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Bokova E, Prasade N, Lewis WE, Feira CN, Lim IIP, Oyetunji TA, Rentea RM. Evaluation of Post-neonatal Intensive Care Unit Home Irrigations Prior to Pull-through: Implications for Hirschsprung Disease Management. J Pediatr Surg 2024:S0022-3468(24)00163-5. [PMID: 38570262 DOI: 10.1016/j.jpedsurg.2024.03.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Pull-through procedures for Hirschsprung disease (HD) can be performed during the Neonatal Intensive Care Unit (NICU) stay or delayed until discharge following home irrigations. This study assesses the safety of a delayed pull-through as an alternative to neonatal reconstruction in infants with successful abdomen decompression with home irrigations based on Hirschsprung-associated enterocolitis (HAEC) development. METHODS A single-institution retrospective review of neonates with HD who underwent delayed or neonatal pull-through from July 2018-July 2022. Endpoints included post-pull-through HAEC incidence, recurrence at an 18-month follow-up, time to the first HAEC episode, NICU length of stay (LOS), and HAEC-related LOS. RESULTS Twenty-four neonates were included. Eighteen were discharged from the NICU with home irrigations. Of these, 3 (28%) developed enterocolitis preoperatively, 12 (67%) underwent a delayed pull-through. NICU LOS in the delayed cohort was 3 times shorter than in the neonatal (6 vs. 18 days, p < 0.01). The incidence of enterocolitis (82% vs. 80%), time to the first episode (43 vs. 57 days), and HAEC-related LOS (median of 3 days) were similar. CONCLUSIONS Delayed HD pull-through is a viable neonatal reconstruction alternative that reduces NICU stay without increasing the risk of postoperative HAEC development. TYPE OF STUDY Original Research Article. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Ninad Prasade
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Wendy E Lewis
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Christine N Feira
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Irene Isabel P Lim
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA.
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Badillo A, Tiusaba L, Jacobs SE, Al-Shamaileh T, Feng C, Russell TL, Bokova E, Sandler A, Levitt MA. Sparing the Perineal Body: A Modification of the Posterior Sagittal Anorectoplasty for Anorectal Malformations with Rectovestibular Fistulae. Eur J Pediatr Surg 2023; 33:463-468. [PMID: 36356590 DOI: 10.1055/a-1976-3611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformation (ARM) with a rectovestibular fistula involves incising the perineal body skin and the sphincter muscles and a posterior sagittal incision to the coccyx. Perineal body dehiscence is the most common and morbid complication post-PSARP which can have a negative impact on future bowel control. With consideration of all the other approaches described to repair this anomaly, we developed a perineal body sparing modification of the standard PSARP technique. METHODS Four patients with ARM with a rectovestibular fistula were repaired with a perineal body sparing modified PSARP at a single institution between 2020 and 2021. The incision used was limited, involving only the length of the anal sphincter, with no incision anterior or posterior to the planned anoplasty. Dissection of the distal rectum and fistula was performed without cutting the perineal body. Once the distal rectum was mobilized off the posterior vaginal wall and out of the vestibule, the perineal body muscles, where the fistula had been, were reinforced and an anoplasty was then performed. RESULTS Operative time was the same as for a standard PSARP. There were no intraoperative or postoperative complications. No postoperative dilations were performed. All patients healed well with an excellent cosmetic result. All are too young to assess for bowel control. CONCLUSION We present a new technique, a modification of the traditional PSARP for rectovestibular fistula, which spares the perineal body. This approach could eliminate the potential complication of perineal body dehiscence.
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Affiliation(s)
- Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Shimon Eric Jacobs
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Tamador Al-Shamaileh
- Department of General Surgery, Faculty of Medicine, Mutah University, Karak, Jordan
| | - Christina Feng
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Teresa Lynn Russell
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Elizaveta Bokova
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Anthony Sandler
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
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Sharadze D, Abramov A, Konovalov O, Fomina A, Generalova Y, Kakabadze E, Bokova E, Shegai A, Kozlova Z, Fokina S. MEDICAL AND SOCIAL ASPECTS OF PREVENTING SPORTS INJURIES AMONG CHILDREN AND ADOLESCENTS. Georgian Med News 2023:64-71. [PMID: 38236101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Sports injuries among children and adolescents typically involve mild bruises and sprains. However, any sport can cause injuries to the musculoskeletal system. It is crucial to prevent such injuries through proper training and supervision to ensure the safety of young athletes. Therefore, when providing medical care to these patients, physicians must have the appropriate qualifications and skills and take into account the specific nature and location of injuries in each sport. Training programs and performance standards for young athletes should consider participants' biological age, physical and psychological immaturity, rather than their chronological age to prevent serious musculoskeletal injuries in child and youth sports. This review outlines the incidence of sports injuries in adolescents and considers how biological and social factors (factors related to coaches, peers and parents), influence the incidence and nature of injuries in different sports. Coaches and parents, though, have the ability to reduce the risk of injury by selecting suitable sports activities, employing the right equipment, enforcing rules, promoting safe playing conditions, and ensuring adequate supervision. Healthcare providers involved in the prevention and treatment of injuries in young athletes must possess the skillset to diagnose and assess the severity and risk to the athlete's future health and performance.
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Affiliation(s)
- D Sharadze
- 1State Budgetary Institution "Children's City Polyclinic No. 130" of the Moscow City Health Department, Russia
| | - A Abramov
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Russia
| | - O Konovalov
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Russia
| | - A Fomina
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Russia
| | - Yu Generalova
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Russia
| | - E Kakabadze
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Russia
| | - E Bokova
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Russia
| | - A Shegai
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Russia
| | - Z Kozlova
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Russia
| | - S Fokina
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Russia
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Sharadze D, Abramov A, Konovalov O, Fomina A, Generalova Y, Kakabadze E, Bokova E, Mityushkina T, Korovushkina E, Kozlova Z, Eliseeva T. THE OCCURRENCE OF SPORTS INJURIES AMONG PRE-ADOLESCENTS. Georgian Med News 2023:57-62. [PMID: 38096517] [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: 12/18/2023]
Abstract
Preschool children's harmonious development, cognitive and communicative abilities are enhanced through physical activities in sports, yet sports training and competition pose a risk of injury to children aged three to seven years due to their physiological and psychological features. Although sports injuries in preschool children are not common, they can be undesirable and unavoidable, and fortunately, these injuries are usually reversible. This review article presents data on the physiological features of the developing musculoskeletal system and its relationship to sports injuries in children, which together determine the nature of children's sports injuries. We also present a classification of sports injuries among preschool children, based on the literature, which considers the type, location, and severity of the trauma as estimated by the duration of mandatory missed practice.
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Affiliation(s)
- D Sharadze
- 1State Budgetary Institution "Children's City Polyclinic No. 130" of the Moscow City Health Department, Russia
| | - A Abramov
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - O Konovalov
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - A Fomina
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - Yu Generalova
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - E Kakabadze
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - E Bokova
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - T Mityushkina
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - E Korovushkina
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - Z Kozlova
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - T Eliseeva
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
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Sharadze D, Abramov A, Konovalov O, Fomina A, Generalova Y, Kakabadze E, Bokova E, Eliseeva T, Kostinskaya M, Smirnov D, Urazgulov A. THE INCIDENCE OF SPORTS INJURIES AMONG SCHOOL-AGED CHILDREN AND ADOLESCENTS. Georgian Med News 2023:193-198. [PMID: 38096539] [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: 12/18/2023]
Abstract
It is estimated that approximately one in ten school-aged children experience sports-related injuries annually. These injuries are most common at 12 years of age. Boys are more likely to get injured and more likely to get seriously injured than girls. The probability of injury is greater in contact or high-impact sports, with American soccer accounting for the largest number of injuries, followed by wrestling, basketball, soccer, and baseball. In certain sports, such as horseback riding, women are four times more likely to sustain injuries. The presented literature review details the incidence of various sports-related injuries in adolescents. Sports-related injuries observed in children under the age of 10 are nonspecific and include contusions, mild sprains, and fractures of the extremities, most commonly Salter-Harris fractures (growth plate fractures) or plastic fractures. In young athletes, sports-related injuries of the ligaments or muscles, as well as spinal or head injuries, are rare. This is particularly true during puberty, where growth plate fractures and musculoskeletal injuries occur more frequently.
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Affiliation(s)
- D Sharadze
- 1State Budgetary Institution "Children's City Polyclinic No. 130" of the Moscow City Health Department, Russia
| | - A Abramov
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - O Konovalov
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - A Fomina
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - Yu Generalova
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - E Kakabadze
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - E Bokova
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - T Eliseeva
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - M Kostinskaya
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - D Smirnov
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
| | - A Urazgulov
- 2Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN), Moscow, Russia
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Bokova E, Prasade N, Rosen JM, Lim IIP, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies. Children (Basel) 2023; 10:1558. [PMID: 37761519 PMCID: PMC10529947 DOI: 10.3390/children10091558] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. METHODS To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023. RESULTS Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22-71% of patients achieve social continence dependent on the type and level of the lesion. CONCLUSION Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient's age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Ninad Prasade
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - John M. Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Irene Isabel P. Lim
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Marc A. Levitt
- Division of Colorectal and Pelvic Reconstruction, Children’s National Medical Center, Washington, DC 20010, USA
| | - Rebecca M. Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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Bokova E, Prasade N, Janumpally S, Rosen JM, Lim IIP, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease. Children (Basel) 2023; 10:1418. [PMID: 37628417 PMCID: PMC10453740 DOI: 10.3390/children10081418] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - Ninad Prasade
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - Sanjana Janumpally
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - John M. Rosen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Irene Isabel P. Lim
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Marc A. Levitt
- Division of Colorectal and Pelvic Reconstruction, Children’s National Medical Center, Washington, DC 20001, USA
| | - Rebecca M. Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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Badillo A, Tiusaba L, Jacobs SE, Al-Shamaileh T, Feng C, Russell TL, Bokova E, Sandler A, Levitt MA. Response to: Sparing the Perineal Body, A Modification of the Posterior Sagittal Anorectoplasty (PSARP) for Anorectal Malformations with Rectovestibular Fistulae. Eur J Pediatr Surg 2023; 33:329. [PMID: 37414025 DOI: 10.1055/s-0043-1770998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Shimon Eric Jacobs
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Tamador Al-Shamaileh
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Christina Feng
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Teresa Lynn Russell
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Elizaveta Bokova
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Anthony Sandler
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
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Bokova E, Svetanoff WJ, Rosen JM, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation. Children (Basel) 2023; 10:1078. [PMID: 37371309 DOI: 10.3390/children10061078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. METHODS A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5-10 years. RESULTS The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test. CONCLUSION Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Wendy Jo Svetanoff
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - John M Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, DC 20001, USA
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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Bokova E, Svetanoff WJ, Lopez JJ, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations. Children (Basel) 2023; 10:children10050846. [PMID: 37238394 DOI: 10.3390/children10050846] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Wendy Jo Svetanoff
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Joseph J Lopez
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, DC 20001, USA
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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Bokova E, Svetanoff WJ, Levitt MA, Rentea RM. Pediatric Bowel Management Options and Organizational Aspects. Children 2023; 10:children10040633. [PMID: 37189882 DOI: 10.3390/children10040633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients’ quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age.
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Badillo A, Tiusaba L, Jacobs SE, Al-Shamaileh T, Feng C, Russell TL, Bokova E, Sandler A, Levitt MA. Sparing the Perineal Body: A Modification of the Posterior Sagittal Anorectoplasty for Anorectal Malformations with Rectovestibular Fistulae. Eur J Pediatr Surg 2023. [PMID: 36929124 DOI: 10.1055/s-0043-1760838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/18/2023]
Abstract
BACKGROUND The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformation (ARM) with a rectovestibular fistula involves incising the perineal body skin and the sphincter muscles and a posterior sagittal incision to the coccyx. Perineal body dehiscence is the most common and morbid complication post-PSARP which can have a negative impact on future bowel control. With consideration of all the other approaches described to repair this anomaly, we developed a perineal body sparing modification of the standard PSARP technique. METHODS Four patients with ARM with a rectovestibular fistula were repaired with a perineal body sparing modified PSARP at a single institution between 2020 and 2021. The incision used was limited, involving only the length of the anal sphincter, with no incision anterior or posterior to the planned anoplasty. Dissection of the distal rectum and fistula was performed without cutting the perineal body. Once the distal rectum was mobilized off the posterior vaginal wall and out of the vestibule, the perineal body muscles, where the fistula had been, were reinforced and an anoplasty was then performed. RESULTS Operative time was the same as for a standard PSARP. There were no intraoperative or postoperative complications. No postoperative dilations were performed. All patients healed well with an excellent cosmetic result. All are too young to assess for bowel control. CONCLUSION We present a new technique, a modification of the traditional PSARP for rectovestibular fistula, which spares the perineal body. This approach could eliminate the potential complication of perineal body dehiscence.
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Affiliation(s)
- Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Shimon Eric Jacobs
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Tamador Al-Shamaileh
- Department of General Surgery, Faculty of Medicine, Mutah University, Karak, Jordan
| | - Christina Feng
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Teresa Lynn Russell
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Elizaveta Bokova
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Anthony Sandler
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
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Bokova E, McKenna E, Krois W, Reck CA, Al-Shamaileh T, Jacobs SE, Tiusaba L, Russell TL, Darbari A, Feng C, Badillo AT, Levitt MA. Reconstructing the anal sphincters to reverse iatrogenic overstretching following a pull-through for Hirschsprung disease. One-year outcomes. J Pediatr Surg 2023; 58:484-489. [PMID: 36470689 DOI: 10.1016/j.jpedsurg.2022.10.052] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND In patients with Hirschsprung disease (HSCR), soiling may be related to anal sphincter damage following the initial pull-through. No optimal treatment has been developed for such patients, although enemas (rectal or antegrade) have been applied with some success. We present the one-year outcomes of a new technique for anal sphincter reconstruction. METHODS All patients with HSCR referred from other institutions for post pull-through soiling were studied. Seven patients with patulous sphincters underwent sphincter reconstruction. Six had a full preoperative evaluation and were included in the study. Their 12-month outcomes were assessed. RESULTS All six patients had soiling without voluntary bowel movements (VBMs). One patient was clean on Malone flushes when referred. Three underwent pre- and post-reconstruction non-sedated three-dimensional anorectal manometry, and objectively were able to close their sphincters following the reconstruction. All patients without Down syndrome (4 of 6) showed improvement in the abbreviated Baylor Continence Scale (4.5 vs. 0.75). One patient has achieved total bowel control without antegrade flushes, three now have VBMs which they did not have before but have occasional accidents and use antegrade flushes intermittently. They reported higher productivity, the ability to participate in sports and be away from home with confidence in their regimen. Two of 6 patients have Down syndrome and required a redo pull-through for other indications and underwent empiric sphincter reconstruction. For these two patients we do not have an outcomes assessment. CONCLUSIONS A new technique for sphincter reconstruction shows promising results in improvement of bowel control at one year. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elizaveta Bokova
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA.
| | - Elise McKenna
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA
| | - Wilfried Krois
- Comprehensive Center for Pediatrics, Department of Surgery, Clinical Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlos A Reck
- Comprehensive Center for Pediatrics, Department of Surgery, Clinical Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
| | - Tamador Al-Shamaileh
- Department of General Surgery, Faculty of Medicine, Mu'tah University, Kerak, Jordan
| | - Shimon E Jacobs
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA
| | - Teresa L Russell
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA
| | - Anil Darbari
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA
| | - Christina Feng
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA
| | - Andrea T Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA
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Al-Shamaileh T, Tiusaba L, Jacobs SE, Russell TL, Bokova E, Pohl HG, Varda BK, Ho C, Feng C, Badillo A, Levitt MA. Cloacal Malformation with Associated Urethral Atresia. European J Pediatr Surg Rep 2023; 11:e1-e4. [PMID: 36760663 PMCID: PMC9904968 DOI: 10.1055/s-0043-1761206] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/13/2020] [Indexed: 02/09/2023] Open
Abstract
Introduction Cloacal malformations comprise a heterogeneous group of anomalies that are considered the most complex anorectal malformations (ARMs) in females. Precise evaluation to identify the unique anatomy prior to reconstruction with collaboration between colorectal surgeons, urologists, and gynecologists is vital. Here, we present a rare anatomical variation in a patient with a cloacal malformation which affected operative and postoperative management. Case description A 6-year-old female with cloaca who underwent colostomy, vaginostomy, and vesicostomy as a newborn presented for reconstruction. Her VACTERL workup was negative except for an atretic right kidney. Her ARM index included the cloaca, a normal spine, and sacrum with a lateral sacral ratio of 0.7, predicting good potential for bowel continence. Cystoscopy through the vesicostomy showed a small bladder with normal ureteral orifices, and a closed bladder neck, with no identifiable urethra. A cloacagram showed an atretic common channel, a single small vagina, and a rectum below the pubococcygeal line. The patient underwent a posterior sagittal anorectovaginourethroplasty, vaginal patch using rectum, rectoplasty, and perineal body reconstruction. The urethra was not amenable to reconstruction, so the vesicostomy was preserved and a future Mitrofanoff was planned. Conclusion Urethral atresia is a rare and challenging finding in cloaca patients, and a vesicostomy is needed to drain urine in the newborn period. Preoperative examination under anesthesia, cystoscopy, vaginoscopy, and cloacagram are crucial to identify the precise anatomy and to plan accordingly.
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Affiliation(s)
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Shimon Eric Jacobs
- Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Teresa Lynn Russell
- Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Elizaveta Bokova
- Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Hans G. Pohl
- Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
| | - Briony K. Varda
- Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
| | - Christina Ho
- Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
| | - Christina Feng
- Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Marc A. Levitt
- Division of Colorectal and Pelvic Reconstruction, Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States,Address for correspondence Marc A. Levitt, MD Division of Colorectal and Pelvic ReconstructionDepartment of Surgery, Children's National Hospital, Washington, District of ColumbiaUnited States
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Jacobs SE, Tiusaba L, Bokova E, Russell TL, Al-Shamaileh T, Feng C, Badillo AT, Darbari A, Levitt MA. Functional constipation refractory to medical management: The colon is the problem. J Pediatr Surg 2023; 58:246-250. [PMID: 36411110 DOI: 10.1016/j.jpedsurg.2022.10.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Management of refractory constipation in children has not been standardized. We propose a protocolized approach which includes a contrast enema, anorectal manometry and exclusion of Hirschsprung disease (HD). For those without HD or with normal sphincters, an assessment of the colonic motility may be needed. The subgroups of dysmotility include (1) slow motility with contractions throughout, (2) segmental dysmotility (usually the sigmoid), or (3) a diffusely inert colon. We offered a Malone appendicostomy in all groups with the hope that this would avoid colonic resection in most cases. METHODS Patients with medically refractory constipation were reviewed at a single institution (2020 to 2021). For patients without HD or an anal sphincter problem, assessment of colonic motility using colonic manometry was performed followed by a Malone appendicostomy for antegrade flushes. RESULTS Of 196 patients evaluated for constipation refractory to medical management, 22 were felt to have a colonic motility cause. These patients underwent colonic manometry and Malone appendicostomy. 13 patients (59%) had a slow colon but with HAPCs throughout, 5 (23%) had segmental dysmotility, and 4 (18%) had a diffuse colonic dysmotility. 19 (86%) responded well to antegrade flushes with 17 reporting no soiling and 2 having occasional accidents. 3 patients (14%) failed flushes and underwent a colon resection within 6-month following Malone procedure. CONCLUSION We propose a protocol for medically refractory constipation which provides a collaborative framework to standardize evaluation and management of these patients with antegrade flushes, which aids in avoidance of colonic resection in most cases. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Shimon E Jacobs
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Elizaveta Bokova
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Teresa L Russell
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | | | - Christina Feng
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Andrea T Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Anil Darbari
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, 111 Michigan Avenue NW, Washington DC 20010, United States.
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Jacobs SE, Tiusaba L, Bokova E, Al-Shamaileh T, Russell TL, Rutan EC, Haroyan H, Wang Y, Feng C, Badillo A, Levitt MA. A Deeper Curse: A Hirschsprung Patient's Evaluation Unmasks a Rare Association with Congenital Central Hypoventilation Syndrome and Neuroblastoma. European J Pediatr Surg Rep 2022; 10:e156-e159. [PMCID: PMC9708406 DOI: 10.1055/s-0042-1758826] [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: 01/13/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
We present a rare case of a 2-year-old male patient referred for primary evaluation of constipation and ultimately treatment of Hirschsprung disease (HSCR) whose preoperative workup incidentally revealed a posterior paraspinal mass. Following the biopsy of the mass, the patient exhibited hypoventilation and hypoxia requiring a delayed extubation, raising suspicion for congenital central hypoventilation syndrome (CCHS). We focus on the known history of associations between HSCR and CCHS, in addition to recently found genetic mutations in paired-like homeobox 2B that link HSCR, CCHS, and neuroblastoma.
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Affiliation(s)
- Shimon Eric Jacobs
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Elizaveta Bokova
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | | | - Teresa Lynn Russell
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Emily C. Rutan
- Department of Radiology, Children's National Hospital, Washington, District of Columbia, United States
| | - Harutyun Haroyan
- Department of Radiology, Children's National Hospital, Washington, District of Columbia, United States
| | - Yong Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Christina Feng
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Marc A. Levitt
- Division of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States,Address for correspondence Marc A. Levitt, MD Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National HospitalWashington, 20010, DCUnited States
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Jacobs SE, Tiusaba L, Bokova E, Al-Shamaileh T, Russell TL, Varda BK, Feng C, Badillo AT, Levitt MA. Where Is the Vagina? A Rectal Stricture after a Presumed Cloacal Repair Turns Out to be the Mobilized Vagina and a Missed High Rectovaginal Fistula. European J Pediatr Surg Rep 2022; 10:e145-e147. [PMID: 36225532 PMCID: PMC9550519 DOI: 10.1055/s-0042-1755538] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022] Open
Abstract
We present a case of a rare complication in a 10-month-old female referred to our institution for an anal stricture after primary cloacal repair as an infant. Multimodal imaging, careful physical exam, and endoscopic evaluation revealed her vagina had been pulled through to the location of her anal sphincter muscle complex. We describe the correction of this problem, including identification of her rectum.
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Affiliation(s)
- Shimon E. Jacobs
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Laura Tiusaba
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Elizaveta Bokova
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Tamador Al-Shamaileh
- Department of General Surgery, Division of Pediatric Surgery, King Hussain Cancer Center, Amman, Jordan
| | - Teresa L. Russell
- Department of Urology, Children's National Hospital, Washington, District of Columbia, United States,Address for correspondence Marc A. Levitt, MD Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National HospitalWashington, DC 20010United States
| | - Briony K. Varda
- Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
| | - Christina Feng
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Andrea T. Badillo
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
| | - Marc A. Levitt
- Department of Surgery, Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
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Bosshard P, Tsaturyan A, Bokova E, Bonny O, Stritt K, Roth B. The impact of stenting prior to oral chemolysis of upper urinary tract uric acid stones. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tsaturyan A, Bosshard P, Bokova E, Bonny O, Stritt K, Roth B. The impact of stenting prior to oral chemolysis of upper urinary tract uric acid stones. Int Urol Nephrol 2021; 54:37-45. [PMID: 34850328 DOI: 10.1007/s11255-021-03072-6] [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: 08/24/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the impact of ureteral stenting on the success rate of oral chemolysis in the management of suspected uric acid upper urinary tract (UUT) stones. METHODS Retrospective matched-pair analysis of 172 patients treated with oral chemolysis from 01/2010 to 12/2019. Patients with low density (upon non-contrast enhanced computer tomography [NCCT]), radiolucent (on plain radiography) urinary stones, a low urine pH (< 6) and/or history of uric acid urolithiasis were included. Potassium citrate and/or sodium bicarbonate were used for alkalization (target urine pH: 6.5-7.2). Patient 1:1 matching was performed for the presence of indwelling ureteral stent, stone diameter, stone density, and stone localization. Stone-free status was evaluated after 12 weeks using NCCT. Multivariable logistic regression analysis was used to assess factors affecting the outcome. RESULTS Mean patient age was 61 years (73% males). Mean stone size was 12 mm. Overall success rates after 12-weeks of chemolysis for stones at any localization in the UUT and ureteral stones were 60.5 and 77.3%, respectively. Smaller stone size (OR = 0.94; CI 0.888-0.992; p = 0.026) and lower pre-treatment urine pH (OR = 0.131; CI 0.023-0.737; p = 0.021) significantly increased the success of oral chemolysis. Ureteral stenting did not have any impact on the efficacy of oral chemolysis. CONCLUSION Oral chemolysis is an effective treatment modality for patients with UUT stones suspected of uric acid content irrespective of ureteral stenting. Smaller stone diameter and lower urine pH at diagnosis increase its efficacy.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology, Inselspital, University of Bern, Bern, Switzerland
| | - Piet Bosshard
- Department of Urology, Inselspital, University of Bern, Bern, Switzerland
- Department of Urology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011, Lausanne, Switzerland
| | - Elizaveta Bokova
- Department of General Medicine, First Moscow State Medical University After I.M. Sechenov, Moscow, Russia
| | - Olivier Bonny
- Department of Nephrology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Kevin Stritt
- Department of Urology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011, Lausanne, Switzerland
| | - Beat Roth
- Department of Urology, Inselspital, University of Bern, Bern, Switzerland.
- Department of Urology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011, Lausanne, Switzerland.
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Bokova E, Kuptsova M, Gorozhanina E, Bogomolov D, Berechikidze I, Grinev A. [PECULIARITIES OF INTERACTION IN THE "PARASITE-HOST" SYSTEM IN HIV-INFECTED PATIENTS WITH TOXOPLASMOSIS: LITERATURE AND CLINICAL CASE REVIEW]. Georgian Med News 2020:130-136. [PMID: 32535577] [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: 06/11/2023]
Abstract
The article presents a review of current literature data on the development of opportunistic toxoplasmosis in patients suffering from HIV infection and a clinical case of an immunocompromised patient with toxoplasmosis. Current information concerning the incidence of toxoplasmosis in Russia and other countries are presented. Special attention is paid to the Toxoplasma gondii interactions with the host cell in HIV-infected people. The mechanism of parasite penetration into the host cell and subsequent modifications that the parasite makes with the occupied cell are analyzed in detail. The significance of the chosen topic is illustrated by the description of a clinical case of toxoplasmosis in an HIV-infected patient. The authors hope that the article will help to attract attention of the professional community to the problem of opportunistic infections in HIV/AIDS carriers, and in particular to the mechanisms of the "parasite-host" interactions in patients with toxoplasmosis.
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Affiliation(s)
- E Bokova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia
| | - M Kuptsova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia
| | - E Gorozhanina
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia
| | - D Bogomolov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia
| | - I Berechikidze
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia
| | - A Grinev
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Russia
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