1
|
Low YX, Teo YM, Lee YY, Nyo YL, Loh DL, Mali VP. Navigating Inconclusive Upper-Gastrointestinal Series in Infantile Bilious Vomiting: A Case Series on Intestinal Malrotation. Am J Case Rep 2024; 25:e943056. [PMID: 38483097 PMCID: PMC10949343 DOI: 10.12659/ajcr.943056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/26/2024] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Bilious vomiting in a child potentially portends the dire emergency of intestinal malrotation with volvulus, necessitating prompt surgical management, with differentials including small-bowel atresia, duodenal stenosis, annular pancreas, and intussusception. Although the upper-gastrointestinal series (UGI) is the diagnostic investigation of choice, up to 15% of the studies are inconclusive, thereby posing a diagnostic challenge. CASE REPORT We report a case series of 3 children referred for bilious vomiting, whose initial UGI was inconclusive and who were eventually confirmed to have intestinal malrotation at surgery. The first child was a female born at 37 weeks with antenatally diagnosed situs inversus and levocardia, who developed bilious vomiting on day 1 of life. The duodenojejunal flexure (DJ) could not be visualized on the UGI because of faint opacification on first pass of the contrast and subsequent overlap with the proximal jejunal loops. The second child was a male born at 36 weeks, presenting at age 4 months with bilious vomiting of 2 days duration. The third child was a female born at 29 weeks, presenting with bilious aspirates on day 3 of life. UGI for all 3 showed persistent hold-up of contrast at the proximal duodenum with no opacification of the distal duodenum or small bowel.Adjunctive techniques during the UGI and ultrasound examination helped achieve a preoperative diagnosis of malrotation in these children. CONCLUSIONS Application of diagnostic adjuncts to an inconclusive initial UGI may help elucidate a preoperative diagnosis of intestinal malrotation in infantile bilious vomiting.
Collapse
Affiliation(s)
- Yi Xian Low
- Department of Diagnostic Imaging, National University Hospital, Singapore City,Singapore
| | - Yi Ming Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore City,Singapore
| | - Yang Yang Lee
- Department of Paediatric Surgery, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital, Singapore City, Singapore
| | - Yoke Lin Nyo
- Department of Paediatric Surgery, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital, Singapore City, Singapore
| | - Dale Lincoln Loh
- Department of Paediatric Surgery, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital, Singapore City, Singapore
| | - Vidyadhar Padmakar Mali
- Department of Paediatric Surgery, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital, Singapore City, Singapore
| |
Collapse
|
2
|
Kwa ZY, Li J, Loh DL, Lee YY, Liu G, Zhu L, Pikkarainen M, He H, Mali VP. An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation. JMIR Form Res 2024; 8:e52337. [PMID: 38363589 PMCID: PMC10907943 DOI: 10.2196/52337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps. OBJECTIVE This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers. METHODS Based on the review of the literature and previous studies, Bandura's self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision. RESULTS The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis. CONCLUSIONS ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404.
Collapse
Affiliation(s)
- Zhi Yin Kwa
- Department of Nursing, National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Jinqiu Li
- Nursing Department, Zhuhai Campus, Zunyi Medical University, Zhuhai, China
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dale Lincoln Loh
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Yang Yang Lee
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Guangyu Liu
- Integrated Health Promotion, Ministry of Health Office for Healthcare Transformation, Singapore, Singapore
| | - Lixia Zhu
- Hôpital Chinois de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Minna Pikkarainen
- Department of Health Technology and Rehabilitation and Department of Product Design, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, Oulu Business School, University of Oulu, Oulu, Finland
| | - Honggu He
- National University Health System, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vidyadhar Padmakar Mali
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| |
Collapse
|
3
|
Koh ZJ, Nyo YL, Teo S, Lau P, Lee YY, Loh DL, Ng KH, Yap HK, Mali V. Excellent outcomes in living-related kidney transplantation in children 15 kg or less: experience from a tertiary pediatric referral center in Singapore. Korean Journal of Transplantation 2022. [DOI: 10.4285/atw2022.f-3921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Zong Jie Koh
- Department of Pediatric Surgery, National University Hospital of Singapore, Singapore
| | - Yoke Lin Nyo
- Department of Pediatric Surgery, National University Hospital of Singapore, Singapore
| | - Sharon Teo
- Department of Pediatrics, National University Hospital of Singapore, Singapore
| | - Perry Lau
- Department of Pediatrics, National University Hospital of Singapore, Singapore
| | - Yang Yang Lee
- Department of Pediatric Surgery, National University Hospital of Singapore, Singapore
| | - Dale Lincoln Loh
- Department of Pediatric Surgery, National University Hospital of Singapore, Singapore
| | - Kar Hui Ng
- Department of Pediatrics, National University Hospital of Singapore, Singapore
| | - Hui Kim Yap
- Department of Pediatrics, National University Hospital of Singapore, Singapore
| | - Vidyadhar Mali
- Department of Pediatric Surgery, National University Hospital of Singapore, Singapore
| |
Collapse
|
4
|
Koh ZJ, Gao Y, Nyo YL, Lee YY, Loh DL, Tiong HY, Mali V. Mixed reality imaging in the preoperative planning of high-risk pediatric renal transplants: proof of concept case report. Korean Journal of Transplantation 2022. [DOI: 10.4285/atw2022.f-4027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Zong Jie Koh
- Department of Pediatric Surgery, National University Hospital, Singapore
| | - Yujia Gao
- Department of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore
| | - Yoke Lin Nyo
- Department of Pediatric Surgery, National University Hospital, Singapore
| | - Yang Yang Lee
- Department of Pediatric Surgery, National University Hospital, Singapore
| | - Dale Lincoln Loh
- Department of Pediatric Surgery, National University Hospital, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, Singapore
| | - Vidyadhar Mali
- Department of Pediatric Surgery, National University Hospital, Singapore
| |
Collapse
|
5
|
Kimpo MS, Francisco KL, Chong QT, Lian DWQ, Lin NY, Mali V, Loh DL, Prabhakharan K. Mesothelioma with ALK gene mutations in two pediatric patients: Clinical course and outcome. Pediatr Blood Cancer 2022; 69:e29544. [PMID: 34957683 DOI: 10.1002/pbc.29544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Miriam Santiago Kimpo
- Division of Paediatric Hematology and Oncology, KTP University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore
| | - Krista Lea Francisco
- Division of Paediatric Hematology and Oncology, KTP University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore
| | - Quah Thuan Chong
- Division of Paediatric Hematology and Oncology, KTP University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore
| | | | - Nyo Yoke Lin
- Department of Paediatric Surgery, KTP University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore
| | - Vidyadhar Mali
- Department of Paediatric Surgery, KTP University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore
| | - Dale Lincoln Loh
- Department of Paediatric Surgery, KTP University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore
| | - Krishnan Prabhakharan
- Department of Paediatric Surgery, KTP University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore
| |
Collapse
|
6
|
Fukuda A, Sakamoto S, Shigeta T, Uchida H, Hamano I, Sasaki K, Kanazawa H, Loh DL, Kakee N, Nakazawa A, Kasahara M. Clinical outcomes and evaluation of the quality of life of living donors for pediatric liver transplantation: a single-center analysis of 100 donors. Transplant Proc 2014; 46:1371-6. [PMID: 24836837 DOI: 10.1016/j.transproceed.2013.12.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/16/2013] [Indexed: 01/10/2023]
Abstract
There are few reports about the quality of life (QOL) and morbidities of pediatric living donor liver transplantation (LDLT) donors. We evaluated the potential morbidities and identified the predictive factors regarding the QOL of living donors after pediatric LDLT. This cross-sectional study was a single-center analysis of 100 donors for pediatric LDLT. The severity of morbidities was assessed with the Clavien classification, the QOL was investigated with the short form-36 (SF-36), and the decision-making process regarding donation was analyzed with questionnaires. The median follow-up period was 3.8 years (range, 2.2-6.0 years). A total of 13% of the donors developed postoperative complications of Clavien grades I (7%), II (3%), and IIIA (3%). There was no grade IV morbidity or mortality. Eighty-one donors responded to the questionnaire and SF-36. The analysis of the questionnaires revealed that the donors had difficulty in the decision-making process, and suggested that it may be necessary to administer multistep informed consent. We identified unique predictive risk factors for lower SF-36 scores in the donors, which were the time to donation (more than 4 weeks) and the predonation self-oriented perception. The donors who have risk factors require enhanced pre- and post-donation psychological care.
Collapse
Affiliation(s)
- A Fukuda
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
| | - S Sakamoto
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - T Shigeta
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - H Uchida
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - I Hamano
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - K Sasaki
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - H Kanazawa
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - D L Loh
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - N Kakee
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - A Nakazawa
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - M Kasahara
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
7
|
Mali VP, Robless PA, Aw M, Loh DL, Quak SH, Prabhakaran K. Unusual shunt for symptomatic portal vein thrombosis after liver transplantation - Clatworthy revisited. Pediatr Transplant 2012; 16:E120-4. [PMID: 21834802 DOI: 10.1111/j.1399-3046.2011.01548.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PV thrombosis is not an uncommon occurrence following pediatric LT. Symptomatic PHT following PV thrombosis is treated medically, surgical portosystemic shunting (mesorex, splenorenal, and mesocaval) being reserved for refractory cases. A 10-yr-old boy suffered recurrent malena and hemorrhagic shock because of chronic PV thrombosis following LT nine yr ago (1999). Extensive work-up failed to localize the bleeding source. The liver function remained normal. Initial attempts at surgical shunts failed owing to thrombosis (mesocaval 2001, splenorenal, inferior mesenteric-left renal vein, splenic-left external iliac vein 2008). In this situation, we performed a Clatworthy shunt by anastomosing the divided lower end of the LCIV to the side of SMV. There was a single, large caliber anastomosis. Post-operatively, the malena stopped completely, and clinically, there was no lower limb edema or encephalopathy. Doppler USG revealed persistence of hepatopetal flow within the portal collaterals. Follow-up at two yr reveals stable hepatic function with a patent shunt. To the best of our knowledge, we are not aware of a Clatworthy shunt being performed in a transplant setting. We reviewed the literature pertaining to this shunt in non-transplant patients with PHT.
Collapse
Affiliation(s)
- V P Mali
- Departments of Paediatric Surgery, National University Hospital, Singapore.
| | | | | | | | | | | |
Collapse
|
8
|
Aw MM, Phua KB, Ooi BC, Da Costa M, Loh DL, Mak K, Tan KC, Isaac J, Prabhakaran K, Quak SH. Outcome of liver transplantation for children with liver disease. Singapore Med J 2006; 47:595-8. [PMID: 16810431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The advent of liver transplantation has revolutionised the outcome of children with both acute liver failure and chronic end-stage liver disease. The aim of this study was to review the outcome of all paediatric liver transplants performed since the National Liver Transplant Programme began in 1990. METHODS A retrospective review of all paediatric liver transplants from 1990 to December 2004 was performed. RESULTS 46 liver transplants were performed in 43 children, of whom 23 (53.3 percent) were female. Median age at transplant was 21 months (range 11 months to 14 years). The most common indication for liver transplant was biliary atresia (71.7 percent). Living-related transplants accounted for 63 percent (29). Re-transplant rate was 6.5 percent with allograft loss as a result of hepatic artery thrombosis (two) and hepatic vein thrombosis (one). Tacrolimus was the primary immunosuppressive agent used in 89 percent of patients, with a 19.6 percent incidence of acute allograft rejection within the first six months. There were nine deaths. They were related to portal vein thrombosis (three), chronic rejection (one), sepsis (two), post-transplant lymphoproliferative disease (two) and primary graft non-function (one). Overall actuarial one- and five-year survival rate was 85.7 percent and 81.8 percent, respectively. CONCLUSION Liver transplantation is an established form of intervention for end-stage liver disease and a variety of liver-related metabolic disease. Our results are comparable to those of well-established liver transplant centres.
Collapse
Affiliation(s)
- M M Aw
- Department of Paediatrics, Children's Medical Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Loh DL, Munro FD, Wilson-Storey D, Orr JD. Early appendicitis--a safe diagnosis? Ann Acad Med Singap 2004; 33:530-1. [PMID: 15329771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Serosal inflammation of the appendix in association with a significant peritoneal exudate can be mistaken for early acute appendicitis. We highlight the importance of looking for other sources of intra-abdominal sepsis in this clinical setting. CLINICAL PICTURE We present 3 cases of so-called "mild" appendicitis with serosal inflammation that was ultimately shown to be caused by Meckel's diverticulitis. TREATMENT All 3 patients initially underwent an appendicectomy. In 2 of these cases, a further laparotomy and excision of a Meckel's diverticulum was carried out. All 3 made an uneventful recovery. CONCLUSION Meckel's diverticulitis can mimic acute appendicitis in clinical history, physical findings and operative findings. It is important to always consider this as a possible cause for an acute abdomen.
Collapse
Affiliation(s)
- D L Loh
- Department of Paediatric Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
| | | | | | | |
Collapse
|
10
|
Abstract
This report describes three cases of significant lower gastro-intestinal haemorrhage caused by a bleeding Meckel's diverticulum. In the first two cases a pre-operative technetium-pertechnetate or Meckel's scan was negative or inconclusive, and in the third case no Meckel's scan was carried out. The diagnosis was established at laparoscopy in all three cases and in each case the diverticulum was excised extracorporeally.
Collapse
Affiliation(s)
- D L Loh
- Department of Pediatric Surgery, Royal Hospital for Sick Children, Sciennes Road, EH9 1LF, Edinburgh, UK
| | | |
Collapse
|