BACKGROUND: Data on thyroid surgery in children are scarce. OBJECTIVE: Analyze outcome data on thyroid surgery in a pediatric population. DESIGN: Medical record review. SETTING: Tertiary health care institution. PATIENTS AND METHODS: We collected demographic and clinical data on patients 18 years or younger who had thyroid surgery in the period 2000 to 2014. Descriptive data are presented. MAIN OUTCOME MEASURES: Indications for thyroidectomy, thyroid pathology, complications, length of stay, and radioactive iodine treatment and recurrences. SAMPLE SIZE: 103. RESULTS: Of 103 patients who underwent 112 thyroidectomy procedures, 80 (78%) were females and the mean age at operation was 13.2 years. and 17 (16%) were associated with multiple endocrine neoplasia type 2. There was no history of radiation exposure. Eighty-one patients (78%) had fine needle aspiration (FNA) which correlated with the final histopathology in 94% of cases. Sixty-six patients (64%) had malignant cancer (61 papillary), 44 (74.6%) of 59 patients who had neck dissection had lymph node metastasis and 7 (11%) had distant metastases to the lung. Procedures included total thyroidectomy (50%), hemithyroidectomy (17%), completion (31%), and subtotal thyroidectomy (2%). Twenty-three patients (22%) developed hypocalcemia (3 permanent) and 6 (5.8%) had unilateral recurrent laryngeal nerve injury (3 permanent). Patients were followed up for a mean duration of 71.7 months (median 60 months). Of 66 patients with thyroid cancer, 43 (65%) received radioactive iodine, and 10 (15%) had recurrence. CONCLUSION: Malignancy is the commonest indication for thyroid surgery in children and FNA is highly diagnostic. Hypocalcemia and recurrent laryngeal nerve injury are significant complications. The recurrence rate in thyroid cancer is 15%. LIMITATIONS: Retrospective. CONFLICT OF INTEREST: None.

BACKGROUNDColostomy is a common part of the management of high anorectal malformation (ARM) in the pediatric population.OBJECTIVETo evaluate whether the type of colostomy (loop vs divided) has an impact on outcome in patients with ARM.DESIGNA retrospective study.SETTINGKing Faisal Specialist Hospital and Research Center, a tertiary care center.PATIENTS AND METHODSAll patients who were managed with colostomy for ARM and had definitive repair during the period of January 2000 to December 2014. Outcomes relative to the type of the colostomy were compared.MAIN OUTCOME MEASURESMorbidities associated with each type of colostomy.RESULTSThere were 104 patients managed for ARM with colostomy as staged procedures, 63 males and 41 females. Patients had a colostomy at a median age of 6 days and were closed at a median of 11 months. Definitive repair was at a median age of 17 months. Type of fistula was 8 perineal, 21 rectovestibular, 35 rectourethral, 11 rectovesical and there were 16 without fistula and 13 cloaca anomalies. There were 55 loop and 49 divided colostomies. There were 91 descending/sigmoid and 13 transverse colostomies. Operative time for loop colostomy closure was shorter than with divided colo6stomy (76 minutes vs 94 minutes, P=.002). Three patients among the divided group had reversed orientation of the colostomy that had affected bowel preparations negatively prior to its repair. There was no differences in complications of creation and closure of loop and divided colostomies except in occurrence of skin excoriation. There was more skin excoriation with divided colostomy compared to loop colostomy (17 vs 10, P=.04).CONCLUSIONSLoop colostomy has a shorter closure operative time and relatively fewer complications compared to the divided colostomy. Our data suggests that loop colostomy may be more favorable than divided colostomy for ARM patients.LIMITATIONSRetrospective nature of the study and some colostomies performed at other hospitals.

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Introduction: Cryptorchidism, or undescended testis (UDT), is the failure of one or both testes to descend to the base of the scrotum. It is a common problem that increases the risk of infertility and testicular malignancy. We aimed to review the outcomes of orchidopexy and evaluate the risk factors for failure after surgery. Methods: We retrospectively reviewed all boys who underwent orchidopexy between 2018 and 2021 at a tertiary pediatric hospital.Data on patient demographics, surgical approach, complications and followup period were collected. Descriptive data were generated and compared using t-test and chi-squared tests. Statistical significance was set at p<0.05.Multivariate and univariate analyses were used to assess the significance of each factor studied. Results: One hundred patients aged < 14 years underwent orchidopexy. Among them, 76 patients underwent the open approach, and 24 underwent the laparoscopic approach. Among the laparoscopic approaches, six patients were operated on in one stage while the remaining underwent a 2stages approach. Postoperative complications, including Hematoma (8%), wound infection (2%), testicular atrophy (4%) and recurrence (5%), occurred in 16 patients. When analyzing the risk factors for testicular atrophy after orchidopexy, only the intra-abdominal location of the testis was found to be significant (P-value<0.0001). However, no factors were found to be significant when assessing for recurrence. Conclusion: Intra-abdominal testes are associated with a higher risk of postoperative testicular atrophy. Parents of patients with intra-abdominal testes should be aware of the higher risk.

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Background: Appendicitis is caused by the occlusion of the appendiceal lumen; it is the most cause of abdominal surgery emergency. The low fiber diet can cause the blockage of the appendiceal lumen. It is necessary to know the impact of the low fiber diet on the risk of appendicitis. Aim: To assess the association between a low fiber diet and the increased risk of appendicitis.Methods: This study is a case-control study that was conducted at 15 main hospitals in Qassim region during the period from 01 January 2020 to 01 June 2021. The study investigated the demographics and the nutritional habits of participants related to fibers using a fat & fiber behavior questionnaire "FFBQ" survey. The data were analyzed using the SPSS program. Results: Two groups were included; the patient group, which included 115 appendicitis patients, and the normal control group, which included 230 participants without history of appendicitis. There was a group match regarding the demographics of all the participants. The normal control group significantly tended to consume more different types of fiber diet compared to the patients' group. Also, between the two groups, there was a significant difference regarding the overall fiber diet frequency (P=0.0001). Conclusion: A low fiber diet is a major risk factor for appendicitis; the patients suffering appendicitis consume low fiber diets compared to normal individuals.

BACKGROUND: Trauma is one of the leading causes of pediatric mortality so the prevention of pediatric trauma is an important goal of any healthcare system. There are only a few studies on pediatric trauma in Saudi Arabia. The availability of data is vital for healthcare leaders in planning for healthcare services. OBJECTIVE: Assess the epidemiology, patterns, and outcome of trauma in the pediatric population in the Qassim region in Saudi Arabia. DESIGN: Descriptive medical records review. SETTING: A single-center, academic specialized pediatric referral hospital. PATIENTS AND METHODS: We reviewed all electronic and paper records for children (<14 years of age) admitted with a diagnosis of trauma to Maternity and Childrens Hospital (MCH) in Buraidah city in the two-year period between January 2017 and December 2018. MAIN OUTCOME MEASURE: Type of injury, length of stay, and mortality. SAMPLE SIZE: 133 children. RESULT: In this cohort, 77 cases (58%) were admitted to the pediatric intensive care unit (PICU) and 56 (42%) to the pediatric surgery ward. The median (interquartile range) age was 5 (1.1-8) years, and 92 (69%) were boys. The most frequent trauma was road traffic accidents, accounting for 70 cases (52%), followed by fall from a height for 40 (30%) cases. Traumatic brain injury was the most frequent type of injury, accounting for 56 cases (42%), and blunt abdominal trauma was in 11 cases (8.3%). Neurosurgery was the primary subspecialty actively involved in 62 cases (47%). Of the injured children who were admitted to PICU, 36 (46%) needed mechanical ventilation support, while 7 (9%) of those admitted to PICU required the insertion of intra-costal drainage. The mortality in our study was 3.7% (5 cases); 4 of 5 deaths were secondary to road traffic accidents. CONCLUSION: Pediatric trauma is a serious problem in our region with high mortality compared to international benchmarks. Road traffic accidents are the leading type of pediatric trauma, followed by falls from height. Further studies and perhaps national efforts are needed to identify ways to prevent road traffic accidents, and optimize the data registry and trauma services. LIMITATION: There were many missing data and incomplete files that affect accuracy and preclude generalization. CONFLICT OF INTEREST: None.