Background:Gastrointestinal (GI) tract atresias occur in approximately 1 in 2000 live births and frequently present with associated congenital anomalies. This study aimed to determine the frequency and spectrum of associated anomalies in neonates with GI atresias and provide screening recommendations. Materials and Methods:A retrospective analysis was conducted on 150 neonates with congenital GI atresia at a tertiary pediatric surgery referral center over 7 years. All patients underwent systematic screening, including echocardiography, abdominal ultrasonography, cranial ultrasonography, and radiographic evaluation. Demographics, atresia type, associated anomalies, and in-hospital outcomes were evaluated. Results:The cohort comprised esophageal atresia/tracheoesophageal fistula in 33.3%, anorectal malformations in 34%, duodenal atresia in 18%, jejunoileal atresia in 10%, colonic atresia in 2.7%, and pyloric atresia in 2%. Associated anomalies were present in 87.3% of patients. Cardiovascular anomalies were most common (57.3%), followed by genitourinary (50%), central nervous system (19.3%), and limb (12.7%) anomalies. Atrial septal defect was the most frequent cardiovascular finding. Overall, in-hospital mortality was 14%. Sepsis was the leading cause of death (33%). Prematurity and low birth weight were significant mortality predictors, while the presence of associated anomalies was not. VACTERL association (66% mortality) was identified as a high-risk subgroup. Conclusions:GI atresias are frequently associated with multisystem anomalies, particularly involving the cardiovascular and genitourinary systems. Systematic screening for associated anomalies is recommended in all neonates with GI atresia for comprehensive care planning. While anomalies are highly prevalent, prematurity and low birth weight remain the primary determinants of mortality.

The aim of this study was to determine the treatment options for pulmonary hydatid cysts (HC) in children according to the size and location of the cyst and the presentation of the patients. Children with HC treated between 2004 and 2022 were evaluated. Patients were grouped according to the size of the HC and those with ruptured and intact cysts at the time of admission, and the data were compared. ROC curve was created to determine the HC size limit in operated patients. P < 0.05 was considered statistically significant. A total of 72 patients with a mean age of 8.9 ± 3.4 years were included in the study. HC sizes 2.5–18 cm, and half of the patients had bronchial/pleural ruptures at presentation. Forty-six patients (64

Pediatric testicular tumors are rare entities accounting for only 1–2

Background/Aims: Chilaiditi Syndrome is a rare anatomical condition characterized by the interposition of the bowel between the liver and diaphragm, often presenting with non-specific respiratory and gastrointestinal symptoms. This report aims to highlight the diagnostic challenges of Chilaiditi Syndrome in pediatric patients and emphasize the importance of radiographic evaluation in cases of recurrent, unexplained symptoms. Case Presentation: We present a 5-year-old male patient with recurrent respiratory and abdominal symptoms who had been treated for extended periods with diagnoses of asthma, allergic rhinitis, and pneumonia. Despite receiving bronchodilators, corticosteroids, antihistamines, and antibiotics, the patient’s symptoms persisted. Comprehensive imaging studies, including chest and abdominal radiographs and ultrasonography, were performed to identify potential anatomical abnormalities. Discussion/Conclusion: Although rare, Chilaiditi syndrome should be considered in the differential diagnosis of children presenting with recurrent and unexplained respiratory or abdominal symptoms. Radiological assessment plays a critical role in achieving accurate diagnosis and preventing unnecessary treatments. This case underscores the importance of raising clinical awareness and not overlooking rare anatomical conditions in the pediatric population.

Objective: Umbilical hernia is a common anterior abdominal wall defect in childhood. Although the defect is present at birth, unlike other hernias of childhood, it may close spontaneously over time without the need for surgery. However, when these hernias do not close spontaneously, complications can develop that require emergency surgery. The aim of this study was to determine the incidence of spontaneous closure in patients diagnosed with umbilical hernia and the factors that influence this incidence, the complications that may develop during follow-up, the indications for surgery and the issues to consider when planning the follow-up of patients. Material and Methods: Between January 2006 and December 2011, 1928 patients diagnosed with umbilical hernia and followed up and treated in our clinic were included in the study. In this retrospective cohort study the current size of umbilical hernia, comorbidities and demographic characteristics of the patients were analysed. Operative data, complications and postoperative follow-up of the operated patients were evaluated. Results: The spontaneous closure rate of umbilical hernia was found to be 60%. The rate of spontaneous closure of umbilical hernia was higher in boys and the rate of operation was higher in girls. The risk of incarceration was higher in girls than in boys. The rate of spontaneous closure decreased with increasing defect size. It was found that comorbidities did not affect spontaneous closure of umbilical hernias. The rate of emergency surgery for incarceration was low (2%). Strangulation was noted in 1% of patients. All patients with incarceration were in Lassaletta group 2 (defect diameter 0.5-1.5 cm). Conclusion: Conservative management is still the most accepted and safest method in the treatment of umbilical hernia. Incarceration and strangulation are very rare in umbilical hernias. Even if the umbilical hernia is complicated, surgical treatment is possible and peri- and post-operative complication rates are very low. Long-term morbidity and mortality due to incarceration have not been reported in the literature.

Introduction: The management of the patient who applied to the emergency department with corrosive substance exposure varies according to the characteristics of the substance and the clinical conditions of the patient. In this study; demographic and clinical characteristics, patient management strategies and prognosis of the children presenting with corrosive substance ingestion are presented. Methods: Cases who applied with corrosive substance intake and were under the age of 18 were included in the study. Demographic data of the patients, characteristics of the substance, presence of intraoral lesions or any symptoms or signs, treatment and prognosis, radiographs and hospital stay were examined. Drool scores were calculated.Results: One hundred-ten patients were included. The mean age of the patients was 41 +/- 13 months and 56 (50.9%) were male. 53% of the patients were asymptomatic at presentation. The most common symptom was nausea-vomiting, the most common finding was hyperemia in the oropharynx. The mean Drool score of the patients was 8.9 +/- 1.7. Seventy-seven patients (70%) took alkaline, 33 patients (30%) took acidic substances; 45 patients sodium hydroxide, 27 patients sodium hypochlorite, 26 patients took hydrochloric acid. Findings were mostly observed in hydrochloric acid and sodium hydroxide intake. Endoscopy was performed in 3 of the patients. The mean Drool score of the patients who underwent endoscopy was 6.7. No complications were observed in any of the patients in the follow-up.Conclusion: Ingestion of corrosive substances is one of the important and preventable causes of emergency department admissions with chemical poisoning. There is usually accidental and small amount of intake in early childhood. Patients may be asymptomatic or rarely present with severe symptoms. It is important to know the chemical content of the ingested substance in order to predict the risk of damage to the gastrointestinal tract and respiratory system and to provide appropriate management in emergency services.

Pneumothorax is defined as the presence of air between the parietal and visceral leaves of the pleura, resulting in lung collapse. The aim of this study was to evaluate the respiratory functions of these patients when they reach school age and to reveal whether they cause permanent respiratory pathology. The files of 229 patients who were hospitalised in a neonatal intensive care clinic had received a diagnosis of pneumothorax and had undergone tube thoracostomy were included in a retrospective cohort review. The respiratory functions of participants in the control and patient groups were evaluated using spirometry in a prospective cross-sectional study design. The study found the rates of pneumothorax to be higher in males, term infants and after caesarean delivery, mortality was 31

INTRODUCTION: It was aimed to evaluate the etiology, clinical, laboratory and imaging findings and treatment methods of patients who have admitted with acute pancreatitis (AP) and progressed to chronic pancreatitis (CP) with ARP (acute recurrent pancreatitis). METHODS: The data of children under the age of 18 years who were admitted to our hospital between January 2013-July 2020 and were diagnosed with acute, acute recurrent or chronic pancreatitis according to INSPPIRE diagnostic criteria were evaluated retrospectively. RESULTS: There were 77 patients who were followed-up with the diagnosis of acute pancreatitis. Pancreatitis attack did not recur in 53/77 patients and no underlying cause was found in 35.84% (19/53) of the patients. The most common factor in those whose cause could be determined was gallstones (15.1%) (8/53). The pancreatitis attack recurred in 24 (31%) of the patients. Congenital anomalies (9/24) and hereditary pancreatitis (5/24) were the most common causes of pancreatitis in these patients and these factors were a risk factor for the recurrence of pancreatitis attack. There was no difference between the groups in terms of complications (p=0.423); however, chronicity was more common in the group with ARP (p=0.003). DISCUSSION AND CONCLUSION: Beside the pancreatitis is a rare disease in childhood, with the increase of awareness and increased accessibility to diagnostic imaging methods, more and more pancreatitis is diagnosed day by day. Idiopathic acute pancreatitis cases still constitute the largest group. If other causes are excluded in these cases, it is important to investigate congenital anomalies, genetic and metabolic etiologies

Behçet’s Disease (BD) is a rare vasculitic disorder that is consists of a triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. Although BD may present with its common symptoms, it may be appeared with the delayed healing of the wounds caused by environmental factors. 16 year-old-boy operated for noncommunicating hydrocele and short period after discharging, he presented to the emergency room with the complaint of recurrent dehiscence and serous leak of incision although it revised once. After detailed investigations the patient diagnosed as BD and treated with colchicine, so that, Behçet's disease (BD) should also be kept in mind in patients with deficient wound healing, history of surgical interventions and different ulcer lesions after surgery.

Amaç: Hirschsprung hastalığı (HH) tanısıyla transanal endorektal pull-through (TEPT) ve Martin-modifiye Duhamel ameliyatları yapılmış olan hastalarımızın sonuçlarının

Chilaiditi syndrome is defined as hepatodiaphragmatic interposition of colon or small intestine. Wheezy infant and Chilaiditi syndrome are not described in the literature. Radiographs of the lung taken for differential diagnosis should be fully evaluated. We emphasize the importance of air under the right diaphragm in the wheezy infant.

AbstractBackground/Aims: Although rare, torsion and malignancy of the uterine adnexa, are a common concern of differential diagnosis while dealing with abdominal pain in girlsMethods:Forty-seven patients who were operated for adnexal torsion or ovarian tumor between March 2004 and December 2010 are enrolled in the study. Results:Twenty one patients had torsion of the uterine adnexa, 18 had ovarian tumors and 8 had an ovarian tumor with torsion. The rate of radical surgery was 47% in torsion which was elevated to 72% in tumor and 100% in tumors with torsion. In ovarian torsion, the rate of radical surgery and adnexal sparing were not different between early versus late presenting cases. Conclusions: Despite encouraging data in the literature favor ovarian sparing, radical surgery still seems to remain high in girls with adnexal torsion and tumors. Ovarian sparing seems possible in tumors but further studies are needed to determine the best management strategy.

1Kırıkkale Üniversitesi Tıp Fakültesi Çocuk Cerrahi Anabilim Dalı, Kırıkkale, 2 Dr. Sami Ulus Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi Çocuk Cerrahisi Kliniği, Ankara, 3Hitit Üniversitesi Tıp Fakültesi Çocuk Cerrahi Anabilim Dalı, Çorum, 4Gazi Üniversitesi Tıp Fakültesi Çocuk Cerrahi Anabilim Dalı, Ankara, TÜRKİYE Evaluation of adhesive ileus risk factors and treatment modalities among the patients undergoing laparotomy Orjinal Makale

PURPOSE:The gold standard for the diagnosis of malrotation is barium contrast study of the upper gastrointestinal system (UGCS), while color Doppler ultrasonography (CDUS) is another method used in the diagnosis. We investigated the value of CDUS for the diagnosis of malrotation in this study.METHODS:UGCS images, CDUS images, plain abdominal images, demographic data, and symptoms of 82 patients who were investigated for presumed malrotation during a 7-year period were evaluated, retrospectively.RESULTS:All patients underwent CDUS, and 18% of these patients were diagnosed with malrotation as the superior mesenteric vein was seen to be on the left of the superior mesenteric artery. We found that 16% of the 75 patients who underwent UGCS were diagnosed with malrotation. The sensitivity and specificity of CDUS in the diagnosis of malrotation was found to be 93.8 and 100%, respectively. The respective values for UGCS were 91.7 and 98.4%.CONCLUSION:Current data in the literature and our results underline that UGCS may yield false-positive and false-negative results. Although CDUS was found to be a reliable method for the diagnosis of malrotation in our study, the limitations of UGCS are also recognized for CDUS. Prospective studies are needed to determine the more valuable method.

Amaç: Postoperatif yapışıklıklar intestinal obstrüksüyona yol açması, reoperasyon durumlarında abdominal eksplorasyonu zorlaştırması, organ yaralanmalarına sebep olması nedeniyle hem hasta hem de hekimler için önemli bir klinik durumdur. Bu çalışmada brid ileus gelişimine etki eden faktörlerin saptanması ve brid ileusdaki tedavi sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: 2005-2010 yılları arasında çeşitli nedenlerle laparotomi yapılan hastalar brid ileus gelişimi açısından retrospektif olarak değerlendirildi. Bulgular: Bu çalışmaya l aparotomi yapılan 3271 hasta dahil edildi. Apandisit en sık laparotomi endikasyonuydu (%66). 152 hastada (%4,6) postoperatif brid ileus geliştiği tespit edildi. Bunların %88’inin postoperatif ilk 6 ayda, %99’unun da ilk 3 yıl içinde geliştiği görüldü. Yaş ve cinsiyet ile brid ileus gelişimi arasında ilişki yoktu. Vakaların %23’ü kirli vasıfta ameliyatlardı. Temiz, temiz kontamine ameliyatlardan sonra brid ileus gelişme oranı %3,4 iken, kontamine ve kirli ameliyatlardan sonra bu oran %10,9 olarak bulundu. Batın içerisine dren yerleştirilmesinin brid ileus gelişimini etkilemediği saptandı. Ameliyat süresi uzadıkça postoperatif brid ileus gelişme oranının arttığı tespit edildi. Ayrıca ameliyatta Meckel divertikülü gibi ek patolojiler araştırılan hastalarda brid ileus gelişme oranının 3 kat arttırdığı görüldü. Brid ileus gelişen hastaların %61’i nonoperatif-konservatif yollarla tedavi edilirken %39’unda cerrahi girişim gerektiği tespit edildi. Sonuçlar: Çalışmamızda batın içinde uygulanan ek girişimlerin, operasyon süresinin uzun olmasının ve intraperitoneal kontaminasyonun brid ileus gelişimini artırdığı gösterilmiştir. Bu konulara dikkat edilmesinin brid ileus gelişimini azaltabileceği düşünülmüştür. Çocuk yaş grubunda uygun vakalarda konservatif tedavi ile daha yüksek oranlarda başarı sağlanabileceği kanısına varılmıştır.

In the neonatal period, the most common cause of pleural effusion is idiopathic congenital chylothorax. Congenital chylothorax is rarely associated with chromosomal abnormalities, such as Down, Turner and Noonan syndromes. The diagnosis can be made after analysis of the pleural fluid drained by thoracentesis or chest tube placement. During the neonatal period, chylothorax treatment is composed of conservative and surgical therapies. Nowadays, for cases among which conservative therapies fail, treatment with octreotide has been reported to be beneficial with promising results. In this report, a case of congenital chylothorax, in a newborn with Down syndrome, treated by octreotide after failure of chest tube drainage and medical treatment (total parenteral nutrition and medium chain fatty acid formula) is presented.

Objective: Sacrococcygeal tumor is a rare benign or malign germ cell tumor of infancy and early childhood. We report a 12-year single-center experience. Materials and Method: A total of 16 children operated with sacrococcygeal teratoma from 2004 to 2016 were reviewed retrospectively for their clinical features, treatment and follow-up. Results:  There were five boys and eleven girls between 1 day to 4 years of age. The most common symptom was sacrococcygeal mass. Complete resection of tumor involving coccyx was performed in all patients. Recurrence was seen in one case. Metastasis was also seen in one case.Conclusion: Sacrococcygeal tumor is the most common tumor in newborn. Total excision is the treatment. The prognosis is excellent despite large tumor size and local invasion.  Key Words: Sacrococcygeal teratoma, child, newborn

Introduction: Inguinal hernias and hydroceles are the most frequently performed procedures in pediatric surgery departments. In this study, we aimed to define the spontaneous regression rate in different types of hydroceles, the regression age, the timing of surgery, and the optimal treatment approaches for each hydrocele type in cases with isolated hydroceles in children. Material &Methods: This historical cohort study included 2625 patients which were admitted between January 2004 and December 2012. The hydroceles were classified as: ‘non-communicating hydroceles’, ‘communicating hydroceles’, ‘spermatic cord hydroceles’ and ‘abdomino-scrotal hydroceles’ (ASH). Patients were divided into two groups with regard to their ages at diagnosis as follows: those presenting in the newborn period and before 24 months of age (Younger– Group 1) and those presenting after 24 months of age (Older – Group 2). Determining the type of isolated hydrocele, the decision making for follow-up or surgery, and the follow-up period were conducted by 7 attending pediatric surgeons and 6 residents. Results: In Group 1, 93% of 1086 non-communicating hydroceles, 40% of 158 cord hydroceles, and 15% of 34 communicating hydroceles resolved during the follow-up, and the remaining patients with each type of hydrocele underwent surgery. In Group 2, 8.7% of 183 non-communicating hydroceles resolved during the follow-up. Conclusion: The primary treatment of patients with isolated hydrocele should be decided regarding the type of hydrocele, along with age at admission, and accordingly, conservative or surgical treatment should be considered.

Morgagni hernia is a relatively rare form of diaphragmatic hernia in the pediatric age group and it is conventionally treated with open surgical repair. Minimal access surgery is currently being adapted for many procedures in children. However, to date just a few techniques have been described relevant to minimal access surgical repair of Morgagni hernia in children. Herein, we report two cases of Morgagni hernia repaired by a new single-port laparoscopic technique assisted by an optical forceps. Two infants, a one-year-old boy and an eight-month-old girl, were operated with this technique in just 26 and 35 min and were discharged with oral analgesic prescription by postoperative hour 5 and 8, respectively. In the English-language literature, these cases are the first reports of laparoscopic Morgagni hernia repair that were performed as an outpatient procedure. Also, the technique introduced can be easily applied by a single surgeon without an assistant to operate the laparoscope.