RESUMEN
Peutz-Jeghers syndrome (PJS) is a familial condition characterized by the presence of pigmented mucocutaneous spots and intestinal polyposis. Intussusception is the most frequent abdominal complication, but it is very rare. In our country, this is the second known report. In this article we present four cases of PJS associated with intussusception. All the patients were female and all underwent a surgical procedure. The intussusception was located in the ileum and colon. There are no more than 20 reported cases in the world where these two entities are associated. Children with PJS have a high risk of suffering from ileo-ileal or jejuno-ileal intussusception that will frequently require a special surgical procedure.
Asunto(s)
Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Válvula Ileocecal , Intususcepción/etiología , Intususcepción/cirugía , Enfermedades del Yeyuno/etiología , Enfermedades del Yeyuno/cirugía , Síndrome de Peutz-Jeghers/complicaciones , Adolescente , Niño , Preescolar , Femenino , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Ileostomía , Intususcepción/diagnóstico por imagen , Enfermedades del Yeyuno/diagnóstico por imagen , Laparotomía , Masculino , Radiografía Abdominal , Resultado del TratamientoRESUMEN
INTRODUCTION: Acute adhesive obstruction of the small intestine is a surgical emergency in which there is a risk of intestinal ischemia. By delaying diagnosis and institution of appropriate treatment for ischemic obstruction, morbidity and mortality increase. MATERIAL, METHOD AND RESULTS: The hospital records of 63 patients with diagnosis of intestinal obstruction and regional ischemia due to fibroadhesive peritonitis were reviewed in an attempt to identify criteria that could be used to separate patients who would require an emergency operation; 39 (61.9%) were male and three (4.7%) newborn. This complication was seen after 3 years of age in 39 patients (69.1%). Appendicitis was first cause with 26 cases (41.2%). Range of time of appearance after operation was from 1 week to 15 years (median 10 months). In 87% of patients the operation was a second procedure. All had gangrene and an enterostomy was constructed. General morbidity rate was 80%. Four children died. CONCLUSION: It is mandatory to identify which patients require non conservative management.
Asunto(s)
Enfermedades Intestinales/etiología , Intestinos/irrigación sanguínea , Isquemia/etiología , Laparotomía/efectos adversos , Peritonitis/etiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Obstrucción Intestinal/etiología , Masculino , Adherencias Tisulares/etiologíaRESUMEN
INTRODUCTION: Major trauma, specially abdominal and thoracic trauma due to child abuse is a serious, but fortunately infrequent problem which carries unacceptably high mortality. MATERIAL AND METHODS: We reviewed our experience with childhood trauma due to battered child syndrome in our hospital to learn the extent, circumstances, presentations, and consequences of this kind of events. Our hospital is the most important center for traumatized child care in Mexico. RESULTS: After our study, mild trauma due to child abuse accounted for 35 and major trauma accounted for 50 cases. In the former group, 10 patients with fractures were observed; 21 were male patients. Children were abused by father or stepfather in the 21 cases, and by the mother in six. There was delay in seeking immediate medical attention treatment in all patients. In the second group, there were ruptures of small bowel in 27, of the colon in four patients, pancreas in three, and esophagus in two. Lung, pleura, bladder, spleen and other anatomic structures also were affected. Five patients died. Similarity between the two patient groups studied indicates both the widespread nature of child abuse and the need to suspect this diagnosis whenever a child is present with unexplained shock or peritonitis, specially if there is anemia or bilious emesis. Delay in diagnosis contributed to mortality.
Asunto(s)
Síndrome del Niño Maltratado/cirugía , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Acute pancreatitis in children is an uncommon, little known, poorly defined disease and thus is rarely considered in diagnosis of pediatric abdominal pain. It is rare but is being recognized more frequently, and differs from the disease in the adult both in etiology and therapeutic approach. CLINICAL MATERIAL: Fifty children with acute pancreatitis were managed. Their history and postoperative course were analyzed in a retrospective study. RESULTS: The clinical presentation was unremarkable; all patients had abdominal pain, specially in epigastrium, and vomiting was the only other clinical sign exhibited by > 80%. More than 40 biliary diseases were the cause of pancreatitis; trauma was the cause in 30%. Diagnosis could be difficult and unnecessary laparotomy was performed in 16 cases (32.0%) instances of suspected acute abdomen. Morbidity included sepsis, diabetic cetoacidosis, and pancreatic pseudocyst. Biliary disease is a frequent cause of both pediatric and adult pancreatitis. They are differences in clinical course and prognosis. In children, pancreatitis is usually confused with appendicitis.