Etiological pattern of LA in children has remained the same over the years, and in most regions, it is associated with Staphylococcus aureus and amebic LA is quite uncommon. US or CT scan is the most frequently employed diagnostic modality for LA, and follow-up is usually performed by serial US scans. Antimicrobial therapy along with, if necessary, drainage of the abscess by either percutaneous or open surgical route remains the treatment of choice.
ABSTRACT ABSTRACTBackground/Purpose: The purpose of this prospective study was to review the operative findings, treatment strategies, as well as the results of management of 46 consecutive cases of jejunoileal and colonic atresia, managed over a 2-year period. Materials and Methods: There were 42 patients with jejunoileal atresia (JIA) and 4 with colonic atresia (CA). The 4 group types were: type I-membranous (n=20), type II-blind ends separated by a fibrous cord (n=6), type IIIa-blind ends with a V-shaped mesenteric defect (n=10), type IIIb-apple-peel atresia (n=4) and type IV-multiple atresias (n=6). Primary surgery for JIA consisted of resection with a single anastomosis (n=37), anastomosis after tapering jejunoplasty (n=3), multiple anastomosis (n=1) and a Bishop-Koop ileostomy (n=1). For CA, resection with primary anastomosis was performed. A single end-to-oblique anastomosis after adequate resection of dilated proximal bowel, was the preferred surgical procedure. In the absence of facilities for administering TPN, early oral/ nasogastric (NG) tube feeding was encouraged. In patients with anastomotic dysfunction, conservative treatment of the obstruction followed after its resolution by gradually increased NG feeds, was the preferred treatment protocol. Results: Late presentation or diagnosis with hypovolemia, electrolyte imbalance, unconjugated hyperbilirubinemia (n=25) and sepsis (n=6), were significant preoperative findings. After resection and anastomosis, significant shortening of bowel length was seen in 16 patients (34.7%). Postoperative complications included an anastomotic leak (n=3), a perforation proximal to the anastomosis in 1 and anastomotic dysfunction in 5 patients. Full oral or NG tube feeding was possible only by the 13th to 31st postoperative day (POD), after the primary surgery in patients with anastomotic dysfunction and those undergoing reoperation. Overall, 38 patients survived (82.6%). Mortality was highest in patients with type IIIb or type IV JIA. Conclusions: Despite lack of ideal facilities for neonatal intensive care and administration of TPN, good results were achieved in the management of JIA and CA by following these principles: (1) adequate preoperative resuscitation, (2) meticulous surgical technique and a standardized surgical protocol, (3) early recognition of postoperative complications and their management by a uniform protocol and (4) wherever possible, early institution of oral or NG feeds, preferably by breast milk.
Since propranolol was accidentally discovered to induce involution of hemangiomas, it is being used by many clinicians with a favourable response. We present our experience with use of propranolol and report three infants with hemangiomas who were treated with propranolol. First infant had a marked involution of the lesion; second infant had a appreciable response while the third infant had a initial minimal response with progressive increase in size of the lesion.
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