Double duodenal atresia with perforation: a case report

Duodenal atresia is a common cause of neonatal bowel obstruction. Double duodenal atresia has been reported as a rare variation of duodenal atresia. This report discusses the importance of an appreciation of unusual anatomy in neonatal duodenal obstruction and highlights the importance of assessing bowel continuity intraoperatively.     

A case report of laparoscopic duodenal atresia repair in a neonate using a novel miniature stapling device

IntroductionLaparoscopic duodenal atresia repair is an advanced procedure performed in select pediatric surgical centers. Recently, sub–6 mm endosurgical staplers have been introduced, facilitating and accelerating the creation of intracorporeal intestinal anastomoses.Presentation of caseWe performed a laparoscopic duodenojejunostomy in a one-day-old child with duodenal atresia due to annular pancreas using a novel 5.8 mm articulating endostapler with excellent outcome. The technical details are reported.DiscussionLaparoscopic duodenojejunostomy is a technically demanding procedure due to difficulty in hand-sewn anastomosis in a small and restricted space. With this novel 5.8 mm articulating endostapler, we were able to perform a quicker and easier anastomosis.ConclusionWe report a case of laparoscopic duodenal atresia repair in a neonate using a novel miniature stapling device. This new technique is a safe, quick and easier way to perform laparoscopic duodenal atresia repair.     

Robotic repair of congenital duodenal atresia: a case report

Although repair of duodenal atresia has been performed laparoscopically, it can be a difficult procedure using rigid handheld laparoscopic instruments. Only a few pediatric surgeons are performing this operation with a minimally invasive approach. Robotic surgery may help overcome the obstacles presented by the use of traditional rigid laparoscopic instruments. We present the world's first robotic repair of congenital duodenal atresia in a 2.4-kg, 1-day-old newborn. The procedure took less than 3 hours, and the patient had an unremarkable postoperative course.     

How to treat a neonate with duodenal atresia and intrapancreatic choledochocele causing persistent hyperbilirubinemia: A case report

IntroductionThe congenital combination of duodenal atresia and choledochal cyst has only been reported in a few children. None of these patients had an intrapancreatic choledochocele causing persistent hyperbilirubinemia in the newborn period.Presentation of caseA female newborn presented with duodenal atresia and received a duodeno–duodenostomy on day two of life. The postoperative course was uneventful except for progressive hyperbilirubinemia and elevation of liver enzymes. No evidence for surgical obstruction, malformations of the hepatobiliary system, or infectious diseases were found. At three months of age and persistent hyperbilirubinemia an intrapancreatic choledochocele type III according to Todani was confirmed by ultrasound and MRI. Upon laparotomy no lesion was visible or palpable within the pancreas. Even after duodenotomy distally of the duodeno–duodenostomy only a normal papilla Vateri could be identified. Transduodenal ultrasound allowed for localization and saline distension to outline the borders of the choledochocele. A transduodenal marsupialization provided immediate biliary drainage and postoperatively bilirubin levels returned to normal limits.DiscussionWe present a case of duodenal atresia and choledochocele requiring surgical treatment in the neonatal period. Transduodenal marsupialization prompted adequate biliary drainage without inflicting the potential complications of biliary and pancreatic diversion at this early age. A life-long endoscopic observation seems mandatory to examine the potential risk of metaplasia of the cystic remnant.ConclusionEarly transduodenal marsupialization of an intrapancreatic choledochocele in a case of duodenal atresia is safe and feasible to prevent secondary liver cirrhosis.     

Regional anesthesia in a very low-birth-weight neonate for a neurosurgical procedure

BACKGROUND AND OBJECTIVES: Peripheral nerve blocks can be successfully utilized in infants for neurosurgical procedures. Our objective was utilizing a series of peripheral nerve blocks for a neurosurgical procedure in a very low-birth-weight neonate. CASE REPORT: We report the use of supraorbital, great auricular, and greater occipital nerve block in a very low-birth-weight neonate (700 g) who was scheduled for a neurosurgical procedure. DISCUSSION: We were able to successfully utilize peripheral nerve blocks and were able to blunt physiologic responses to surgical stress without compromising hemodynamic stability using high-dose opioids.     

Esophageal atresia, duodenal atresia, and unilateral lung agenesis: a case report

The association of pure esophageal atresia, duodenal atresia, and unilateral lung agenesis has not been reported previously. Here the authors present a case of a newborn with this constellation of anomalies that underwent staged repair. The primary principle guiding treatment was the avoidance of iatrogenic injury to the single lung. Therefore, the order of operations proceeded as follows: (1) placement of a decompressing gastrostomy tube, (2) repair of the duodenal atresia, and (3) repair of the esophageal atresia. The congenital closed loop obstruction caused by the esophageal and duodenal atresias was beneficial in that it resulted in growth by stretching of the distal esophagus, allowing a tension-free primary repair of the esophageal atresia.     

A unique presentation of a standard type C esophageal atresia in a very low-birth-weight neonate

Neonates with esophageal atresia and tracheoesophageal fistula usually present with inability to swallow immediately after birth often associated with respiratory distress. This is an unusual presentation of a very low-birth-weight neonate with a type C tracheoesophageal fistula that was fed for the first 4 days of life through an unintentional tracheogastric tube without incident.     

Pulmonary embolism was suspected during hip surgery under spinal anesthesia: a case report]

Most of the lower leg surgeries are done under spinal anesthesia. This 53 year old male had undergone a surgery for his left hip fracture previously and was scheduled for the removal of the screw. Spinal anesthesia was administered and sensory block was obtained up to T8. After the removal of the screw, he coughed weakly for several times. Suddenly ECG monitor showed severe bradycardia and hypotension was observed. He complained of chest pain, dyspnoea and went into shock. Immediately after giving atropine 0.5 mg iv, ephedrine 8 mg x 2 was necessary to raise his heart rate. About 3 minutes later he recovered from his shock state. ECG changes were transient and the bradyarrhythmia during his shock turned out to be AV dissociation. Arterial blood gas analysis showed decreased PaO2 and increased PaCo2. We suspected lung embolism. However, postoperative chest X-ray and pulmonary perfusion scans were within normal limits.     

硬膜外麻醉下腹腔镜胆囊切除术254例报告

回顾分析近4年来254例连续硬膜外麻醉下腹腔镜胆囊切除术(LC)患者的临床资料。253例LC获得成功，1例因肌肉松弛效果不满意中转全麻插管完成手术。未发生胆管损伤及术后并发症。提示连续硬膜外麻醉下腹腔镜胆囊切除术是安全可靠的，值得推广。     

Disseminated Staphylococcus aureus infection following spinal anesthesia: a case report

We here presented a 65-year-old woman with disseminated Staphylococcus aureus infection following spinal anesthesia. The patient underwent spinal anesthesia for great saphenous vein stripping. Twenty days after the procedure, the patient developed hydrocephalus, pulmonary infection, and epidural abscess. Microbiological culture of the pus showed infection by S aureus. Appropriate antibiotic therapy and prompt surgical abscess drainage were associated with good outcome. Hydrocephalus is thought to be associated with arachnoiditis caused by S aureus infection, which provides new insights into the pathophysiology of arachnoiditis. Here we reported a case of disseminated S aureus infection following spinal anesthesia, implicating that appropriate interventions should not be delayed for waiting for the microbiological results.     

Anaphylactic reaction to latex during spinal anesthesia: a case report

A 46-year-old man, with a history of atopic dermatitis and bronchial asthma, underwent surgery for an inguinal hernia. Forty-three minutes subsequent to spinal anesthesia, the patient complained suddenly of dyspnea with wheezing. Blood pressure decreased and skin eruption was observed on his chest. Postoperative laboratory tests revealed high IgE concentration, and a skin test confirmed an allergy to latex. The patient's allergic reaction was easily overlooked because of his history of bronchial asthma and the possibility that the hypotension was caused by the high spinal anesthesia. Latex allergy should be considered in any suspicious case presenting with these symptoms during surgery. After recovery, a skin test should be used to confirm the allergy to avoid repeated allergic episodes.     

Perioperative management of a neonate with a retroperitoneal giant teratoma who underwent its extirpation under general anesthesia: a case report

We gave anesthesia to a neonate with a retroperitoneal giant teratoma who underwent its extirpation. Even if patients have a prenatal diagnosis of teratoma like this case, there are many patients, especially infants, with severe general condition. We report the difficulty for management during anesthesia because of severe respiratory acidosis due to pressure from diaphragmatic pleura by tumor, severe circulatory disorder due to massive bleeding during operation and severe hyperkalemia due to renal failure.     

Meningioma in a neonate: case report.

A 10-day-old female with a parasagittal meningioma presenting as a subcutaneous tumor is reported. Meningiomas within the 1st month of life are rare. The clinical and pathological characteristics of congenital meningioma are reviewed.     

Obstructive sleep apnea uncovered after high spinal anesthesia: a case report

PURPOSE: To illustrate how a patient's previously undiagnosed obstructive sleep apnea was uncovered after administration of a spinal anesthetic with a high sensory blockade, and to discuss possible explanations for this occurrence and anesthetic implications. CLINICAL FEATURES: A 55-yr-old male presented for osteotomy and open reduction and internal fixation of his left femur secondary to malunion from a previous fracture. Past medical history consisted of hypertension, hypercholesterolemia, bipolar disorder, gastroesophageal reflux disease, and cluster headaches. A combined spinal-epidural technique was chosen. Isobaric bupivacaine 0.5% (15 mg), was provided for the spinal anesthetic, along with 1 mg iv midazolam for procedural sedation and 0.5 mg iv droperidol for mild nausea. Throughout the operation, many apneic events were noted, often with respiratory efforts. The patient was easily arousable during each event and would breathe normally until the next episode. Vital signs remained stable throughout. Postoperative respirology consultation was requested, and a sleep study revealed severe obstructive sleep apnea. The patient was subsequently started on continuous positive airway pressure with marked improvement in symptoms, including the cluster headaches. CONCLUSION: Recent literature suggests that high spinal blockade can result in altered levels of arousal by producing a de-afferentation of peripheral proprioceptive and sensory stimuli necessary for maintaining an awake state. In patients predisposed to upper airway obstruction, decreasing the level of consciousness can result in airway obstruction as occurs during sleep in these patients. This serves to underline the importance of considering capnography for all cases utilizing a neuraxial anesthetic technique.