Murat Alkan

Severe Abdominal Trauma Involving Bicycle Handlebars in Children

Objectives To emphasize the severity of the underlying injury which may not be realized during the initial patient admission to the emergency department. Methods A retrospective case note review of children admitted to our institution with the severe abdominal injury. Results Eight children were identified with the severe abdominal injury secondary to the trauma from a bicycle handlebar that needed special care in the intensive care unit. All injuries were due to blunt trauma. The mean delay from the time of the accident to the time of presentation was 34.5 hours. All patients had an imprint of the handlebar edge on the hypochondrium. There were 3 pancreatic lacerations, 1 duodenal laceration, 1 jejunal laceration, 1 liver laceration, 1 abdominoinguinal laceration that all required open surgery, and 1 duodenal hematoma that resolved in 4 weeks follow-up period. The patients who required open surgery were evaluated with computed tomographic scans before surgery. Conclusions Children with an imprint made by the handlebar edge on the abdominal wall or give a clear history of injuries by a bicycle handlebar should be treated with great care. Early computed tomography evaluation may help to reduce the morbidity resulting from the delay in diagnosis of injuries to the internal organs.

Fetal urinary ascites in a neonate without detectable obstructive uropathy or neurogenic bladder etiology

Fetal urinary ascites is usually secondary to an obstructive uropathy or neurogenic bladder. We present such a case in the absence of these conditions, but the presence of ipsilateral vesicoureteral reflux with Hutch diverticula. The patient was a 5-day-old boy presenting with distension of the abdomen and impairment of renal function. Tests revealed urinary ascites and renal insufficiency which spontaneously resolved after transurethral urinary drainage was established. This rare complication should be considered in neonates with high intrapelviureteric and intrarenal pressure as a result of high-grade vesicoureteral reflux with paraureteral diverticula.

Clues to the diagnosis of biliary atresia in neonatal cholestasis.

BACKGROUND/AIMS The purpose of this study was to identify important clues in differentiating biliary atresia (BA) from causes of neonatal cholestasis other than BA (non-BA) and establishing the reliability of current tests. MATERIALS AND METHODS Thirty-four patients with BA and 27 patients with non-BA cholestasis being monitored at the Çukurova University Medical Faculty, the Pediatric Gastroenterology Department and the Pediatric Surgery Department between 2009 and 2015 were retrospectively assessed. RESULTS Cases of early onset jaundice, acholic stool, gamma-glutamyl transferase (GGT) elevation, and absent or small gallbladder on ultrasonography (USG) were greater in the BA group, while the levels of consanguinity and splenomegaly were higher in the non-BA group. The highest positive predictive value and specificity was determined for a GGT level greater than 197 in addition to absent or small gallbladder on USG and acholic stool in the BA group. Moreover, the presence of acholic stool (97%) exhibited the highest sensitivity and accuracy in the diagnosis of BA. CONCLUSION Pale stool, GGT elevation, and absent or small gallbladder on USG are the most reliable tests for diagnosing BA. We recommend that intraoperative cholangiography should be performed without waiting for further test results when a neonate or infant presents with acholic stool, high GGT values, and absent or small gallbladder on abdominal USG.

Laparoscopy-Assisted Percutaneous Cholangiography in Biliary Atresia Diagnosis: Comparison with Open Technique

Introduction. Biliary atresia is a surgical cause of prolonged jaundice, which needs to be diagnosed with cholangiography that has traditionally been performed via laparotomy. Laparoscopic assistance has lately been introduced to avoid unnecessary laparotomy. We aim to evaluate the benefits of the laparoscopy-assisted cholangiography and compare it to the traditional procedure via laparotomy. Patients and Method. The medical records of the cases who had undergone cholangiography for prolonged jaundice between 2007 and 2014 were analyzed. The patients were grouped according to cholangiography technique (laparotomy/laparoscopy). The laparoscopy and laparotomy groups with patent bile ducts were focused and compared in terms of operation duration, postoperative initiation time of enteral feeding, and full enteral feeding achievement time. Results. Sixty-one infants with prolonged jaundice were evaluated between 2007 and 2014. Among the patients with patent bile ducts, operation duration, postoperative enteral feeding initiation time, and the time to achieve full enteral feeding were shorter in laparoscopy group. Conclusion. Laparoscopic cholangiography is safe and less time-consuming compared to laparotomy, with less postoperative burden. As early age of operation is a very important prognostic factor, laparoscopic evaluation should be an early option in work-up of the infants with prolonged jaundice with direct hyperbilirubinemia, for diagnosis/exclusion of biliary atresia.

Rectus sheath block for postoperative pain relief in children undergoing major abdominal surgery

Abstract Background: Regional anaesthetic techniques in children has become increasingly popular and used to provide analgesia for umbilical and epigastric hernia repair, laparoscopic surgery, pyloromyotomy and other

Factors Affecting the Prevalence of Gastro-oesophageal Reflux in Childhood Corrosive Oesophageal Strictures

BACKGROUND Gastro-oesophageal reflux may accompany the corrosive oesophageal damage caused by the ingestion of corrosive substances and affect its treatment. The factors that affect the development of reflux in these cases and their effects on treatment still remain unclear. AIMS Our aim is to investigate the prevalence of gastro-oesophageal reflux in children with corrosive oesophageal strictures, the risk factors affecting this prevalence and the effects of gastro-oesophageal reflux on treatment. STUDY DESIGN Case-control study. METHODS We enrolled 52 patients with oesophageal stricture due to corrosive substance ingestion who were referred to our clinic between 2003 and 2010. Groups, which were determined according to the presence of gastro-oesophageal reflux (GER), were compared with each other in terms of clinical findings, results of examination methods, characteristics of the stricture and success of the treatment. RESULTS The total number of patients in our study was 52; 30 of them were male and 22 of them were female. The mean age of our study population was 4.2±2.88 years. Thirty-three patients had gastrooesophageal reflux (63.5%). Patients who had strictures caused by the ingestion of alkali substances were 1.6-times more likely to have reflux. There were no differences between patients with or without reflux in terms of number and localisation of strictures. Mean distance of stricture was longer in patients with reflux (3.7±1.8 cm) than in patients without (2.2±1.0 cm) (p<0.005). Only one patient among 17 who had a long stricture (≥4 cm) did not suffer from reflux. Patients with long stricture were 1.9-times more likely to have reflux. Dilatation treatment was successful in 69.6% of patients with reflux and in 78.9% of patients without. The mean treatment period was 8.41±6.1 months in patients with reflux and 8.21±8.4 months in the other group. There was no significant difference between groups in terms of frequency of dilatation and dilator diameters (p>0.05). CONCLUSION Corrosive oesophageal stricture was usually accompanied by gastro-oesophageal reflux and the length of stricture is an important risk factor. Negative effects of reflux over dilatation treatment have not yet been demonstrated in the short-term. Nevertheless, this frequent rate of reflux may eventually increase the risk of oesophagitis and Barretts oesophagus; therefore, we suggest that these effects should be prospectively evaluated in a large number of patients and these patients should be followed-up routinely in terms of the long-term effects of reflux.

Spontan Superior Mezenter Arter Rüptürüne Bağlı İntraabdominal Kanama

Mezenterik damarlarin spontan olarak rupturu cocuklarda cok nadir bir durumdur. Bu calismada travma oykusu olmaksizin akut karin ve hemorajik sok tablosu ile basvuran 14 yasinda ikiz esi bir erkek cocuk sunulmaktadir. Acil laparotomide a. mezenterika superiorun rupture oldugu saptanmis, onarimi denendiyse de ileri derecede vaskuler frajilite nedeni ile basarilamamistir. Tum orta barsakta nekroz gelistiginden, duodenumdan inen kolona kadar genis rezeksiyon yapilmasi gerekmis, duodenal ve kolonik uclar kapatilmistir. Ameliyat sonrasinda abdominal kompartman sendromu, duodenal fistul ve sepsis gelisen hastada uc hafta icerisinde hem kompartman sendromu, hem de fistul kaybolmustur. Ikiz esinde ve hastamizdaki atipik yuz gorunumu, ince cilt yapisi, kanamaya egilim bulgularinin esliginde, yapilan histopatolojik incelemenin de destegi ile ameliyattan 4 hafta sonra Ehler Danlos Sendromu Tip IV tanisi konulabilmistir. Ameliyat sonrasi 3. ayda spontan gelisen femoral arteriovenoz fistul konservatif tedavi edilebilmis, ancak, hasta ince barsak nakli icin bekleme listesinde iken bes ay sonra kaybedilmistir. Abdominal apopleksi olgularinda Ehler Danlos Sendromu akilda tutulmalidir. Bu olgulardaki vaskuler komplikasyonlarin onarimi tip III kollajen anormalligine bagli vaskuler frajilite nedeni ile mumkun olmayabilir.

Radionuclide imaging of jejunoileal duplication cyst in a child.

A 2-and-a-half-year-old boy was hospitalized for painless bloody stools for the last few months. The patient underwent Tc-99m pertechnetate scintigraphy to confirm the presence of a Meckel diverticulum. Images showed generalized increased uptake in the inferior area of the stomach. At laparotomy, a 70-cm long jejunoileal cystic and tubular duplication was resected. Histologic examination showed gastric mucosal lining and hemorrhagic areas. The importance of Tc-99m pertechnetate scintigraphy for the diagnosis in heterotopic gastric mucosa is highlighted.