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New tools in the treatment of motility disorders in childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastrointestinal motility disorders can develop in neurologically impaired children and those with congenital malformations of the gut. It is characterized by moderate to severe abdominal pain, vomiting, and failure to thrive. Antral dysmotility after fundoplication and increased sympathetic over activity are 2 factors associated with this condition that make it difficult to treat. This paper proposes a management strategy using metoclopramide, celiac plexus blockade, and thoracic splanchnectomy. It reviews our experience with 11 patients. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Robert Carachi, John M. Currie, Mairi Steven Source Type: journals

Potential of cell therapy to treat pediatric motility disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gut motility disorders represent a significant challenge in clinical management with current palliative approaches failing to overcome disease and treatment-related morbidity. The recent progress with stem cells to restore missing or defective elements of the gut neuromusculature offers new hope for potential cure. Focusing on enteric neuropathies such as Hirschsprung's disease, the review discusses the progress that has been made in the sourcing of putative stem cells and the studies into their biology and therapeutic potential. It also explores the practical challenges that must be overcome before stem cell-based therapi...
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Ryo Hotta, Dipa Natarajan, Nikhil Thapar Source Type: journals

Intestinal transplantation for motility disordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Intestinal transplantation (ITx) has now become an accepted form of replacement therapy for intestinal failure (IF) and its complications. Disorders of bowel motility may represent up to 25% of patients on waiting lists for ITx. Some patients with short bowel as a cause for IF may also have dysmotile bowel. Underlying pathology of the intestine is heterogenous and may be due to abnormalities in the nerve supply, intestinal smooth muscle, or may be regarded as idiopathic (chronic intestinal pseudo-obstruction). Outcome after ITx for dysmotility has previously been guarded, but providing the appropriate graft is used and tak...
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Alastair J.W. Millar, Girish Gupte, Khalid Sharif Source Type: journals

The dilated bowel: a liability and an assetEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The gastrointestinal tract responds to significant mechanical or functional obstruction by dilatation and hypertrophy of the segment proximal to the obstruction. Excessive dilatation compromises motility, and absorption and is associated with considerable morbidity (intraluminal stasis, sepsis) such that bowel dilatation represents a major liability that predisposes the patient to intestinal failure. The dilated bowel proximal to an obstruction provides valuable autologous material for reconstruction with “tissue appropriate to the part.” Bowel elongation and dilatation are integral to the natural intestinal adaptation...
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: A. Bianchi, A. Morabito Source Type: journals

Internal anal sphincter achalasiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Internal anal sphincter (IAS) achalasia is a clinical condition with presentation similar to Hirschsprung's disease, but with the presence of ganglion cells on rectal suction biopsy. The diagnosis is made by anorectal manometry, which demonstrates the absence of the rectosphincteric reflex on rectal balloon inflation. The IAS is regulated by several neurogenic mechanisms, and so its pathogenesis is thought to be multifactorial, including the absence of nitrergic innervations, defective innervation of the neuromuscular junction, and altered distribution of interstitial cells of Cajal. The recommended treatment of choice is ...
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Reshma Doodnath, Prem Puri Source Type: journals

Omega-3 lipids for intestinal failure associated liver diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Intestinal failure associated liver disease (IFALD) is one of the most common and devastating complications in infants with intestinal failure. Although multifactorial, its pathophysiology is clearly related to the administration of parenteral nutrition (PN), with a recent focus on the role of PN lipid emulsions. This paper will review the evidence for the use of omega-3 fatty acid PN lipid emulsions, which are proposed to have efficacy in the treatment of IFALD. Mechanisms explaining their effects will be considered as will future research directions. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Ivan R. Diamond, Paul B. Pencharz, Paul W. Wales Source Type: journals

Clinical management of motility disorders in childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We review the current clinical evaluation and management of the most common esophageal and gastrointestinal motility disorders in children based on the literature and our experience in a pediatric motility center in the United States. The disorders discussed include esophageal achalasia, pre- and post-fundoplication motility disorders, gastroparesis, motility disorders occurring after repair of congenital atresias, motility disorders associated with gastroschisis, chronic intestinal pseudo-obstruction, motility after intestinal transplantation, motility disorders after colonic resection for Hirschsprung's disease, chronic ...
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Cheryl E. Gariepy, Hayat Mousa Source Type: journals

Practical pathology and genetics of Hirschsprung's diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Diagnosis and management of Hirschsprung's disease (HSCR) requires understanding of the malformation's anatomic features and multigenic nature. Rectal biopsies, intraoperative frozen sections, and resection specimens provide invaluable information. Extraction of these data requires thoughtful biopsy technique, adequate histologic sections, histochemistry, and collaboration of surgeon and pathologist. Critical consideration of transition zone anatomy and published studies of “transition zone pull through” indicate that more research is needed to determine how much ganglionic bowel should be resected from HSCR patients. ...
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Raj P. Kapur Source Type: journals

The histopathology of gastrointestinal motility disorders in childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastrointestinal motility disorders and chronic constipation are common pediatric problems. Symptoms of abdominal discomfort are frequently encountered in the daily practice of pediatricians and pediatric surgeons. Normal peristalsis depends on the interaction between muscles, nerve cells, and tendinous connective tissue of muscularis propria. Malfunction of any of these components results in a motility disorder. Aganglionosis, typically of the left distal colon, is the cause of Hirschsprung disease. Hypoganglionosis constitutes another gastrointestinal motility disorder. In hypoplastic hypoganglionosis, the number of nerv...
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Sonja Feichter, William A. Meier-Ruge, Elisabeth Bruder Source Type: journals

Development of the enteric nervous system and its role in intestinal motility during fetal and early postnatal stagesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Motility patterns in the mature intestine require the coordinated interaction of enteric neurons, gastrointestinal smooth muscle, and interstitial cells of Cajal. In Hirschsprung's disease, the aganglionic segment causes functional obstruction, and thus the enteric nervous system (ENS) is essential for gastrointestinal motility after birth. Here we review the development of the ENS. We then focus on motility patterns in the small intestine and colon of fetal mice and larval zebrafish, where recent studies have shown that the first intestinal motility patterns are not neurally mediated. Finally, we review the development of...
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Alan J. Burns, Rachael R. Roberts, Joel C. Bornstein, Heather M. Young Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Two years ago, I corresponded with Professor Jay Grosfeld about the lack of evidence-based medicine concerning gastrointestinal motility disorders. In a prompt reply, he described it as one of the “black box” areas in surgery and how little is known about this spectrum of disorders. A lot of experimental work has unravelled the mysteries of the “enteric nervous system (ENS),” and there is a growing interest in the management of these disorders by pediatricians, gastroenterologists, and neurogastroenterologists that seems very far removed from the realms of the general pediatric surgeon. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Authors: Robert Carachi Source Type: journals

TopicsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Pediatric Surgery - September 28, 2009 Category: Pediatrics Source Type: journals

Forthcoming topicsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Pediatric Surgery - July 22, 2009 Category: Pediatrics Source Type: journals

Ethical issues in pediatric bariatric surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Performance of bariatric surgery in pediatric patients carries profound ethical burdens for all stakeholders: morbidly obese children and adolescents, their parents and families, pediatric physicians and surgeons, pediatric health care institutions, and society. The decision to proceed with a bariatric intervention should be made only after it is established that the patient's comorbidities could not be treated with less invasive means, the patient has a favorable risk/benefit profile, the patient and her/his family have received extensive preoperative counseling and given informed consent, and the pediatric bariatric team...
Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Authors: Donna A. Caniano Source Type: journals

How young for bariatric surgery in children?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses the problems obesity presents to children and their families, highlights the unique aspects of treating obesity in children, reviews the currently utilized bariatric surgical procedures, and introduces those bariatric procedures that are under development. When considering whether to use bariatric surgical procedures in a multidisciplinary weight management program for children, the special needs and characteristics of children with a severe weight problem must be considered. Development of bariatric surgical techniques and devices and implementation of these tools in multidisciplinary weight managem...
Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Authors: Allen F. Browne, Thomas Inge Source Type: journals

Medical versus surgical interventions for the metabolic complications of obesity in childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The global epidemic of obesity has not spared children. Although prevention of obesity is commendable, we cannot hide from the pressing need to identify, assess, and actively manage children seriously afflicted by obesity and its associated conditions. Sustained weight loss (or, for children, lowering of body mass index standard deviation score) delivers major health benefit, but in children has been difficult to achieve. In adults, the success of the diabetes prevention programs using practical lifestyle interventions is indisputable. Medical therapy, although currently limited in it scope, provides some promise for older...
Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Authors: John B. Dixon, Kay Jones, Maureen Dixon Source Type: journals

Weighing risk: the Expert Committee's recommendations in practiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews recommendations on assessment of BMI, nutrition and activity, and obesity-related comorbidities. Principles of obesity prevention and treatment are discussed and high-risk eating and activity behaviors are addressed. Prevention and treatment of obesity are reviewed as set in the context of the Medical Home using the principles of the chronic disease model. The stepwise approach to obesity treatment and prevention is reviewed along with specific evidence-based/informed strategies. The skills needed to implement the recommendations, such as integration of the care team, roles and training, links to the h...
Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Authors: Sandra G. Hassink Source Type: journals

Diet, exercise, behavior: the promise and limits of lifestyle changeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The prevalent surge in childhood and adolescent obesity within the past 3 decades poses a significant challenge for many pediatric clinicians who are charged with treating this condition. Comprehensive, research-based pediatric obesity treatment programs are essential to addressing this problem and preventing the transition of obesity and its many comorbidities into adulthood. This paper will identify dietary, physical activity, and behavioral approaches to lifestyle change and describe how they are incorporated as part of multidisciplinary treatment interventions in youth. Specific tailoring of treatment programs to addre...
Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Authors: Brian Bennett, Melinda S. Sothern Source Type: journals

Diagnosis and treatment of pediatric nonalcoholic steatohepatitis and the implications for bariatric surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This review focuses on the diagnosis, risk factors, prevalence, pathogenesis and treatment of pediatric nonalcoholic steatohepatitis (NASH). NASH is a progressive form of nonalcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease in children. The factors that account for differences between children with NASH and children with milder forms of NAFLD are unclear. The diagnosis of NASH requires interpretation of liver histology because no noninvasive markers predict the presence or severity of NASH. There is no proven treatment for NASH. Several clinical trials for NAFLD are in progress; however,...
Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Authors: Perrie E. Pardee, Joel E. Lavine, Jeffrey B. Schwimmer Source Type: journals

Use of the metabolic syndrome in pediatrics: a blessing and a curseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The clustering of traditional cardiovascular disease risk factors is known as the metabolic syndrome. The metabolic syndrome was first characterized as a distinct entity by Dr. Gerald Reaven in 1988. The intent was to identify individuals at greatest risk for cardiovascular disease mortality and those in urgent need of lifestyle intervention. Since then the metabolic syndrome has evolved into a diagnosable entity recognized by the National Cholesterol Education Program, Adult Treatment Panel III, World Health Organization, and the International Diabetes Foundation. However, the metabolic syndrome as a diagnosis faces consi...
Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Authors: Michelle Battista, Robert D. Murray, Stephen R. Daniels Source Type: journals

Changes in physiology with increasing fat massEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Obesity has reached epidemic proportions in the USA with a nearly fourfold rise in the prevalence of childhood obesity. There are many possible etiologies of obesity as the adipose tissue plays a significant, complex role in the physiology of fuel metabolism and hormone regulation. The development of obesity represents a pathophysiologic increase in fat mass in which multiple metabolic pathways are deranged. The consequences of these metabolic derangements, including insulin resistance and inflammation, are reflected in obesity-related comorbidities and can be seen in the setting of pediatric obesity. Obese adolescents dem...
Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Authors: Dara P. Schuster Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Although the overall health status of the pediatric population in the United States has improved, the last quarter century has witnessed a dramatic rise in the prevalence of childhood obesity and its associated comorbid conditions. Specifically, the medical community is witnessing a steady and alarming rise in the prevalence of chronic diseases among obese children, including diabetes, hypertension, obstructive sleep apnea, hyperlipidemia, and cardiovascular disease. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Authors: Steven Teich, Marc P. Michalsky Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Pediatric Surgery - July 1, 2009 Category: Pediatrics Source Type: journals

Managing the adverse event occurring during elective, ambulatory pediatric surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Adverse medical events occurring in the context of care of children undergoing elective surgical procedures are usually truly unexpected occurrences with the potential for long-term consequences. Such events, when they occur, are obviously devastating to the patient and family, but frequently also to the pediatric surgeon and his/her team. When such events occur, it is important to ensure uninterrupted care of the patient, a full disclosure of events leading to harm, and an ongoing accessibility to the family for disclosure of new information as it becomes available. Finally, it is important that the adverse event be syste...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Erik D. Skarsgard Source Type: journals

Lethal outcome after percutaneous aspiration of a presumed ovarian cyst in a neonateEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present a newborn infant who was admitted with sepsis and respiratory failure after home delivery. Ultrasound done on day 8 to check for umbilical venous line placement incidentally showed a simple cyst measuring 3.6 × 5.9 × 6.9 cm that was presumed to be of ovarian origin. Percutaneous needle aspiration was atraumatic and revealed serous fluid, with a high estradiol level. Four days later, surgery was indicated for clinical deterioration with suspected hemorrhage into the cyst. We found a midgut volvulus with extensive necrosis secondary to a jejunal duplication cyst. Ovaries were normal and there was no evidence of ...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Pramod S. Puligandla, Jean-Martin Laberge Source Type: journals

The pitfalls of endotracheal intubation beyond the fistula in babies with type C esophageal atresiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The intraoperative management of a neonate with esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) is a true anesthetic challenge. Pediatric anesthesia textbooks recommend a distal tracheal intubation beyond the fistula and spontaneous ventilation, if possible, until surgical control of the fistula is achieved to minimize gastric distention. A full-term neonate with Trisomy 21 presented with an EATEF and was transferred to the operating theater for repair after appropriate evaluation. After induction of anesthesia, a size 3.0 endotracheal tube was inserted orally with confirmation of its position by good ai...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Saleh I. Alabbad, Kenneth Shaw, Pramod S. Puligandla, Rubin Carranza, Chantal Bernard, Jean-Martin Laberge Source Type: journals

Paraplegia after chest wall resection for primitive neuroectodermal tumorEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present a patient who became paraplegic after resection of a chest wall tumor. After neoadjuvant radio- and chemotherapy, a 10-year-old girl with primitive neuroectodermal tumor (PNET) of the right chest underwent a right chest wall resection. Ribs #3, 4, 5, and 6 were resected en masse with a pulmonary wedge resection of right upper and middle lobes. To obtain clear margins, the ribs were disarticulated from the vertebral column. Significant bleeding arose when the fourth rib was detached. Presuming an intercostal vessel bleed, the area was packed with surgicel with resolution of the bleeding. The patient was kept seda...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Jon Ryckman, Jean-Martin Laberge, Pramod S. Puligandla Source Type: journals

Intestinal venous congestion as a complication of elective silo placement for gastroschisisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Use of a spring-loaded silastic silo has been advocated as a means of gentle reduction of the herniated bowel, while avoiding the possible complications of primary closure of gastroschisis. We recently encountered intestinal venous congestion during elective silo reduction of gastroschisis. Two babies with gastroschisis were treated postdelivery with a spring-loaded silo placed under the fascial defect and the eviscerated bowel suspended within the silo. Patient #1 had no bowel matting. On day of life 2, the bowel within the silo was noted to be dusky. The silo was removed, and the bowel was indeed congested, but viable. C...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Jon Ryckman, Ann Aspirot, Jean-Martin Laberge, Kenneth Shaw Source Type: journals

Delayed fistulisation from esophageal replacement surgeryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present two patients who developed delayed fistulisation following esophageal replacement surgery. The first is a 13-year-old child who, at the age of 3 years, underwent a trans-mediastinal colonic esophageal replacement for a refractory corrosive injury followed by a retrosternal reverse gastric tube after an early catastrophic leak. Ten years later, he presented with a history of intermittent chest pain for 6 months. He developed a tension pneumopericardial tamponade caused by a fistula between gastric tube and pericardium. He recovered after sternotomy. The second was born prematurely with type C esophageal atresia a...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Ahmed Abdalwahab, Mohammed Al Namshan, Abdullah Al Rabeeah, Jean-Martin Laberge Source Type: journals

Gastric volvulus in children: lessons learned from delayed diagnosesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastric volvulus in infants, children, and adolescents is a rare event. The purpose of this study is to examine this congenital abnormality and its consequences, using cases with significant adverse outcomes. We will specifically discuss issues of diagnosis and treatment of acute gastric volvulus in association with diaphragmatic anomalies. In addition, the different types of gastric volvulus are compared and contrasted, highlighting areas that may allow for early recognition and prevention of complications related to this foregut obstructive process. Three clinical cases are reviewed, all with significant morbidity and/or...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: J. Ted Gerstle, Priscilla Chiu, Sherif Emil Source Type: journals

Percutaneous endoscopic gastrostomy (PEG) in children is not a minor procedure: risk factors for major complicationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Percutaneous endoscopic gastrostomy (PEG) provides for enteral nutrition in children with feeding problems. PEG, however, is not without complications. The present study has a twofold aim: (1) comparing our incidence of major complications after PEG with the incidence in other centers, and (2) identifying risk factors for major complications. All patients receiving a PEG or laparoscopic-assisted PEG (lap PEG) in the period 1992-2008 were reviewed. Primary outcome was the occurrence of major complications, defined as the need for surgery, nonprophylactic antibiotics, or blood transfusion, and procedure-related death. Potent...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Dirk Vervloessem, Frank van Leersum, Dirk Boer, Wim C.J. Hop, Johanna C. Escher, Gerard C. Madern, Lissy de Ridder, Klaas N.M.A. Bax Source Type: journals

Attention to small details: big deal for gastrostomiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastrostomy tubes are used in the pediatric population when long-term enteral feeding is needed. A common method of placement is percutaneously with endoscopy (PEG, percutaneous endoscopic gastrostomy). Although PEG placement is a straightforward procedure most of the time, it can be associated with a significant rate of minor complications and a smaller but significantly important rate of major complications. Some of these complications may also occur after any type of gastrostomy. We will present representative case studies outlining major complications and discuss how we may be able to prevent them at the time of PEG in...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Alana Beres, Ioana Bratu, Jean-Martin Laberge Source Type: journals

Skin erosion over totally implanted vascular access devices in childrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Erosion of the skin over a totally implanted vascular access device (TIVAD) is a rare event that may lead to life-threatening sequelae. From 1994 to 2007, we reviewed the medical records and central line database of 960 central line insertions for the complication of skin erosion over the TIVAD. Outcome measures included age, gender, and nutritional status, number of days until complication, insertion site, and attending surgeon. A total of 540 of the 960 central lines were TIVAD. Skin erosion occurred in 9 patients for an incidence of 1.67%. Average age at insertion was 51 months (range 25-116.5 months). The average cathe...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Juan Bass, Jacqueline M. Halton Source Type: journals

Rare but serious complications of central line insertionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussions on the complications of central venous catheterization in children typically focus on infectious and the more common mechanical complications of pneumothorax, hemothorax, or thrombosis. Rare complications are often more life-threatening, and inexperience may compound the problem. Central venous catheter complications can be broken down into early or late, depending on when they occur. The more serious complications are typically mechanical and occur early, but delayed presentations of pericardial effusions, cardiac tamponade, and pleural effusions may be of equal severity, and delay in diagnosis can be catastro...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Johanna R. Askegard-Giesmann, Donna A. Caniano, Brian D. Kenney Source Type: journals

Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This paper presents four severe cardiac injuries that occurred in patients who underwent the minimally invasive repair of pectus excavatum (MIRPE). These complications occurred in different clinical settings, namely in a patient with an extremely severe form of pectus, in a patient who had previously undergone an open repair, after a previous open heart surgery, and at the time of bar removal. The purpose of this article is to review the circumstances leading to these cardiac injuries, share what we have learned from these patients, and hopefully help avoid these complications in the future. (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Sarah Bouchard, Andrew R. Hong, Brian F. Gilchrist, Keith A. Kuenzler Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Complications are part of the life as a surgeon, hence the popular saying, “The only surgeons who don't have surgical complications are those who don't operate.” Many complications are unavoidable. For example, a small percentage of wound infections will always occur in patients with perforated appendicitis, despite meticulous technique and the use of properly timed preoperative antibiotics. Those who leave all contaminated wounds open may never have to report a wound infection, but is it worth submitting all children to the discomfort of an open wound and dressing changes to avoid a 5-10% rate of wound infection? Pers...
Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Authors: Jean-Martin Laberge Source Type: journals

Forthcoming topicsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Source Type: journals

MastheadEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Pediatric Surgery - May 1, 2009 Category: Pediatrics Source Type: journals

Preface.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PMID: 19348993 [PubMed - in process] (Source: Seminars in Pediatric Surgery)
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Laberge JM Tags: Semin Pediatr Surg Source Type: journals

Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This paper presents four severe cardiac injuries that occurred in patients who underwent the minimally invasive repair of pectus excavatum (MIRPE). These complications occurred in different clinical settings, namely in a patient with an extremely severe form of pectus, in a patient who had previously undergone an open repair, after a previous open heart surgery, and at the time of bar removal. The purpose of this article is to review the circumstances leading to these cardiac injuries, share what we have learned from these patients, and hopefully help avoid these complications in the future. PMID: 19348994 [PubMed ...
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Bouchard S, Hong AR, Gilchrist BF, Kuenzler KA Tags: Semin Pediatr Surg Source Type: journals

Rare but serious complications of central line insertion.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussions on the complications of central venous catheterization in children typically focus on infectious and the more common mechanical complications of pneumothorax, hemothorax, or thrombosis. Rare complications are often more life-threatening, and inexperience may compound the problem. Central venous catheter complications can be broken down into early or late, depending on when they occur. The more serious complications are typically mechanical and occur early, but delayed presentations of pericardial effusions, cardiac tamponade, and pleural effusions may be of equal severity, and delay in diagnosis can be catastro...
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Askegard-Giesmann JR, Caniano DA, Kenney BD Tags: Semin Pediatr Surg Source Type: journals

Skin erosion over totally implanted vascular access devices in children.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Erosion of the skin over a totally implanted vascular access device (TIVAD) is a rare event that may lead to life-threatening sequelae. From 1994 to 2007, we reviewed the medical records and central line database of 960 central line insertions for the complication of skin erosion over the TIVAD. Outcome measures included age, gender, and nutritional status, number of days until complication, insertion site, and attending surgeon. A total of 540 of the 960 central lines were TIVAD. Skin erosion occurred in 9 patients for an incidence of 1.67%. Average age at insertion was 51 months (range 25-116.5 months). The average c...
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Bass J, Halton JM Tags: Semin Pediatr Surg Source Type: journals

Attention to small details: big deal for gastrostomies.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastrostomy tubes are used in the pediatric population when long-term enteral feeding is needed. A common method of placement is percutaneously with endoscopy (PEG, percutaneous endoscopic gastrostomy). Although PEG placement is a straightforward procedure most of the time, it can be associated with a significant rate of minor complications and a smaller but significantly important rate of major complications. Some of these complications may also occur after any type of gastrostomy. We will present representative case studies outlining major complications and discuss how we may be able to prevent them at the time of PE...
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Beres A, Bratu I, Laberge JM Tags: Semin Pediatr Surg Source Type: journals

Percutaneous endoscopic gastrostomy (PEG) in children is not a minor procedure: risk factors for major complications.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Percutaneous endoscopic gastrostomy (PEG) provides for enteral nutrition in children with feeding problems. PEG, however, is not without complications. The present study has a twofold aim: (1) comparing our incidence of major complications after PEG with the incidence in other centers, and (2) identifying risk factors for major complications. All patients receiving a PEG or laparoscopic-assisted PEG (lap PEG) in the period 1992-2008 were reviewed. Primary outcome was the occurrence of major complications, defined as the need for surgery, nonprophylactic antibiotics, or blood transfusion, and procedure-related death. Po...
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Vervloessem D, van Leersum F, Boer D, Hop WC, Escher JC, Madern GC, de Ridder L, Bax KN Tags: Semin Pediatr Surg Source Type: journals

Gastric volvulus in children: lessons learned from delayed diagnoses.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastric volvulus in infants, children, and adolescents is a rare event. The purpose of this study is to examine this congenital abnormality and its consequences, using cases with significant adverse outcomes. We will specifically discuss issues of diagnosis and treatment of acute gastric volvulus in association with diaphragmatic anomalies. In addition, the different types of gastric volvulus are compared and contrasted, highlighting areas that may allow for early recognition and prevention of complications related to this foregut obstructive process. Three clinical cases are reviewed, all with significant morbidity an...
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Gerstle JT, Chiu P, Emil S Tags: Semin Pediatr Surg Source Type: journals

Delayed fistulisation from esophageal replacement surgery.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present two patients who developed delayed fistulisation following esophageal replacement surgery. The first is a 13-year-old child who, at the age of 3 years, underwent a trans-mediastinal colonic esophageal replacement for a refractory corrosive injury followed by a retrosternal reverse gastric tube after an early catastrophic leak. Ten years later, he presented with a history of intermittent chest pain for 6 months. He developed a tension pneumopericardial tamponade caused by a fistula between gastric tube and pericardium. He recovered after sternotomy. The second was born prematurely with type C esophageal atresia a...
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Abdalwahab A, Al Namshan M, Al Rabeeah A, Laberge JM Tags: Semin Pediatr Surg Source Type: journals

Intestinal venous congestion as a complication of elective silo placement for gastroschisis.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Use of a spring-loaded silastic silo has been advocated as a means of gentle reduction of the herniated bowel, while avoiding the possible complications of primary closure of gastroschisis. We recently encountered intestinal venous congestion during elective silo reduction of gastroschisis. Two babies with gastroschisis were treated postdelivery with a spring-loaded silo placed under the fascial defect and the eviscerated bowel suspended within the silo. Patient #1 had no bowel matting. On day of life 2, the bowel within the silo was noted to be dusky. The silo was removed, and the bowel was indeed congested, but viabl...
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Ryckman J, Aspirot A, Laberge JM, Shaw K Tags: Semin Pediatr Surg Source Type: journals

Paraplegia after chest wall resection for primitive neuroectodermal tumor.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We present a patient who became paraplegic after resection of a chest wall tumor. After neoadjuvant radio- and chemotherapy, a 10-year-old girl with primitive neuroectodermal tumor (PNET) of the right chest underwent a right chest wall resection. Ribs #3, 4, 5, and 6 were resected en masse with a pulmonary wedge resection of right upper and middle lobes. To obtain clear margins, the ribs were disarticulated from the vertebral column. Significant bleeding arose when the fourth rib was detached. Presuming an intercostal vessel bleed, the area was packed with surgicel with resolution of the bleeding. The patient was kept seda...
Source: Seminars in Pediatric Surgery - April 9, 2009 Category: Pediatrics Authors: Ryckman J, Laberge JM, Puligandla PS Tags: Semin Pediatr Surg Source Type: journals