Although thoracic injuries occur less frequently in children than adults, they remain a source of substantial morbidity and mortality. Disparate problems such as rib fractures, lung injury, hemothorax, pneumothorax, mediastinal injuries, and others may present in isolation or in combination with one another. Knowledge of the manner in which pediatric anatomy, physiology, and injury patterns change with age may expedite the evaluation of the pediatric chest after trauma. Differences in pulmonary functional residual capacity, blood volume, chest wall and spinal soft-tissue mobility, and cardiac function may translate into problems or benefits of important consequence. For example, although more predisposed to hypoxemia, young children may remain well compensated hemodynamically, despite significant blood loss. Rare injuries in children, such as cardiac and great vessel trauma, may remain undiagnosed precisely because of their scarcity and protean symptoms.
Performance of a primary ERPT for Hirschsprung disease in the newborn is an excellent option. Results were comparable to those of the two-stage procedure. The greater incidence of enterocolitis appears to be due to a lower threshold in diagnosing enterocolitis in more recent years.
Anal canal duplication (ACD) is a rare entity that is difficult to recognize. After the presentation of two patients, a review of the literature found 45 reported patients with ACD. This article presents the largest collection of known patients ACD in the literature. Of the 47 patients, 43 were female. The mean age at presentation was 28 months (range 0-24 years). The majority of the duplications were discovered incidentally (n = 21). Several presented with infectious complications such as epidural abscess with sepsis. Forty-two patients manifested an opening in the midline posterior to the native anus. Eighteen patients had associated anomalies, the majority of which were midline. Thirty-five of the patients underwent successful resection with rare complications. ACDs characteristically appear in females as incidental findings of an extra perineal orifice. They are frequently associated with additional congenital anomalies. Generally, ACDs are resectable with excellent outcomes.
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