Browsing by Author "Sretenović, Aleksandar (15724144300)"

Introduction Chronic intestinal pseudo-obstruction represents a group of rare disorders characterized by impaired gastrointestinal motility in the absence of mechanical bowel obstruction. These disorders can be primary or secondary, with autoimmune intestinal leiomyositis falling into the latter category. This condition is observed in adolescence and adulthood but is very rarely seen in children, especially in infancy. Case outline A nine-month-old male infant was hospitalized due to persistent vomiting, abdominal bloating, and distension. After diagnostic evaluations and failure of conservative treatment measures, surgical formation of an ileostomy was performed. During the procedure, intestinal samples were obtained, revealing T lymphocyte infiltration of the intestine. Immunological blood analyses showed elevated serum immunoglobulins and smooth muscle autoantibodies. Combined with histological findings and elevated inflammatory markers, a diagnosis of autoimmune intestinal leiomyositis was established. Immunosuppressive therapy was initiated, leading to normalization of inflammatory markers and resolution of clinical symptoms. After four years of immunomodulatory therapy, the ileostomy was closed, and intestinal biopsies showed no inflammatory infiltrates. Five years later, the boy remains free of gastrointestinal symptoms, with normal growth and development. Conclusion Although a rare condition, autoimmune intestinal leiomyositis is an important differential diagnostic entity in chronic intestinal pseudo-obstruction. Early disease recognition with intestinal biopsies, coupled with prompt and aggressive immunosuppressive therapy, enables favorable therapeutic outcomes. © 2025, Serbia Medical Society. All rights reserved.

Introduction Biliary atresia (BA) is an idiopathic, progressive obliterative cholangiopathy of unknown etiology. The incidence of BA is 5–10 cases per 100,000 live births. Two clinical phenotypes of BA have been described: syndromic and non-syndromic form. From 1959, Kasai procedure is a standard therapeutic procedure. However, patients in whom there is an association of BA with other structural anomalies may have a worse outcome after the procedure. The goal was to present our patient with unusual form of BA associated with intestinal malrotation. Case report We present a two-month-old female infant hospitalized because BA was suspected. On the echosonographic examination of the abdomen the gallbladder was not visible. Intraoperative diagnosis of BA was confirmed, and the Kasai procedure was performed. During the operation, intestinal malrotation with Ladd’s bands was identified. In this case, after the complete Ladd procedure, we decided to trace the Roux coil through the mesoduodenum and then behind the duodenum towards the portal plate, where a portoenterostomy was then created in a standard way. During the “follow-up” the infant was free of complaints, the stools were normally discolored, and the values of liver function tests had a downward trend. Conclusion Any doubt about the diagnosis of BA obliges us to determine the existence of all other possible anatomical abnormalities and associated anomalies, due to their potential importance in changing treatment plans and surgical approach, but also the impact on the outcome of treatment. © 2025, Serbia Medical Society. All rights reserved.

Introduction Intussusception is a common abdominal emergency in early childhood. It is idiopathic in more than 90% of cases with incidence of 1.5-4 per 1,000 live births. The treatment of choice is non-operative hydrostatic or air enema reduction. Objective The aim of the study was to evaluate the influence of clinical presentation and symptom duration in non-operative treatment, considering the indications for delayed enema reduction and its efficacy. Methods From the total number of 107 patients with intusussception, aged from 2 months to 14 years (median 9 months), 102 (95%) patients with ileo-colic intussusceptions were treated initially by ultrasound guided saline enema. Records were reviewed for patients with failed initial treatment and delayed repeated enemas or operative procedure. The predictor variable included duration of presenting symptoms. Results Successful treatment by hydrostatic saline enemas had 58/102 (57%) patients. Success in reduction was greater if symptom duration was <24 hours (54/62 cases; 87%, p<0.001), compared with >24 hours, (4/45 cases; 9%). Despite failed initial attempts, enema reduction was reattempted in 12 patients, with success in 7/12 (60%) patients. Children with symptom duration >24 hours had a greater risk of requiring surgery (41/45 cases; 91%, p<0.001), including 5 (5%) patients with ileo-ileal intussusceptions. Conclusion The accuracy of ultrasound guided saline enema in intussusception reduction is high. Delay in presentation decreases success of non-operative treatment. Delayed enema reduction is important therapeutic option for intussusceptions. Surgical treatment is indicated in cases of complications. © 2014, Serbia Medical Society. All rights reserved.

Introduction Extra-hepatic portal vein obstruction (EHPVO) is one of the most often causes of portal hypertension in children.; Objective Establishing the importance of shunt surgery in combination with partial spleen resection in selected pediatric patients with EHPVO, enormous splenomegaly and severe hypersplenism.; Methods Distal splenorenal shunt (DSRS) with partial spleen resection was performed in 22 children age from 2 to 17 years with EHPVO. Indications for surgery were pain and abdominal discomfort caused by spleen enlargement, as well as symptomatic hypersplenism with leucopenia, thrombocytopenia and anemia. The partial spleen resection was performed by ligation of blood vessels to caudal two thirds of the spleen. After ischemic parenchymal demarcation transection with electrocautery LigaSure was performed with preservation of 20-30% of spleen tissue, and then Warren DSRS was created. Platelet and leucocytes counts and liver function tests were obtained before, one month and one year after surgery. Growth was assessed with SD scores (Z scores) for height, weight and body mass index at the time of surgery and one year later.; Results In all patients postoperative period was without significant complications. Platelets and leucocytes counts were normalized. Patency rate of shunts was 100%. Two significant shunts stenosis were observed and successfully treated with percutaneous angioplasty. During the follow-up period (1 to 9 years) all patients were asymptomatic, with improved quality of life and growth.; Conclusion Results of our study indicate that shunt surgery with a partial spleen resection is an effective and safe procedure for patients with enormous splenomegaly and severe hypersplenism caused by EHPVO. © 2014 Serbia Medical Society. All rights reserved.