Can the human neonate mount an endocrine and metabolic response to surgery

Classification and risk-factor analysis of infections in a surgical neonatal unit.

We present a rare case of congenital intrathoracic stomach due to short esophagus in a preterm infant. Antenatal ultrasound during the second trimester showed a tubular cystic structure in the posteri

Congenital Intrathoracic Stomach: Short Esophagus or Hiatal Hernia?

Seventy-two out of 1,325 consecutive pediatric patients (5.43%) developed an operative wound infection in a general pediatric surgery unit. The wound infection rate was observed to be highest in neonates (13.75%) as compared with the children over 5 years of age (2.93%). The increased susceptibility of newborns to wound infection was found to be statistically significant. Patients operated for gastrointestinal problems and solid abdominal neoplasms had the highest wound infection rate.

Postoperative wound infection in a pediatric surgical service

OBJECTIVES 
Congenital paraesophageal hernia is a rare condition in the pediatric age group. The symptomatology of these patients is usually non-specific in the form of repeated attacks of chest infection and/or recurrent attacks of vomiting but can be associated with serious complications such as intrathoracic gastric volvulus.
 METHODS 
Between 1989 and 1997, 6 children with paraesophageal hernia were treated at our hospital.
 RESULTS 
Six children (4 males and 2 females) were treated for congenital paraesophageal hernia. Their age at presentation ranged from 2 days to 21/2 years (mean 1.3 years). Two presented with recurrent chest infection, while 3 others had recurrent attacks of vomiting with fullness and pain in the epigastrium in one of them. One of our patients presented acutely immediately after birth with respiratory distress while another was found to have intrathoracic gastric volvulus. Chest x-ray was suggestive of paraesophageal hernia in all of them but the diagnosis was confirmed by Barium swallow and meal. Intraoperatively there was a hernial sac in all of them. The surgical treatment consisted of excision of the hernial sac after reducing the stomach and tightening of the crura of the esophageal hiatus. Nissen's fundoplication was added in 3 patients, but in one of them this was dismantled because of tight repair. Anterior and fundal gastropexy was added in one patient, while 2 had tightening of the crura only.
 CONCLUSIONS 
Congenital paraesophageal hernia, although rare in the pediatric age group, can present acutely with respiratory distress or intrathoracic gastric volvulus. Physicians caring for these patients should be aware of such a presentation and complication and paraesophageal hernia should be included in the differential diagnosis of children with repeated attacks of chest infection and/or vomiting. The rarity of this condition in children makes it difficult to evaluate the true necessity of adding an antireflux procedure in these patients. We feel some form of gastropexy may be a more appropriate procedure to be added to the repair.

https://smj.org.sa/content/smj/21/2/164.full.pdf

Congenital paraesophageal hernia in infancy and childhood

This paper reviews the presentation and management for congenital intrathoracic stomach (CIS). The features that distinguish CIS from congenital short oesophagus and acquired oesophageal shortening are emphasised. The study is based on a retrospective review of six patients treated between 1988 and 1994. The four youngest presented with vomiting and the older two with respiratory symptoms. Chest radiographs were abnormal in every case, although the precise diagnosis was confirmed by barium meal. All cases were repaired through an abdominal approach; in each case the oesophagus was of sufficient length to allow the stomach to lie below the diaphragm. CIS is an uncommon condition. The most frequent cause is a large hiatus hernia, and the transabdominal route is the most satisfactory approach for operative repair.

Congenital intrathoracic stomach.

An audit of 143 consecutive neonatal surgical operations performed in one neonatal surgical unit is reported. Wound infections developed in 13 patients (9.1%) and bacteraemia in 9 (6.3%). Three groups at increased risk were identified: small-for-dates infants subjected to major surgery, infants subjected to invasive monitoring, and infants over 1 week of age with Staphylococcus aureus as a skin commensal. Infections were significantly less frequent in potentially contaminated wounds if antibiotic prophylaxis had been used (7.6% compared to 26.7%: P <0.05).

L. Spitz

Papers

Congenital intrathoracic stomach.

An audit of postoperative sepsis in a neonatal surgical unit