HighlightsSeven year old girl presents with abdominal pain, nausea, and vomiting consistent with a gastric outlet obstruction.History of trichotillomania but no observed behavior since 4 years of age.On imaging, concern for trichobezoar extending into the duodenum.Exploratory laparotomy with removal of 18 cm by 18 cm mass of hair through gastrotomy.Clear, high quality intra-operative photographs showing gastrotomy and trichobezoar.

Objective: Few studies have focused on perioperative management of cleft lip repair. We sought to evaluate the available data on this topic to create evidence-based clinical guidelines. Design: Systematic review, meta-analysis. Methods: A PubMed search was performed focusing on perioperative management of cleft lip repair. Studies were included if they included comparative data. A systematic review and meta-analysis was performed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Main Outcome Measures: Systematic review of literature regarding wound closure, postoperative arm restraints, perioperative antibiotics, outpatient or ambulatory surgery, or feeding restrictions postoperatively. Results: Twenty-three articles met inclusion criteria after initial screening of 3103 articles. This included 8 articles on wound closure, 2 on postoperative restraints, one on perioperative antibiotics, 6 on outpatient surgery, and 6 on postoperative feeding. Meta-analysis could be performed on dehiscence rates with postoperative feeding regimen and readmission rates after outpatient versus inpatient lip repair. There were few studies with low risk of bias. Outpatient cleft lip repair does not increase readmission (odds ratio [OR]: 0.92, 95% CI: 0.28-3.07). Allowing postoperative breastfeeding or bottle-feeding does not increase dehiscence (OR: 0.61, 95% CI: 0.19-1.95). There was no evidence of publication bias. Conclusion: Within the limitations of available data, there is no evidence of a clearly superior closure material. The evidence does not support use of postoperative arm restraints. The evidence does not support the use of preoperative nasal swabs for antibiotic guidance. With careful patient selection, outpatient cleft lip repair appears safe. The evidence supports immediate breastfeeding or bottle-feeding after cleft lip repair.

HighlightsMVC with blunt abdominal trauma with grade 4 liver injury, grade 3 splenic injury found. An exploratory laparotomy was performed with packing of liver laceration. Abdominal pain, distention and ileus persisted.CT performed showing centrally located bile leak with biloma and HIDA showing extravasation at right main hepatic duct. Gastroenterology consulted, endoscopic stent placed.Returned to operating room for evacuation of bilomas with 3 liters drained and BioGlue placed at site of liver laceration.

HighlightsSeven year old male who presents as a transfer three hours following injury after a high speed motor vehicle accident.He suffered an ileocecal perforation, sigmoid injury, and an aortoiliac near complete transection.Bovine pericardium bridge used to reconstruct the aortoiliac injury, including an elliptical bovine pericardium patch on the anterior aspect of the injury.Palpable pulses found postoperatively.One year follow up with palpable pulses and no claudication.