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Öğe Effect of admission time on morbidity and mortality in children with intussusception: Analysis of 123 cases(2001) Öztürk H.; Ihsan Dokucu A.; Otçu S.; Önen A.; Gedik Ş.Background/Aim: Intussusception is one of the most frequent reasons of intestinal obstruction in newborn and infants. Delay in diagnosis results in severe morbidity and mortality. We aimed to investigate the effects of admission time on morbidity and mortality in children with intussusception. Methods: A total of 123 intussusception cases were diagnosed and treated at our department between June 1983 and March 2000. We reviewed the charts of these cases retrospectively and evaluated the age, sex, the time of hospitalization, symptoms and signs, the type of intussusception, leading point, recurrence, the mode of treatment, postoperative complications, and mortality. According to time of the admission, we grouped the patients into three; G1: admitted before 12 hours after the first sign, G2: admitted between 12 to 24 hours, G3: admitted after 24 hours. The differences between the groups were investigated for postoperative complications and mortality. Results: Seventy six percent of the cases were under the age of 12 months: The most frequent symptom of the cases in admission were vomiting. Eighty per cent of the cases occurred between the months of April and September when epidemic gastroenteritis is very frequent. The most frequently encountered type of intussusception was ileocaeco-colic (77 %). The leading point of the disease were seen only in 7 % of the cases in. Colon enema with barium for hydrostatic reduction was performed in 25 patients and reduction could be successful in 5 (20 %) of them. Sixty-three percent of cases was treated by manual reduction, 30 % by resection and anastomosis, 3 % resection and ostomy. Postoperative complications were observed in 27 % of the patients. The mortality rate of our patients was 6.5 %. The postoperative complication and mortality rate in the group 3 (>24h) was found significantly different in comparison with G1 and G2 (p<0.0001, p<0.0001). Conclusion: The method of non-invasive treatments may be more frequently used in children diagnosed in early period of disease, while the delay in diagnose determine the mode of the treatment as surgery which cause high morbidity and mortality.Öğe Gastric perforation in neonates: Analysis of five cases(2003) Öztürk H.; Önen A.; Otçu S.; Dokucu A.I.; Gedik Ş.The aetiology of neonatal gastric perforation (NGP) remains unknown and the mortality rate is still very high. We have treated five cases of gastric perforation over the past 17 years, and analysed them retrospectively to present our experience. Clinical data included age, sex, weight, maternal complication, fetal complication, gestational age, type of delivery, admission time, associated pathologies, localization of perforation, perforation age, operative procedures and outcome. There were four boys and one girl. Three of the infants were full-term, while two were premature. All of the infants were septic prior to rupture. Two infants had acute respiratory distress syndrome (ARDS); one due to prematurity and low gestational weight, and one due to meconium aspiration. Perforation was located at major curvature and anterior wall of the stomach in four patients, while it was located in minor curvature and anterior wall in one. The rupture was closed in two layers. Histopathology revealed local chronic inflammation and ischemia. Mortality rate was 60%. In conclusions, gastric perforation is a life-threatening complication in neonates. In our limited series, sepsis, prematurity and corticosteroid treatment were likely to be predictive for development of NGP. Early diagnosis and prompt management before clinical deterioration of the metabolic status may improve the outcome of such infants with NGP.Öğe Hirschsprung's disease: An 18-years experience(2002) Öztürk H.; Otçu S.; Önen A.; Dokucu A.I.; Gedik Ş.; Yücesan S.Aim: In this study, we aimed to analyse the diagnostic and therapeutic features, morbidity, mortality and long-term functional results of patients with Hirschsprung's disease, whom the majority were treated hy Duhamel-Martin procedure. Method: A total of 64 Hirschsprung's disease cases were diagnosed and treated in the department between June 1983 and February 2001. We reviewed the charts of these retrospectively and evaluated the age, sex, symptoms and signs, associated anomalies, the length of bowel involved, type of pull-through performed, functional results of treatment, morbidity and mortality of these patients. Results: There were 52 boys and 12 girls. Thirty seven percent of the cases were diagnosed below the age of one month. The most frequent presenting symptom was abdominal distention (34%). Thirteen of the cases had associated anomalies (20%). The most frequent site of aganglionosis was at the rectosigmoid (82%). A decompressing enterestomy was performed in 56 patients. Soave-Boley's and Duhamel-Martin's technique with protective colostomy were performed in 7 and 41 patients respectively. Postoperative complications were seen in 25 % of the patients. In 4 cases a Duhamed-Martin's procedure was performed without a colostomy. In the postoperative period 16 cases (25%) developed a complication. The most frequent complication was intestinal obstruction due to adhesions (33%). Preoperative and postoperative enterocolotis was found in three (2%) and 5 (9%) patients respectively. Eight children (12%) died, one related to associated anomalies and six due to sepsis one patient died from enterocolitis after the definitive procedure. In the 10 to 15 year age and the greater than 15 year age groups, functional scores were significantly increased when compared to the 5 to 10 year age group (p<0.05). A significant correlation was not found between the functional score and age of the patients. Conclusion. As a conclusion, we have used Duhamel-Martin procedure in majority of patients with Hirschsprung's disease. Long-term fonctional evaluations have shown an improvement in functional score in children older than 10 year in comparison with younger ones.
