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Article
Factors That Predict The Morbidity of Colostomy in Patient with Ano-Rectal Malformation in Children in Baghdad

Author: Amer Abd Allah Ejrish
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 294 -306
Publisher: Babylon University جامعة بابل

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Abstract

Colostomyis surgically fashioned colo-cutanous fistula for the diversion of the feces and flatus away from distal pathology or a surgical site either temporary or permanent type, indication of colostomies in our study were ARM.Identify the most common complication of colostomy in patient with ARM and how to be avoided, and which colostomy type carries a low risk of complication.Prospective study of 100 cases ARM that underwent colostomy was conducted at Medical City Children Welfare Teaching Hospital of department of pediatric surgery between January 2014 – November 2015.Most of colostomies (75%) were done in the neonatal period and mainly for recto urethral fistula in male (45%), the most common type of colostomy was a loop sigmoid colostomy (69%) this may be due to simplicity in creation and closure, in addition to surgeon's preference.Divided colostomy was done in 26 patients, and mainly for male patients. Seventy patients (70%) develop different complications and the most common were prolapsed (39%).others were skin excoriation, UTI, wound sepsis, parastomal hernia and bleeding.Prolapsed and skin excoriation were most in loop colostomies, while skin dehiscence was commonly seen in divided types. Associated anomalies were seen to be related to increase incidence of colostomy related complication. Mortality rate was (5%); the causes of death were septicemia, associated congenital anomaly and complex malformation.To decrease the incidence of prolapsed, it better to created divide rather than loop sigmoid colostomy for complete diversion of faces. We recommend divided proximal sigmoid colostomy for complete diversion of feces for protect definitive PSARP.


Article
Types and Outcome of Congenital Diaphragmatic Hernia in Children in Basrah

Authors: Haithem Husian Ali --- Amer Abd Allah Ejrish --- Sadik Hassan Kadhem
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 264 -270
Publisher: Babylon University جامعة بابل

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Abstract

A prospective study that review the types of congenital diaphragmatic defects in pediatric age groups in Basra and their outcome, to describe the demography of diaphragmatic defects and to assess their mortality and morbidity. This study was conducted at the neonatal intensive care unit and surgical ward of the Basra children specialty hospital. The medical records of 67 diaphragmatic defects patients, admitted to the hospital from July 2013and July 2015. Data for patient demographics, associated congenital anomalies, and mortality were collected in this study in addition to the types of diaphragmatic defects. In this study Bochdalek hernia is the commonest type of diaphragmatic defects in all age groups (64.2%), followed by diaphragmatic event ration (13.4%), hiatus hernia (11.9%), Morgagni hernia (4.5%), congenital central hernia (4.5%), and finally absent hemi diaphragm (1.5%). Male is affected more than female in all age groups. Shortness of breath is the presenting feature in all age groups with predominance in neonates. Vomiting is the second presenting feature, especially in infant and older children. Associated anomalies occur in about 19.4%. Overall complication rate was 24.1 and the survival rate was 80.3%. It may not reflect the real survival because many fetal and post-delivery deaths occurred and not registered in our society.One should have a high index of suspicion regarding diaphragmatic defects especially those neonates presenting with shortness of breath. Most neonates with diaphragmatic defects are diagnosed by plain chest x-rays (88.2%) so that we should avoid injudicious use of contrast study or CT scan for the diagnosis of diaphragmatic defects. High survival rate may not reflect the real event because many patients died before, during, or just after delivery so that prenatal diagnosis and management of diaphragmatic defect must be encouraged.

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