Iranian Journal of Pediatric Surgery
Volume:2 Issue: 1, Aug 2016

Double aortic arch (DAA) is a rare congenital malformation. Strategies for diagnosis and treatment are different. Thoracoscopic treatment of DAA is limited to case reports or little case series. We report a description of our diagnostic and therapeutic approach and evaluate outcomes.
We reviewed charts of infants with double aortic arch who were hospitalized in our department from 2008 to 2014. Age at symptom onset, clinical presentation, diagnostic modality, operative details and post operative outcomes were retrieved.
We identified 7 patients presenting at a median age of 11,8 months (range: 2months-27months) and median weight of 10kg. Respiratory symptoms were present in all cases. Difficulties in feedings were present in 3 cases. Chest radiography, oesophagogram and Computed Tomography (CT) with three-dimentional (3D) reconstructions were performed for all patients. One patient have had laryngo tracheoscopy and 3 patients echocardiography. The dominant branch was the right one in all cases. Associated cardiac anomaly was found in 1case. Operative approach was thoracotomy in 3 cases and thoracoscopic video assisted surgery (VATS) in 4 cases. Median operative time was 132min. Only one patient required conversion. Median hospital stay was 4,1days.
Double artic arch is a rare malformation which can cause persistent non specific respiratory symptoms in infants. The use of 3D-CT scan reconstruction that facilitate diagnosis and the operative approach. Thoracoscopy and thoracotomy are effective procedures even for patients with low weight. The operative time seems similar for both. Thoracoscopy offers less post operative analgesia, shorter hospital stay and good cosmetic results.

Management of pediatric blunt abdominal trauma in resource-restricted settings requires precise clinical expertise. In this study, we reviewed pediatric patients who were suspected to have blunt abdominal trauma in a level III trauma center in Iran.
In a cross-sectional study, 66 injured children were studied from October 01, 2014 to October 01, 2015 in Nikshahr, Sistan-va-Balouchestan, Iran. Patient characteristics, type of trauma, initial evaluation and final decisions were analyzed.
Mean age was 8.2 ± 13.3 years. Thirty five patients (53%) were boys and 31 patients (47%) were girls. Focused Assessment with Sonography for Trauma (FAST) was done for all patients. Diagnostic Peritoneal Lavage (DPL) was done on five patients (7.6%). Laparatomy was conducted on seven patients (10.6%). Ten patients (15.2%) were referred to a higher level trauma center. There were three mortalities (4.5%). Positive FAST was associated with hemodynamic instability (p Computed tomography and intensive care unit may be unavailable in resource restricted settings with level III and IV trauma centers. However, physical examination, FAST and DPL are useful diagnostic tools for assessment of injured children with blunt abdominal trauma.

Hospitalization and surgery are among of the most difficult experiences for the children and their parents have to face. Many parents experience preoperative anxiety during the hospitalization of their children.
This study attempts to quantify pre operative anxiety in the parents of children admitted to hospital for elective surgery and to isolate factors associated with increased anxiety.
Patients and In a cross-sectional study, all parents consecutively admitted to the study hospitals ( Shahid Beheshti hospital in kashan and Emam Hossein hospital in Esfahan) were assessed. In this study, The Spielberger’s State-Trait Anxiety Inventory... .

Foregut duplication cysts associated with vertebral anomalies are referred to as neurenteric cyst. About 30 cases have been reported in the literature so far. Posterior mediastinal neurenteric cysts are very rare and a few studies could be found in the literature even after extensive search. Because of rarity we are prompted to present 7 cases of posterior mediastinal neurenteric cysts to further add on to the literature.
Study design: All the details of the patients of neurenteric cysts operated in department of paediatric surgery over a period of 2010-15 were taken from patient case files.
There were 7 pateints of neurenteric cyst including 3 males and 4 females with age ranged from 4 months to 8 years. Patients presented with recurrent chest infection along with two case having dysphasia also. In 5 cases there were right sided cysts while two had cyst on left side in posterior mediastinum. In 2 cases the cysts were extending to abdomen while one patient had separate ileal duplication cyst. Another case had mediastinal cyst which was communicating with ileum. All the mediastinal cysts were excised through posterior thoracotomy and subsequently confimed on histolpathology.
Neurenteric cysts should be considered in the differential diagnosis of mediastinal cysts of paediatric age group.

Study design: A retrospective radiographic review was undertaken in patients treated for AIS.
To determine the most important preoperative factors that affect on postoperative junctional kyphosis complication.
sagittal spine profilewere measured on the standing radiographs before, after and in the last follow-up visit of the operated patients for AIS. The following parameters were measured on lateral views including: lumbar lordosis, thoracic kyphosis, the sagittal offset distance of C7 to a vertical line from postero-superior edge S1 (Sagittal Vertical Axis-SVA) and T9 sagittal offset angle.
One hundred twenty patients with mean of 42 months follow-up(24-112 months) were included in the study. Mean values of the parameters before corrective surgery were: lumbar lordosis 45° ± 13.6°, thoracic kyphosis 28°±18.4°, SVA 35 ± 27.2mm and T9 offset angle, 7.8°± 5.1°. Mean values at last follow-up were: lumbar lordosis 49 ± 9.8°, thoracic kyphosis 35 ± 16.4°, SVA 39 ± 24mm and T9 offset angle, 8.6°± 5.8° . There were 10 upper junctional kyphosis (8.4%).T test statistics revealed significant correction of lumbar lordosis and thoracic kyphosis after fusion in all patients (P Normal sagittal balance of spine is essential for the optimum function of the intervertebral disks and preventing sagittal postoperative complication like proximal junctional kyphosis. More attention to preoperative sagittal parameters of the spine like T9 offset may be important to prevent such complications.

Background/ Ulcerative colitis(UC) is a chronic, idiopathic, destructive disorder of colon. The incidence of UC peaks in the age group of15 to 25,and only 1% are infantile. Despite initial medical treatment, in refractory cases, colectomy is needed. There are few studies regard surgical results in infancy with UC.
In this retrospective study we reviewed infants with ulcerative colitis that consulted with us for surgery between 2009 and 2014. We measured age at onset, family history of inflammatory bowel disease, symptoms of onset, colonoscopic findings, duration of Medical treatment, Indication of surgery, Type of operation, surgical complications and Management of them, and rate of mortality.
5 patients (4 boys, 1girl) were identified. The mean age of onset of the disease was 35(range3-60) days. The mean age of patients at the time of surgical consult was7months.The disease began in 3 patients with watery diarrhea .One case (12month old) had positive family history of his sister with similar presentation that expired in 3 month. He had sever FTT with no response to medical treatment as indication for surgery and underwent total proctocoletomy, ileoanal anasthomosis and loop ileostomy but it failed and 3 days after first operation we performed end ileostomy.2 cases had colon perforation followed colonoscopy and one of them(4month girl)expired before laparotomy and the other(12 month boy)underwent colostomy in septic shock. The fourth patient was 2 day old neonate with abdominal distention and intestinal obstruction that rectal biopsy showed agangliosis and underwent transanal pulthrough procedure but after surgery had recurrent watery diarrhea and investigation showed UC. The last case was 3 days neonate that underwent ileostomy,in initial surgery with suspicion to total colonic agangliosis and then underwent subtotal colectomy at 2month old.At1.5 year old he referred to us with toxic megacolon in remenant colon and underwent colostomy,and 3 month later underwent final surgery.
If a child presents with recurrent bloody or waterly diarrhea even in infancy, UC should be considered as a differential diagnosis. The pattern of the disease in infancy appears more rigorous. Evidence-based management of UC presenting in infancy is incomplete but early surgical attempt can reduce catastrophic results.

Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cyst of the pelvis and it is most frequently encountered in women of reproductiveage and Rarely, they may occur in males.
A 12 year old boy was referred with a two-day history of abdominal pain. Abdominal examination revealed lower abdominal tenderness. Laboratory tests were normal. Abdominal ultrasound and CT scan showed intrapelvis fluid collection with some septations and lymphadenopathies. Shapeless cystic mass with thin membrane which was independent of abdominal organs was found during laparoscopy and extracted from pelvic cavity. Histopathologic examination established the diagnosis of peritoneal inclusion cyst.
peritoneal inclusion cyst should be in mind as differential diagnosis in a patient with intra-abdominal cystic fluid collection even in childhood and male gender.

Urinary bladder hemangiomas are very rare and accounting for 0.6% of all urinry bladder toumors. It is rare cause of hematuria. A 8-year old boy presented with painless gross hematuria for one week. He had past history of this problem 5 months ago. Physical examination revealed no unusual findings. Sonogeraphy and CT scan showed intraluminal bladder mass with exteravesical cyctic component. partial transurethral resection of mass revealed lymphangioma. Open syrgery was performed and pathologist reported hemangioma of bladder associated with exteravesical cyct.