Type of ostomy closure has connection with some complications and also cosmetic effects.
This study aimed to compare result of colostomy closure using purse-string method versus linear method in terms of surgical site infection, surgical time, and patient satisfaction.
In this study, 50 patients who underwent purse-string ostomy closure and 50 patients who underwent linear closure were included. Two groups were compared for surgical time, wound infection, patient satisfaction, scar length. A p-value <0.05 was considered significant.
Wound infection was not reported among purse-string group compared to 10% in linear group (p=0.022). Scar length was 24.09±0.1 mm in purse string and 52.15±1.0 mm in linear group (p=0.033). Duration of hospital admission was significantly shorter in purse-string group (6.4±1.1 days) compared to linear (15.5±4.6 days, p=0.0001). The Patient and Observer Scar Assessment Scale scale for observer (p=0.038) and parents (p=0.045) was more favorable among purse-string group compared to linear.
Purse-string technique has the less frequent surgical site infection, shorter duration of hospital admission, less scar length, and more favorable cosmetic outcome, compared to linear technique.
Bishop-Koop ileostomy has been widely used in pediatric patients with the intention of including as much bowel as possible in the intestinal transit early in the management of children with meconium ileus and intestinal atresia. In recent years, we have been using it as an alternative to test the distal bowel function before closure of a previously constructed ostomy in selected children with questionable distal bowel motility.
The aim of this study was to present our experience with this alternative use of the Bishop-Koop ostomy.
This is a cross-sectional retrospective review of hospital records, combined with a comprehensive literature review.
Seven children were included: five had suspected aganglionosis, one had gastroschisis complicated with ileal atresia, and one had a colonic stricture secondary to necrotizing enterocolitis. In this short series of patients, motility of the distal bowel was correctly assessed in six patients and partially correctly assessed in one patient. One patient did not pass stools per anus after the Bishop-Koop, and he was later confirmed to have Hirschsprung disease. Four patients resumed normal evacuation pattern after closure of the Bishop-Koop. One patient had a Bishop-Koop colostomy because of recurrent enterocolitis after a transanal pull-through. Although he evacuated normally while having the colostomy, the diarrhea recurred after the ostomy was closed. An additional patient, with a severe behavioral problem, did not evacuate per anus after her colostomy was transformed in a Bishop-Koop-type ostomy, despite the apparent presence of normal ganglia in the bowel wall.
Data from the present series allow us to affirm that Bishop-Koop-type ostomy is a safe and efficient procedure that can be used to assess distal bowel function before a definitive transit reconstruction, in children with uncertain motility issues.
Dysontogenetic cysts, commonly referred as dermoid cysts or teratoid cysts, are hamartomas which may contain various derivatives of endoderm, mesoderm and ectoderm7. The majority of cases is reported in the midline of the body and especially in testes and ovaries. The most common site in the head and neck region is the lateral eyebrow, the so-called angular dermoid, and approximately 6.5% of the cases occur in the oral cavity. The teratoid cyst of the floor of the mouth is distinctly uncommon, with only a few cases reported, usually in the anterior portion8,14.
Three theories with regard to the origin of cysts in the floor of the mouth were found in literature. According to the 1st and most prevalent theory, these cysts originate from embryonic cells of the 1st and 2nd branchial arches during the 3rd/4th week of embryonic life. The 2nd theory explains the pathogenic mechanism of the acquired form, which may be due to the implantation of epithelial cells subsequent to accidental or surgical injury (traumatic causes, iatrogenic antecedents, or an occlusion of a sebaceous gland duct). Lastly, the 3rd theory maintains that these cysts are considered a variation of the cyst of the thyroglossal pore6. With regard to the etiology of dermoid and teratoid cysts in this site, there is much theory, but the most accepted is a possible sequestration of ectodermal tissue in the midline at the time of fusion of the first (mandibular) and second (hyoid) brachial arches2,10.
Histologically, the dermoid cyst differs from epidermoid cyst only in the presence of normal or dysmorphic adnexal appendages within its walls, usually sebaceous glands or abortive hair follicles. The teratoid cyst is considered if the cyst wall contains other elements, such as muscle or bone11. Surgical approaches for excision have been the treatment of choice for dermoid or teratoid cyst, including intraoral and extraoral skin incisions12. Most of the authors recommend conservative surgical removal, trying not to rupture the cyst, as the luminal contents may act as irritants to fibrovascular tissues, producing postoperative inflammation. Recurrence and malignant transformation of oral cysts are unlikely after treatment8,9.
This paper presents a case of teratoid cyst in a child with emphasis on the management and follow-up of six months.
Desenvolvido por Surya MKT