Iranian Journal of Pediatric Surgery
Volume:2 Issue: 2, Feb 2016

The incidence of caustic ingestion injuries in developed countries has been decreasing, while it still remains a great concern in developing countries including Iran. In this study we focused on alkali esophageal injuries in children which occur frequently in southern Iran, due to both, unsafe products and unfamiliarity of families with the alkali consumption hazards. In a cross-sectional study, sixty four children who were admitted due to alkali ingestion at Nemazee hospital, Shiraz, Iran during a 4 year period, were evaluated for hospital stay, hospital charges and number of admissions. Data were obtained from medical records and through a phone survey. All ingestions were unintentional. Children had a prolonged hospital stay (m=13.2 day) and needed multiple admissions (m=7.8 admission). The mean hospital charge was $14,580.00 USD for each patient. High incidence and complications of alkali ingestion in south of Iran suggests a need for prompt preventive actions to stop the production of highly concentrated alkali and educating families for proper use of these substances.

As recently some reported is investigated about relation between cold weather and testicular torsion (TT), so we decided to evaluate this hypothesis risk factor for testicular torsion in our children’s hospital.
The aim of this study is to evaluate the relation between cold weather and testicular torsion in children.
From January 2011 toDecember 2015 totally Hundred seventy patients due to acute scrotum admitted in Mofid Children’s Hospital. According to our hospital guidelines,those patients who had proven TT were candidate for this study.The records of all operated patients were evaluated and analyzed by age, season of year, and operation type.
Totally Hundred seventy patients were included in this study within five years, with the mean age of 28.6 32.9 (range1 to 144).Winter season showed most frequently (42%) referred cases of testicular torsion.
The incidence rate of testicular torsion will be increased with cold weather.

Respiratory failure is one of the most important related factors to morbidity and high mortality in neonates with congenital diaphragmatic hernia (CDH). Determining indices that could ultimately and perceively predict the disease severity, prognosis and morbidity of these neonates is crucial.
This study aimed to evaluate the predictive value of Pao2/Fio2 ratio (P/F ratio) in neonates with CDH.
Methods and Materials: In a retrospective study, documents of all neonates with CDH that admitted to Alzahra hospital, Isfahan, Iran were checked from 2005 to 2015. 35 neonates with CDH were studied. Data such as gestational age, sex, weight, Pao2, Fio2 and the outcome of the neonate were collected.
In this survey 28 neonates with CDH were studied. The mean P/F ratio in the live group was 2.12 ±0.90 and in the death group 1.38± 0.48. According to these results the P/F ratio in the live group was higher than the other group and this difference was statistically significant (P= 0.02). Results showed that the specificity of P/F ratio in predict of the live neonates is 72.2 percent and its sensitivity in predicting the dead neonates is 80 percent.
P/F ratio can be used as an index for predicting the survival of neonates with CDH.

Neostigmine and midazolam are each added to bupivacaine for the purposes of caudal anesthesia. In this study, we compared neostigmine and midazolam, each coadministered with bupivacaine, in terms of analgesia and side effects during pediatric inguinal hernia operations.
We included 60 children 1–6 years of age who were candidates for elective unilateral herniorrhaphy. After general anesthesia induction with inhaled sevoflurane, a caudal block was performed. Patients were randomly allocated to one of two trial groups: midazolam group patients received bupivacaine 25% 1 ml/kg with midazolam 50µg/kg, and neostigmine group patients received bupivacaine 25% 1 ml/kg with neostigmine 2 µg/kg through the caudal route. Heart rate, mean arterial pressure, and oxygen saturation were recorded before induction and every five minutes after caudal anesthesia up to 30 minutes. Pain and sedation scores were recorded at two, four, six, 12, and 24 hours after the operation, along with rescue analgesia dosage, vomiting, and respiratory depression.
Mean duration of analgesia in the midazolam group was similar to the neostigmine group (18.8±9 vs. 20.4±7.5; P= 0.44). The analgesic dosage required was not significantly lower in the neostigmine group compared to the midazolam group (58.3±121.7 VS .70.8±125.8; P=0.63).The number of patients who needed analegesic agents was similar in two trial groups ( P= 0.76 ),Nausea(P= Midazolam (50 µg/kg) compared to neostigmine (2 µg/kg) provided higher sedation, lower incidence of postoperative nausea and vomiting.

Premature or anemic infants who undergoing hernia repair operation had more chance to have postoperative complications such as apnea as compared with full-term infants. The incidence of respiratory complications among noted infants is more than 30% and postoperative apnea was most common complication among them. In one study, investigators found that gestational and postconceptional age, the presence of continuing apnoeic episodes and anemia as main determinants of postoperative apnea. It seems that infant who did not receive IV anesthetics were experience less respiratory complications. In the other hand IV anesthetics had hepatic metabolism for elimination and immature liver in premature infants had not sufficient elimination capacity. Study participants were 1047 neonates with post conceptual age (PCA) lower than 60 weeks who had undergoing inguinal operation during study period. Sevoflure gas mask was used for anesthesia induction and then in deep anesthesia situation, caudal anesthesia was prepared with 1cc/kg solution of bupivacaine 2% and neonates were managed with spontaneous breathing with Sevoflurane gas mask or endotracheal tube until end of operation. In the present study, 916 (87.5%) male and 131 (12.5%) female neonates were included. Mean of gestational age and PCA among neonates were 36.62 ± 38.0 and 46.80 ± 45.60 weeks. Totally, postoperative apnea did not occur among any of study participants.

Longitudinal follow-up of bowel function in children with anorectal malformations (ARMs)) as they grow, to determine the anorectal function problems and help to resolve them somedeal.
Material and This study included 262 patients with ARM that operated in our center between 2006 until 2013.Patients that definitive reconstruction was performed in another center and underwent reoperation in this center excluded. Also children that expired or did not come for visit removed. Bowel function was prospectively evaluated by using a structured questionnaire that asked from their parents. Additional bowel treatment with enemas and stool softeners and use of diapers were recorded.
Interviews were completed with 242 children, age ranging from 3 to 10 years. 37.7% of patients had constipation.32.5% Grade 1 Manageable by changes in diet,54.3% Grade 2 Requires laxative and 13.2% Grade 3 Resistant to laxatives and diet. 18.6% of patients had fecal soiling , 31.5% Grade 1: Occasionally (once or twice per week),24% Grade 2: Every day, no social problem and 44.5% Grade 3:Constant, social problem.
In the present study there were many bowel function problems in ARM children, that needs additional attention to achieve them more near to level of healthy children. Pediatric surgeons who do the definitive surgery on anorectal malformations Should don’t lose contact with the patients as they become adults .These patients have many great troubles in adolescence.

Although many techniques have been described for reconstruction of the giant omphalocele, we present a simple , effective and safe new technique. We have studied 11 neonates with giant omphalocele that were treated by a new technique, Umbrella repair, in Sarvar pediatric hospital of Mashhad, Iran. In this new technique we released the skin around the omphalocele membrane just near the junction and a purse string suture is placed at the edge of the skin with beads beneath each bite and graded tightening of the suture in order to pushing the omphalocele toward the abdominal cavity. Finally we compare the Among total 11 patients, mean age and weight at the time of operation were 2.18 days and 2150 grams respectively. comparing the results between groups, we observed significant less operative time and number of surgeries in neonatal period among patients who managed by umbrella repair. Post-operative complications, morbidity and mortality in umbrella repair group were also less than coventional methods. Umbrella repair provide a rapid and safe method for management of giant omphalocele with acceptable results and low morbidity and mortality.

This is a case of a 6 mouths old boy victim of an attempted infanticide by using sharp long needles inserted through his abdominal wall. he was successfully managed by laparoscopic approach.

The rectum villous tumour is an uncommon pathology in paediatrics, it represent 1% of all the children's malign tumours. An eleven-year-old girl present a rectal adenocarcinoma developed from a villous tumour. the aim of this study is to assess , an overview of litterature, the frequency of rectum villous tumours; to specify the value of the clinical examination , of the radiologic finding in the assessement of the loco-regional extension of villous tumours and rectum adenocarcinoma ; and finally to discuss the treatment modalities .
The child rectum villous tumours symptomatology is not very specific. Therefore, a good knowledge of the clinical presentations and the predisposing situations can improve the prognosis of this rare disease.