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Comparing sedative and non-sedative reduction techniques in paediatric intussusception: Insights from a 6-year study

Purnomo E, Gibran K, Makhmudi A, Andi D, Gunadi

Med J Malaysia, 2024 Aug;79(Suppl 4):38-43.
PMID: 39215413

INTRODUCTION: Intussusception is a prevalent paediatric emergency condition. The standard of care involves the reduction using air or fluid enema is considered a safe procedure. Sedation-induced muscle relaxation thus optimising the treatment. We present a comprehensive 6- year study involving non sedative reduction (NSR) versus sedative reduction (SR) utilising ketamine and midazolam.
MATERIALS AND METHODS: A retrospective cohort study was conducted between January 2017 and July 2023 in Yogyakarta, Indonesia. A total of 85 children diagnosed with intussusception underwent hydrostatic reduction, which employed water-soluble contrast administered into the rectum. Cases that were unsuccessful in reduction underwent immediate surgical intervention.
RESULTS: Among the 85 children with intussusception underwent reduction, 22 children underwent the SR procedure and 63 underwent NSR procedure. We found a successful outcome in 17 cases (77%) of SR procedure with one recurrent and the other five (23%) got surgical reduction such as anastomosis resection (3 cases) due to Meckel- Diverticula. On the other hand, we found 24 successful cases (38.0%) in NSR procedure with one recurrent after case. 39 others who failed with NSR continued to surgical reduction. Manual reduction was done for 31 patients with one case mortality due to pulmonary bleeding. Anastomosis resection (4 cases) and, stoma (4 cases) were decided for others surgical reduction. The relative risk (RR) on this study was 2.02 (p value < 0.05, CI 95%).
CONCLUSION: Implementation of the SR procedure may reduce surgery rates in paediatric intussusception, thereby enhancing patient management. Furthermore, the success rate of hydrostatic reduction higher in under sedation procedure. We contribute to evolve insight of non-operative approaches of paediatric intussusception management, particularly in the Yogyakarta.
Uncommon splenic cysts in paediatric patients: A case series

Febrianti M, Purnomo E, Dwihantoro A, Makhmudi A, Kashogi G

Med J Malaysia, 2024 Aug;79(Suppl 4):91-94.
PMID: 39215423

Splenic cysts are uncommon and classified into parasitic and non-parasitic origins. Non-parasitic cysts are further categorised into primary and secondary forms; primary cysts develop congenitally and progress into adulthood and secondary cysts result from factors such as abdominal trauma, infection or ischemia. This case series presents three instances of splenic cysts in children. The first case involves a splenic epidermoid cyst, the second a pseudocyst and the third a splenic epithelial cyst. All patients exhibited an abdominal lump in the left quadrant that increased in size over time, without additional symptoms. The third patient had a history of abdominal blunt trauma a year prior to symptom onset. Treatment approaches varied: the first and third patients underwent total splenectomy, while the second patient underwent aspiration drainage with frozen section analysis and partial splenectomy. All patients, first, second and third, were discharged 6, 3 and 5 days postoperatively, respectively, without complications. Splenic epithelial cyst (SEC) emerged as the predominant primary non-parasitic splenic cyst type, with an unclear pathogenesis. Typically asymptomatic, splenic cysts are commonly detected incidentally during imaging or exploratory laparotomy. Histopathology stands as the gold standard diagnostic method for splenic cysts. Although rare, paediatric splenic cysts should be considered in cases of abdominal trauma. Imaging serves a vital role in diagnosis, guiding decisions between conservative or surgical interventions based on cyst size, symptoms and associated complications.
Risk factor for inappropriate use of prophylactic antibiotics in inguinal hernia repair surgery

Hendrawan F, Nugrahningsih DAA, Purnomo E, Azdy NA

Med J Malaysia, 2024 Aug;79(Suppl 4):58-62.
PMID: 39215416

INTRODUCTION: There are some complications that can arise after surgery, like surgical site infection (SSI). In hernia repair, SSI incidence is low. Hence, the clinical practice guideline (CPG) published by the HerniaSurge Group (THG) does not recommend prophylactic antibiotics for hernia repair. Despite the unnecessary use of prophylactic antibiotics, regarding patient safety, prophylactic antibiotics can be used. However, each hospital has its own CPG and recommended antimicrobials based on the infection cases in its site. Regarding antimicrobial resistances, evaluating prophylactic antibiotics is essential to prevent increasing incidence of antimicrobial resistance cases. The aim of this study is to evaluate the use of prophylactic antibiotics in hernia inguinal cases.
MATERIALS AND METHODS: This cross-sectional analytic study used patients' medical records between 2015 to 2020. Demographic data, surgery data and the used antimicrobial data were extracted and written in case report form. Identification of risk factors for inappropriate use of prophylactic antibiotics was done using logistic regression.
RESULTS: We identified 55 inappropriate times of preoperative prophylactic antibiotic therapy cases out of 80 cases and 63 cases in post-operative antibiotics were different from the guideline. Statistical analysis did not find any factor related to inappropriate therapy time.
CONCLUSION: The misuse of prophylactic antibiotics was frequently found regarding the duration of prophylactic antibiotics in both pre- and post-surgery setting. Nonetheless, no risk factor was identified with the inappropriate use of prophylactic antibiotics.

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