Stjepan Višnjić

Two-port Laparoscopic Management of an Autoamputated Ovarian Cyst in a Newborn

A 4-week-old newborn underwent laparoscopic removal of a hemorrhagic cyst measuring 4 cm in diameter. Preoperative diagnostics suggested autoamputation, which is a rare complication of fetal ovarian torsion. The laparoscopic procedure, lasting 26 minutes, was performed, without any major intraoperative complications--bleeding, rupture, or leakage. The modified 2-port technique was used. The identification of all structures was exact. The hemorrhagic cyst was freed of the cyst bed, suctioned to fit the size of the umbilical port, and removed. The presentation of a blind adnexal stump proved autoamputation. The condition of the contralateral ovary was verified. The authors present the laparoscopic procedure with the emphasis on the technique.

Isolated fallopian tube torsion with partial hydrosalpinx in a premenarcheal girl: a case report

IntroductionIsolated fallopian tube torsion as a complication of a preexisting hydrosalpinx is a rare finding in pediatric patients. The obvious rarity of this condition, its subtle diagnostic features and dissonant previous reporting about the appropriate therapeutic approach according to age, future conception capacity and potential complications of possible pregnancies make the decision about which surgical approach to use very difficult. In this report, we describe the case of a patient with such a presentation and review the literature. Very few similar reports of neosalpingostomy in pediatric patients have been published to date.Case presentationIn our present report, we describe the case of an 11-year-old Caucasian prepubertal girl who presented to our hospital with complaints of abdominal pain in the right lower quadrant, nausea and vomiting. The diagnostic workup led us to conclude that she had a torsion of the right ovary, which was cystically altered. Exploratory surgery revealed a partial hydrosalpinx and consecutive isolated torsion of the fimbrial part. The proximal isthmic part of the fallopian tube was intact and vital. Restorative surgery was performed to create a neosalpingostomy on the viable isthmic part of the tube and remove the cystic and twisted fimbrial and infundibular parts.ConclusionThe surgical procedure described in this report is technically simple and feasible, but leaves doubts about the final outcome.

An unusual outcome in a child with hepatosplenic cat-scratch disease.

ZusammenfassungDie klassische Katzenkratzkrankheit (Infektion mit Bartonella hensalae) ist bei einem immunkompetenten Kind mit der Anamnese eines Kratzers, Bisses oder intimen Kontaktes mit einer Katze vergesellschaftet. Die meisten Patienten entwickeln nach drei bis 10 Tagen einen harten Knoten in der Kratzlinie. Dieser kann wenige Tage, aber auch zwei bis drei Wochen bestehen bleiben. Während der nächsten ein bis zwei Wochen, manchmal auch länger, schwellen die regionalen Lymphknoten, die das Gebiet drainieren, in 10% der Patienten allmählich an und wieder ab. Die Knoten entwickeln ein Erythem, manchmal eitern sie. In wenigen Fällen von Katzenkratzkrankheit ist der Verlauf atypisch: Es kommt dann zu Augen- oder neurologischen Symptomen, Befall der Leber und Milz, Osteomyelitis der Wirbel, Endocarditis und Ähnlichem. Die Infektion mit Bartonella hensalae kann bei immunkompromittierten Individuen zu einer bazillären Angiomatose, bzw. Peliosis und zu einer rezidivierenden Bakteriämie führen. Es gibt verschiedene Berichte über Granulome in der Leber oder Milz die bei immunkompetenten Kindern durch B. hensalae ausgelöst wurden. Wir berichten über einen sechsjährigen Knaben mit einer derartigen hepatosplenalen Form der Katzenkratzkrankheit. Trotz früher Diagnose und Langzeit-Antibiotika-Behandlung konnte bei ihm eine Splenektomie nicht vermieden werden.SummaryTypical cat-scratch disease (Bartonella henselae infection) in an immunocompetent child is usually associated with a history of scratch, bite or intimate contact with a cat. Most patients develop a non-tender papule in the scratch line after three to ten days. This may persist for only a few days or as long as two to three weeks. During the next two weeks or more, regional lymph nodes that drain the area gradually enlarge and then slowly resolve in more than 10% of patients. The nodes develop overlying erythema and may suppurate. Atypical forms of cat-scratch disease occur in a minority of cases and are characterized by ocular or neurological manifestations, hepatosplenic involvement, vertebral osteomyelitis, endocarditis etc. Immunocompromised individuals with B. henselae infection may develop bacillary angiomatosis, bacillary peliosis, and relapsing bacteremia. There have been several reports of hepatosplenic granulomas caused by B. henselae in immunocompetent children. We report a case of a 6-year-old boy with the hepatosplenic form of cat-scratch disease. Despite early diagnosis and long-term antimicrobial treatment, splenectomy could not be avoided.

Laparoscopically assisted appendectomy

ZusammenfassungGRUNDLAGEN: Die akute Appendizitis ist die häufigste kinderchirurgische Indikation. METHODIK: Fallbericht über die erste Einzel-Trokar-Laparoskopie-assistierte extrakorporale Appendektomie in Kroatien. ERGEBNISSE: Bei dieser Technik wird der Appendix über den Arbeitsport herausgezogen und die Resektion vor der Bauchdecke durchgeführt. Analog zu publizierten Daten ist unsere Erfahrung mit der Technik sehr gut, auch mit gutem kosmetischem Ergebnis. SCHLUSSFOLGERUNGEN: Die Erfahrung mit der neuen minimal invasiven Technik steht im Einklang mit publizierten Daten.SummaryBACKGROUND: Acute appendicitis is probably the most common problem in pediatric surgery. METHODS: Report on first case of single port laparoscopically assisted extracorporeal appendectomy in Croatia. RESULTS: In this technique, the appendix is delivered to the surface through the working port, and appendectomy is carried out extracorporeally. In keeping with recent publications, our experience is encouraging. Superior cosmetic result and lower operative stress are advantages compared to open surgery; shorter procedure and reduced cost are advantages compared to conventional laparoscopic procedure. CONCLUSIONS: Experience with single port laparoscopically assisted extracorporeal appendectomy is in keeping with published data.

Short-term “double natural orifice catheterization”: Nonoperative management of hydrocolpos in persistent cloaca patients – case series

PURPOSE Management of hydrocolpos in cloaca patients is of clinical importance. We report a nonoperative method for the management of hydrocolpos in the form of initial catheter decompression, followed by an endoscopy with catheters placement into both the bladder and vagina, and leaving these catheters for 9 and 14days respectively. METHODS The medical records of six cloaca patients with hydrocolpos in the last 12years were reviewed. The outcomes measured were the renal function, bladder emptying, the presence/resolution of hydronephrosis, and the recurrence of hydrocolpos. RESULTS Complete drainage of hydrocolpos was achieved in four out of six cases and partial drainage in two. On common channel endoscopy, in four patients the structures were identified and balloon catheters inserted. After catheter removal, the vagina and urinary tract remained adequately drained through the natural cloacal opening with no post-micturition residual urine, resolution of hydroneprosis within 60days, preserved renal function, and no hydrocolpos reaccumulation. CONCLUSION Initial decompression and short time catheterization can be the definite solution for some cloaca patients with hydrocolpos. Our case-series showed a success rate in two-thirds of patients by achieving the three main goals; permanent hydrocolpos derivation, undisturbed voiding, and preservation of renal function. LEVEL OF EVIDENCE Study can be classified as a Treatment Study, LEVEL IV Case series with no comparison group.

Minimalno invazivna urološka kirurgijadječje dobi - Što možemo učiniti danas?

Urološka minimalno invazivna kirurgija danas se u većini centara rutinski primjenjuje za bazične operativne zahvate. U posljednje vrijeme počinje njena sve veća primjena u složenijim operativnim zahvatima u odabranim centrima diljem svijeta. Iznosimo pregled urološke patologije koja se trenutno liječi minimalno invazivnim pristupkom te izdvajamo pojedine relevantne članke o kojima se raspravljalo i usporedilo s iskustvom Klinike za dječju kirurgiju Klinike za dječje bolesti Zagreb. Od početka primjene minimalno invazivne kirurgije u Klinici za dječju kirurgiju Klinike za dječje bolesti Zagreb operirano je više od 1300 djece različite urološke patologije. primijenjena su tri pristupa: transperitonealni, retroperitonelani i transvezikalni. Najveći broj operacija pripada endoskopskom liječenju vezikoureteralnog refl uksa (VUR-a). Indikaciju za primjenu minimalno invazivnih postupaka osim VUR-a imaju nepalpabilni testisi, varikokela, nefrektomija te adrenalektomija. Čak i najsloženije urološke operacije mogu se izvoditi služeći se minimalno invazivnim pristupom, premda većina opisanih slučajeva pripada kategoriji „case report-a“. U posljednje vrijeme svjedoci smo mnogih publikacija o ablativnoj i rekonstruktivnoj minimalno invazivnoj kirurgiji. Transperitonealni i retroperitonelani pristup primjenjuju se s približno istim rezultatima. Transvezikoskopska kirurgija trebala bi se brzo razvijati i postati standardni pristup za Cohenovu reimplantaciju. Smatra se da će tehnički napredak osigurati priliku pedijatrijskim urolozima za razvijanje minimalno invazivnih postupaka.

Predictors of pediatric surgeons’ career satisfaction: a national survey

ObjectiveA survey was performed to identify factors for professional career satisfaction and for dissatisfaction. MethodsDuring General Assembly of CSPS, attendees answered the 37-question form grouped into the following categories: demographic, professional activity and organizational issues, type of service, education, and compensation and status. Data were analyzed using the Pearson &khgr;2 test (P<0.05). ResultsThe response rate was 74.5% (n=44/59). The average age was 46 years, and 91% were male. The average participant had 17 years of surgical practice, worked 8.5 hours daily and 208 hours monthly, in children’s (49%), university (35%), or community (16%) hospital. Pediatric surgeons were satisfied with professional career (77%), and 88% would chose the same profession again. Patient satisfaction (85%), quality of care (79%), and professional achievements (76%) were rated very high. Dissatisfaction responders pointed at shortage of time for effective communication (69%), excessive administrative work (88%), too many working hours (73%), professional burnout (66%), and technical issues – IT technology (73%) and equipment (79%) out of date or old/unsuitable facilities (73%). An overall 57% of responders had presented paper on international congresses, and 32% had published paper in indexed journals. Two major concerns about education are insufficient training (61%) and lack of time for continuous education (79%). ConclusionPediatric surgeons are satisfied with professional career. Patient care is a leading area of satisfaction. Educational, organizational, technical, and structural issues need improvements. A large pay gap exists between expectations and real income.

Duodenal Duplication Cyst: A Rare Differential Diagnosis in a Neonate with Bilious Vomiting.

Bilious vomiting is a relevant sign in neonates that requires immediate evaluation and diagnosis. A duplication of the intestinal tract is a possible cause of obstruction if located distally to the major duodenal papilla of Vater and most of them involve the jejunum, stomach, or colon. Duodenal duplications are very rare and can have an endoscopic or surgical treatment after diagnosis. We present a case of a 16-day-old term newborn that consulted because of bilious vomiting and after evaluation with imaging and upper endoscopy, a duodenal duplication cyst was found at the level of the third portion causing compression of the intestinal lumen that required surgical resolution with duodenocystostomy.