Neonatal Intestinal Obstruction in Acute Renal Failure in Premature Infant: A Case Report

Introduction: Intestinal obstruction is a common cause of abdominal surgery in the neonate. Diagnosis is straightforward using standard radiology, and surgical technique depends on the underlying anatomical lesion. Peritoneal dialysis (PD) is an effective, albeit invasive, therapy for neonatal renal failure. We report a case of neonatal obstruction with severe renal failure treated by PD to highlight our hospital practice and possible remedies in a context of limited resources. Case Presentation: This was a female neonate of moderate prematurity admitted on day 4 of life for management of a flat neonatal obstruction. Radiological diagnosis suggested small bowel atresia. Biological tests revealed severe renal failure with creatinine levels of 416 micromoles per liter and blood urea of 27.1 micromoles per liter. Management consisted of preoperative peritoneal dialysis for 48 hours followed by laparotomy. The intraoperative diagnosis was GROSFELD type IIIa digestive atresia. The postoperative course was favourable, transit was resumed on day 5 and the patient returned home on day 12. Progress at 3 months was satisfactory. Conclusion: Neonatal intestinal obstruction with renal failure in premature infants is associated with a poor prognosis, even more so if there is a delay in treatment. Peritoneal dialysis seems to be a suitable alternative for this management in our working conditions with limited resources.

Large Conventional Osteosarcoma of the Proximal Humerus in a 13-Year-Old Child: Case Report

Introduction: Osteosarcoma is the most common primary malignant bone tumor in children. It is highly aggressive and has a poor prognosis. A late presentation modifies and makes difficult the management affecting the survival of children. We report the case of a large conventional osteosarcoma in a 13-year-old girl. Case Presentation: Adolescent girl admitted for painful swelling of the left shoulder with absolute functional impotence of the thoracic limb and severe anemia. The painful swelling was thought to have been caused by a minor trauma that had occurred six months previously. The patient’s general condition was poor, and she presented with a large, shiny, painful mass over the shoulder and upper 2/3 of the left arm, measuring 28 cm long by 28 cm wide and 57 cm in circumference, and a large fistulous axillary adenopathy. CT scan showed a tumour lesion of the left humerus with liver and lung metastases, raising suspicion of osteogenic osteosarcoma. The tumor was classified according to TNM staging: T2N1M1(a + b). Management was modified when uncontrolled bleeding developed. It consisted of an extended amputation of the left thoracic limb. Pathological analysis showed a high-grade conventional osteosarcoma. Quality improvement was obtained for thirty days, followed by the onset of dyspnea. The evolution was towards death at forty days post-operatively. Conclusion: Osteosarcoma is a highly aggressive cancer. Delayed treatment leads to a fatal outcome. Early diagnosis is one of the challenges to be met in order to improve survival.

Traumatic Diaphragmatic Hernia in Children: A Case Report

Introduction: Traumatic diaphragmatic hernia is a rare condition in children complicating closed or penetrating trauma to the abdomen and thorax. We report the case of an 11-year-old girl with a traumatic diaphragmatic hernia. Case Presentation: An 11-year-old girl was seen in the paediatric surgery department for a thoracolumbar spine deformity and intermittent chest pain. These symptoms occurred after a domestic accident involving a fall from a low wall onto the thoracolumbar spine 5 months previously. The diagnosis was suggested by the presence of a left hemithoracic hydroaera and confirmed by a thoraco-abdominal CT scan. Surgical exploration revealed a linear rupture of the entire left hemi-diaphragm with herniation of the stomach, small intestine, cecum, transverse colon and omentum. We performed a double-layer suture of the diaphragmatic rupture with a non-absorbable suture without edge rejuvenation after the reduction of the hernia. The outcome was favourable with normal postoperative radiographs at one year follow-up. Conclusion: Traumatic diaphragmatic hernia, although uncommon and difficult to diagnose, is a condition that is relatively easy to manage surgically, even if it is discovered late. In all cases of trauma to the thoracolumbar spine, regular follow-up and repeat X-rays are necessary if pain persists.

Isolated Caeco-Vesical Fistula: A Case Report

Congenital uro or genito-digestive fistulas are frequently found in the context of caudal pole malformations. Isolated congenital forms without associated anorectal malformation have not been reported until now. We report the first case we know a 9 year old female child received in a pediatric surgery consultation for fecaluria evolving since birth with a permeable anus. She presented a good general condition, a good staturo-ponderal and psychomotor development, a vulva soiled by stool and a permeable anus with a tonic sphincter. A retrograde urethrocystography revealed a caeco-vesical fistula. Surgery consisted of ligation-section of the caeco-vesical septum. A follow-up urethrocystography at three months post-surgery no longer visualized the fistula. Our post-operative follow-up is 4 years. Isolated congenital caeco-vesical fistula is an unknown pathology whose late diagnosis can have serious repercussions.

Rare Neonatal Digestive Surgical Emergencies at the Brazzaville University Hospital Center

The purpose of our study was to evaluate the morbidity-morality of rare neonatal digestive emergencies in order to improve their management. Observations: 7 newborns ranging in age from 6 hours to 3 weeks were treated for rare digestive pathologies between January 2013 and July 2017 (a period of 3 years and 6 months) in the Department of Pediatric surgery of Brazzaville University Center, Congo. Males were predominant (5 versus 2 females). Pathologies listed were: 1 antenatal volvulus of the small intestine, 1 annular pancreas and 5 gastric perforations. The average time of care in the operating room was 12 hours. The newborns were hospitalized in the pediatric surgery department in 28.6% of cases (n = 2), and 71.4% (n = 5) in the neonatology department. The antenatal volvulus of the intestine and annulus pancreas were integrated into a nosologic entity named neonatal occlusion (NNO). The postoperative outcomes were simple for 4 patients (57.14%) while 3 patients died immediately after surgery (42.86%). Conclusion: Neonatal surgical emergencies are still difficult to manage in our context. The lack of knowledge of these rare pathologies, which delays their management, considerably increases morbidity-mortality. The critical analysis of this series highlights diagnostic and therapeutic difficulties particularly with gastric perforations, hence the interest of better popularization of pediatric surgery.

Anorectal Malformations Operated at University Hospital Brazzaville

Aim: To appreciate the care of children operated for an anorectal malformation. Materials and methods: It was a retrospective study carried out from January 2014 to December 2018 (5 years) in the department of pediatric surgery of university hospital of Brazzaville. Results: We retained 35 files including 20 boys and 15 girls. The mean age of discovery of the malformation was 1.7 days (range 0 and 4 days). On physical examination, we found intestinal occlusion in 22 patients (62.9%): the absence of an anal opening (62.9%), abdominal bloating with tympanism were the most represented signs. (57.1%). There were 13 cases (37.1%) of anorectal malformations high, 12 cases (34.3%) of low and 10 cases (28.6%) of intermediate. There were 20 cases (57.1%) of anorectal malformations without fistula and 15 cases (42.9%) with fistula. The mean age at the time of the anal plasty was 12.7 months (range 2 days and 14 years). We performed the anorectoplasty according to the Peňa and De Vries technique in 26 cases (74.3%), perineal anoplasty in 5 cases (14.3%) and a transposition of the fistula in 4 cases (11.4%). Twenty-seven patients (77.1%) were reviewed with an average follow-up of 2.7 years (1 year and 5 years extremes). The anus had a normal aspect in 20 cases (74.1%). We evaluated anal continence according to the Krickenbeck criteria in 10 patients aged over 3 years, and six had good results.

Anderson-Hines Open Pyeloplasty in the Treatment of Pyelo-Ureteral Junction Syndrome: Results from 36 Cases

Goal: To evaluate the results and complications of open pyeloplasty according to Anderson-Hynestechnic. Patients and Methods: We conducted a retrospective study from 2000 to 2014. The study included 36 cases of opening the ureteropyelic junction operated pit syndrome according to Anderson-Hynes technique. Results: Lumbotomy was used in all patients. A pelvic pyelolithotomy for lithiasis was performed in two patients (5.5%) and unwinding of a lower polar pedicle in 3 cases (8.3%). The average duration of response was 119 ± 15 min. The average length of hospital stay was 11.2 ± 3 days. Patients were followed for a mean of 10 months. Thirty-five patients were asymptomatic and in one case lower back pain persisted. IVU to 6 months showed a permeable junction in 97.2% of cases. Seven patients (19.4%) had short-term complications. Ureteropelvic stenosis was the only complication in the medium and long term in one case (2.8%). The success rate of the Pyeloplasty was 97.2%. Conclusion: The open pyeloplasty as Anderson-Hynes remains the treatment of choice in our context SJPU with great results. The indications tend to decrease in favor of laparoscopic pyeloplasty.