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[Laparoscopic decompression of celiac trunk in children]
A Yu Razumovsky1, Z B Mitupov1, E V Feoktistova2
1Chair of Pediatric Surgery of Pirogov Russian Research Medical University of Healthcare Ministry of the Russian Federation, Moscow, Russia.
Insights
Laparoscopic decompression of the celiac trunk effectively treated compression in pediatric patients. This minimally invasive surgery resolved abdominal pain and ischemia without complications, demonstrating its efficacy for this rare condition.
Area of Science:
- Vascular Surgery
- Pediatric Surgery
- Gastroenterology
Background:
- Compressive stenosis of the celiac trunk is a rare condition, particularly in children.
- Diagnosis can be challenging due to the rarity and varied presentation of symptoms.
Purpose of the Study:
- To evaluate the effectiveness of laparoscopic decompression for celiac trunk compression in pediatric patients.
- To highlight diagnostic and treatment challenges associated with this condition in childhood.
Main Methods:
- Retrospective analysis of four pediatric patients (ages 14-17) diagnosed with celiac trunk compression.
- Diagnostic tools included pulse-wave Doppler sonography, contrast-enhanced MDCT, and angiography.
- Surgical intervention involved laparoscopic decompression of the celiac trunk.
Main Results:
- All three patients who underwent laparoscopic decompression were discharged without complications or conversion.
- The average surgical time was 65 minutes, with an average postoperative hospital stay of 4 days.
- Long-term follow-up in two patients showed reduced severity, incidence, and duration of pain syndrome.
Conclusions:
- Laparoscopic decompression is a safe and effective treatment for celiac trunk compression in pediatric patients.
- Despite diagnostic challenges, instrumental confirmation of abdominal ischemia and celiac trunk stenosis warrants surgical intervention.
Material And Methods:
For the period 2013-2016 four patients were treated at the Filatov Children's City Clinical Hospital #13. There were 2 children aged 14 years and 2 children aged 17 years. All patients have been diagnosed via anamnesis, complaints, pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. After comprehensive examination 3 patients underwent laparoscopic decompression of celiac trunk. In all cases celiac trunk compression was predominantly caused by median arcuate ligament of the diaphragm combined with neurofibrotic tissue of celiac plexus.
Results:
All patients were discharged after laparoscopic decompression of celiac trunk. Intra- and postoperative complications, as well as cases of conversion were absent. Mean time of surgery was 65 minutes. In all cases postoperative period was smooth (4 days on the average). Two patients underwent follow-up examination in long-term postoperative period: pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. In both cases reduced severity, incidence and duration of pain syndrome were observed.
Conclusion:
Clinical examples show some problems in diagnosis and treatment of compressive stenosis of celiac trunk due to rarity of pathology especially in childhood. Nevertheless, combination of abdominal ischemia and celiac trunk stenosis confirmed by instrumental diagnosis is indication for surgical treatment.
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