapse group was significantly larger than the non-relapse group (p=0.007). In cases of surgery, group 4 had significantly less intraoperative blood loss than group 1 (p<0.001). Group 4 had significantly fewer postoperative complications than groups 1 and 2 [group 4 vs. group 1 (p=0.009), group 4 vs. group 2 (p=0.034)]. The postoperative hospital stay in groups 2 and 4 were significantly shorter than group 1 [group 1 vs. group 2 (p=0.015), group 1 vs. group 4 (p<0.001)]. On the contrary, group 1 had significantly shorter total hospital stay than groups 2 and 4 [group 1 vs. group 2 (p=0.029), group 1 vs. group 4 (p<0.001)]. Conclusion Interval laparoscopic appendectomy and non-surgical treatment were safe and effective in children. From the viewpoint of avoiding unnecessary emergency surgery and prolonged hospitalization, we believe that interval laparoscopic appendectomy or non-surgical treatment should be performed after identifying patients who do not require surgery, paying attention to the risk factors for relapse.
Ruchira Nandan, Anjan Dhua, Sidharth Tyagi, Vishesh Jain, Sandeep Agarwala, Veereshwar Bhatnagar
Annals of Pediatric Surgery, Volume 17, pp 1-3; doi:10.1186/s43159-021-00087-7

Background Teratoma of the hepatoduodenal ligament is a rare entity. Only 17 cases of hepatoduodenal ligament teratoma exist in the literature. Case presentation A girl with antenatally detected intraabdominal lesion was brought to us at the age of 3 years for the prime concern of progressive abdominal distension. Evaluation showed that the mass was a teratoma arising likely from the hepatoduodenal ligament. During the excision, there was an inadvertent pin-point perforation of the common bile duct. Primary repair of the common bile duct was performed. The child had an uneventful recovery. Conclusions The significance of anticipating complications and taking adequate measures while dissecting the porta has been emphasized in this kind of rare location of a teratoma.
Juliette F. Bollemeijer, Annelies M. C. Mavinkurve-Groothuis, Cezanne D. Kooij, József Zsiros, Annemieke S. Littooij, Alida F. W. van der Steeg, Marc H. W. A. Wijnen,
Annals of Pediatric Surgery, Volume 17, pp 1-9; doi:10.1186/s43159-021-00086-8

Background Retroperitoneal germ cell tumors (GCTs) are rare, commonly large tumors, often diagnosed in infancy. Complete surgical resection may pose a serious challenge as encasement of major vessels and organ displacement can lead to perioperative complications. This study aims to illustrate the surgical challenges of excising retroperitoneal GCTs. Results Nine patients were included: six patients with a teratoma, two patients with a mixed GCT with a yolk sac tumor component, and one patient with a pure yolk sac tumor. Six were males and seven were younger than 1 year of age at time of presentation. In all cases, perioperative vascular or organ-related complications occurred in one patient; this resulted in short bowel syndrome. There was no recurrence or mortality during the follow-up period. Relevant literature is reviewed and described. Conclusions The anatomical relation of a retroperitoneal GCT to the major vessels and organs is unpredictable. Preoperative radiological evaluation can help to improve the understanding of the vascular anatomy and to plan accordingly. Anteriorly displaced veins may appear insignificant and arteries, such as the superior mesenteric artery may be encased. Preoperative imaging may prevent perioperative complications, leading to safer surgical procedures. Level IV evidence Therapeutic study
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