Pediatric radiology mission work: opportunities, challenges and outcomes

Establishment of an interdisciplinary vascular anomalies program in Tanzania, East Africa

Purpose

The aim of this project is the sustainable implementation of a vascular anomalies (VA) program in Tanzania.

Materials and methods

In 2021 the first interdisciplinary VA program was initiated at Muhimbili National Hospital (MNH), Dar Es Salaam, Tanzania in a stepwise approach. During the planning phase the clinical need for minimally-invasive therapies of VAs and the preexisting structures were assessed by the local Interventional Radiology (IR) team at MNH. During the initiation phase, an IR team from two German VA centers joined the interdisciplinary team at MNH for clinical workup, image-guided procedures and follow-up. VA patients were recruited from existing patient records or seen at clinics as de novo presentations following nationwide advertisement. In the post-processing phase joined online conferences for follow-up and support in management of new patients were established. Further follow-up was supported by attending providers from other established VA centers, traveling to bolster the primary operators of MNH.

Results

The first interdisciplinary VA program was successfully launched in Tanzania. Minimally-invasive treatments were successfully trained, by performing ultrasound-guided sclerotherapy with polidocanol and bleomycin in twelve patients with slow-flow malformations, one endovascular embolization of a high-flow malformation, and medical treatment of an aggressive infantile hemangioma. Regular online follow-up presentations have been initiated. Follow-up evaluation and required treatment was sustained when appropriate.

Conclusion

The presented "hands-on" training set the ground for the first interdisciplinary VA program in Tanzania. This framework is expected to establish comprehensive and sustainable care of patients with VAs in East Africa and can serve as a blueprint for other sites.

Isolated vascularized gastric tube biliary enteric drainage: a paediatric case series experience

Background

Despite the enormous surgical advancements in the last century, access to the biliary system is lost when a Roux-en-Y (RY) biliary drainage procedure is performed. Attempts have been made to overcome this inconvenient sequel using variations in the RY anastomosis, small bowel grafts and vascular grafts. These have been predominantly unsuccessful. An isolated vascularized gastric tube (IVGT) graft has been reported in the literature, which was successfully used for adult patients with common bile duct injuries. We have adopted the technique of using an IVGT graft for bile duct reconstruction in the paediatric patients at our institution. We reviewed our experience at our institution between January 2015 and October 2019. This was a retrospective review of all paediatric patients undergoing an IVGT graft procedure for biliary tract anatomical obstruction in the past 5 years. We looked at the indications for surgery, the demographic profile of the patients and outcomes following surgery and outlined the surgical technique used.

Results

IVGT bile duct reconstruction was performed on eight patients. Patients ranged from 2 months to 7 years, and there was an equal number of males and females. The diagnosis was made on clinical suspicion and confirmed with ultrasound (U/S) and magnetic resonance cholangiopancreatography (MRCP). There was an 87.5% resolution of biliary obstruction, and two patients who had bile leaks postoperatively were managed conservatively. Unfortunately, one patient died in the early postoperative period from sepsis due to pneumonia. Follow-up was for a minimum of 6 months and up to 5 years.

Conclusion

IVGT biliary enteric drainage is a safe, reproducible procedure that allows access to the biliary tree if required in the future. Thus, this procedure serves as an alternative, especially in limited-resource areas where interventional radiology is not available for future interventions.

Pediatric radiology crossing continents

This paper will discuss, from a subjective perspective, aspects of paediatric radiology in different parts of the world. A small survey was conducted to improve our understanding of radiologic care and to explore the current status of paediatric radiology worldwide. As part of this survey, the number of paediatric radiologists and radiologists was compared to the population and to the number of children in 34 countries. The number of paediatric radiologists varied between 0 and 50 per million children. In general, the proportion of paediatric radiologists compared to radiologists is poor, even in countries with an aging population. Unfortunately, developing countries are severely underserved in terms of radiology, while paediatric radiology is almost nonexistent. The author, based on her experiences as a volunteer paediatric radiologist in Malawi, India, Cambodia and Tanzania, highlights some of the difficulties in radiologic care in developing countries. The author's personal experiences and the survey both suggest that the need for paediatric radiology is high across the world, but the supply is not sufficient, especially in developing countries, when compared to developed countries.