Journal of Pediatric Surgery Article Review: September 2021
With Dr. Mikko Pakarinen & Dr. Julian Goddard & Dr. Iris Limbuel · hosted by Dr. Rod Gerardo & Dr. Ellen Encisco & Dr. Todd Ponsky
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Meckel's Diverticulum 3 items
Chapter 1 of 4 · Fundamentals
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Although there is evidence that early feeding in adult patients after intestinal surgery is beneficial, the Chinese study authors did not find any benefit in neonates.
In the early feeding group, patients did not have a decompressing nasogastric tube.
The early feeding group was fed through the NG tube left to gravity, not decompressing the stomach after anastomosis.
Ponsky concludes that nasogastric tubes are not needed after a baby anastomosis based on the Chinese trial data.
Pakarinen states that blood in stool causing a decrease in hemoglobin has always been a red flag sign for Meckel diverticulum in his experience.
Ponsky would use a high Meckel score to go straight to laparoscopy, skipping the Meckel scan, because even with a negative scan he would still suspect Meckel diverticulum.
The Meckel score would help Ponsky potentially skip the Meckel scan in certain subsets of patients, representing a practice change.
The Cincinnati perianal Crohn's study included all children aged 0-18 years living within a 15-mile radius of Cincinnati Children's who presented with perianal disease.
The study also reviewed all children within a 50-mile radius diagnosed with Crohn disease.
Overall, 3% of children presenting with perianal symptoms were diagnosed with Crohn disease.
No children under age 1 in the study ended up having Crohn disease within the study period.
Higher rates of Crohn disease were seen in older children, particularly over age 10.
Many patients in the study had fissures, which are very common in children.
The study included patients whose perianal symptoms were managed as outpatients, who may never have been seen by the surgical team.
Ponsky concludes that under age 10, workup for Crohn disease is not needed for perianal symptoms, but over age 10 it should be performed.
Ponsky previously thought Crohn disease most commonly presented with GI symptoms like abdominal pain and diarrhea, but learned that quite a few kids present with perirectal abscess.
Ponsky has been sending children with perirectal abscess to GI for colonoscopy and has been finding Crohn disease.
In the Chinese randomized trial, the early feeding group started feeds at 2 days compared to 6 days for the traditional feeding group.
The Chinese trial found no significant difference between early and traditional feeding groups in length of stay, time to full feeds, postoperative complications, 30-day mortality, or 30-day readmissions.
The Meckel diverticulum study examined patients under age 18 who presented with hematochezia and determined which presenting factors predict Meckel diverticulum, creating a risk score.