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Li Z, Zhang X, Sun C, Li Z, Fei H, Zhao D. Global, regional, and national burdens of early onset pancreatic cancer in adolescents and adults aged 15-49 years from 1990 to 2019 based on the Global Burden of disease study 2019: A cross-sectional study. Int J Surg 2024; 110:01279778-990000000-00947. [PMID: 38215264 PMCID: PMC11020133 DOI: 10.1097/js9.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Early-onset pancreatic cancer (EOPC) in younger populations (age≤50 y) is likely to be a more aggressive phenotype characterized by poor differentiation. The emerging analysis of the global burden of EOPC is limited and outdated. AIM To systematically investigate the burden and trend of EOPC based on global populations. METHODS In this systematic analysis based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we present the number of cases, age-standardized rates (ASRs) per 100,000 population, and risk factors for 204 countries and territories. The average annual percentage changes (AAPCs) for the incidence, mortality, and disability-adjusted life-years (DALYs) of EOPC were calculated using joinpoint regression analysis. RESULTS According to the GBD 2019 estimates, there were 36,852 new cases of EOPC and 32,004 related deaths. East Asia had the highest number of cases, with 11,401 incidences and 10,149 deaths. The ASRs were 0.94 per 100,000 individuals for incidence and 0.81 per 100,000 for mortality. From 1990 to 2019, the age-standardized incidence increased by 46.9%, mortality increased by 44.6%, and DALYs increased by 41.9% globally. In trend analysis, the global incidence (AAPC, 1.26), mortality (AAPC, 1.24), and DALYs (AAPC, 1.25) of EOPC showed an increasing pattern. The ASRs of incidence, mortality, and DALYs of EOPC in Africa, America, and Asia exhibited a continuous upward trend, while the trend in Europe was fluctuating. Asian males exhibited the fastest growth in incidence (AAPC, 2.15) and mortality (AAPC, 2.13), whereas males in the Americas experienced the slowest increase in new cases (AAPC, 0.72) and deaths (AAPC, 0.67). A certain proportion of EOPC DALYs were attributable to known risk factors: tobacco smoking (13.3%), high body-mass index (BMI, 5.6%), and high fasting plasma glucose (FPG, 3.2%). Integrating the socio-demographic index (SDI), ASRs of incidence and mortality initially increased with rising SDI, reaching a peak in central Europe (1.5 per 100,000 CONCLUSIONS The findings offer valuable insights into the global distribution and magnitude of the EOPC burden. The burden is increasing at a rapid pace worldwide, particularly in Asia, and is notably high in central and eastern Europe. This highlights the need for additional preventive control efforts targeting high-risk populations.
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Affiliation(s)
| | | | | | | | | | - Dongbing Zhao
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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Foster C, Mamaeva O, Shrestha S, Hidalgo B. Epigenetic age in African American adolescents with type 2 diabetes: A cross-sectional case-control study protocol. Health Sci Rep 2023; 6:e1747. [PMID: 38078300 PMCID: PMC10702396 DOI: 10.1002/hsr2.1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/01/2023] [Accepted: 11/21/2023] [Indexed: 02/12/2024] Open
Abstract
Background and Aims Type 2 diabetes (T2D) is a disease caused by a relative insulin deficiency compared to the significant insulin requirement needed by the body to achieve glycemic control. T2D in adolescence appears to be increasing in prevalence over the past several decades, necessitating studies to understand for the onset of the disease to occur early in the lifespan. Given the high burden of disease, specifically in young African American adolescents, our study chose to focus initially on feasibility of recruitment of this population. Methods Data was collected at a single study center at Children's of Alabama. The protocol was completed as part of routine care or at a study visit. The study team was able to leverage the Electronic Medical Record to prescreen eligible patients to discuss the study. A variety of times of day were utilized to improve likely of success with reaching potential participants. Inclusion criteria for patients with T2D was focused on the adolescent population (ages 12-18 years), with no history of an obesity syndrome. DNA methylation age will be calculated using the EPIC 850K array. Statistical analysis will be done using linear regression analysis, adjusting for covariates. Conclusions This study's aim was to screen and enroll young African American adolescents for a study investigating epigenetic aging and T2D. Our study found that more direct contact (face-to-face- or phone call) improve success of recruitment. Leveraging the electronic medical record also helped improve success with pre-screening participants. Challenges included recruiting participants who might come from long distances to a tertiary care center. Consolidating appointments helped improve the success of reaching these participants. Other challenges included frequent address changes and changed phone numbers. Close attention to the barriers as well as the successes will aid in understanding effective strategies for this important population.
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Affiliation(s)
- Christy Foster
- Division of Pediatric EndocrinologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Olga Mamaeva
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Sadeep Shrestha
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Bertha Hidalgo
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Liao Y, Zhou W, Dai M, Zhou J, Wang Y, He X, Liu Y, Cheng W. Analysis of the clinical efficacy of laparoscopic middle pancreatectomy in the treatment of benign or low-grade malignant tumors of the pancreas. Front Oncol 2023; 13:1231647. [PMID: 38023120 PMCID: PMC10652557 DOI: 10.3389/fonc.2023.1231647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The aim of this study was to investigate the clinical efficacy of laparoscopic middle pancreatectomy in the treatment of benign and junctional tumors of the pancreas. Methods Retrospective analysis of basic data, tumor diameter, statistical analysis, and evaluation of efficacy-related indicators such as operative time, intraoperative bleeding, pathological findings, postoperative hospital stay, postoperative pancreatic fistula incidence, and pancreatic endocrine function was carried out on 17 patients diagnosed with benign or low-grade malignant tumors of the pancreas and laparoscopic middle pancreatic resection from January 2018 to January 2023 at the First Affiliated Hospital of Hunan Normal University. Results A total of 17 patients were screened. There were eight males and nine females; mean age was 42.8 ± 17.4 years (range: 15-69 years); BMI was 22.6 ± 2.5 kg/m2 (range: 18.4-27.5 kg/m2), and the tumor size was 3.4 ± 1.2 cm (range: 1.5-5.5 cm). Preoperative glycan antigen CA19-9 was negative and CA125 was negative. Surgical time was 393.2 ± 57.9 min; intraoperative bleeding was 211.7 ± 113.9 ml; tumor diameter size was 3.4 ± 1.2 cm; postoperative admission time was 19.4 ± 7.6 days; postoperative pancreatic fistula (POPF) grading was 17 cases, including nine cases of A-grade fistula, three cases of B-grade fistula, and none of C-grade fistula; postoperative pathology results were five cases of plasmacytoma, three cases of mucinous cystadenoma, four cases of SPN (solid pseudopapillary neoplasm), one case of Intraductal Papillary Mucinous Neoplasm (IPMN), three cases of pancreatic Neuroendocrine Neoplasm (pNEN), one case of inflammatory myofibroblastic osteoblastoma. All cases did not develop pancreatic origin diabetes or exacerbation of previous diabetes, and no cases presented symptoms of exocrine insufficiency such as dyspepsia and diarrhea. Conclusion Laparoscopic middle pancreatectomy is safe and feasible in the treatment of benign or low-grade malignant tumors in the body of the pancreatic neck and is not accompanied by increased risk of intraoperative and postoperative complications and endocrine dysfunction of the pancreas.
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Affiliation(s)
- Yan Liao
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
- Translational Medicine Laboratory of Pancreas Disease of Hunan Normal University, Changsha, China
| | - Wei Zhou
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
- Translational Medicine Laboratory of Pancreas Disease of Hunan Normal University, Changsha, China
- Department of Hepatobiliary Surgery, Yueyang People’s Hospital, Affiliated Hospital of Hunan Normal University, Yueyang, Hunan, China
| | - Manxiong Dai
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
- Translational Medicine Laboratory of Pancreas Disease of Hunan Normal University, Changsha, China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
- Translational Medicine Laboratory of Pancreas Disease of Hunan Normal University, Changsha, China
| | - Yi Wang
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
- Translational Medicine Laboratory of Pancreas Disease of Hunan Normal University, Changsha, China
| | - Xiangyu He
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
- Translational Medicine Laboratory of Pancreas Disease of Hunan Normal University, Changsha, China
| | - Yi Liu
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
- Translational Medicine Laboratory of Pancreas Disease of Hunan Normal University, Changsha, China
| | - Wei Cheng
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
- Translational Medicine Laboratory of Pancreas Disease of Hunan Normal University, Changsha, China
- Department of General Surgery, The Third People’s Hospital of Hunan Province, Yueyang, Hunan, China
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Taher H, Kidr E, Kamal A, ElGobashy M, Mashhour S, Nassef A, Tawfik S, El Tagy G, Shaban M, Eltantawi H, Abdullateef KS. Transhepatic ultrasound guided embolization as a successful novel technique in treatment of pediatric complex intrahepatic arterioportal fistula: a case report and review of the literature. J Med Case Rep 2023; 17:412. [PMID: 37710289 PMCID: PMC10503188 DOI: 10.1186/s13256-023-04047-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/19/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Intrahepatic vascular shunts "IHVS" are abnormal communications between intra-hepatic vasculature involving the arterial, portal, or hepatic venous system. Arterio-portal fistula "APF" is an intrahepatic communication between the hepatic arterial system and the portal venous system without any communication with the systemic venous circulation. APF is considered a rare cause of portal hypertension and gastrointestinal bleeding in infancy. CASE PRESENTATION A 3-month-old Mediterranean female with known cardiac congenital anomalies presented to us with abdominal distension and diarrhea. Ultrasonography revealed massive ascites and computerized tomography (CT) abdomen with intravenous (IV) contrast revealed a left hepatic lesion. On further evaluation, an intrahepatic arterio-portal vascular malformation was detected. Attempted trans arterial embolization failed and radiology team successfully carried out direct trans hepatic ultrasound guided coiling of the aneurysmal venous sac followed by successful resection of segment 4 of the liver with the vascular malformation avoiding life threatening intra operative bleeding. CONCLUSION Any child with recurrent gastrointestinal bleeding, failure to thrive, vomiting, diarrhea, steatorrhea, splenomegaly, or ascites should be investigated for intrahepatic arterio-portal fistula "IAPF". Our novel technique of direct trans hepatic ultrasound guided coiling is an alternative method if trans arterial embolization "TAE" failed.
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Affiliation(s)
- Heba Taher
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt.
| | - ElSayed Kidr
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Ahmed Kamal
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Mohamed ElGobashy
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | - Shady Mashhour
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | - Amr Nassef
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | | | - Gamal El Tagy
- Department of Radiology, Cairo University Kasr Al Einy, Faculty of Medicine, Cairo, Egypt
| | - Muayad Shaban
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Haytham Eltantawi
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
| | - Khaled S Abdullateef
- Pediatric Surgery Department, Specialized Pediatric Hospital, Cairo University Kasr Al Einy, Faculty of Medicine, 1 Abou El Rish Sq., El Sayeda Zeinab, Cairo, Egypt
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Jamil S, Hossain MJ, Alam M, Bari QI, Hasan M, Swadhin HR, Akhter A, Sohel MS, Mukul MEH, Ali HM, Islam MR. Prevalence of fried food consumption in Ramadan (Arabian) month and factors associated with health status among university students in Bangladesh: A cross-sectional study. Health Sci Rep 2023; 6:e1551. [PMID: 37674623 PMCID: PMC10478645 DOI: 10.1002/hsr2.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Safayet Jamil
- Department of PharmacyKhwaja Yunus Ali UniversitySirajganjBangladesh
| | | | - Morshed Alam
- Institute of Education and ResearchJagannath UniversityDhakaBangladesh
| | - Quazi Istiaque Bari
- Department of PharmacyKhwaja Yunus Ali UniversitySirajganjBangladesh
- Department of PharmacyState University of BangladeshDhakaBangladesh
| | - Mahdi Hasan
- Department of StatisticsDhaka CollegeDhakaBangladesh
| | | | - Asma Akhter
- Department of PharmacyKhwaja Yunus Ali UniversitySirajganjBangladesh
| | - Md. Salman Sohel
- Department of Development StudiesDaffodil International UniversityDhakaBangladesh
| | | | - Habib Mohammad Ali
- Department of Media Studies and JournalismUniversity of Liberal Arts Bangladesh (ULAB), MohammadpurDhakaBangladesh
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Kamel K, Nasr H, Tawfik S, Azzam A, Elsaid M, Qinawy M, Kamal A, Taher H. Complicated urachal cyst in two pediatric patients: a case report. BMC Pediatr 2023; 23:147. [PMID: 37004016 PMCID: PMC10064585 DOI: 10.1186/s12887-023-03962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND A urachal cyst has a rare incidence that has been reported as 1/5,000 live birth. CASE PRESENTATION We report two patients with a complicated urachal cyst, a 5-year-old female who presented to the emergency department with severe abdominal pain and a 3-year-old female presenting with abdominal pain and constipation. Upon laparoscopic exploration both patients had complicated urachal cysts which were adherent to the urinary bladder. CONCLUSION Complicated urachal cysts can present with acute abdominal pain.
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Affiliation(s)
- Karol Kamel
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Hadeer Nasr
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Sherifa Tawfik
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Ahmed Azzam
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Mohamed Elsaid
- Faculty of Medicine, Misr University for Science and Technology, 6th of October, Giza, Egypt
| | - Mohamed Qinawy
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Ahmed Kamal
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt
| | - Heba Taher
- Department of Pediatric Surgery, Cairo University, Cairo, 11441, Egypt.
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Frenkel M, David A, Sapire K, Hausner D. Complementary and Integrative Medicine in Pancreatic Cancer. Curr Oncol Rep 2023; 25:231-242. [PMID: 36735141 DOI: 10.1007/s11912-023-01370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Pancreatic cancer has high mortality and morbidity rates, associated with the issues of typically late diagnosis and the limited effectiveness of current treatments. Patients tend to experience multiple symptoms that can include anxiety, fear, depression, fatigue, weakness, peripheral neuropathy, and abdominal pain, which reduce quality of life (QoL) and may compromise the treatment continuum. Many of those symptoms are amenable to complementary and integrative medicine (CIM) therapies as a part of supportive and palliative care. This article reviews research findings on the beneficial effect of use of CIM modalities in regard to pancreatic cancer, with emphasis on pancreatic ductal adenocarcinoma (PDAC). RECENT FINDINGS Given the often-poor prognosis of the disease, patients with PDAC often seek integrative therapies to help manage the disease itself, to provide support through cancer treatment and its symptoms, and to provide emotional stress relief. Data is accumulating in the past few years on the potential benefits of CIM to the management of pancreatic cancer symptoms and treatment side effects, in order to augment supportive care. This data reveal that nutrition counselling; digestive enzyme therapy; microbiome support; dietary supplements; lifestyle interventions (physical activity and circadian health/sleep hygiene) appear to improve QoL of these patients through reduced symptom burden and meeting psychological needs, such as distress and fatigue. Acupuncture, mindfulness, yoga, reflexology, massage, and homeopathy may also contribute to symptom reduction, both physical and psychological, in all stages of the disease. There is supporting evidence that some CIM modalities may alleviate side effects and symptoms related to pancreatic cancer and its treatment, suggesting that practitioners might consider integrating these modalities in certain situations encountered in the treatment of pancreatic cancer. Further investigation is needed to define the optimal integration of CIM into the treatment and supportive care of patients affected by pancreatic cancer.
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Affiliation(s)
- Moshe Frenkel
- Complementary and Integrative Medicine Service, Oncology Division, Rambam Health Care Campus, Haifa, Israel.
| | - Adi David
- Tal Center for Integrative Medicine, Institute of Oncology, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Kenneth Sapire
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Hausner
- Tal Center for Integrative Medicine, Institute of Oncology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,Palliative Care Service, Chaim Sheba Medical Center, Ramat Gan, Israel
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Arbuckle C. Exploring the use of alternative diets in people living with cancer. Nurs Stand 2023; 38:63-68. [PMID: 36710635 DOI: 10.7748/ns.2023.e11963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 01/31/2023]
Abstract
There is significant use of alternative diets by people living with cancer, with data suggesting this has continued to increase since the 1980s. Commonly used alternative diets include the ketogenic diet, Gerson therapy, alkaline diets and fasting diets. This article explains the latest trends in relation to alternative diets, discusses the reasons why people may want to use these and examines their hypothesised mechanisms of action. The author outlines and critically reviews the evidence underpinning the use of such diets in those living with cancer, and suggests that this remains weak. The article also explores the challenges that nurses may experience when a person living with cancer wishes to adopt an alternative diet, and provides practical advice and recommendations on nutrition.
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Affiliation(s)
- Cameron Arbuckle
- University College London Hospitals NHS Foundation Trust, London, England
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Umbilical hernia repair post umbilical cord graft closure of gastroschisis: A cohort study. Int J Surg Case Rep 2022; 95:107175. [PMID: 35580418 PMCID: PMC9117534 DOI: 10.1016/j.ijscr.2022.107175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Gastroschisis a common congenital anomaly in the anterior abdominal wall, the bowel is present outside the abdominal cavity, completely devoid of any coverings, management of gastroschisis involves umbilical cord graft coverage of the defect after bowel reduction when there are concerns about compartmental syndrome, this is a widely used technique but there are few reports about the incidence umbilical hernia development after this technique and need for future repair of the defect. Presentation of cases We had 8 patients with simple gastroschisis who had umbilical cord graft coverage of the defect at birth between 2017 and 2020, we present 4 patients who had the cord graft without cutting of rectus fascia, 2 patients resolved spontaneously and 2 developed an umbilical hernia requiring repair. Discussion Umbilical cord graft has been reported in several studies, in those studies the authors reported the spontaneous closure of the defect and some reported that incising the rectus fascia will contribute to development of the umbilical hernia, in our series the rectus fascia was preserved yet 2 patients developed umbilical hernia. Conclusion Pediatric surgeons should look out for umbilical hernia in patients who had umbilical cord graft repair of gastroschisis defect and closure should be carried out by an experienced surgeon. Umbilical cord graft is used in closure of gastroschisis defect. Umbilical cord graft used when there are concerns about compartment pressure. Umbilical hernia can develop following this technique. Incision of rectus fascia increases the incidence of umbilical hernia. Umbilical hernia repair can be challenging due to adhesions.
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