A 3-year-old boy presented with a 3-day history of total blindness. There were no features of raised intracranial pressure or endocrine disturbance. Magnetic resonance imaging of the brain showed a giant craniopharyngioma measuring 5 x 3 cm. It was located in the suprasellar region and produced a mass effect with compression of the III and both lateral ventricles. The tumour extended downwards into the pituitary fossa. Urgent surgical decompression and subtotal excision of the tumour resulted in complete visual recovery in the right eye. The left eye remained blind. The blindness might have been caused by direct pressure on the optic nerves and chiasma by the tumour. The lack of visual recovery in the left eye may be the consequence of additional ischaemic insult to the left optic nerve. It is concluded that surgical decompression should be carried out in a patient with a giant craniopharyngioma presenting with total blindness before the condition is considered hopeless.
Background The clinical utility of antimicrobial prophylaxis in clean pediatric surgical cases remains enigmatic. The present study aims to evaluate the prevalence of surgical site infections in instances where antibiotic prophylaxis is not employed prior to clean pediatric surgical procedures. Methods A retrospective cross-sectional study that included data of all pediatric clean surgical procedures from January 2018 till January 2020 was conducted. All children undergoing clean surgical procedures who did not receive antibiotics at least two weeks prior to the procedure were included in the study. The exclusion criteria included patients with congenital heart disease, ventriculoperitoneal shunt, nephrotic syndrome, immunodeficiency, and prior administration of antimicrobial prophylaxis. All patients were followed for two to four weeks for any signs of surgical site infections. Results Of the 178 patients included, 119 were male and 59 were female, with the mean age hovering at 8.19 ± 2.87 years. Orchidopexy and herniotomy were the most commonly performed surgical procedures, and were performed in 56 (31.46%) and 54 (30.33%) patients, respectively. Only one case of postoperative surgical site wound infection was reported, accounting for a prevalence rate of 0.56%. Conclusion In clean pediatric surgical procedures, the risk of surgical site infections is exceedingly low. The unnecessary use of antibiotics in children can cause deleterious adverse effects and promote antimicrobial resistance. In a carefully selected pediatric population, administration of antibiotic prophylaxis might confer no added benefit.
Superior mesenteric artery syndrome, or Wilkie's syndrome, is an unexpected cause of upper gastrointestinal tract obstruction. The exact incidence of the condition remains unknown, and limited case reports are present in the literature. The obstruction results in the compression of the third part of the duodenum between the superior mesenteric artery and aorta. It is widely known that a lack of subcutaneous tissue in the area can precipitate the obstruction by significantly reducing the aortomesenteric angle. Wilkie's syndrome presents a clinically diagnostic challenge as patients initially remain undiagnosed with relapsing episodes of upper abdominal pain and bilious vomiting. In some cases, an acute obstruction may arise. Undertaking an initial contrast study of the upper gastrointestinal tract and a CT scan are required to confirm the diagnosis of the condition. In the present study, we elucidate the case of a 12-year-old girl who presented with upper abdominal pain and bouts of bilious vomiting. Upon extensive diagnostic evaluation, Wilkie's syndrome was diagnosed. Since the patient failed to respond to conservative treatment, a laparotomy with subsequent duodenojejunostomy was undertaken. The postoperative recovery of the patient was uneventful with no recurrence of symptoms on follow-up.
Background Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a rare congenital malformation of the trachea and the esophagus. While the condition can result in a debilitating clinical picture, its outcomes have significantly ameliorated in recent times. The diminishing mortality associated with the disease can be attributed to a myriad of factors, including surgical advances, specialized anesthetic care, and categorical ventilator provision. These advances have resulted in increased survival rates even in premature infants who present with exceedingly low birth weights. Nevertheless, the mortality surrounding the condition still remains exceedingly high in some parts of the world, including the Middle East and Asia. The aim of the present study is to identify and outline the management of the postoperative complications that are intricately linked with soaring mortality rates. Methods We conducted a single-center retrospective study, three years in duration, of all the patients who were operated for esophageal atresia with tracheoesophageal fistula. The exclusion criteria included patients who died before the operation and those who were referred to other centers for management. The study evaluated several factors, including the various postoperative complications, their adept management, and the eventual outcomes. Data pertaining to the patient demographics, treatment, and radiological and laboratory findings was obtained and eventually analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0 (IBM Corp., Armonk, NY, USA) software. Results The present study included a total of 12 cases diagnosed in our hospital during the aforementioned study period. Of these patients, two patients (16.7%) died before operation because of associated severe congenital anomalies such as cardiac pathologies. Three patients were referred to other centers for management. These patients were excluded from our analysis. The remaining seven patients were included in our analysis. In our study, gastroesophageal reflux was the most common postoperative complication and was noted in six patients. Leakage of anastomosis was noted in two patients. Lung collapse was noted in merely one patient and was thus the least common complication. The overall mortality rate hovered around 28.6%. Conclusions While most patients who are surgically managed for esophageal atresia with tracheoesophageal fistula develop postoperative complications, these complications are amenable to conservative management through the means of antibiotics, ventilator support, and total parenteral nutrition.
BackgroundNecrotizing enterocolitis (NEC) is a debilitating disease that predominantly afflicts premature neonates, although it can also affect term neonates. The clinical features of the ailment vary widely and range from transient feed intolerance to life-threatening complications such as septicemia and disseminated intravascular coagulation. While surgery is usually only reserved for severe cases, such as those presenting with intestinal perforation, the role of surgical management in cases of NEC without perforation remains elusive. MethodsA retrospective chart review of patients, three years in duration, was conducted and studied confirmed cases of NEC. The clinical presentations studied included cases of NEC with pneumatosis intestinalis, fixed bowel loop, pneumoperitoneum, and abdominal wall erythema. The patients were divided with regards to their intestinal perforation status and with pertinence to the treatment modality employed (medical or surgical). The results in either group were eventually analyzed in terms of the overall survival rate. ResultsA total of 48 patients were included in the study, of which 79.16% presented without perforation and 20.83% with perforation. Of the study participants included, 26 were females and 22 were males. Pertinently, no gender predominance was appreciated. In patients without perforation, medical management was noted to boast a lower mortality rate when compared with surgical intervention (15.6% vs 50.0%, respectively). In patients with perforation, the overall mortality was noted to hover at 50.0%, which was higher than that encountered in the non-perforation group. ConclusionIn patients with NEC without perforation, surgical treatment confers no comparative therapeutic advantage when compared with medical management alone. Conservative management with broad-spectrum antibiotics including metronidazole yields equally favorable outcomes in such cases.
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