Browsing by Author "Ilić, Predrag (57207790079)"

Introduction Esophageal achalasia is a neurodegenerative motility disorder, which is characterized by ineffective or absent esophageal peristalsis and the lack of hypertonic lower esophageal sphincter relaxation. Achalasia causes failure to thrive in children and can have serious respiratory complications. Achalasia is a very rare condition in pediatric population, and usually misdiagnosed as gastroesophageal reflux. The treatment of choice is Heller esophagocardiomyotomy. The aim of this paper is to present a rare case of a two-year-old child with achalasia, diagnostic procedures, and successful operative treatment. Case outline The patient´s problems started at the age of six months, with audible breathing and respiratory stridor. The child was admitted at a local hospital at seven months of age, dismissed with dietary advices, again admitted at the age of 19 months, and transferred to our institution. Upper gastrointestinal series and computed tomography revealed findings characteristic for achalasia, and on esophagoscopy exam there was no opening of lower esophageal sphincter and cardia on insufflation. Pneumatic dilation was performed with temporary improvement. Laparotomic Heller esophagocardiomyotomy with Dor partial fundoplication was successfully performed. Conclusion Achalasia is a very rare condition in infants and young children. There is often a delay when establishing the correct diagnosis. Upper gastrointestinal series and endoscopic exam are most reliable methods to detect achalasia. Pharmacological treatment, intrasphincteric injection of botulinum toxin and pneumatic dilations are not efficient methods, especially in small children. The method of choice in the treatment of achalasia is Heller esophagocardiomyotomy with partial fundoplication. © 2020, Serbia Medical Society. All rights reserved.

Background/Aim. Renal stones located in the lower pole of kidney represent a serious challenge for surgical treatment in children. The options are: open surgery, extracorporeal shock-wave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. Reports about the endoscopic treatment in children are limited. The aim of the study was to evaluate the effectiveness of retrograde intrarenal surgery in pediatric patients with renal stones in lower pole of the kidney. Methods. We retrospectively analyzed the results of the retrograde intrarenal surgery in 24 patients with renal stones in lower pole, between April 2012 and April 2016. Flexible ureterorenoscopy in combination with holmium laser lithotripsy were performed. We considered stone fragment size 3 mm or less as a measure of sufficient fragmentation of the stone. Results. Mean duration of general anesthesia was 68 (range, 40–90) minutes. Duration of hospitalization was 1–3 (mean, 1.6) days. Complications were found after two (8.4%) surgical procedures: perirenal haematoma in one (4.2%) and urinoma in one (4.2%) patient. The stone was completely fragmented in 18 (75%) patients. In 3 (12.5%) patients the stone was incompletely fragmented and in 3 (12.5%) patients the stone was not fragmented. Double J stent was placed in 5 (21%) patients. Mean follow-up was 9 (range, 6–18) months. Conclusion. Retrograde intrarenal surgery in children is the least invasive, effective and safe surgical procedure for stones in lower pole of the kidney, with minimal complication rate. Unsuccessful treatment in some patients was due to loss of ureterorenoscope deflection with laser probe in working channel. © 2018, Routledge. All rights reserved.