DOCSLIB.ORG

Original Article Diagnosis and Management of Post-Operative Complications in Esophageal Atresia Patients in China: a Retrospective Analysis from a Single Institution

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Original Article Diagnosis and Management of Post-Operative Complications in Esophageal Atresia Patients in China: a Retrospective Analysis from a Single Institution Int J Clin Exp Med 2018;11(1):254-261 www.ijcem.com /ISSN:1940-5901/IJCEM0059994 Original Article Diagnosis and management of post-operative complications in esophageal atresia patients in China: a retrospective analysis from a single institution Haitao Zhu*, Min Wang*, Shan Zheng, Kuiran Dong, Xianmin Xiao, Chun Shen Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai, P.R. China. *Equal contribu- tors. Received June 21, 2017; Accepted December 2, 2017; Epub January 15, 2018; Published January 30, 2018 Abstract: Post-operative complications (PCs) remain a common morbidity of esophageal atresia (EA) repairs. Ac- curate diagnosis and appropriate treatments for these PCs remain a great challenge for pediatric surgeons. All EA patients admitted to our institution from 2010 to 2016 were retrospectively reviewed. Demographics, types of PCs, PC diagnosis, treatments, and follow-ups were recorded. Totally 157 of 172 patients with EA underwent primary repairs. PCs occurred in 65 patients (41.4%). Based on univariate analysis, the Gross classification sig- nificantly influenced the incidence of PCs (P < 0.01). The most frequent PCs were anastomotic strictures (23.7%), anastomotic leakages (11.1%), gastroesophageal reflux (5.9%), and recurrent tracheoesophageal fistulas (5.2%). Anastomotic strictures and leakages were confirmed by esophagography. Gastroesophageal reflux and recurrent tracheoesophageal fistulas were demonstrated with radionuclide scintigraphy and esophagoscopy, respectively. All of the patients with anastomotic strictures underwent esophageal dilatation. Conservative treatments were successfully performed in all of the patients with anastomotic leakages. Anti-reflux medications were prescribed to all of the patients with gastroesophageal reflux. All of the patients with recurrent tracheoesophageal fistulas -un derwent re-operations. In conclusion, Anastomotic strictures and leakages, gastroesophageal reflux, and recurrent tracheoesophageal fistulas are the most common PCs in patients undergoing EA repairs. Esophagography is the best option for diagnosing anastomotic strictures and leakages. Diagnosis of gastroesophageal reflux and recurrent tracheoesophageal fistulas requires radionuclide scintigraphy and esophagoscopy. Recurrent tracheoesophageal fistula is an indication for re-operation. Surgical outcomes are favorable in EA patients with PCs. Keywords: Esophageal atresia, post-operative complications, esophagoscopy, esophageal dilation, re-operation Introduction cheoesophageal fistulas (RTEFs), and gastro- esophageal reflux (GER). Accurate diagnosis Esophageal atresia (EA) with or without a tra- and appropriate treatments for these PCs cheoesophageal fistula (TEF) is the most fre- remain a great challenge for pediatric sur- quent congenital malformation of the esopha- geons. gus, with a prevalence ranging from 1 to 1.8 per 4500 live births [1, 2]. An increased num- In the current study, we retrospectively review- ber of neonates with EA have undergone suc- ed our experience on the diagnosis and man- cessful surgical repairs during the past 3 de- agement of the most frequent PCs in EA pa- cades. The prognosis of EA has improved fr- tients, as well as the outcomes and potential om remarkable advances in both neonatal causative factors associated with PCs in our management and surgical care, and the surviv- institution from 2010 to 2016. al rate is currently > 90% [3]. However, post- Materials and methods operative complications (PCs) remain a com- mon morbidity in EA patients after esophageal Patient population repair [3, 4]. Post-operative morbidity mainly depends on the incidence of anastomotic le- Approval was obtained from our Hospital In- akages (ALs) and strictures (ASs), recurrent tra- stitutional Review Board prior to the initiation of Post-operative complications in esophageal atresia patients Table 1. Clinical features of esophageal atre- 1640-4260 g (mean, 2852 ± 515 g). The types sia patients who underwent primary esopha- of EA were classified according to the Gross geal repair classification [1], as follows: A (n = 9 [5.7%]); C No. % (n = 139 [88.5%]); D (n = 2 [1.3%]); and E (n = 7 [4.5%]). EA-associated anomalies were diag- Sex Male 89 57% nosed in 81 neonates (51.6%) and included Female 68 43% congenital heart diseases, anorectal malfor- Gestational age 0-36 weeks 33 21% mations, urogenital anomalies, and anomalies 37-40 weeks 99 63% of limbs or vertebrae (Table 2); 70 neonates > 40 weeks 25 16% (86.4%) had 1 or 2 associated defects and 11 Birth weight 1500-2499 g 41 26% (13.6%) had > 3 associated malformations. 2500-4000 g 105 67% > 4000 g 11 7% Primary esophageal surgical procedure in EA patients Classification Gross A 9 5.7% Gross C 139 88.5% 157 of 172 neonates with EA underwent sur- Gross D 2 1.3% gery by the same pediatric surgeon at our in- Gross E 7 4.5% stitution. The surgical procedures and appro- aches depended on the types of EA (Table 3). Patients with type A EAs underwent staged this study. A single institution retrospective surgery, while a one-stage esophageal anasto- review was performed on 172 EA neonates mosis with or without TEF ligation was per- with or without a TEF between January 2010 formed for all of the other Gross types. The and December 2016. The medical record, in- surgical methods were as follows: thoracoto- cluding demographics, Gross classification of mies, n = 88 (56.0%); cervical, n = 6 (3.8%); EA, operative details, type of PCs, PC diagnos- thoracoscopies, n = 59 (37.6%); and combina- is and therapy, and prognosis, of each patient tion open thoracotomies and cervical, n = 2 was reviewed. Follow-up information was col- (1.3%). Two neonates (1.3%) required conver- lected from outpatient and inpatient records sions from thoracoscopy-to-thoracotomy due with telephone communications or question- to severe bleeding. Thirteen neonates with naires. EAs died after the primary surgical procedure; Statistical analysis the early post-operative survival rate in EA patients was 91.7%. The causes of death we- Data analysis was performed using SPSS re respiratory distress, heart failure, severe version 20.0 statistical software (SPSS, Inc., sepsis, and treatment abandonment in 3, 2, Chicago, IL, USA). The parametric data are 1, and 7 patients, respectively. reported as percentages. The non-parametric continuous data are expressed as the mean PCs and risk factors ± SD. The differences between the non-para- PCs were observed in 65 operative cases metric unpaired continuous data were analyz- (41.4%; Table 4). The most common PC was ed using a chi-square or Fischer’s exact test. ASs (21.7%), followed by ALs (10.2%), GER A p-value < 0.05 was considered statistically (5.1%), and RTEFs (4.5%). Among the neona- significant. tes with PCs, 56 had only 1 PC, whereas 9 Results patients had 2 PCs. Univariate and multivariate analyses with a logistic regression model we- Patient demographics re applied to investigate risk factors for PC occurrence and the results are summarized One hundred seventy-two EA patients with or and shown in Table 5. Based on univariate without a TEF were identified from January analysis, demographic variables, such as gen- 2010 to December 2016. Primary surgery was der, birth weight, gestational age, operation performed on 157 EA patients (Table 1). The methods, operation staging, and associated male-to-female ratio was 1.3:1. The gestatio- anomalies had no significant association with nal age ranged from 34 to 43 weeks (mean, the incidence of PCs (P > 0.05); however, the 38 ± 2 weeks). The birth weights ranged from Gross classification significantly influenced the 255 Int J Clin Exp Med 2018;11(1):254-261 Post-operative complications in esophageal atresia patients Table 2. Malformations associated with esopha- gography with barium or omnipaque (Figures geal atresia 1 and 2). Regular endoscopic esophageal No. (%) bougie or balloon dilatation was performed Congenital heart disease 63 (77.8%) in all AS patients once every 1-3 months Figure 1C 1D Patent ductus arteriosus 47 ( , ). The number of times eso- phageal dilatation was required in AS pati- Atrial septal defect 25 ents ranged from 1 to 10 (mean, 2.8 ± 2.2). Ventricular septal defect 15 The duration of dilatation treatments rang- Anomalous pulmonary venous connection 1 ed from 1 to 24 months (mean, 6.5 ± 5.4 Cor triatriatum 1 months). After endoscopic dilation, symptoms Right aortic arch 1 were relieved in all AS patients. Furthermore, Dextrocardia 1 all ALs were resolved with conservative tr- Coarctation of the aorta 1 eatment, including total parenteral nutritio- Anorectal malformation 12 (14.8%) nal support, trans-anastomotic feeding by Rectoperinaeal fistula 5 nasogastric tube, use of broad-spectrum an- Recto-urethral bulbar fistula 2 tibiotics, and chest tube drainage. The leng- Rectovestibular fistula 5 th of spontaneous healing of leaks ranged from 7 to 51 days (mean, 31.1 ± 16.3 days). Urogenital anomaly 8 (9.9%) The average length of chest tube drainage Hypospadias 4 and post-operative hospital stay were 12.3 ± Cryptorchidism 1 6.7 days (range, 5-26 days) and 31.1 ± 16.3 Hydronephrosis 1 days (range, 11-78 days). Horseshoe kidney 1 Renal ectopia 1 Post-operative GER Anomaly of limbs or vertebrae 10 (12.3%) Eight patients had post-operative GER, whi- Polydactyly 7 ch were diagnosed with contrast esophagog- Anomaly of rib cage 1 raphy and 24-hour esophageal pH monitor- Anomaly of thoracic vertebra 3 ing or radionuclide scintigraphy. The severity Gastrointestinal malformation 3 (3.7%) of GER in EA patients was assessed with Annular pancreas 1 the Boix-Ochoa score according to the crite- Esophageal duplication cyst 1 ria developed by the Group of Digestive Hiatal hernia 1 Diseases Branch of Pediatrics of the Chine- Others 4 (4.9%) se Medical Association [5]. Three GER pa- Laryngeal cleft 1 tients (37.5%) had mild reflux (mean Boix- Ear neoplasm 2 Ochoa score, 15.1 ± 3.7), and moderate re- Cleft palate 1 flux existed in 5 GER patients (62.5%; mean Boix-Ochoa score, 27.3 ± 4.1).
Load more

Recommended publications
  • Scarica La Rivista
    Rivista trimestrale di Chirurgia Generale e Specialistica fondata nel 1959 da Tommaso Greco APRILE - GIUGNO 2011 Volume 17Nuova Serie N. 2 Tariffa R.O.C.: Poste Italiane s.p.a. - Spedizione in a.p. - D.L. 353/2003 (conv. in L. 27.02.2004 n. 46) art. 1, comma 1, DCB (Firenze), con I.R. VOL. 17 - Nuova serie - N. 2 Sommario Aprile - Giugno 2011 Articoli Allegato CD-ROM n. 2 - 2011 131 Informazioni per gli autori ARTICOLI ORIGINALI EDITORIALE 145 La chirurgia transanale per prolasso rettale esterno Transanal surgery for external rectal prolapse Alfonso Carriero Nell’ambito di una teoria unitaria del prolasso rettale, è ormai dimostrata una relazione importante tra età dei pazienti e grado del prolasso, cosa che supporta l’ipotesi che il prolasso rettale interno sia un precursore di quello esterno. Dopo avere analizzato le possibili ipotesi fisiopatologiche sulla formazione del prolasso rettale esterno, con le conseguenti opzioni chirurgiche della chirurgia transanale, sono messe a confronto le varie procedure chirurgiche transanali, in particolare la retto-sigmoidectomia perineale secondo Altemeier, intervento attualmente rivalutato soprattutto se combinato alla plastica degli elevatori dell’ano. Il contributo della laparoscopia è ancora in fase di discussione e il suo ruolo nella chirurgia del prolasso rettale esterno potrà meglio evidenziarsi nel tempo. SINGLE-SITE LAPAROSCOPIC SURGERY 154 Trattamento laparoscopico dell’ernia iatale con accesso single-port: esperienza preliminare su 4 casi Single-port laparoscopic hiatal hernia repair: a preliminary experience with 4 cases Felice Pirozzi, Pierluigi Angelini, Vincenzo Cimmino, Francesco Galante, Camillo La Barbera, Francesco Corcione A partire dalla fine degli anni ’90, l’accesso laparoscopico si è imposto come gold standard nella chirurgia del giunto gastro-esofageo.
    [Show full text]
  • Imperforate Anus and Cloacal Malformations Marc A
    C H A P T E R 3 5 Imperforate Anus and Cloacal Malformations Marc A. Levitt • Alberto Peña ‘Imperforate anus’ has been a well-known condition since component but were left with a persistent urogenital antiquity.1–3 For many centuries, physicians, as well as sinus.21,23 Additionally, most rectovestibular fistulas were individuals who practiced medicine, have tried to help erroneously called ‘rectovaginal fistula’.21 A rectoblad- these children by creating an orifice in the perineum. derneck fistula in males is the only true supralevator Many patients survived, most likely because they suffered malformation and occurs in about 10%.18 As it is the only from a type of defect that is now recognized as ‘low.’ malformation in males in which the rectum is unreach- Those with a ‘high’ defect did not survive. In 1835, able through a posterior sagittal incision, it requires an Amussat was the first to suture the rectal wall to the skin abdominal approach (via laparoscopy or a laparotomy) in edges which was the first actual anoplasty.2 Stephens addition to the perineal approach. made a significant contribution by performing the first Anorectal malformations represent a wide spectrum of anatomic studies in human specimens. In 1953, he pro- defects. The terms ‘low,’ ‘intermediate,’ and ‘high’ are arbi- posed an initial sacral approach followed by an abdomi- trary and not useful in current therapeutic or prognostic noperineal operation, if needed.4 The purpose of the terminology. A therapeutic and prognostically oriented sacral stage of this procedure was to preserve the pub- classification is depicted in Box 35-1.24 orectalis sling, considered a key factor in maintaining fecal incontinence.
    [Show full text]
  • Physical Assessment of the Newborn: Part 3
    Physical Assessment of the Newborn: Part 3 ® Evaluate facial symmetry and features Glabella Nasal bridge Inner canthus Outer canthus Nasal alae (or Nare) Columella Philtrum Vermillion border of lip © K. Karlsen 2013 © K. Karlsen 2013 Forceps Marks Assess for symmetry when crying . Asymmetry cranial nerve injury Extent of injury . Eye involvement ophthalmology evaluation © David A. ClarkMD © David A. ClarkMD © K. Karlsen 2013 © K. Karlsen 2013 The S.T.A.B.L.E® Program © 2013. Handout may be reproduced for educational purposes. 1 Physical Assessment of the Newborn: Part 3 Bruising Moebius Syndrome Congenital facial paralysis 7th cranial nerve (facial) commonly Face presentation involved delivery . Affects facial expression, sense of taste, salivary and lacrimal gland innervation Other cranial nerves may also be © David A. ClarkMD involved © David A. ClarkMD . 5th (trigeminal – muscles of mastication) . 6th (eye movement) . 8th (balance, movement, hearing) © K. Karlsen 2013 © K. Karlsen 2013 Position, Size, Distance Outer canthal distance Position, Size, Distance Outer canthal distance Normal eye spacing Normal eye spacing inner canthal distance = inner canthal distance = palpebral fissure length Inner canthal distance palpebral fissure length Inner canthal distance Interpupillary distance (midpoints of pupils) distance of eyes from each other Interpupillary distance Palpebral fissure length (size of eye) Palpebral fissure length (size of eye) © K. Karlsen 2013 © K. Karlsen 2013 Position, Size, Distance Outer canthal distance
    [Show full text]
  • Case Report Anterior Anorectocolonic Tubular Duplication Presenting As
    pISSN 2383-5036 eISSN 2383-5508 Kim JY, et al: Anterior Anorectocolonic Tubular Duplication in Infant J Korean Assoc Pediatr Surg Vol. 23, No. 2, December 2017 https://doi.org/10.13029/jkaps.2017.23.2.55 Case Report Anterior Anorectocolonic Tubular Duplication Presenting as Rectovestibular Fistula in an Infant Ja-Yeon Kim*,†, Joong Kee Youn*, Soo-Hong Kim, Hyun-Young Kim, Sung-Eun Jung, Kwi-Won Park‡ Department of Pediatric Surgery, Seoul National University Children’s Hospital, Seoul, Korea Anorectal duplications account for only 5% of gastrointestinal duplications, and cases with involvement of the anal canal are much rarer. Nearly all anorectal duplications are posterior to the rectum; duplications located anterior to the normal rectum are highly un- usual, and only a few cases have been reported. We report the case of an anterior anorectocolonic duplication presenting as a rec- tovaginal fistula in a 2-month-old infant. After diagnosis, the duplication was excised completely without further intestinal complications. Keywords: Anal canal duplication, Rectal duplication, Colonic duplication, Duplication, Rectovaginal fistula INTRODUCTION infant. We also provide a brief literature review. Gastrointestinal tract duplications are rare conditions, CASE REPORT comprising 0.1% to 0.3% of all congenital anomalies. Duplications can occur throughout the gastrointestinal A 2-month-old female infant presented to our hospi- tract, from the mouth to the anus [1,2]. Anorectal dupli- tal with a 1-month history of stool passing through the cations account for only 5% of all duplications and are vagina. She was born at 36 weeks’ gestation weighing primarily found in the retro-rectal space.
    [Show full text]
  • A Case of Imperforate Anus with Rectovaginal
    BMJ Case Reports: first published as 10.1136/bcr-2015-210084 on 21 October 2015. Downloaded from Global health CASE REPORT Access to essential paediatric surgery in the developing world: a case of imperforate anus with rectovaginal and rectocutaneous fistulas left untreated Marilyn L Vinluan,1 Remigio M Olveda,1 Clive K Ortanez,2 Modesto Abellera,2 David U Olveda,2 Delia C Chy,3 Allen G Ross4 1Department of Health, RITM, SUMMARY a malformation, compared with the incidence of Manila, Philippines Anorectal malformations consist of a wide spectrum of about 1 in 5000 in the general population.5 There 2University of the East-Ramon Magsaysay Memorial Medical conditions which can affect both sexes and involve the is a reported association between imperforate anus Center, The Philippines distal anus and rectum as well as the urinary and genital and prenatal thalidomide exposure, maternal dia- 3Department of Health, tracts. Patients have the best chance of a good betes mellitus and maternal age.4 Additionally, a Northern Samar, The functional outcome if the condition is diagnosed early recent systematic review and meta-analysis indi- Philippines and efficient anatomic repair is promptly instituted. This cated that paternal smoking and maternal obesity 4Griffith Health Institute, Southport, Queensland, report describes a rare case of imperforate anus were associated with increased risks for the devel- 6 Australia associated with both rectovaginal and rectocutaneous opment of ARM. Although no factors are known fistulas in a 6-year-old Filipino girl. The case highlights to prevent or reduce the risk for imperforate anus Correspondence to shortcomings in the healthcare delivery system combined during pregnancy, a study conducted in China Professor Allen G Ross, μ a.ross@griffith.edu.au with socio-economic factors that contributed to the delay showed that daily maternal consumption of 400 g in both diagnosis and the institution of adequate of folic acid before and during early pregnancy Accepted 28 August 2015 treatment.
    [Show full text]
  • PAPSA 2008 Abstracts
    Annals of Pediatric Surgery, Vol 4, No 3,4, July& October, 2008 PP 110-123 PAPSA 2008 Abstracts Papers presented at the 7th Biennial Meeting of Pan African Pediatric Surgical Association (PAPSA) August 17-23 2008 Accra, Ghana 7th Biennial Meeting of Pan African Pediatric Surgical Association *(PAPSA) August 17-23 , 2008 Accra, Ghana Surgical Presentations of HIV Positive Children Sarcoma of Kaposi witch involve intussusception, an other boy had psoas abscess. The third boy had urethral stenosis, and the Bankolé Sanni R., Nandiolo R., Vodi L., Yebouet Eric, Coulibaly last boy had anal fistula. D., Kirioua B., Mobiot L., HIV treatment was not available in our country before 2003 for children, 10 of girls with acquired rectovaginal fistula died and the Introduction: Human immunodeficiency virus (HIV) disease is an others did not come for follow-up after colostomy. increasingly common infection in children in Sub Sahara Africa. Acquired recto vaginal fistula is the more frequent surgical The five boys have received anti retroviral therapy. The urethral condition, but other disease can reveal this infection in children. stenosis resolved with the HIV treatment. Methods: From January 1999 to December 2006, a retrospective Conclusion: Different presentations can reveal HIV disease in study found 37 children presenting with HIV relative disease. children. With the available of HIV treatment in our country, a They were 32 females’ patients and 5 males’ patients with age precocious diagnosis and treatment can save these children. ranging from 4 week to 15 years. Background/purpose: The aim of this study was to evaluate the functional outcome specifically continence after a one-stage Results: Among the female children, 30 had acquired recto transanal pull-through operation for Hirschsprung's disease in vagina fistula, 2 had perianal and perineal condyloma.
    [Show full text]
  • Elixir Journal
    45637 Ganesh Elumalai and Jenefa Princess / Elixir Embryology 103 (2017) 45637-45640 Available online at www.elixirpublishers.com (Elixir International Journal) Embryology Elixir Embryology 103 (2017) 45637-45640 “CLOACAL MEMBRANE ANOMALIES” EMBRYOLOGICAL BASIS AND ITS CLINICAL IMPORTANCE Ganesh Elumalai and Jenefa Princess Department of Embryology, College of Medicine, Texila American University, South America. ARTICLE INFO ABSTRACT Article history: Cloacal malformation is a rare but important anomaly. The cloacal anomaly is Received: 1 January 2017; characterised by the persistence of a common channel draining the urinary, genital and Received in revised form: alimentary tracts through a single orifice. It results from abnormal compartmentalization 1 February 2017; of features that are normal in the primitive female embryo. Abnormal embryology and Accepted: 10 February 2017; cloacal anatomy are described in detail. Cloacal abnormalities are usually diagnosed promptly in the neonatal period. Keywords © 2017 Elixir All rights reserved. Cloacal membrane, Uro-rectal septum, Extrophy of the cloaca, Recto-urinary fistulas, Anal agenesis, Rectal atresia. Introduction dilate them to make an anus.. Initial management focuses on Abnormal cloacal development takes place when rectum, anatomic remodelling of the urinary and gastrointestinal vagina and lower urinary tract fuse into a single common system to achieve continence. Improved paediatric channel. Persistent cloaca is a most severe malformation of management strategies have increased the patient survival into cloacal anomalies in girls and is associated with complex adult life. In order to provide appropriate advice, clinicians pelvic malformations. The abnormality of these structures who are undertaking life-long management of adolescent and varies from bladder neck to just beneath the perineal skin.
    [Show full text]
  • Rectovestibular Fistula – Diagnosis by Radiological Evaluation: a Case Report
    Citation: Sharma BB, Sharma S, Bhardwaj N, Dewan S, Aziz MR. European Journal of Rectovestibular fistula – diagnosis by radiological evaluation: a case report. European Journal of Medical Case Reports. 2017;1(2):65–68. Medical Case Reports https://doi.org/10.24911/ejmcr/1/16. CASE REPORT Rectovestibular fistula – diagnosis by radiological evaluation: a case report Bharat Bhushan Sharma1*, Shashi Sharma2, Naveen Bhardwaj1, Sakshi Dewan1, Mir Rizwan Aziz1 ABSTRACT Background: Anorectal malformations (ARM) can present in different fashions. Rectovestibular fistula is one of the congenital ARM. There is abnormal connection between the rectum and vulval vestibule. ARM is called as rectovaginal fistula if it is within the hymen. Case presentation: We present a 7-years old female child who reported of passing feces and gas through the vaginal passage. The child was brought late by the parents because of rural background. She was evaluated by abdomen plain Xray, US, MRI and special investigation by injecting contrast from the common opening. The diagnosis was confirmed as that of congenital recto-vestibular fistula (CRF) by these radiological investigations. Conclusion: Radiological modalities are of great importance for the confirmatory diagnosis of rectovestibular fistula. This further helps in appropriate surgical management. Keywords: anorectal malformation, US, MRI, special investigation, CRF, case report. Background Rectovestibular fistula (RVF) is the communication assistance. There was no proper anal orifice at birth. between rectum and vulvar vestibular part which lies On examination, the child was found to be of average posterior to the hymen. The ectopic anal opening lies physical parameters without any abnormality in in the frenulum of the labia minora.
    [Show full text]
  • Chronic Constipation Due to Undiagnosed Imperforate Anus with Rectovestibular Fistula in an 18 Month Old Female
    Journal of Clinical Case Studies SciO p Forschene n HUB for Sc i e n t i f i c R e s e a r c h ISSN 2471-4925 | Open Access CASE REPORT Volume 3 - Issue 3 | DOI: http://dx.doi.org/10.16966/2471-4925.172 Chronic Constipation due to Undiagnosed Imperforate Anus with Rectovestibular Fistula in an 18 Month Old Female Abiezer Disla*, Dulce Gonzalez, Wallis Tavarez and George Vermenton Department of Pediatrics, Lincoln Medical and Mental Health Center, Affiliated with Weill Cornell Medical College, New York, USA *Corresponding author: Abiezer Disla, Department of Pediatrics, Lincoln Medical and Mental Health Center, Affiliated with Weill Cornell Med- ical College, New York, USA, E-mail: [email protected] Received: 11 Jun, 2018 | Accepted: 03 Jul, 2018 | Published: 09 Jul, 2018 distention associated with intermittent vomiting described as small in amount, with food contents, non-bloody and non-bilious. The Citation: Disla A, Gonzalez D, Tavarez W, Vermenton G (2018) patient had multiple visits to different emergency departments, and Chronic Constipation due to Undiagnosed Imperforate Anus with the mother was using Polyethylene glycol 3350 (Miralax), 1-2 times/ Rectovestibular Fistula in an 18 Month Old Female. J Clin Case Stu week, with a mild resolution of symptoms. 3(3): dx.doi.org/10.16966/2471-4925.172 On physical examination, she was noted to have abdominal Copyright: © 2018 Disla A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution distention, normal bowel sound auscultated in all quadrants without License, which permits unrestricted use, distribution, and organomegaly, normal external female genitalia, but no anal opening, reproduction in any medium, provided the original author and source instead a small opening was noted in the posterior aspect of the are credited.
    [Show full text]
  • Alimentary Tract Duplications KATIE W
    39 Alimentary Tract Duplications KATIE W. RUSSELL and GEORGE W. HOLCOMB III Alimentary tract duplications have been described for hun- distention, pain, obstruction, intussusception, bleeding, dreds of years, and multiple terms have been used in the perforation, respiratory compromise, or as a painless mass. literature. The term duplication of the alimentary tract was Generally, symptoms are related to size, location, and the coined by William Ladd in 1937.1 He described three com- presence of heterotopic mucosa. With advances in prenatal mon findings: a well-developed smooth muscle coat, an imaging, many of these masses are being diagnosed in utero epithelial lining, and attachment to the alimentary tract. (Fig. 39.1) and the majority are discovered before 2 years In 1952 Gross et al. reported the first large series describ- of age.4,5,15 A recent study from the Children’s Hospital of ing 67 patients with these findings.2 These duplications are Philadelphia (CHOP) found that 58% of duplications were relatively rare congenital anomalies found anywhere from diagnosed prenatally over a 25-year period.16 The major- the mouth to the anus with an incidence reported to be 1 in ity of duplications are cystic (Fig. 39.2), and the remaining 4500 births.3 Presentation is variable, and resection is usu- are tubular (Fig. 39.3). The ileum and jejunum are the most ally recommended in order to prevent worsening symptoms commonly affected locations, followed by the esophagus.5 or malignant transformation. The epithelial lining is usually native to the surrounding enteric tract, but heterotopic mucosa is found in approxi- mately one-third of duplications.5 Gastric tissue is the most Embryology common type of ectopic mucosa, followed by pancreatic tis- sue, and there are reports of respiratory epithelium being Alimentary tract duplications take many forms, and one found as well (Fig.
    [Show full text]
  • Ocular Manifestations of Inherited Diseases Maya Eibschitz-Tsimhoni
    10 Ocular Manifestations of Inherited Diseases Maya Eibschitz-Tsimhoni ecognizing an ocular abnormality may be the first step in Ridentifying an inherited condition or syndrome. Identifying an inherited condition may corroborate a presumptive diagno- sis, guide subsequent management, provide valuable prognostic information for the patient, and determine if genetic counseling is needed. Syndromes with prominent ocular findings are listed in Table 10-1, along with their alternative names. By no means is this a complete listing. Two-hundred and thirty-five of approxi- mately 1900 syndromes associated with ocular or periocular manifestations (both inherited and noninherited) identified in the medical literature were chosen for this chapter. These syn- dromes were selected on the basis of their frequency, the char- acteristic or unique systemic or ocular findings present, as well as their recognition within the medical literature. The boldfaced terms are discussed further in Table 10-2. Table 10-2 provides a brief overview of the common ocular and systemic findings for these syndromes. The table is organ- ized alphabetically; the boldface name of a syndrome is followed by a common alternative name when appropriate. Next, the Online Mendelian Inheritance in Man (OMIM™) index num- ber is listed. By accessing the OMIM™ website maintained by the National Center for Biotechnology Information at http://www.ncbi.nlm.nih.gov, the reader can supplement the material in the chapter with the latest research available on that syndrome. A MIM number without a prefix means that the mode of inheritance has not been proven. The prefix (*) in front of a MIM number means that the phenotype determined by the gene at a given locus is separate from those represented by other 526 chapter 10: ocular manifestations of inherited diseases 527 asterisked entries and that the mode of inheritance of the phe- notype has been proven.
    [Show full text]
  • Patient Information on Hirschsprung's Disease
    What happened during follow up? This information sheet is intended to inform the details of the procedure and the care you have to Both the procedures requires placement of bowel to the participate in as a parent of a child with HD or For ARM patients the perineum will be checked and anal muscle which takes control of continence. The muscle dilatation will be perfomed and thought to parents.6weeks ARM. develops before birth and in ARM small number of children to 3 months.once child is well and anal dilatation is at good size date will be given for closure of stoma. are born with poorly developed muscle which leads to What are the preparation prior to surgery? incontinence. The operation is done under general anesthesia (GA) For HD patients perineum will be checked. You are required to perform rectal washout/distal bowel wash- Generally the outcome after the surgery is good.Some of them Sometimes anal dilatation is aslo required for HD patients out at home as usual for temporary period. will develop constipation at which there is intermittent The child needs admission minimum of 2 days prior to the staining of stool on diapers or underpants otherwise still able surgery. This is for monitored/supervised preparation of the If there is a stoma date will be given for closure to hold and pass good amount of stool. A small number will bowel clean the bowel as much as possible. Such preparation would involve frequent washouts and some require medications for their constipation. restrictions on feeding. Instructions for this will be given by Follow up for the patients will be for a long duration of time the doctors.
    [Show full text]