This study suggests that a later onset is a protective sign for the progression to surgery, whereas lower pH values and higher CRP levels are prognostic factors associated with the need for surgery. The line of treatment involving explorative laparotomy in case of perforation seems to be rewarded by low morbidity and mortality rate.
Introduction Prenatal ultrasound diagnosis of anorectal malformations (ARMs) is challenging and often missed as direct visualization of the anal sphincter is not routinely performed, plus the technique is operator-dependent and inaccurate, also in expert hands. Other indirect signs, such as rectosigmoid overdistension or intraluminal calcifications, are occasionally present in late pregnancy. The detection of a cyst of the lower abdomen in the first trimester may be an early sign of ARM. Here we reported our experience and a review of the literature of such cases. Material and methods Isolated cases of lower abdomen cysts encountered in the first trimester at the Prenatal Diagnosis Unit during the last 5 years were retrieved and compared with those found in literature. Post-natal clinical data were analyzed to check the presence and type of malformations. Results A total of three cases of lower abdomen cysts were found in our center and 13 in literature. In our case series all the cysts spontaneously regressed and were no longer visible since the second trimester of pregnancy, while in literature this was reported in only 4 out of 13 cases. ARM was confirmed in all patients at birth or post-mortem. Conclusions The finding of a lower abdomen cyst during the first trimester of pregnancy could be an early predictive sign of ARM, even if it disappears during pregnancy. In these cases, we suggest mentioning to the parents the possibility of an ARM during the counseling and to refer the couple to a Colorectal Center. Graphical Abstract
The case of a toddler with long-channel cloaca, mild chronic kidney disease (CKD) due to renal dysplasia, and early onset of ulcerative colitis (UC) is herein reported. The patient underwent definitive repair of cloaca, that included vaginal elongation with colon, at 5 months of age and was admitted for episodes of vaginal bleeding at 22 months of age. A vaginoscopy revealed a severe inflammation of the colonic neovagina. As rectal bleeding was also noticed, she underwent a colonscopy that showed the same macroscopic inflammatory picture. Neovaginal and colonic biopsies confirmed UC. The mother turned out to be affected by UC since adolescence. The patient is now on oral therapy with mesalazine and topical steroid and mesalazine in the neovagina. The association between cloaca and inflammatory bowel disease (IBD) is anecdotal, but the family history of IBD should be considered when planning the surgical reconstruction of patients with cloaca. In this patient, the occurrence of UC may require a new neovagina in the future and the concomitance of CKD may complicate the overall management due to the potential nephrotoxicity of drugs used for UC therapy.
Background Early complications and their surgical management after esophageal atresia (EA) correction aren’t largely described in the literature. Anastomotic stricture and anastomotic leakage are the most commonly described. Those, along with iatrogenic chylothorax, are safely managed with a conservative approach. Surgery is indicated for nonresponding cases and often carries major invasiveness. This study reports thoracoscopy use for EA complications at our center in a 2-year period (2017–2018). Case Reports Case 1, birth weight (BW) 1550 gr, presented respiratory difficulties 6 days after open surgery: chest X-ray revealed right diaphragmatic eventration probably due to phrenic nerve damage; Case 2 (BW 3420 gr) presented anastomotic dehiscence with salivary traces in drainage tube, 9 days after thoracoscopic (TS) repair with azygos vein sparing; Case 3 (BW 2530 gr) developed right chylothorax 13 days after right thoracotomy following primary TS left approach for dextrocardia (5 days after oral feeding was started) resistant to Octreotide treatment. All cases were successfully treated with TS technique. Case 1 underwent TS right diaphragmatic plication after an initial conservative approach. In case 2 we performed TS anastomosis revision with bovine pericardium patch apposition. Case 3 underwent right TS cruentation and glueing of the right costophrenic recess (6 weeks after surgery) for chylothorax persistence despite 22 days of Octreotide therapy. No intra- or postoperative complication occurred. A TS approach for EA repair is replacing open surgery, which is nowadays limited to selected neonates. The open technique seems to increase the risk of postoperative early complications, probably because thoracoscopy allows optimal anatomy visualization and minimal tissue handling. It is also postulated that TS azygos sparing may be a preventive factor against anastomotic leakage, even though it can be technically demanding. Furthermore, thoracoscopy can reduce invasiveness in the case of a diagnostic maneuver such as left anatomy exploration. Conclusions Early surgical complications after EA repair are rare, and can be safely treated with a TS approach, regardless of the primary surgical technique. If properly managed, they have good prognosis. Benefits of TS EA repair are widely known, and early reintervention for complications with this technique seems to be safe and justified in centers where neonatal MIS is the –first-choice approach.
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