Purpose: The STAT trial is a multicenter randomized controlled trial in 12 centers worldwide aiming to determine the most effective operation for neonates with necrotizing enterocolitis (NEC) requiring intestinal resection: stoma formation (ST) or primary anastomosis (PA). Methods: Infants having a primary laparotomy for NEC were randomized intraoperatively to PA or ST if the operating surgeon thought that both were viable treatment options for that patient. The primary outcome (duration of parenteral nutrition [PN]) was evaluated by Cox regression. Results: Eighty patients were recruited from 2010 to 2019. Infants undergoing anastomosis finished PN significantly earlier than patients undergoing stoma (hazard ratio PA vs. ST 2.38, 95% CI 1.36–4.12 p = 0.004). There was no difference in mortality between the two groups (PA 4/35 vs. ST 8/38 p = 0.35) or in the rate of complications requiring further unplanned operations (p = n.s.). Multiple intestinal complications were more frequent in the stoma group compared to the anastomosis group (ST 12/26 vs. PA 5/31, p = 0.02, Fisher’s Exact test). Conclusion: At laparotomy for NEC, when there is no disease distal to resected intestine, primary anastomosis should be performed as it enhances the recovery from NEC, reduces the risk of multiple intestinal complications and does not increase adverse outcomes.

Introduction/Aim: The aim of the study was to determine the frequency of various histopathological findings in biopsies of children with intestinal hypomotility and the incidence and characteristics of Hirschsprung disease (HD). Methods: Biopsies of colon and rectum taken due to intestinal hypomotility and chronic constipation at the Department of Pediatric Surgery of the University Children's Hospital in Belgrade over the 10-year period (from 2009 to 2018) were reviewed using pathology reports from the archive of the Institute of pathology, Faculty of Medicine, University of Belgrade. Results: A total of 287 patients with intestinal motility disorder were identified, with 554 biopsy samples. Of the total number of patients, 56% (161/287) were without any morphological changes in enteric nervous system (ENS). The most common histopathological findings were HD (69/287; 24%) and immaturity of ganglion cells (29/287; 10%). Isolated hypoganglionosis of ENS was found in 5 (2%) cases. Heterotopia of ganglion cells was the only finding in 8 (3%) cases. Rare causes of intestinal dysmotility were: eosinophilic proctitis/colitis (EPC) (4/287), neuronal intestinal dysplasia B (2/287), unclassified disganglionoses (3/287). Rectosigmoid variant of HD was the most frequent HD variant (80.3%). Acetylcholinesterase method and immunohistochemical staining were used in 19.5% cases. Conclusions: HD and immaturity of ganglion cells were the most common pathological findings in ENS of constipated children. It is important to differentiate EPC from other lesions of enteric plexuses due to different natural history and therapy.

Background. Tension gastrothorax is a rare life-threatening condition that occurs when the stomach is herniated into the thoracic cavity, most often through the congenital left posterolateral diaphragmatic defect, causing a mediastinal shift when distended with gas and fluid. Case Presentation. A previously healthy 2-year-old boy was admitted with acute abdominal pain, vomiting and dyspnea. Chest X-ray was initially interpreted as hydropneumothorax, but after careful observation the decision was made to insert a nasogastric tube and to perform a computerized tomography scan to confirm the suspicion of tension gastrothorax. Laparotomy was performed the following day, organs were repositioned into the abdomen and reconstruction of the left hemidiaphragm was conducted. Conclusion. When symptoms of respiratory distress occur in an otherwise healthy child, tension gastrothorax should be on the list of differential diagnosis. It is important to recognize distinct radiographic features of this life-threatening condition in order to promptly manage it. Initial placement of nasogastric tube for decompression should be followed by the reduction of the organs into the abdomen and diaphragmatic repair.

Cleft lip and palate are the most common congenital craniofacial anomalies. The etiology of this condition is unclear. The overall incidence of cleft lip and palate is 1/700. Prenatal diagnosis of cleft lip by 3D ultrasound is possible in more than 70% of cases, while it is less effective for cleft palate. There are several classifications of cleft lip and palate that were proposed over the years, however, only few have found clinical application, with none of them generally accepted as most effective and understandable. Allori et al. presented classification of a cleft lip and palate which is comprehensive and uniform, and it can precisely define the vast majority of the clefts, thus enabling easier communication between the health workers during their everyday practice. In this paper, we compared the accuracy of preoperative diagnoses compared to intraoperative diagnoses according to Kernahan and Stark classification from 1958, and these diagnoses were converted according to the Allori et al. classification of cleft lip and palate. Classification of cleft lip and palate presented by Allori et al. is clear, easy to understand, and it can be successful tool in studying the epidemiology of clefts.

Background: The current living conditions, which impose an increased sedentary lifestyle and unhealthy habits among children, are associated with an increase in the occurrence of spinal column deformities during the developmental period. Numerous risk factors are known to be associated with development and progression of spinal deformities. Methods and Objectives: The aim of this observational, clinical study is to present the distribution of sociodemographic factors and levels of physical activity, along with their mutual conditioning, for the occurrence of spinal deformities in pediatric population during the developmental period. The study participants were children who were examined by a physiatrist and a pediatric surgeon. The first group included 100 children with spinal deformities. The control group consisted of 100 children without spinal deformities. Results: Respondents in the group with spinal deformities were statistically significantly older (11.5±3.1 years vs. 10.4±3.1 years, p=0.016), overweight (43.9±16.0 vs. 39.3±16.6 kg, p=0.046), toller (151.7±17.2 vs. 145.8±18.2 cm, p=0.019) and less frequently engaged in free physical activities (81.0% vs. 92.0%, p=0.001). Positive family history of spinal deformities was shown to be in 29% of respondents with spinal deformity and 14% of respondents without this deformity, which represents a statistically significant difference between these two groups (p=0.010). Respondents from the group with spinal deformities are engaged in some physical activity in 81% of cases, while respondents from the group without spinal column deformities were more physically active in 92% of cases, which was shown to be a statistically significant difference between the compared groups (p=0.001). Conclusion : Our results demonstrated that certain groups of children including those that are overweight, toller and the ones that were less frequently physically active should be regularly followed for the evaluation of onset and progression of spinal deformities during the period of growth and development.

Diagnosing Hirschsprung disease (HD) and related disorders can be complex and demands a deep understanding of the mechanisms governing intestinal motility, which involves the enteric nervous system (ENS), interstitial cells of Cajal (ICCs), and the muscle layers of the intestine. The London classification identifies three groups of gastrointestinal neuromuscular disorders: neuropathies, myopathies, and ICC abnormalities. Hirschsprung disease, characterized by the absence of ganglion cells, is the most common intestinal neuropathy and it results from the impaired migration of neural crest cells during development. It affects about 1 in 5,000 live births and involves several genetic factors, notably the RET gene. HD typically affects the rectum and a part of the colon, with varying extents of aganglionosis. The diagnosis is based on the histopathological analysis of suction biopsies, the absence of ganglion cells, and the presence of thick submucosal nerves on a standard hematoxylin and eosin stain, supplemented by enzyme histochemistry (acetylcholinesterase method) or immunohistochemical methods (calretinin and other antibodies) staining. The treatment for HD involves surgical resection of affected bowel segments. Accurate intraoperative assessment of tissue margins is critical to preventing postoperative complications related to pseudoobstruction. Communication between surgeons and pathologists is essential to ensure successful treatment outcomes. Other intestinal neuropathies include intestinal hypoganglionosis, hyperganglionosis, delayed maturation of ganglion cells, and gliopathies. Enteric myopathies are exceptionally rare conditions, with typical morphological changes such as atrophy of the muscularis propria, intracellular vacuolization of smooth muscle cells, and interstitial fibrosis. Disruption in ICC network and arrangement forms the morphological basis of slow transit constipation. Each of aforementioned disorders has unique characteristics and diagnostic challenges. Understanding and diagnosing these conditions often require a combination of histological, histochemical, immunohistochemical, and sometimes genetic analyses. The integration of these techniques is vital for accurate diagnosis and effective treatment planning. In summary, the complexity of intestinal dysmotility disorders necessitates a thorough understanding of intestinal motility mechanisms and the utilization of advanced diagnostic methods to provide accurate diagnoses and effective treatments.