Aim.To evaluate the efficacy of the Peristeen^Ⓒtransanal irrigation system when treating faecal incontinence in children due to chronic idiopathic constipation.Methods.A retrospective study was conducted of the first cohort of patients affected with faecal incontinence and referred to our centre for Peristeen^Ⓒtransanal irrigation treatment between January 2010 and December 2012. Patients with neurogenic bowel disturbance were excluded. A previously described and validated faecal continence scoring system was used to assess bowel function and social problems before and after treatment with Peristeen^Ⓒ.Results.13 patients were referred for Peristeen^Ⓒtransanal irrigation during the study period. Mean time of using Peristeen^Ⓒ was 12.6 months (±0.6 months) and mean length of follow-up was 21.2 months (±0.9 months). All patients were noted to have an improvement in their faecal continence score, with a mean improvement from 9.7 ± 1.4 to 14.8 ± 2.7 (P=0.0008) and a reduction in episodes of soiling and increasing in quality of life scores.Conclusion.In this initial study, Peristeen^Ⓒappears to be a safe and effective bowel management system, which improves bowel function and quality of life in children affected with faecal incontinence as a result of chronic idiopathic constipation, Hirschsprung’s disease, and anorectal malformations.

Introduction Understanding the challenges experienced by pediatric surgeons in the early phases of the pandemic may help identify key issues and focus research. Materials and Methods Two pediatric surgeons from each of the 10 countries most affected by COVID-19 were surveyed over a 10-day period. Data were obtained regarding service provision, infection control, specific surgical conditions, and the surgical workforce. Results Twenty pediatric surgeons responded. All centers had postponed non-emergency surgery and clinics for nonurgent conditions with virtual consultations being undertaken in 90% of centers. A majority (65%) of centers had not yet knowingly operated on a positive patient. Minimal access surgery was performed in 75% centers but a further 75% had reduced or stopped upper gastrointestinal endoscopy. The management of simple appendicitis was unchanged in 70% centers, patients with intussusception were being referred for radiological reduction in all centers and definitive pull-through surgery for Hirschsprung patients was performed by 95% where washouts were successful. Timing of surgery for reducible neonatal inguinal hernias had changed in 55% of centers and the management of urgent feeding gastrostomy referrals and of inflammatory bowel disease patients failing with biological therapy varied considerably. Conclusion Service provision has been severely affected by COVID-19 leading to an inevitable increase in untreated surgical pathology. Better understanding of extrapulmonary infectivity, the risk of asymptomatic carriage in children, and the reliability of testing for surgical scenarios may allow appropriate use of conventional surgery, including laparoscopy and endoscopy, and rational development of the novel care pathways needed during the pandemic.

The aim of this study was to review the aetiology, presentation and management of these patients with upper gastrointestinal bleeding (UGIB) at a tertiary children’s unit in the United Kingdom. This was a retrospective single-institution study on children (<16 years) who presented with acute UGIB over a period of 5 years using known International Classification of Diseases (ICD) codes. A total of 32 children (17 males, 15 females) were identified with a total median age at presentation of 5.5 years. The majority (24/32) of patients presented as an emergency. A total of 19/32 presented with isolated haematemesis, 8/32 with isolated melaena and 5/32 with a combination of melaena and haematemesis. On admission, the mean haemoglobin of patients who presented with isolated haematemesis was 11 g/dL, those with isolated melaena 9.3 g/dL and those with a combination 7.8 g/dL. Blood transfusion was required in 3/19 with haematemesis and 3/5 with haematemesis and melaena. A total of 19/32 underwent upper gastrointestinal endoscopy. Endoscopic findings were oesophageal varices (5/19) of which 4 required banding; bleeding gastric ulcer (1/19) requiring clips, haemospray and adrenaline; gastric vascular malformation (1/19) treated with Argon plasma coagulation therapy; duodenal ulcer (3/19) which required surgery in two cases; oesophagitis (5/19); and gastritis +/− duodenitis (3/19). A total of 13/32 patients did not undergo endoscopy and the presumed aetiology was a Mallory–Weiss tear (4/13); ingestion of foreign body (2/13); gastritis (3/13); viral illness (1/13); unknown (2/13). While UGIB is uncommon in children, the morbidity associated with it is very significant. Melaena, dropping haemoglobin, and requirement for a blood transfusion appear to be significant markers of an underlying cause of UGIB that requires therapeutic intervention. A multi-disciplinary team comprising gastroenterologists and surgeons is essential.

Enterocolic lymphocytic phlebitis (ELP) is a rare pathology, usually seen in the adult population. The condition affects the venous vasculature of the intestine sparing the arteries and lymphatics. It is commonly identified histologically after surgical resection making the preoperative diagnosis a clinical challenge. As the condition can lead to intestinal ischaemia and necrosis, surgical resection of the affected segment is the treatment of choice. We report the case of a 9-year-old girl who presented with a 2-day history of lower abdominal pain and anorexia. The initial diagnosis of appendicitis was made clinically and the patient underwent a diagnostic laparoscopy . The appendix was macroscopically normal and there were no other obvious intra-abdominal pathologies to account for her presenting complaints . The appendix was removed, as per the preoperative discussion and consent from parents. She recovered well and was discharged home the following day. The histological examination of the appendix demonstrated ELP. We describe this rare clinical entity in a child especially in view of the scarce published literature in the paediatric population.

Introduction: H-type tracheo-esophageal fistula (TEF) is rare. Different techniques of fistula ligation are practiced around the world. The aim of this study is to report our experience of thoracoscopic stapling ligation and division of the TEF. Methods: Retrospective review of patients who underwent thoracoscopic ligation of H-type TEF from April 2016 to January 2024. The diagnosis was made with a preoperative esophagram and confirmed with intraoperative rigid bronchoscopy. The procedure was standardized, and, in all cases, a 5 mm laparoscopic stapler was used to ligate and divide the TEF. Demographics, operative details, and complications were collected and analyzed. Results: A total of 12 patients were included (7 males) during the 8-year study period. The median age at surgery was 2.5 months (IQR: 1-3), and the median gestational age at birth was 38 weeks (IQR: 35-39). The median weight was 4.8 kg (IQR: 3-5). One case was a redo surgery of a failed ligation by another surgeon, and another had two previous endoscopic ablation attempts. The median operative time was 55 minutes (IQR: 45-79), and there were no conversions to thoracotomy. None of the patients experienced recurrence of the TEF, leak, or recurrent laryngeal nerve injury. Conclusion: The thoracoscopy approach to H-type TEF is feasible and allows a clear visualization of the fistula and the surrounding anatomical structures. The use of a 5 mm laparoscopic stapler represents a superior, reproducible, and safe method of ligating the fistula with no reported complications in this series.