Lukošiūtė - Urbonienė, Aušra

Omphalocele is a congenital defect of the abdominal wall with high morbidity and high practice variation. Evidence based guidance on its management is currently absent. The European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) developed this guideline to aid clinical decision-making.

Introduction Traumatic diaphragmatic hernia (TDH) is a rare pediatric injury (<1% of trauma cases). Leftsided defects are more common but may be overlooked, particularly when initial imaging is negative. Delayed diagnosis increases the risk of visceral herniation, respiratory compromise, and life-threatening complications [1]. Case Presentation An 11-year-old girl presented with severe respiratory distress, abdominal pain, and persistent vomiting. She was initially treated for suspected pneumonia; however, chest X-ray revealed herniation of the stomach into the right thoracic cavity. Medical history revealed severe polytrauma with predominant head injury following a motor vehicle accident two years earlier, with an initially unremarkable thoracic CT scan. In the preceding months, the patient experienced recurrent self-limiting episodes of vomiting and abdominal pain. The patient was transferred to a tertiary center where emergency laparotomy revealed herniation of a markedly distended stomach containing approximately 4 liters of gastric contents, along with the left hepatic lobe, through a 5-cm diaphragmatic defect. Primary diaphragmatic repair was performed. Postoperatively, the patient developed right lung consolidation, suspected to be aspiration pneumonia, requiring high-flow oxygen therapy. Broad-spectrum antibiotics were initiated. The patient was discharged in good condition 9 days postoperatively and remained asymptomatic at follow-up. Discussion Traumatic diaphragmatic rupture in children is uncommon and often clinically occult, particularly in polytrauma patients where associated injuries dominate initial management. Respiratory symptoms are frequently nonspecific, and normal breath sounds or oxygen saturation do not exclude diaphragmatic injury [2]. Small tears may remain undetected on initial imaging and enlarge over time, allowing delayed herniation of abdominal viscera months or years after trauma. From a pediatric surgical standpoint, timely recognition is critical, as leftsided defects carry a high risk of gastric or intestinal incarceration, necrosis, and perforation [2,3]. Once diagnosed, surgical repair should not be delayed to prevent life-threatening complications [4]. Conclusions In pediatric patients with respiratory symptoms and a history of high-energy blunt trauma, TDH should be considered to avoid delayed diagnosis and prevent life-threatening complications.

Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems.

Aim of the study. To assess the experience and challenges associated with diagnosing peritoneal tuberculosis in children. Methods. A literature review was conducted using the PubMed, Web of Science and Cochrane databases, including reported cases of paediatric peritoneal tuberculosis published between 2007 and 2022. Results. The search identified 219 potentially relevant articles; 12 met the inclusion criteria, comprising 37 patients. The most common symptoms were abdominal pain (67.6%), abdominal distension (67.6%) and fever (64.9%). The most frequent ultrasound findings were free fluid in the pelvic cavity (86.5%) and enlarged mesenteric lymph nodes (56.8%). Most culture samples for Mycobacterium tuberculosis were negative. Surgical intervention was performed in 32 cases (86.5%). Histological examination revealed granulomas in all evaluated biopsy samples. Conclusions. The clinical presentation, laboratory findings, and radiological findings of peritoneal tuberculosis are non-specific. This literature review indicates that peritoneal tuberculosis is most often diagnosed following surgery. An algorithm of less invasive procedures and tests is suggested before considering surgical intervention.

Kasos solidinė pseudopapilinė karcinoma (SPN) – reta, mažo piktybiškumo potencialo kasos neoplazma, dažniausiai pasireiškianti jauniems pacientams. Nors liga dažniau diagnozuojama suaugusiesiems, SPN sudaro apie 8–12 proc. visų vaikams nustatomų kasos navikų. Diagnostiką apsunkina tai, kad dažniausiai navikai ilgą laiką nesukelia jokių simptomų, todėl aptinkami jau dideli – 5–7 cm. Be to, daliai sergančiųjų gali pasireikšti nespecifiniai simptomai, kurie taip pat gali komplikuoti diagnostinį procesą. Pirmojo pasirinkimo gydymas – kasos rezekcinė operacija, kurios metu radikaliai pašalinamas navikas. Ilgalaikė SPN prognozė įprastai gera, tačiau pooperaciniu laikotarpiu dažnai išsivysto kasos fistulė, kuriai gydyti gali reikėti antibiotikų terapijos ir parapankreatinio skysčio sankaupų drenavimo. Straipsnyje pristatomas klinikinis atvejis, kai 15 m. mergaitei atsitiktinai diagnozuota kasos solidinė pseudopapilinė karcinoma, lokalizuota kasos uodegoje, ir atlikta formali kasos rezekcija. Aptariama atidaus paciento stebėjimo pooperaciniu laikotarpiu svarba, galimos pooperacinių komplikacijų priežastys.

Introduction: Over recent decades, the study of the bacterial microbiome has gained increasing attention due to its vital role in human health. The development of the gut microbiome is especially critical during infancy, as it supports nutrient absorption, metabolic regulation, and immune system maturation. Several perinatal factors, including delivery mode, gestational age, and health status, have been shown to influence micro -biome establishment. Preterm and low-birth-weight infants, in particular, face heightened vulnerability to disruptions in microbiome development, which may contribute to adverse health outcomes. Aims & Methods: This study aimed to analyze the longitudinal development of the gut microbiome in preterm, low-birth-weight neonates over the first two months of life and to identify microbial patterns and alterations associated with delivery mode, gestational age, and clinical conditions. The study cohort included 115 low-birth-weight preterm infants and 99full-term, normal-weight controls. Stool samples from preterm infants were collected at multiple time points between day 1 and day 61 of life and grouped into six age categories for analysis. In total, 819 stool samples were examined. DNA was extracted and amplified targeting the V3–V4 region of the 16S rRNA gene, followed by sequencing on the Illumina MiSeq platform. Microbiome data were analyzed using bioinformatic and statistical tools to assess taxonomic composition, alpha diversity, and beta diversity. Results: Significant differences in microbiome profiles were associated with gestational age, mode of delivery, postnatal age, maternal medication, and the presence of necrotizing enterocolitis (NEC). Bacterial com-munities began to stabilize between days 26 and 35. A total of 56 bacterial genera — including Bifidobacterium, Clostridium, Escherichia-Shigella, Gemella, Klebsiella, Lactobacillus, and Streptococcus — showed a positive correlation with infants’ age in days, while 31 genera — including Bacillus, Cutibacterium, Flavobacterium, Macrococcus, Pseudomonas, and Staphylococcus — were negatively correlated. Eighteen bacterial genera were associated with the mode of delivery at various time points. Genera such as Fusobacterium, Bacteroides, Entero-coccus, Streptococcus, Gemella, and Corynebacterium were more commonly associated with vaginal birth, while Staphylococcus, Rahnella, Yokenella, Millisia, Negativicoccus, Finegoldia, Haemophilus, Acinetobacter, Conservatibacter, Serratia, Stenotrophomonas, and Peptoniphilus were associated with Caesarean section delivery. Moderate differences in early-life microbiome composition were also ob -served between low-birth-weight preterm and full-term infants. Conclusion: Gut microbiome development in preterm, low-birth-weight newborns is strongly influenced by clinical and perinatal factors, particularly during the first month of life. Mode of delivery, gestational maturity, and disease presence such as NEC contribute to microbial variability and delayed community stabilization. These findings highlight the importance of early-life monitoring and tailored interventions to support healthy microbiome development in vulnerable neonates.

TYRIMO TIKSLAS: Vaikų populiacijoje blužnies sužalojimai yra dažniausiai pasitaikančios parenchiminių organų traumos, tačiau potrauminė blužnies pseudoaneurizma (BPA) išlieka reta komplikacija. Šiuo metu nėra aiškių gairių, apibrėžiančių optimalią BPA gydymo taktiką. Šio atvejo tikslas – pabrėžti laiku taikyto gydymo svarbą, siekiant išvengti gyvybei pavojingų komplikacijų. ATVEJO APTARIMAS: 5 metų berniukas buvo pristatytas į LSMUL KK VSPS dėl bukos pilvo traumos. Pradinės apžiūros metu stebėtas saikiai išpūstas pilvas su pilvaplėvės dirginimu kairiojoje pilvo pusėje. Ultragarsinio tyrimo metu buvo stebėta blužnies laceracija su nedideliu kiekiu laisvo skysčio pilvo ertmėje. Atliktoje pilvo KT stebėtas IIׄI° blužnies plyšimas. Pacientas stacionarizuotas, paskirtas konservatyvus gydymas. Gydymo eigoje, bendra berniuko būklė pagerėjo. Šeštą hospitalizacijos dieną berniukui pakartota pilvo echoskopija, kurios metu rasta blužnies apatinio poliaus pseudoaneurizma su aktyvia kraujotaka. Besiruošiant išrašyti pacientą, tos pačios dienos vakarą, berniukas pasiskundė stipriu pilvo skausmu, stebėta hipotenzija, sąmonės sutrikimas. Atliktoje echoskopijoje stebėtas ženkliai padidėjęs laisvo skysčio kiekis pilvo ertmėje. Įtariant kraujavimą į pilvo ertmę, berniukas skubiai operuotas – atlikta laparotomija ir splenektomija dėl BPA plyšimo. Pooperacinis laikotarpis sklandus, berniukas išrašytas į namus devintą dieną po operacijos. IŠVADOS: Nors šiuo atveju buvo išvengta mirties, tačiau šis atvejis pabrėžia aiškių BPA gydymo gairių trūkumą, kas galėtų padėti išvengti tolimesnių gyvybei grėsmingų komplikacijų kitiems pacientams.

Over the past decades, bacterial microbiome studies have become increasingly important. The development of the gut microbiome has been shown to play an essential role in human health, and to be especially decisive in infants [1]. It influences nutrient absorption, metabolism regulation, and immune system development. Various factors have been proposed to modulate the development of the microbiome and therefore shape the growth and health of newborns [2]. Premature babies are often lowweight and even more sensitive to health issues. This study aims to analyse the development of the microbiome in preterm neonates over the first two months of life and look for patterns and alterations associated with several factors, like delivery mode, gestation time and necrotizing enterocolitis (NEC). A total of 78 preterm newborns were included in the study, with stool samples being taken at several timepoints from each baby. In total 515 samples were collected. The timepoints varied between ages of one and 61 days and were grouped in six age groups during the analysis. Genomic DNA was extracted from stool samples, and the bacterial V3–V4 hypervariable region of the 16S rRNA gene was amplified and sequenced on the Illumina MiSeq platform. The data were processed using bioinformatical tools and analysed bioinformatically and statistically to access microbiome composition, abundancies, alpha- and beta-diversities. The analysis revealed significant differences in the bacterial profiles across different timepoints, gestational ages, delivery modes, and in relation to the development of NEC. Alpha diversity indices increased over time; however, fewer or no significant differences were observed between the later timepoints. Consistent patterns emerged from both PCoA and PERMANOVA analyses. Notably, NEC was associated with distinct bacterial. Additionally, the abundance of several bacterial taxa correlated with gestational age. The bacterial profile of premature, low-birth-weight newborns varies according to factors such as age, delivery mode, gestational age, and the presence of disease. Comparing these microbiome dynamics in low-birth-weight infants with those in full-term newborns could provide valuable insights into the development of neonatal diseases such as necrotizing enterocolitis.

Aim of the Case Study This is a case report of a child presenting with severe, recurrent skin and subcutaneous ulcers, tissue necrosis, and systemic symptoms of unknown origin. A year later, it was discovered that the mother had induced the symptoms by repeatedly injecting Formalin, uncovering a case of child abuse associated with factitious disorder imposed on another (Münchausen syndrome). Case Description A 1.5-month-old infant was hospitalized with cellulitis, skin ulcerations, and deep tissue necrosis, primarily affecting the extremities. The clinical presentation also included intermittent irritability, abdominal pain, vomiting, and fever. Over one year, the infant was hospitalized 13 times, requiring wound debridement, dressing changes, surgeries, and numerous diagnostic tests, including histological examinations. Despite extensive investigations into infectious, systemic, and genetic causes, definitive diagnosis was not determined. The patient eventually experienced episodes of shock accompanied by seizures, respiratory insufficiency, and sepsis, ultimately leading to death despite intensive medical treatment. A year later, the mother was hospitalized with similar symptoms, and a syringe containing Formalin was discovered in her possession, leading to criminal proceedings. Psychiatric evaluation revealed that she suffered from delegated Munchausen syndrome, a mental disorder in which a caregiver induces illness or injury in someone under their care. It was determined that the mother had administered Formalin to the child orally at home and injected it directly into venous catheter during hospitalizations, causing the observed symptoms. Conclusions Unexplained, recurrent symptoms in pediatric patients should prompt consideration of possible child abuse or delegated Munchausen syndrome.

Introduction: Obstructive urinary tract dilatation (OUTD) is a prevalent condition in paediatric urology that often necessitates surgical intervention. Understanding factors contributing to reoperations is critical for optimizing outcomes. This study aimed to analyze factors associated with reoperations in OUTD. Methods: A prospective cohort study was conducted from 2019 to 2023, including 81 paediatric patients who underwent surgery for OUTD. Patients were categorized into reoperated and non-reoperated groups. Data on diagnostic characteristics, surgical management, and outcomes were collected. The study was approved by the Research Ethics Committee (No. BE-2-34). Statistical analyses was made SPSS, significance level of p<0.05. Main results: The cohort of 81 patients consisted of 51 (63%) patients with ureteropelvic junction obstruction, 20 (24.7%) with ureterovesical junction obstruction, and 10 (12.3%) with aberrant vessel-related obstruction. Over a median follow-up of 16 months (range: 2–72), 17 patients (21%) required reoperations, with a median time to reoperation of 5 months (range: 1–48). Early post-operative complications (56.3% vs. 15.5%, p<0.001) and early UTI during first 3 month after primary operation (52.9% vs. 15.5%, p=0.001) were significantly associated with higher reoperation rates. UTIs occurring later than 3 months postoperatively were not correlated with higher reoperation rates (p>0.05). Conclusion: Reoperation rates in paediatric OUTD highlight the critical role of early postoperative management. Early post-operative complications and UTIs within 3 months after primary surgery are strong predictors of reoperation, emphasizing the need for targeted interventions to reduce these risks. Close follow-up during the first 6 months post-surgery is recommended to improve outcomes.