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Rafart G, Bassaganyas C, Morales X, Cuatrecasas M, Rimola J. Enteric duplication cyst as a rare presentation of adult acute abdomen. Gastroenterol Hepatol 2024; 47:389-390. [PMID: 37080289 DOI: 10.1016/j.gastrohep.2023.04.005] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Gerard Rafart
- Servicio de Radiodiagnóstico, Hospital Clínic de Barcelona, Barcelona, España.
| | - Clara Bassaganyas
- Servicio de Radiodiagnóstico, Hospital Clínic de Barcelona, Barcelona, España
| | - Xavier Morales
- Servicio de Cirugía General, Hospital Clínic de Barcelona, Barcelona, España
| | - Míriam Cuatrecasas
- Servicio de Anatomía Patológica, Hospital Clínic de Barcelona, Barcelona, España; Universitat de Barcelona, Barcelona, España
| | - Jordi Rimola
- Servicio de Radiodiagnóstico, Hospital Clínic de Barcelona, Barcelona, España; IDIBAPS, Barcelona, España
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Chu J, Mokkarala M, Zhang M, Dixe de Oliveira Santo I, Lanier MH. Splenogonadal Fusion. Radiographics 2024; 44:e230224. [PMID: 38512727 DOI: 10.1148/rg.230224] [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] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Jia Chu
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
| | - Mahati Mokkarala
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
| | - Meng Zhang
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
| | - Irene Dixe de Oliveira Santo
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
| | - M Hunter Lanier
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (J.C., M.M., M.H.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.Z.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (I.D.d.O.S.)
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Patel D, Banks D, Hira B, Ford M, Ambartsumyan L, Rodriguez L. Persistent and newly developed gastrointestinal symptoms after surgery for intestinal malrotation in children: Dysmotility or disorders of gut and brain interaction? J Pediatr Gastroenterol Nutr 2024; 78:827-835. [PMID: 38451033 DOI: 10.1002/jpn3.12178] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Surgery for intestinal malrotation (IM) aims to correct the defect and improve symptoms; however, many have persistent gastrointestinal (GI) symptoms postoperatively. We evaluated the incidence, clinical presentation, and long-term outcomes of children with surgically repaired IM and its possible association with disorders of gut and brain interaction (DGBI). METHODS Multicenter retrospective study was conducted in patients from 0 to 21 years old, who had surgery for IM from 2000 to 2021 across three pediatric tertiary care centers. Data analyzed included demographics, time to diagnosis, idiopathic diagnosis, incidental diagnosis, postoperative follow-up, surgical time, and the need for surgery including bowel detorsion. Outcome variables were the presence of postoperative GI symptoms and DGBIs, and overall resolution of symptoms. We also evaluated the potential association of demographics and other included variables with our outcome variables. RESULTS Ninety-two patients with surgically corrected IM were included, 54% were male, and median age of diagnosis and surgical correction was 4.9 and 7.8 months, respectively. Median follow-up after surgery was 64 months. A total of 77% had postoperative GI symptoms, and notably, 78% of patients without symptoms before surgery (incidental diagnosis) developed GI symptoms postoperatively and 27% of patients met Rome IV criteria for a one or more DGBI. No factors were associated to the presence of postoperative symptoms or DGBIs in multivariate analysis. Female gender was the only factor associated with lack of resolution of symptoms at follow-up. CONCLUSION Pediatric IM is commonly associated with postoperative GI symptoms and DGBI well beyond surgery. An increased awareness about the prevalence of DGBI in these patients may help reach a prompt and accurate diagnosis, and improve their quality of life.
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Affiliation(s)
- Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Darnna Banks
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, New Haven Children's Hospital, Yale University, New Haven, Connecticut, USA
| | - Bindi Hira
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Madeline Ford
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Leonel Rodriguez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, New Haven Children's Hospital, Yale University, New Haven, Connecticut, USA
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Kedoin C, Muto M, Nagano A, Matsui M, Sugita K, Baba T, Miyoshi K, Masuya R, Murakami M, Yano K, Onishi S, Harumatsu T, Yamada W, Yamada K, Matsukubo M, Kawano T, Kuda M, Nakame K, Torikai M, Ieiri S. Notable Clinical Differences Between Neonatal and Post-Neonatal Intestinal Malrotation: A Multicenter Review in Southern Japan. J Pediatr Surg 2024; 59:566-570. [PMID: 38145920 DOI: 10.1016/j.jpedsurg.2023.11.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Most cases of intestinal malrotation appear in neonates with bilious vomiting due to midgut volvulus, whereas in cases that develop beyond infancy, the initial symptoms vary. This study investigated the clinical features of these two populations and identified issues that should be considered in daily practice. METHODS A retrospective chart review was conducted from January 1, 2010, to December 31, 2022. Data on patients with intestinal malrotation were collected in an anonymized fashion from five pediatric surgical hub facilities in the Southern Kyushu and Okinawa areas of Japan. RESULTS Of the 80 subjects, 57 (71.3%) were neonates (Group N) and 23 (28.7%) were infants and schoolchildren (Group I). The frequencies of initial symptoms, such as abdominal distention (Group N: 19.3% vs. Group I: 13.0%), bilious vomiting (59.6% vs. 43.5%), and hematochezia (8.8% vs. 21.7%), were not skewed by the age of onset (p = 0.535, 0.087, and 0.141, respectively). Midgut volvulus was significantly more frequent in Group N (71.9% [41/57] vs. 34.8% [8/23]; p = 0.005), while the degree of torsion was greater in group I (median 360° [interquartile range: 180-360°] vs. 450° [360-540°]; p = 0.029). Although the bowel resection rate was equivalent (7.0% [4/57] vs. 4.3% [1/23]; p = 1.000), half of the patients in Group N presented with 180° torsion. The neonatal intestine has been highlighted as being more susceptible to ischemia than that in older children. CONCLUSIONS The incidence of midgut volvulus is higher in neonates than in older children. Even relatively mild torsion can cause ischemic bowel changes during the neonatal period. LEVEL OF EVIDENCE LEVEL III.
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Affiliation(s)
- Chihiro Kedoin
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
| | - Ayaka Nagano
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Tokuro Baba
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kina Miyoshi
- Department of Pediatric Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Ryuta Masuya
- Division of the Gastrointestinal, Endocrine, and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Makoto Matsukubo
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Masaaki Kuda
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuhiko Nakame
- Division of the Gastrointestinal, Endocrine, and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Motofumi Torikai
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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Vosloo R, Wyer G, Naidoo L, Enicker B, Maharaj AG, Kapongo NC. Open abdominal wall defects and open spina bifida at a regional hospital in northern KwaZulu-Natal - bellwether conditions for neonatal surgery capacity. S AFR J SURG 2024; 62:48-53. [PMID: 38568126] [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: 04/05/2024]
Abstract
BACKGROUND Abdominal wall defects (AWDs), such as gastroschisis and omphalocele, and neural tube defects (NTDs) such as open spina bifida (SB) are common congenital anomalies. These anomalies are considered a leading cause of neonatal mortality and have been advocated as bellwether conditions to measure access to surgical care. METHODS Newborns with open SB or AWD presenting to the nursery at Queen Nandi Regional Hospital over four years (2018-2021) were retrospectively identified. Clinical and electronic database records were reviewed to determine if transfers to definitive tertiary care occurred timeously. Reasons for delays and associated morbidity and/or mortality were investigated. RESULTS Sixty-five patients were identified and two were excluded due to unavailable or incomplete records. It took a median of 8 days (IQR 2-18 days) to reach tertiary care, with SB cases waiting significantly longer (median 16 days,IQR 8-25 days) (p = 0.000). Lack of tertiary service capacity was the main reason for delays. The COVID-19 pandemic did not affect time intervals (p = 0.676). Complications were common and overall mortality at our facility was high (n = 11/63, 17.46%). CONCLUSION Newborns with open SB or AWDs experience marked delays in reaching definitive care. This is more pronounced for cases of SB and was not influenced by the pandemic. Lack of tertiary service capacity (including bed availability, limited staff, and theatre time) is the most important limiting factor.
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Affiliation(s)
- R Vosloo
- Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
- Department of Paediatrics, Queen Nandi Regional Hospital, South Africa
| | - G Wyer
- Department of Paediatrics, Queen Nandi Regional Hospital, South Africa
| | - L Naidoo
- Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
- Department of Paediatrics (Neonatal ICU), Inkosi Albert Luthuli Central Hospital, South Africa
| | - B Enicker
- Department of Neurosurgery, Inkosi Albert Luthuli Central Hospital, South Africa
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - A G Maharaj
- Department of Paediatric Surgery, Inkosi Albert Luthuli Central Hospital, South Africa
- Department of Paediatric Surgery, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
| | - N C Kapongo
- Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
- Department of Paediatrics, Queen Nandi Regional Hospital, South Africa
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Aoki M, Katsura M, Matsumoto S, Matsushima K. Persistent disparities between trauma center types in the management of children with high-grade blunt splenic injuries. World J Surg 2024; 48:568-573. [PMID: 38501566 DOI: 10.1002/wjs.12072] [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: 10/09/2023] [Accepted: 12/27/2023] [Indexed: 03/20/2024]
Abstract
BACKGROUND In the early 2000s, substantial variations were reported in the management of pediatric patients with blunt splenic injury (BSI). The purpose of this study was to assess the recent trends and disparities between different types of trauma centers. We hypothesized that there would be persistent disparities despite decreased trends in the rate of splenectomy. METHODS This is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database. We included patients (age ≤18 years) with high-grade BSI (Abbreviated Injury Scale 3-5) between 2014 and 2021. The patients were divided into three groups based on trauma center types (adult trauma centers [ATCs], mixed trauma centers [MTCs], and pediatric trauma centers [PTCs]). The primary outcome was the splenectomy rate. Logistic regression was performed to evaluate the association between trauma center types and clinical outcomes. Additionally, the trends in the rate of splenectomy at ATCs, MTCs, and PTCs were evaluated. RESULTS A total of 6601 patients with high-grade BSI were included in the analysis. Overall splenectomy rates were 524 (17.5%), 448 (16.3%), and 32 (3.7%) in the ATC, MTC, and PTC groups, respectively. ATCs and MTCs had significantly higher splenectomy rates compared to PTCs (ATCs: OR = 5.72, 95%CI = 3.78-8.67, and p < 0.001 and MTCs: OR = 4.50, 95%CI = 2.97-6.81, and p < 0.001), while decreased trends in the splenectomy rates were observed in ATCs and MTCs (ATCs: OR = 0.92, 95%CI = 0.87-0.97, and p = 0.003 and MTCs: OR = 0.92, 95%CI = 0.87-0.98, and p = 0.013). CONCLUSIONS This study suggested persistent disparities between different trauma center types in the management of children with high-grade BSI.
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Affiliation(s)
- Makoto Aoki
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
- Division of Traumatology, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Morihiro Katsura
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Shokei Matsumoto
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
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Ching CK, Lyudmer M, Lewis S, Krishnareddy S, Green PHR, Lebwohl B. Predictors of Subsequent Celiac Disease Seropositivity in Patients Diagnosed with Duodenal Villus Atrophy on Upper Endoscopy. Dig Dis Sci 2024; 69:876-883. [PMID: 38112838 DOI: 10.1007/s10620-023-08217-4] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The diagnosis of celiac disease (CD) is based on positive IgA autoantibodies to tissue transglutaminase (TTG IgA) and confirmatory histopathology demonstrating duodenal villus atrophy (VA). Diagnostic challenges can occur when VA is found on duodenal biopsies in patients without prior CD serologies. AIMS To characterize the predictors of CD seropositivity in patients with VA on biopsy without prior CD serologies. METHODS We performed a retrospective cohort study of patients found to have duodenal VA on histopathology from 2010 to 2020 who did not have prior CD serologies measured and who had them checked after their biopsy. Patients with known or suspected CD prior to their duodenal biopsy were excluded. RESULTS Of 162 patients with VA and no prior CD serologies, 50 (31%) subsequently had an elevated TTG IgA consistent with CD. Patients with an elevated TTG IgA were more likely to be non-Hispanic (76% vs. 42%; p < 0.001), white (74% vs. 62%; p = 0.025), and younger (ages 18-39, 26% vs. 12%; p = 0.002) compared to those with a negative TTG IgA. By contrast, these patients were less likely to present in middle adulthood (ages 40-59, 6% vs. 29%; p = 0.002). The most common identified etiologies of seronegative VA were Crohn's disease (13%), seronegative CD (8.9%), H. pylori infection (6.3%), tropical sprue (5.4%), and olmesartan-related enteropathy (3.6%). CONCLUSION Age and ethnicity may be helpful when stratifying the likelihood of CD in the absence of supporting serologies. A majority of patients (69%) diagnosed with VA without prior CD serologies have negative serologies, consistent with seronegative CD or the spectrum of non-celiac enteropathies for which further evaluation is needed.
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Affiliation(s)
- Charlotte K Ching
- Department of Medicine, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA.
| | - Michael Lyudmer
- Department of Medicine, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Suzanne Lewis
- Division of Digestive and Liver Diseases, Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Suneeta Krishnareddy
- Division of Digestive and Liver Diseases, Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Peter H R Green
- Division of Digestive and Liver Diseases, Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, USA
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Marchegiani F, Schena CA, Luzzi AP, De'Angelis N. Robotic caecal atypical resection for an appendiceal mucocele - a video vignette. Colorectal Dis 2024; 26:573-574. [PMID: 38235941 DOI: 10.1111/codi.16869] [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] [Received: 11/07/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| | - Andrea-Pierre Luzzi
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| | - Nicola De'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
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Shirota C, Hinoki A, Tainaka T, Sumida W, Makita S, Amano H, Takimoto A, Yasui A, Nakagawa Y, Liu J, Guo Y, Kato D, Goda Y, Maeda T, Uchida H. Surgical Strategies for Neonates with Prenatally Diagnosed Congenital Biliary Dilatation. J Pediatr Surg 2024; 59:385-388. [PMID: 37968151 DOI: 10.1016/j.jpedsurg.2023.10.045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND This study aimed to develop a postnatal treatment strategy for infants with prenatally diagnosed congenital biliary dilatation. METHODS We performed a retrospective study of patients with prenatal diagnosed congenital biliary dilatation (CBD), aged <1 year who underwent surgery at our hospital between 2013 and 2023. We classified the patients into two groups, the "early group," consisting of patients who could not wait for growth, and required early surgery, and the "scheduled group," consisting of patients who were asymptomatic and could undergo scheduled surgery, and compared them. The parameters for early surgical prediction were AST, ALT, TB, DB, and CRP levels at birth, 1 week, 2 weeks, 1 month, 2 months, and 3 months after birth, and immediately before surgery, as well as the cyst diameter, presence of intrahepatic bile duct dilation, and presence of debris in the common bile duct. RESULTS During the study period, 15 patients were diagnosed prenatally. The cyst diameter was significantly larger at all points in the early group. Patients with a cyst diameter of >30 mm at birth, intrahepatic bile duct dilatation at birth, and postnatal enlargement of the common bile duct to >30 mm are more likely to develop symptoms early. Blood biochemistry tests showed no significant differences between the two groups. CONCLUSIONS Patients with a cyst diameter >30 mm in the early postnatal period require careful postnatal management and parents should be counseled regarding the high likelihood of their child needing surgery within the first 3 months of life. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jiahui Liu
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yousuke Goda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Maeda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yin MD, Hao LL, Li G, Li YT, Xu BL, Chen XR. Adult-onset congenital intestinal malrotation: A case report and literature review. Medicine (Baltimore) 2024; 103:e37249. [PMID: 38394530 DOI: 10.1097/md.0000000000037249] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Intestinal malrotation is an infrequent congenital anomaly primarily observed in neonates, and adult-onset cases are exceedingly rare. Studies on adult congenital intestinal malrotation are limited. METHODS A case with congenital intestinal malrotation is reported in our study. The clinical data were collected and the treatment process and effect were evaluated. RESULTS A 45-year-old female who had been experiencing vomiting for over 40 years was admitted to our hospital. According to the result of CT scan, intestinal volvulus accompanied by bowel obstruction was suspected. Then laparoscopic examination was applied to the patient and was ultimately diagnosed with adult congenital intestinal malrotation. We performed Ladd's procedure combined with gastrojejunostomy and Braun anastomosis. The patient recovered well and was successfully discharged from the hospital on the 13th day after surgery. After a 6-month follow-up, the symptom of vomiting was significantly alleviated and body weight was gained for 10 kg. She was very satisfied with the treatment. CONCLUSION Adult congenital intestinal malrotation is a rare disease that is often misdiagnosed owing to nonspecific clinical manifestations. Therefore, awareness about this condition should be enhanced. Surgery remains the cornerstone of treatment for this disease. Combining gastrojejunostomy and Braun anastomosis with the traditional Ladd procedure can optimize surgical outcomes.
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Affiliation(s)
- Meng-Di Yin
- Linyi People's Hospital, Jinzhou Medical University, Linyi 276000, China
| | - Li-Liang Hao
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Guang Li
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Yu-Tao Li
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Bao-Li Xu
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
| | - Xin-Rui Chen
- Department of Gastrointestinal Surgery, Linyi People's Hospital, Linyi 276000, China
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11
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The people behind the papers - Julia Grzymkowski and Nanette Nascone-Yoder. Development 2024; 151:dev202745. [PMID: 38369734 DOI: 10.1242/dev.202745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
As the digestive system develops, the gut tube lengthens and convolutes to correctly package the intestine. Intestinal malrotation is a prevalent birth anomaly, but its underlying causes are not well understood. In this new study, Nanette Nascone-Yoder and colleagues show that exposure of Xenopus embryos to atrazine, a widely-used herbicide, can disrupt cellular metabolism in the developing gut tube and lead to intestinal malrotation. We caught up with first author Julia Grzymkowski and corresponding author Nanette Nascone-Yoder, Professor at North Carolina State University, to hear more about the story.
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12
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Hawariat BYW, Ali AO, Gebreselassie HA. Ileal prolapse through patent omphalomesenteric duct in a two year-old boy: a case report. J Med Case Rep 2024; 18:67. [PMID: 38311773 PMCID: PMC10840172 DOI: 10.1186/s13256-024-04370-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/06/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Patent omphalomesenteric duct is one of the birth defects included in the spectrum of vitelline duct abnormalities. It is a rare anomaly with estimated prevalence of 0.13-0.2% in the general population. The most common presentation of patent vitelline duct is yellowish or mucoid type umbilical discharge which is usually noted in neonatal age or infancy. The main stay of diagnosis is clinical and outcome is favorable as long as timely surgical correction is offered. Here we present a 2 years old male child who presented with ileal prolapse through patent vitelline duct which is an exceptional mode of presentation of this pathology. CASE PRESENTATION 2 years old Ethiopian male child who was noticed to have umbilical discharge since early infancy presented with protrusion of pinkish mass per the umbilicus of 4 h duration. He had no signs and symptoms of bowel obstruction. Abdominal examination revealed a prolapsed bowel which was viable via the umbilicus which was about 6 cm long. Otherwise, he had no abdominal tenderness or rigidity. He was explored with a smiley incision just above the umbilicus. The prolapsed bowel was reduced gently to the abdominal cavity. The tract of the Patent vitelline duct was identified and completely resected along with a wedge of ileum at its base. Primary repair of the ileal end where the tract was inserted was done in two layers and abdomen was closed in layers. The child had smooth post op course and was discharged on the 4th post-operative day. CONCLUSION Prolapse of a bowel through the umbilicus is unusual presentation of a rare anomaly namely patent vitelline duct. This presentation warrants early surgical intervention before bowel ischemia issues. Hence, all clinicians dealing with children should be aware of this rare pathology so that urgent surgical management can be offered.
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13
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Quigley EMM. Exploring the Small Intestinal Microbiome: Relationships to Symptoms and Small Intestinal Bacterial Overgrowth. Clin Gastroenterol Hepatol 2024; 22:241-242. [PMID: 37797906 DOI: 10.1016/j.cgh.2023.09.025] [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] [Received: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Eamonn M M Quigley
- Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas.
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14
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Nes E, Knell J, Keefe G, Culbreath K, Han SM, McGivney M, Staffa SJ, Modi BP, Carey AN, Jaksic T, Duggan CP. Factors associated with D-lactic acidosis in pediatric intestinal failure: A case-control study. J Pediatr Gastroenterol Nutr 2024; 78:217-222. [PMID: 38374557 PMCID: PMC10883598 DOI: 10.1002/jpn3.12075] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND D-lactic acidosis (DLA) is a serious complication of short bowel syndrome (SBS) in children with intestinal failure (IF). Malabsorbed carbohydrates are metabolized by bacteria in the intestine to D-lactate which can lead to metabolic acidosis and neurologic symptoms. METHODS A retrospective chart review was performed in children ≤18 years old with SBS who had one of the following criteria: unexplained metabolic acidosis, neurologic signs or symptoms, history of antibiotic therapy for small bowel bacterial overgrowth, or high clinical suspicion of DLA. Cases had serum D-lactate concentration >0.25 mmol/L; controls with concentrations ≤0.25 mmol/L. RESULTS Of forty-six children, median age was 3.16 (interquartile range (IQR): 1.98, 5.82) years, and median residual bowel length was 40 (IQR: 25, 59) cm. There were 23 cases and 23 controls. Univariate analysis showed that cases had significantly lower median bicarbonate (19 vs. 24 mEq/L, p = 0.001), higher anion gap (17 vs. 14 mEq/L, p < 0.001) and were less likely to be receiving parenteral nutrition, compared with children without DLA. Multivariable analysis identified midgut volvulus, history of intestinal lengthening procedure, and anion gap as significant independent risk factors. Midgut volvulus was the strongest independent factor associated with DLA (adjusted odds ratio = 17.1, 95% CI: 2.21, 133, p = 0.007). CONCLUSION DLA is an important complication of pediatric IF due to SBS. Patients with IF, particularly those with history of midgut volvulus, having undergone intestinal lengthening, or with anion gap acidosis, should be closely monitored for DLA.
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Affiliation(s)
- Emily Nes
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie Knell
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Keefe
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine Culbreath
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sam M Han
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Megan McGivney
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Steven J Staffa
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Biren P Modi
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra N Carey
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Jaksic
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Duggan
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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15
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Lanning J, Magallon SM, Bukowinski AT, Gumbs GR, Conlin AMS, Hall C. Investigation of a transient increase in omphalocele prevalence in a birth cohort of TRICARE beneficiaries. Birth Defects Res 2024; 116:e2305. [PMID: 38411336 DOI: 10.1002/bdr2.2305] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The Department of Defense Birth and Infant Health Research (BIHR) program leverages medical encounter data to conduct birth defect surveillance among infants born to military families. Omphalocele is a major abdominal wall defect with an annual prevalence of ~2 per 10,000 births in BIHR data, but an unexpected increase was observed during 2017-2019, reaching 6.4 per 10,000 births in 2018. To investigate this transient increase in prevalence, this study aimed to validate the omphalocele case algorithm among infants born 2016-2021. METHODS Omphalocele cases were identified by ICD-10 code Q79.2 (exomphalos) on one inpatient or two outpatient infant encounter records and validated using parental and infant electronic health records. Characteristics of true and false positive cases were assessed using bivariate analyses and compared over time. RESULTS Of 638,905 live births from 2016 to 2021, 230 met the ICD-10 case definition for omphalocele; 138 (60.0%) cases were eligible for validation, of which 68 (49.3%) were true positives. The geometric mean time from birth to first ICD-10 omphalocele diagnosis was 1.1 (standard error [SE] 0.1) days for true positives and 11.9 (SE 3.1) days for false positives. Among the 70 false positives, 36 (51.4%) were cases of confirmed umbilical hernia; rates of umbilical hernia and delayed omphalocele diagnoses (>30 days after birth) were elevated among false positives during 2017-2019. CONCLUSIONS Higher misuse of ICD-10 code Q79.2 during 2017-2019 likely influenced the associated increase in omphalocele prevalence. Timing of diagnosis should be considered for omphalocele case definitions using medical encounter data.
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Affiliation(s)
- Jackielyn Lanning
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
| | - Sandra Michelle Magallon
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
| | - Anna T Bukowinski
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
| | - Gia R Gumbs
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Clinton Hall
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc, San Diego, California, USA
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16
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Terebuh P, Olaker VR, Kendall EK, Kaelber DC, Xu R, Davis PB. Liver abnormalities following SARS-CoV-2 infection in children 1 to 10 years of age. Fam Med Community Health 2024; 12:e002655. [PMID: 38272541 PMCID: PMC10824054 DOI: 10.1136/fmch-2023-002655] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE Beginning in October 2021 in the USA and elsewhere, cases of severe paediatric hepatitis of unknown aetiology were identified in young children. While the adenovirus and adenovirus-associated virus have emerged as leading aetiological suspects, we attempted to investigate a potential role for SARS-CoV-2 in the development of subsequent liver abnormalities. DESIGN We conducted a study using retrospective cohorts of deidentified, aggregated data from the electronic health records of over 100 million patients contributed by US healthcare organisations. RESULTS Compared with propensity score matched children with other respiratory infections, children aged 1-10 years with COVID-19 had a higher risk of elevated transaminases (HR (95% CI) 2.16 (1.74 to 2.69)) or total bilirubin (HR (95% CI) 3.02 (1.91 to 4.78)), or new diagnoses of liver diseases (HR (95% CI) 1.67 (1.21 to 2.30)) from 1 to 6 months after infection. Patients with pre-existing liver abnormalities, liver abnormalities surrounding acute infection, younger age (1-4 years) or illness requiring hospitalisation all had similarly elevated risk. Children who developed liver abnormalities following COVID-19 had more pre-existing conditions than those who developed abnormalities following other infections. CONCLUSION These results indicate that SARS-CoV-2 may prime the patient for subsequent development of liver infections or non-infectious liver diseases. While rare (~1 in 1000), SARS-CoV-2 is a risk for subsequent abnormalities in liver function or the diagnosis of diseases of the liver.
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Affiliation(s)
- Pauline Terebuh
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University, Cleveland, OH, USA
| | - Veronica R Olaker
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University, Cleveland, OH, USA
| | - Ellen K Kendall
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University, Cleveland, OH, USA
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Pediatrics, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University, Cleveland, OH, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
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Chen F, Zeng Y, Yue LL, Xie MF, Liu HJ. Patent vitellointestinal duct with ileal prolapse in a newborn: A case report and literature review. Medicine (Baltimore) 2024; 103:e36919. [PMID: 38241543 PMCID: PMC10798687 DOI: 10.1097/md.0000000000036919] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
RATIONALE Patent vitellointestinal duct is the most common omphalomesenteric duct anomaly to present with symptoms. PATIENT CONCERNS A 10-day-old child presented with increase in the size of a polypoidal lesion into a large, "Y"-shaped reddish, prolapsing lesion, discharging gaseous, and fecal matter at her umbilicus. A laparoscopic exploration was performed, followed by wedge resection and anastomosis. No complications occurred during postoperative follow-up. DIAGNOSES A patent vitellointestinal duct with ileal prolapse. INTERVENTIONS The resection of extended intraperitoneal intestinal tube was performed. OUTCOMES During the follow-up 3 months after surgery, the umbilical cord of the child healed well after surgery. LESSONS Timely surgical treatment can minimize the occurrence of complications, and the overall prognosis is good after surgery.
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Affiliation(s)
- Feng Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Jiangxi Provincial Clinical Research Center for Vascular Anomalies, The First Affiliated Hospital of GanNan Medical University, Ganzhou, China
| | - Yong Zeng
- Department of Pediatric Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Jiangxi Provincial Clinical Research Center for Vascular Anomalies, The First Affiliated Hospital of GanNan Medical University, Ganzhou, China
| | - Lin-Lin Yue
- Department of Intensive Care Unit, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Ming-Feng Xie
- Department of Pediatric Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Jiangxi Provincial Clinical Research Center for Vascular Anomalies, The First Affiliated Hospital of GanNan Medical University, Ganzhou, China
| | - Hai-Jin Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Jiangxi Provincial Clinical Research Center for Vascular Anomalies, The First Affiliated Hospital of GanNan Medical University, Ganzhou, China
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18
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AlKeileh TB, Elsayed S, Adam RM, Nour M, Bhagchandi T. Left-sided appendicitis managed laparoscopically: a case report. J Med Case Rep 2024; 18:21. [PMID: 38233945 PMCID: PMC10795299 DOI: 10.1186/s13256-023-04301-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Appendicitis is one of the most common causes of acute abdominal pain and remains the most common abdominal-related emergency seen in emergency room that needs urgent surgery (Yang et al. in J Emerg Med 43:980-2, 2012. 10.1016/j.jemermed.2010.11.056, Wickramasinghe et al. in World J Surg 45:1999-2008, 2021. 10.1007/s00268-021-06077-5). The characteristic presentation is a vague epigastric or periumbilical discomfort or pain that migrates to the lower right quadrant in 50% of cases. Other related symptoms, such as nausea, anorexia, vomiting, and change in bowel habits, occur in varying percentages. The diagnosis is usually reached through comprehensive history, physical examination, laboratory tests, and radiological investigations as needed. Nowadays, computed tomography of the abdomen and pelvis is considered the modality of choice for definitive assessment of patients being evaluated for possible appendicitis. Anatomical variations or an ectopic appendix are rarely reported or highlighted in literature. CASE PRESENTATION Left-sided appendicitis is a rare (Hu et al. in Front Surg 2022. 10.3389/fsurg.2022.896116) and atypical presentation and has rarely been reported. The majority of these cases are associated with congenital midgut malrotation, situs inversus, or an extremely long appendix (Akbulut et al. in World J Gastroenterol 16:5598-5602, 2010. 10.3748/wjg.v16.i44.5598). This case is of significance to raise awareness regarding an anatomical variation of the appendix that might delay or mislead diagnosis of appendicitis and to confirm safety of a laparoscopic approach in dealing with a left-sided appendicitis case (Yang et al. in J Emerg Med 43:980-2, 2012. 10.1016/j.jemermed.2010.11.056). We report a case of left-sided appendicitis in a 12-year-old child managed successfully via a laparoscopic approach. CONCLUSION Appendicitis remains the most common abdominal-related emergency that needs urgent surgery (Akbulut et al. in World J Gastroenterol 16:5598-5602, 2010. 10.3748/wjg.v16.i44.5598). Left-sided appendicitis is a rare (Hu et al. in Front Surg 2022. 10.3389/fsurg.2022.896116, Hu et al. in Front Surg 9:896116, 2022. 10.3389/fsurg.2022.896116) and atypical presentation and has rarely been reported. Awareness regarding an anatomical variation of the appendix and diagnostic modalities on a computed tomography scan help avoid delay in diagnosis and management of such a rare entity (Vieira et al. in J Coloproctol 39(03):279-287, 2019. 10.1016/j.jcol.2019.04.003). A laparoscopic approach is a safe approach for management of left-sided appendicitis (Yang et al. in J Emerg Med 43:980-2, 2012. 10.1016/j.jemermed.2010.11.056, Hu et al. in Front Surg 9:896116, 2022. 10.3389/fsurg.2022.896116).
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Affiliation(s)
- Tamara B AlKeileh
- Department of General Surgery, Mediclinic Al Noor Hospital, PO BOX 46713, Abu Dhabi, UAE.
| | - Sali Elsayed
- Department of General Surgery, Mediclinic Al Noor Hospital, PO BOX 46713, Abu Dhabi, UAE
| | - Raheemah Mahomed Adam
- Department of General Surgery, Mediclinic Al Noor Hospital, PO BOX 46713, Abu Dhabi, UAE
| | - Mozamil Nour
- Department of Radiology, Mediclinic Al Noor Hospital, Abu Dhabi, UAE
| | - Tarun Bhagchandi
- Department of General Anesthesiology, Mediclinic Al Noor Hospital, Abu Dhabi, UAE
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Nandan R, Yadav DK. Gastric duplication cyst mimicking pancreatic pseudocyst in a child with situs inversus totalis. BMJ Case Rep 2024; 17:e256871. [PMID: 38199658 PMCID: PMC10806963 DOI: 10.1136/bcr-2023-256871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Ruchira Nandan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Delhi, Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Delhi, Delhi, India
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20
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Byer J, Buell MI, Farkouh A, Kuang R, Cheng KW, Chamberlin DA, Chamberlin JD. Echidna Splenule: A Case Study of Continuous Splenogonadal Fusion. Urology 2024; 183:209-211. [PMID: 37774850 DOI: 10.1016/j.urology.2023.09.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
Splenogonadal fusion (SGF) is a rare congenital anomaly of an aberrant accessory spleen-gonad connection. We present a rare case of continuous splenogonadal fusion in a full-term male with a left undescended testis, multiple congenital limb anomalies, and syndromic facies. Diagnostic laparoscopy revealed the "Echidna Splenule," a snake-like intraperitoneal splenule coursing from the spleen along the left paracolic region and engulfing an atrophic intra-abdominal testis preventing spontaneous descent and distally herniating into the left open internal inguinal ring. The atrophic testis and Echidna Splenule were resected. Splenogonadal fusion should be considered in children with left undescended testis and concomitant limb and facial anomalies.
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Affiliation(s)
- Jeanette Byer
- Loma Linda University, School of Medicine, Loma Linda, CA
| | - Matthew I Buell
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - Ala'a Farkouh
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - Ruby Kuang
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - Kai Wen Cheng
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - David A Chamberlin
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA
| | - Joshua D Chamberlin
- Loma Linda University Children's Hospital, Department of Urology, Loma Linda, CA.
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21
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Misanik M, Grajciar M, Smolár M, Miklusica J, Cmarkova K. An unusual case of gastrointestinal tract occlusion, Ladd's syndrome and neuroendocrine tumour of the appendix in a 19-year-old female patient. Rozhl Chir 2024; 102:251-256. [PMID: 38286654 DOI: 10.33699/pis.2023.102.6.251-256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Ladd's syndrome is a complex gastrointestinal anomaly that occurs based on congenital intestinal malrotation and leads to midgut volvulus and intestinal obstruction. It is mostly discovered in paediatric patients and presents itself in 90% of cases within the first year of life. It is a rare diagnosis in adult patients. We present the case report of a 19-year-old female patient with chronic abdominal pain and upper-type dyspeptic syndrome. MRI examination of the abdomen showed an abnormal location of the loops of the small intestine predominantly in the right part of the abdomen, caecum and c. ascendens in the epigastrium, duodenojejunal transition compressed and stenotized between upper mesenteric vessels and the aorta, with prestenotic dilatation of the duodenum and stomach and the "whirlpool sign" in mesentery. The patient was indicated for operational procedure and Ladd's operation was successfully performed laparoscopically, where "Ladd's bands" were divided; the procedure also included adhesiolysis, mobilization of the duodenum with its straightening, widening of the base of the mesentery, appendectomy and removal of an incidental solitary mesothelial cyst. A highly differentiated incidental neuroendocrine tumour of the apex of appendix was confirmed by histology. In the discussion, we focus on the rarity of intestinal malrotation in adulthood, clinical manifestation of the disease, diagnostic options and surgical treatment.
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22
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Kearsey CC, Dritsas S, Mathur M, Wild J. 'It's just a mucocele': a case report of a massive appendiceal mucocele presenting as a left upper quadrant mass. Ann R Coll Surg Engl 2024; 106:93-95. [PMID: 36622245 PMCID: PMC10757871 DOI: 10.1308/rcsann.2022.0068] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 01/10/2023] Open
Abstract
Tumours of the appendix are very rare tumours that can and often present with a mucocele. This is a case report highlighting the associated pathology of appendix tumours and the management of a large mucocele. Specifically, how a right hemicolectomy is very rarely needed in these cases regardless of size and local anatomical relationships and some important considerations for the practicing surgeon in the non-tertiary centre that encounters a case like this.
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Affiliation(s)
- CC Kearsey
- The Christie NHS Foundation Trust, UK
- Institute of Translational Medicine, University of Liverpool, UK
| | - S Dritsas
- The Christie NHS Foundation Trust, UK
| | - M Mathur
- The Christie NHS Foundation Trust, UK
| | - J Wild
- The Christie NHS Foundation Trust, UK
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23
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Girolamo M, Emanuela G, Yu WMC, Anna M, Marta P, Grazia CM, Gandullia P, Arrigo S, Stefano A, Beatrice DM. Diagnostic accuracy of upper gastrointestinal series in children with suspected intestinal malrotation. Updates Surg 2024; 76:201-208. [PMID: 37326933 PMCID: PMC10806024 DOI: 10.1007/s13304-023-01559-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Abstract
Intestinal malrotation (IM) results from an altered or incomplete rotation of the fetal midgut around the superior mesenteric artery axis. The abnormal anatomy of IM is associated with risk of acute midgut volvulus which can lead to catastrophic clinical consequences. The upper gastro-intestinal series (UGI) is addressed as the gold standard diagnosis procedure, but a variable failure degree has been described in literature. The aim of the study was to analyze the UGI exam and describe which features are the most reproducible and reliable in diagnosing IM. Medical records of patients surgically treated for suspected IM between 2007 and 2020 at a single pediatric tertiary care center were retrospectively reviewed. UGI inter-observer agreement and diagnostic accuracy were statistically calculated. Images obtained with antero-posterior (AP) projections were the most significant in terms of IM diagnosis. Duodenal-Jejunal Junction (DJJ) abnormal position resulted to be the most reliable parameter (Se = 0.88; Sp = 0.54) as well as the most readable, with an inter-reader agreement of 83% (k = 0.70, CI 0.49-0.90). The First Jejunal Loops (FJL), caecum altered position and duodenal dilatation could be considered additional data. Lateral projections demonstrated an overall low sensitivity (Se = 0.80) and specificity (Sp = 0.33) with a PPV of 0.85 and a NPV of 0.25. UGI on the sole AP projections ensures a good diagnostic accuracy. The position of the third portion of the duodenum on lateral views showed an overall low reliability, therefore it was not helpful but rather deceiving in diagnosing IM.
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Affiliation(s)
- Mattioli Girolamo
- University of Genoa, DINOGMI, Genoa, Italy
- Pediatric Surgery Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | | | - Wong Michela Cing Yu
- Pediatric Surgery Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
- , Via Gerolamo Gaslini, 5, 16148, Genoa, Italy.
| | - Marzoli Anna
- Radiology Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Pongiglione Marta
- Radiology Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Calevo Maria Grazia
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Paolo Gandullia
- Pediatric Gastroenterology and Endoscopy Department, IRCCS, Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Department, IRCCS, Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Avanzini Stefano
- Pediatric Surgery Unit, IRCCS, Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
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24
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Ohira R, Kanno Y, Asama H, Kodama K, Kuroda M. [Intestinal malrotation accompanied by a right paraduodenal hernia in an adult: a case report]. Nihon Shokakibyo Gakkai Zasshi 2024; 121:42-48. [PMID: 38220179 DOI: 10.11405/nisshoshi.121.42] [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: 01/16/2024]
Abstract
A 72-year-old woman was admitted to our department in March 2020 for an evaluation of nausea, vomiting, diarrhea, liver dysfunction, and hypokalemia, which had persisted intermittently since 2013. Thickening of the descending duodenal wall and a sac-like appearance the intestinal tract in the vicinity of the duodenal papilla were observed in abdominal computed tomography. No duodenojejunal curvature, with two intestinal loops identified in the descending region, was detected in contrast-enhanced upper gastrointestinal imaging. Based on these imaging findings, the patient was diagnosed with intestinal malrotation (incomplete rotation and fixation) accompanied by a right paraduodenal hernia based on the Nishijima classification. Thus, surgery was performed at our hospital. Gastrointestinal symptoms did not recur, and liver dysfunction and hypokalemia improved postoperatively.
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Affiliation(s)
- Rei Ohira
- Department of Gastroenterology, Fukushima Red Cross Hospital
| | - Yukiko Kanno
- Department of Gastroenterology, Fukushima Red Cross Hospital
| | - Hiroyuki Asama
- Department of Gastroenterology, Fukushima Red Cross Hospital
| | - Kenta Kodama
- Department of Gastroenterology, Fukushima Red Cross Hospital
| | - Masahito Kuroda
- Department of Gastroenterology, Fukushima Red Cross Hospital
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25
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Condit PE, McAdams RM. A Newborn with Cardiac Arrest and Abdominal Distention. Neoreviews 2023; 24:e806-e808. [PMID: 38036444 DOI: 10.1542/neo.24-12-e806] [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] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Paige E Condit
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ryan M McAdams
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
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26
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Bhagwanani A, Kearns C, Vijan A, Brun-Vergara ML. Colitis Cystica Profunda. Radiographics 2023; 43:e230184. [PMID: 37971933 DOI: 10.1148/rg.230184] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Anisha Bhagwanani
- From the Department of Radiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Portsmouth Rd, Frimley, Camberley GU16 7UJ, England (A.B.); Department of Radiology, Wellington Regional Hospital, Te Whatu Ora, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India (A.V.); and Department of Radiology, Division of Radiation Oncology and Medical Physics, The Ottawa Hospital, Ottawa, Ontario, Canada (M.L.B.V.)
| | - Ciléin Kearns
- From the Department of Radiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Portsmouth Rd, Frimley, Camberley GU16 7UJ, England (A.B.); Department of Radiology, Wellington Regional Hospital, Te Whatu Ora, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India (A.V.); and Department of Radiology, Division of Radiation Oncology and Medical Physics, The Ottawa Hospital, Ottawa, Ontario, Canada (M.L.B.V.)
| | - Antariksh Vijan
- From the Department of Radiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Portsmouth Rd, Frimley, Camberley GU16 7UJ, England (A.B.); Department of Radiology, Wellington Regional Hospital, Te Whatu Ora, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India (A.V.); and Department of Radiology, Division of Radiation Oncology and Medical Physics, The Ottawa Hospital, Ottawa, Ontario, Canada (M.L.B.V.)
| | - Maria Lucia Brun-Vergara
- From the Department of Radiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Portsmouth Rd, Frimley, Camberley GU16 7UJ, England (A.B.); Department of Radiology, Wellington Regional Hospital, Te Whatu Ora, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India (A.V.); and Department of Radiology, Division of Radiation Oncology and Medical Physics, The Ottawa Hospital, Ottawa, Ontario, Canada (M.L.B.V.)
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27
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Haffar A, Hirsch AM, Morrill CC, Crigger CC, Sponseller PD, Gearhart JP. Classic Bladder Exstrophy Closure Without Osteotomy or Immobilization: An Exercise in Futility? Urology 2023; 181:128-132. [PMID: 37696307 DOI: 10.1016/j.urology.2023.08.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/11/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To review the outcomes of classic bladder exstrophy (CBE) closure without the use of osteotomy or lower extremity/pelvic immobilization. METHODS A prospectively maintained institutional approved exstrophy-epispadias complex database of 1487 patients was reviewed for patients with CBE who had undergone closure without osteotomy nor immobilization. All patients were referred to the authors' institution for reconstruction later in life or for failed closure. RESULTS Of a total of 1016 CBE patients, 56 closure events were identified that met inclusion with a total of 47 unique patients. Thirty-eight closures were completed prior to 1990 (67.9%). Forty-five closure events developed eventual failure (45/56, 80.4%) (Table 1). Thirteen closure events were secondary closures (13/56, 23.2%). The primary closure failure rate was 83.7% (36/43) while the secondary closure failure rate was 69.2% (9/13). Failures were attributed to one or more of dehiscence, bladder prolapse, and vesicocutaneous fistula (25/45, 55.6%) (23/45, 51.1%) (6/45, 13.3%), respectively. Thirty-seven patients developed social continence (37/47, 78.7%), while only 8 patients developed spontaneous voided continence (7/47,17.0%) (Table 2). The most common methods of voiding were continent catheterizable channels (25/47, 53.2%) of which all were socially continent. CONCLUSION These results illustrate the critical role osteotomy and postoperative immobilization can play in both primary and secondary exstrophy closure. While this is a historical case series, the authors believe that these results remain relevant to contemporary exstrophy surgeons.
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Affiliation(s)
- Ahmad Haffar
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Alexander M Hirsch
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Christian C Morrill
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Chad C Crigger
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD
| | - Paul D Sponseller
- Division of Pediatric Orthopedics, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Baltimore, MD
| | - John P Gearhart
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD.
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Xu C, Kohen B, Levi D, Katz R. Girl With Abdominal Mass. Ann Emerg Med 2023; 82:565-582. [PMID: 37865489 DOI: 10.1016/j.annemergmed.2023.06.007] [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] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Curtis Xu
- Department of Emergency Medicine, University of Connecticut, Farmington, Connecticut
| | - Brian Kohen
- Department of Emergency Medicine, Memorial Healthcare System, Hollywood, Florida
| | - Daniel Levi
- Department of Emergency Medicine, Memorial Healthcare System, Hollywood, Florida
| | - Randy Katz
- Department of Emergency Medicine, Memorial Healthcare System, Hollywood, Florida
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29
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Tsai MJ, Lee JH, Cheng KY. Man With Abdominal Mass. Ann Emerg Med 2023; 82:630-633. [PMID: 37865491 DOI: 10.1016/j.annemergmed.2023.06.008] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Jian-Heng Lee
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Kai-Yuan Cheng
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
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30
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Chen YC, Chen PY, Yang PJ. Man with an Abdominal Mass. Ann Emerg Med 2023; 82:e159-e160. [PMID: 37739758 DOI: 10.1016/j.annemergmed.2023.04.008] [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] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Yen-Chung Chen
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Po-Yuan Chen
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Po-Jen Yang
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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31
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Bhowmick M, Mahajan G, Mangipudi UK, Yadav A, Jearth V, Shah J, Rana S. Prophylactic EUS-guided gallbladder drainage in patients with malignant biliary obstruction and cystic duct orifice involvement: Need more answers! Gastrointest Endosc 2023; 98:675. [PMID: 37734818 DOI: 10.1016/j.gie.2023.04.2069] [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] [Received: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Mithu Bhowmick
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Gaurav Mahajan
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Uday Kiran Mangipudi
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Abhishek Yadav
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
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32
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Correia Gomes L, Garcia JL, Pereira D, Faias S, Claro I. A Pancreatic Mass: An Unusual Presentation of a Hematological Malignancy. Am J Gastroenterol 2023; 118:1734. [PMID: 37406086 DOI: 10.14309/ajg.0000000000002389] [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] [Received: 05/25/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Luís Correia Gomes
- Department of Gastroenterology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Joana Lemos Garcia
- Department of Gastroenterology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Daniela Pereira
- Department Anatomic Pathology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Sandra Faias
- Department of Gastroenterology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Isabel Claro
- Department of Gastroenterology, Portuguese Institute of Oncology, Lisbon, Portugal
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33
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Sadiq F, Ahmad K. Efficacy Of Common Salt Application On The Umbilical Granuloma In Infants. J PAK MED ASSOC 2023; 73:2108-2110. [PMID: 37876083 DOI: 10.47391/jpma.8296] [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] [Indexed: 10/26/2023]
Abstract
The objective of this study was to determine the efficacy of the application of common plain salt for the treatment of umbilical granuloma in infants. The study design was descriptive case series and was conducted over a period of 12 months at the paediatric unit, Mardan Medical Complex, Mardan, Pakistan. For this study a total of 50 infants with clinically evident umbilical granuloma were selected. Application of a pinch of common plain salt was advised on the granuloma twice a day for three consecutive days. Outcomes in the shape of complete resolution of the granuloma, adverse effects, and recurrence of granuloma were assessed. The number of patients responding well to the treatment was 45 (90%). The treatment showed good response and there was not any adverse effect or recurrence. It was concluded that the common plain salt is a simple, effective, safe, and cheaper option for the treatment of umbilical granuloma in infants.
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34
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Mitsala A, Romanidis K, Pitiakoudis M. Small bowel obstruction due to congenital adhesion bands in the virgin abdomen. There is more than meets the eye. Ann Ital Chir 2023; 12:S2239253X23039270. [PMID: 37724652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Adhesive small bowel obstruction (SBO) represents a common surgical emergency leading to increased hospital admissions. Most patients presenting with adhesive SBO have a history of previous abdominal surgery. Although bowel obstruction secondary to congenital adhesion bands is rare, it should not be ruled out even in patients with a "virgin abdomen". CASE REPORT We present two rare cases of adult patients with SBO due to congenital adhesions. The first patient was transferred to the operating room, secondary to a closed-loop obstruction diagnosis. Two congenital adhesion bands were detected intraoperatively, then coagulated and divided. The second patient was surgically treated due to worsening abdominal pain. An adhesive band was identified occluding the ileum on surgical exploration, then ligated and excised. Both patients recovered uneventfully, without any recurrence of symptoms on the follow-up. DISCUSSION Single adhesive bands are more commonly found in cases with a "virgin abdomen". Meanwhile, solitary bands usually lead to bowel strangulation and ischemia, mostly mandating operative management. Interestingly, a computed tomography scan may confirm the diagnosis of bowel obstruction, whereas water-soluble contrast agents may help predict the need for surgical treatment. Besides exploratory laparotomy, laparoscopic surgery is gaining ground as an effective SBO diagnosis and management approach. CONCLUSION Adhesive SBO due to congenital bands is a rare condition, particularly in adults, with potentially lifethreatening complications. With the aim of prompt diagnosis and treatment, a high index of suspicion and awareness should be maintained even in patients without previous medical or surgical history. KEY WORDS Small bowel obstruction, Congenital adhesion bands, Virgin abdomen.
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35
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Otsuka Y, Minaga K, Watanabe T. An Overlooked Cause of Multiple Liver Nodules Exhibiting the Bull's-Eye Sign. Gastroenterology 2023; 165:548-551. [PMID: 36804603 DOI: 10.1053/j.gastro.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Yasuo Otsuka
- Department of Gastroenterology and Hepatology, Kindai University Hospital, Osaka-Sayama, Osaka, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Hospital, Osaka-Sayama, Osaka, Japan.
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Hospital, Osaka-Sayama, Osaka, Japan
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36
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Wang M, Yang X, Chen Y, Chen S, Wu J, Zhong C, Li L. Schistosomiasis enteropathy diagnosed by real-time endocytoscopy. Gastrointest Endosc 2023; 98:260-261. [PMID: 37146948 DOI: 10.1016/j.gie.2023.04.2083] [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] [Received: 11/22/2022] [Revised: 01/08/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Affiliation(s)
| | | | | | | | | | - Changqing Zhong
- Department of Gastroenterology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Lianyong Li
- Department of Gastroenterology, PLA Strategic Support Force Medical Center, Beijing, China
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37
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Shekar P A, Yadav A, Bhagat S, Gopalakrishnan G. Inferior Vesical Fissure-A Rare Variant of Exstrophy Bladder: Case Report With Literature Review. Urology 2023; 178:138-142. [PMID: 37028522 DOI: 10.1016/j.urology.2023.03.036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
Exstrophy variants are uncommon developmental anomalies of the bladder; the variants involving only the bladder neck are extremely rare. There are only three case reports of inferior vesical fissure (IVF) to date, and usually it's uncommonly associated with other malformations. A combination of inferior vesical fistula (IVF) as an exstrophy variant with urethral atresia and anorectal malformation has not been described previously. We report a case of IVF in a 4-year-old male previously operated for anorectal malformation who was managed with fistula closure with bladder neck reconstruction of lay open of stenosed urethra. Recognition of the exstrophy variant is important because the treatment and prognosis are very different.
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Affiliation(s)
- Ashwin Shekar P
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, Andhra Pradesh, India.
| | - Anuj Yadav
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, Andhra Pradesh, India
| | - Suresh Bhagat
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, Andhra Pradesh, India
| | - Ganesh Gopalakrishnan
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, Andhra Pradesh, India
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38
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Gerrie SK, Navarro OM. Imaging Features of Neonatal Bowel Obstruction. Radiographics 2023; 43:e230035. [PMID: 37471246 DOI: 10.1148/rg.230035] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Radiologic evaluation of neonatal bowel obstruction is challenging owing to the overlapping clinical features and imaging appearances of the most common differential diagnoses. The key to providing an appropriate differential diagnosis comes from a combination of the patient's gestational age, clinical features, and imaging findings. While assessment of radiographs can confirm bowel obstruction and indicate whether it is likely proximal or distal, additional findings at upper or lower gastrointestinal contrast study together with use of US are important in providing an appropriate differential diagnosis. The authors provide an in-depth assessment of the appearances of the most common differential diagnoses of proximal and distal neonatal bowel obstruction at abdominal radiography and upper and lower gastrointestinal contrast studies. These are divided into imaging patterns and their associated differential diagnoses on the basis of abdominal radiographic findings. These findings include esophageal atresia variants including the "single bubble," "double bubble," and "triple bubble" and distal bowel obstruction involving the small and large bowel. Entities discussed include esophageal atresia, hypertrophic pyloric stenosis, pyloric atresia, duodenal atresia, duodenal web, malrotation with midgut volvulus, jejunal atresia, ileal atresia, meconium ileus, segmental volvulus, internal hernia, colonic atresia, Hirschsprung disease, and functional immaturity of the large bowel. The authors include the advantages of abdominal US in this algorithm, particularly for hypertrophic pyloric stenosis, duodenal web, malrotation with midgut volvulus, and segmental volvulus. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Samantha K Gerrie
- From the Department of Radiology, BC Children's Hospital, 4500 Oak St, Vancouver, BC, Canada V6H 3N1, and Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (S.K.G.); and Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada, and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (O.M.N.)
| | - Oscar M Navarro
- From the Department of Radiology, BC Children's Hospital, 4500 Oak St, Vancouver, BC, Canada V6H 3N1, and Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (S.K.G.); and Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada, and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (O.M.N.)
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39
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McCarthy C, Ware A, Redan JA. Jejunal Intussusception Secondary to Pancreatic and Gastric Heterotopia in a 23-Year-Old. CRSLS 2023; 10:e2023.00018. [PMID: 37671367 PMCID: PMC10476238 DOI: 10.4293/crsls.2023.00018] [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] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Introduction Pancreatic and gastric heterotopias are a rare presentation of pancreatic and gastric tissues located outside their expected location. The most common site of heterotopic pancreas is the gastric antrum, and the most common site of heterotopic gastric mucosa is the proximal esophagus. The two tissues rarely present simultaneously. Although lead-point intussusception secondary to simultaneous heterotypic gastric and pancreatic tissue is extremely rare, its management strategy is the same as other pathological lead-point intussusception. Case Description This report presents a 23-year-old female who presented to the emergency department with abdominal pain, vomiting, and gastrointestinal bleeding. Computed tomography scan revealed features of distal small bowel intussusception secondary to a solid mass lead point. Following laparoscopic assisted small bowel resection and incidental appendectomy, histopathology evaluation confirmed the diagnosis of heterotopic pancreatic and gastric tissue as the lead point. The patient had an uneventful postoperative period and was discharged in stable condition, free of symptoms. Discussion Lead point intussusception of the jejunum in adults due to combined heterotopic tissue is extremely rare, with no reported cases in the literature. Prompt diagnosis and management are essential, with delays in treatments leading to a risk of perforation and mortality. If diagnosed, minimally invasive surgical approaches can treat obstruction and improve intraoperative and postoperative outcomes.
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Affiliation(s)
- Caline McCarthy
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Amendha Ware
- Department of Surgery, AdventHealth-Celebration Health, Celebration, FL, USA
| | - Jay A Redan
- Department of Surgery, AdventHealth-Celebration Health, Celebration, FL, USA
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Judy BF, Materi J, Lee RP, Tracz JA, Patel J, Weber-Levine C, Crigger C, Mistry P, Gearhart JP, Jackson EM. Spinal dysraphism in exstrophy: a single-center study of a 39-year prospective database. J Neurosurg Pediatr 2023; 32:98-105. [PMID: 37119103 DOI: 10.3171/2023.3.peds22447] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/20/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE The two main objectives of this study were to explore the rate of spinal dysraphism within bladder and cloacal exstrophy and to analyze the relationship between spinal dysraphism surgery, including timing of spinal dysraphism surgery, with urological and neurological outcomes. METHODS A prospectively maintained IRB-approved database of pediatric exstrophy patients treated from 1982 to 2021 was retrospectively reviewed for patients with spinal dysraphism. Spinal dysraphism was categorized into the following 7 subtypes: lipoma-based closed defect, myelomeningocele, meningocele, diastematomyelia, myelocystocele, low-lying conus with tethered cord/fatty filum, and sacral bony defect. Other factors assessed included patient demographic characteristics, type of spinal dysraphism procedure, reoperation, complication, presence of other neurological problems (e.g., hydrocephalus, Chiari malformation), neurological status, and urological function. RESULTS Analysis revealed that 114/1401 patients had coexisting spinal dysraphism. Of these 114, sufficient records including type of dysraphism were available for 54. Spinal dysraphism was most common within cloacal exstrophy (83.3% [45/54 patients]), followed by cloacal exstrophy variants (9.3% [5/54]), classic bladder exstrophy (3.7% [2/54]), and classic bladder exstrophy variants (3.7% [2/54]). Within spinal dysraphism, lipoma-based closed defects (63.0% [34/54]) and low-lying conus with tethered cord/fatty filum (11.1% [6/54]) were most common. Hydrocephalus and Chiari malformation occurred in 24.1% (13/54) and 11.1% (6/54) of patients. All 13 patients with hydrocephalus underwent shunt placement. Among those who underwent neurosurgical intervention, the complication rate for spinal dysraphism was 14.6% (7/48). Motor function data were available for 41 patients and revealed that motor function declined for 2/41 (4.8%) patients and improved for 6/41 (14.6%) after neurosurgery. There was no statistical difference in lower-extremity motor outcome related to timing of neurosurgery and exstrophy closure. CONCLUSIONS The authors have reported the surgical management and outcomes of patients with exstrophy and coexisting spinal dysraphism (n = 54). In 54 patients, spinal dysraphism was most common in the subset of patients with cloacal exstrophy (83.3%). Lipoma-based closed defects (63.0%) and low-lying conus with tethered cord/fatty filum (11.1%) were the most common, and the rates of hydrocephalus and Chiari malformation were 24.1% and 11.1%, respectively. There was no difference in lower-extremity motor outcome related to timing of neurosurgery and exstrophy closure.
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Affiliation(s)
| | | | | | | | | | | | - Chad Crigger
- 2Urology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Preeya Mistry
- 2Urology, Johns Hopkins Hospital, Baltimore, Maryland
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Nishie EN, Osmundo Junior GDS, Mohamed SHM, Tannuri ACA, Gibelli MABC, Carvalho WBD, Peres SV, Francisco RPV, Brizot MDL. Three-Dimensional Ultrasound Evaluation of Lung Volume in Fetuses with Abdominal Wall Defect. Fetal Diagn Ther 2023; 50:259-268. [PMID: 37379809 DOI: 10.1159/000531594] [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: 08/15/2022] [Accepted: 06/01/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Abdominal wall defects (AWDs) interfere with postnatal respiratory parameters. We aimed to evaluate lung volume (LV) in fetuses with AWD using three-dimensional (3D) ultrasound (US) and to correlate AWD with the type (omphalocele and gastroschisis) and size of the defect and neonatal morbidity and mortality. METHODS This prospective observational study included 72 pregnant women with fetuses with AWD and a gestational age <25 weeks. The data on abdominal volume, 3D US LV, and herniated volume were acquired every 4 weeks up to 33 weeks. LV was compared with normal reference curves and correlated with abdominal and herniated volumes. RESULTS Omphalocele (p < 0.001) and gastroschisis (p < 0.001) fetuses had smaller LV than normal fetuses. LV was positively correlated with abdominal volume (omphalocele, r = 0.86; gastroschisis, r = 0.88), whereas LV was negatively correlated with omphalocele-herniated volume/abdominal volume (p < 0.001, r = -0.51). LV was smaller in omphalocele fetuses that died (p = 0.002), were intubated (p = 0.02), or had secondary closure (p < 0.001). In gastroschisis, a smaller LV was observed in fetuses discharged using oxygen (p = 0.002). CONCLUSION Fetuses with AWD had smaller 3D LV than normal fetuses. Fetal abdominal volume was inversely correlated with LV. In omphalocele fetuses, a smaller LV was associated with neonatal mortality and morbidity.
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Affiliation(s)
- Estela Naomi Nishie
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil,
| | - Gilmar de Souza Osmundo Junior
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Samirah Hosney Mahmoud Mohamed
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Ana Cristina Aoun Tannuri
- Division of Neonatology, Department of Pediatrics, Hospital das Clínicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Stela Verzinhasse Peres
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Maria de Lourdes Brizot
- Obstetrics, Department of Obstetrics and Gynecology, Hospital das Clinicas, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
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Engwall-Gill AJ, Zhou AL, Penikis AB, Sferra SR, Jelin AC, Blakemore KJ, Kunisaki SM. Prenatal Sonography in Suspected Proximal Gastrointestinal Obstructions: Diagnostic Accuracy and Neonatal Outcomes. J Pediatr Surg 2023; 58:1090-1094. [PMID: 36907770 PMCID: PMC10866136 DOI: 10.1016/j.jpedsurg.2023.02.029] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND The purpose of this study was to assess diagnostic accuracy and neonatal outcomes in fetuses with a suspected proximal gastrointestinal obstruction (GIO). METHODS After IRB approval, a retrospective chart review was conducted on prenatally suspected and/or postnatally confirmed cases of proximal GIO at a tertiary care facility (2012-2022). Maternal-fetal records were queried for presence of a double bubble ± polyhydramnios, and neonatal outcomes were assessed to calculate the diagnostic accuracy of fetal sonography. RESULTS Among 56 confirmed cases, the median birthweight and gestational age at birth were 2550 g [interquartile range (IQR) 2028-3012] and 37 weeks (IQR 34-38), respectively. There was one (2%) false-positive and three (6%) false-negatives by ultrasound. Double bubble had a sensitivity, specificity, positive predictive value, and negative predictive value for proximal GIO of 85%, 98%, 98%, and 83%, respectively. Pathologies included 49 (88%) with duodenal obstruction/annular pancreas, three (5%) with malrotation, and three (5%) with jejunal atresia. The median postoperative length of stay was 27 days (IQR 19-42). Cardiac anomalies were associated with significantly higher complications (45% vs 17%, p = 0.030). CONCLUSIONS In this contemporary series, fetal sonography has high diagnostic accuracy for detecting proximal gastrointestinal obstruction. These data are informative for pediatric surgeons in prenatal counseling and preoperative discussions with families. LEVEL OF EVIDENCE Diagnostic Study, Level III.
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Affiliation(s)
- Abigail J Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice L Zhou
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annalise B Penikis
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shelby R Sferra
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Angie C Jelin
- Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karin J Blakemore
- Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Philip J, Miller N, Cocieru A. Obstructing Duodenal Duplication Cyst. Am Surg 2023; 89:1102-1103. [PMID: 33342289 DOI: 10.1177/0003134820956282] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Justus Philip
- Department of Surgery, Summa Akron City Hospital, Akron, OH, USA
| | - Nic Miller
- Department of Surgery, Summa Akron City Hospital, Akron, OH, USA
| | - Andrei Cocieru
- Department of Surgery, Summa Akron City Hospital, Akron, OH, USA
- Northeastern Ohio Medical University, Roostown, OH, USA
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Thammathiwat T, Suwannasrisuk P, Sirilak S. Hypertension in a Young Man with an Abdominal Mass. Kidney360 2023; 4:e564-e565. [PMID: 37103963 PMCID: PMC10371364 DOI: 10.34067/kid.0000000000000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 04/28/2023]
Affiliation(s)
- Theerachai Thammathiwat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Preaw Suwannasrisuk
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Supinda Sirilak
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
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Xie H, Chen D, Gu W, Li W, Wang X, Tang W. Thyroid function screening and follow-up of children with abdominal distension in Nanjing, China: a cross-sectional study. BMJ Open 2023; 13:e070416. [PMID: 36697039 PMCID: PMC9884940 DOI: 10.1136/bmjopen-2022-070416] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To describe the thyroid function test among children with abdominal distention and to follow up the treatment received by children with abnormal thyroid function. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 1089 children (median age:30 days (IQR=21-60 days) with abdominal distension were included in this single centre study in Nanjing, China. RESULT Thyroid dysfunction was found in 43 of 148 Hirschsprung's disease (HSCR) cases, with 3 (2.03%) having hypothyroidism, 3 (2.03%) having subclinical hypothyroidism and 3 (2.03%) having subclinical hyperthyroidism. Thyroid dysfunction was found in 206 of 941 functional abdominal distension cases, with 4 (0.43%) having hypothyroidism, 23 (2.4%) having subclinical hypothyroidism, 28 (2.9%) having subclinical hyperthyroidism and 1 (0.11%) having hyperthyroidism. Among total 65 cases (9 from HSCR, 56 from functional abdominal distension) diagnosed with thyroid diseases, 12 were treated with levothyroxine (LT-4), of which 9 were discontinued treatment at about 2 years old, and 3 were still receiving LT-4. Thirty-two cases received no treatment and thyroid function returned to normal in about 1 month. Twenty-one cases were lost during the follow-up. CONCLUSION The paediatrician should be vigilant for hypothyroidism when dealing with children with abdominal distension. Thyroid function should be followed up rather than simply administering a short-term levothyroxine treatment.
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Affiliation(s)
- Hang Xie
- Department of Neonatal Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Dongmei Chen
- Department of Emergency, Pediatric intensive care unit, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Gu
- Department of Quality Management, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Li
- Department of Quality Management, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Weibing Tang
- Department of Neonatal Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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Kerkeni Y, Hannachi W, Zouaoui A, Houidi S, Jouini R. Splenogonadal fusion misdiagnosed as spermatic cord cyst: a case report. Tunis Med 2022; 100:730-732. [PMID: 36571759 PMCID: PMC9841463] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Splenogonadal fusion is a rare congenital anomaly. The aim of this study was to report a case of splenogonadal fusion mimicking a spermatic cord cyst, and discuss therapeutic management of this rare congenital malformation. OBSERVATION An eight-years old patient was presented with an asymptomatic three-centimeter oval scrotal mass mistaken for a spermatic cord cyst. Surgical exploration has revealed tow purple-red, firm encapsulated masses. The first mass was two cm long and adherent to the upper pole of the left testis with a cleavage plane. The second mass was four cm long, attached to the first by a fibrous cord and drawn on its superior pole by a serpiginous vascular structure that extended inside the abdomen. The spermatic cord was individualized. Extemporaneous anatomopathological examination of the first mass, totally excised, has concluded to benign lesion. Therefore, the peritoneum was opened, and the superior mass was excised as high as it could be reached without orchiectomy. Definitive Anatomopathological examination concluded to an ectopic splenic tissue. The final diagnosis was a continuous splenogonadal fusion. CONCLUSION This case highlights the clinical characteristics of this condition, with a special focus on the signs and findings that might help prevent unnecessary orchiectomy. Consequently, it is essential to include this malformation in the differential diagnosis of scrotal masses in children.
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Affiliation(s)
- Yosra Kerkeni
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
| | - Wiem Hannachi
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
| | - Arije Zouaoui
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
| | - Senda Houidi
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
| | - Riadh Jouini
- Service de Chirurgie Pédiatrique "A". Hôpital d'Enfants "Béchir Hamza" de Tunis / Université de Tunis El Manar. Faculté de médecine de Tunis
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Brunner S, Bruns CJ. [71/m-Dysphagia, loss of weight and inappetence : Preparation for the medical specialist examination: part 21]. Chirurgie (Heidelb) 2022; 93:95-99. [PMID: 36127481 DOI: 10.1007/s00104-022-01725-5] [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] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Affiliation(s)
- S Brunner
- Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50935, Köln, Deutschland.
| | - C J Bruns
- Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50935, Köln, Deutschland
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Anger F. [47/m-Distended abdomen with acute pancreatitis : Preparation for the medical specialist examination: part 7]. Chirurgie (Heidelb) 2022; 93:30-34. [PMID: 36346449 DOI: 10.1007/s00104-022-01744-2] [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] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Affiliation(s)
- F Anger
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, Haus A2, 97080, Würzburg, Deutschland.
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Özcan R, Hakalmaz AE, Emre Ş, Karagöz A, Tütüncü Ç, Kuruğoğlu S, Tekant GT. Endoscopic septum division of tubular esophageal duplication in two children and systematic review. Pediatr Surg Int 2022; 38:1525-1531. [PMID: 36048241 DOI: 10.1007/s00383-022-05205-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/23/2023]
Abstract
Tubular esophageal duplication is a rare congenital malformation The surgical treatment of this lesion can be challenging. We aimed to present our experience in two cases with tubular esophageal duplication. Both cases were endoscopically treated by a dual knife. The first patient underwent a single, while the second patient required three sessions of endoscopic septum division using an electrosurgical knife. Both showed satisfactory clinical, radiological and endoscopic response to treatment. Moreover, a systematic literature review has been performed. To identify all available studies, a detailed search on tubular esophageal duplication was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Tubular esophageal duplication was reported in 16 pediatric cases in 14 studies in the literature. Surgery was applied to 10 of these cases and endoscopic treatment was applied to two of them. In the follow-up, nine patients who underwent surgical treatment and two patients who underwent endoscopic treatment were uneventful. Tubular esophageal duplications can be successfully treated endoscopically. Endoscopic septum division is a minimally invasive procedure that allows full anatomical recovery and satisfactory therapeutic response.
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Affiliation(s)
- Rahşan Özcan
- Cerrahpasa Medical Faculty, Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey.
- , Haseki Sultan Mah, Münif Paşa Sok. Baypa Apt. No: 2/1, Daire: 5Findikzade, Fatih, 34098, Istanbul, Turkey.
| | - Ali Ekber Hakalmaz
- Cerrahpasa Medical Faculty, Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Şenol Emre
- Cerrahpasa Medical Faculty, Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayşe Karagöz
- Cerrahpasa Medical Faculty, Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Çiğdem Tütüncü
- Cerrahpasa Medical Faculty, Department of Anesthesiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sebuh Kuruğoğlu
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gonca Topuzlu Tekant
- Cerrahpasa Medical Faculty, Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Tirkes T, Yadav D, Conwell DL, Territo PR, Zhao X, Persohn SA, Dasyam AK, Shah ZK, Venkatesh SK, Takahashi N, Wachsman A, Li L, Li Y, Pandol SJ, Park WG, Vege SS, Hart PA, Topazian M, Andersen DK, Fogel EL. Quantitative MRI of chronic pancreatitis: results from a multi-institutional prospective study, magnetic resonance imaging as a non-invasive method for assessment of pancreatic fibrosis (MINIMAP). Abdom Radiol (NY) 2022; 47:3792-3805. [PMID: 36038644 PMCID: PMC9423890 DOI: 10.1007/s00261-022-03654-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine if quantitative MRI techniques can be helpful to evaluate chronic pancreatitis (CP) in a setting of multi-institutional study. METHODS This study included a subgroup of participants (n = 101) enrolled in the Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies (PROCEED) study (NCT03099850) from February 2019 to May 2021. MRI was performed on 1.5 T using Siemens and GE scanners at seven clinical centers across the USA. Quantitative MRI parameters of the pancreas included T1 relaxation time, extracellular volume (ECV) fraction, apparent diffusion coefficient (ADC), and fat signal fraction. We report the diagnostic performance and mean values within the control (n = 50) and CP (n = 51) groups. The T1, ECV and fat signal fraction were combined to generate the quantitative MRI score (Q-MRI). RESULTS There was significantly higher T1 relaxation time; mean 669 ms (± 171) vs. 593 ms (± 82) (p = 0.006), ECV fraction; 40.2% (± 14.7) vs. 30.3% (± 11.9) (p < 0.001), and pancreatic fat signal fraction; 12.2% (± 5.5) vs. 8.2% (± 4.4) (p < 0.001) in the CP group compared to controls. The ADC was similar between groups (p = 0.45). The AUCs for the T1, ECV, and pancreatic fat signal fraction were 0.62, 0.72, and 0.73, respectively. The composite Q-MRI score improved the diagnostic performance (cross-validated AUC: 0.76). CONCLUSION Quantitative MR parameters evaluating the pancreatic parenchyma (T1, ECV fraction, and fat signal fraction) are helpful in the diagnosis of CP. A Q-MRI score that combines these three MR parameters improves diagnostic performance. Further studies are warranted with larger study populations including patients with acute and recurrent acute pancreatitis and longitudinal follow-ups.
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Affiliation(s)
- Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine Indianapolis, 550 N. University Blvd. Suite 0663, Indianapolis, IN 46202 USA
| | - Dhiraj Yadav
- Department of Medicine Division of Gastroenterology, Hepatology & Nutrition University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Darwin L. Conwell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY USA
| | - Paul R. Territo
- Division of Clinical Pharmacology, Stark Neurosciences Research Institute Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Xuandong Zhao
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Scott A. Persohn
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Anil K. Dasyam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Zarine K. Shah
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | | | | | - Ashley Wachsman
- Department of Radiology Cedars-Sinai Medical Center, University of California in Los Angeles, Los Angeles, CA USA
| | - Liang Li
- Department of Biostatistics Director, Quantitative Science Program, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Yan Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Stephen J. Pandol
- Division of Digestive and Liver Diseases Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Walter G. Park
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA USA
| | - Santhi S. Vege
- Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology & Nutrition The Ohio State University Wexner Medical Center, Columbus, OH USA
| | | | - Dana K. Andersen
- Division of Digestive Diseases and Nutrition National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD USA
| | - Evan L. Fogel
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN USA
| | - On behalf of the Consortium for the Study of Chronic Pancreatitis, Diabetes, Pancreatic Cancer (CPDPC)
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine Indianapolis, 550 N. University Blvd. Suite 0663, Indianapolis, IN 46202 USA
- Department of Medicine Division of Gastroenterology, Hepatology & Nutrition University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY USA
- Division of Clinical Pharmacology, Stark Neurosciences Research Institute Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH USA
- Department of Radiology, Mayo Clinic, Rochester, MN USA
- Department of Radiology Cedars-Sinai Medical Center, University of California in Los Angeles, Los Angeles, CA USA
- Department of Biostatistics Director, Quantitative Science Program, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- Division of Digestive and Liver Diseases Cedars-Sinai Medical Center, Los Angeles, CA USA
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA USA
- Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
- Division of Gastroenterology, Hepatology & Nutrition The Ohio State University Wexner Medical Center, Columbus, OH USA
- Mayo Clinic, Rochester, MN USA
- Division of Digestive Diseases and Nutrition National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD USA
- Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN USA
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