Background: Kidney is the most common site of genitourinary trauma. 50% of all urinary injuries is kidney.Kidney is also affected in 8-12% of all blunt and penetrating trauma to abdomen. 80-90% of renal injury is caused by blunt injury GY. Children,  compared to adults, have  at a higher risk of renal injury from blunt trauma due to a variety of anatomic factors including decreased perirenal fat, weaker abdominal muscles, and a less ossified thoracic cage. While there are strong trends toward non-operative management of blunt renal trauma, there are no explicit guidelines for high grade injuries. Organ preservation in children is always a primary goal with solid organ injury. Aim of the work: The aim of the retrospective study is to show the specificity of kidney injury in children as well as the specificity of surgical treatment. Material and Methods: All 19 patients under the age of 18 who were admitted to Clinic for Pediatic surgery in Sarajevo with a diagnosis of renal trauma were retrospectively reviewed .The Echo an CT were used to identify patients with a renal injury. The time period examined was between January 1, 1999- 2019. Inclusion criteria were either a diagnosis of renal trauma or a diagnosis of blunt abdominal trauma and hematuria. Exclusion criterion was death due to an additional traumatic injury. The mechanism of injury (fall, car accident , assault) injury grade (I-V), the presence of hematuria, and demographic data to include age, weight, and sex, were recorded and reviewed.  In addition, amount of blood product required, hematocrit nadir prior to transfusion to assist in ascertaining whether transfusion was necessary, surgical interventions performed, and hospital length of stay were also retrospectively analyzed. Due to the low sample size we used descriptive as opposed to inferential statistics in our analysis. Result: Demographics include male to female ratio of 13:6 and the average age of patients was 11.9 + 4.6 years. Of the nineteen patients who underwent review, eleven (57,89%) children presented with a grade III renal injury, five  with a grade IV injury and three with  grade V injury. Six patients presented with gross hematuria and 3 with microscopic hematuria. Only four patients (22%) required blood transfusions, with the average hematocrit nadir being 31 + 5.3% (24.8-37.8). One of the two patients transfused had a concomitant grade IV splenic laceration with a hematocrit nadir of 24.8% and clinical symptoms consistent with shock. Conclusions:The specificity of the child's anatomy is an aggravating prognostic factor (the kidney is larger in relation to the body cavity than in adults, less protected against the ribs, the muscles of the body and the lower abdomen, the less developed peritoneal and retroperitoneal fatty tissue).It is recommended to initiate conservative treatment (leaching, infusion solution, monitoring) and possibly delayed surgical treatment.Indications for early surgicaly treatment are reserved only for patients with bleeding (absolute) and extravasation (relative).If it is necessary surgical treatment sould be  maximally preserve kidney tissue.

Introduction: Transverse colon volvulus is an uncommon cause of bowel obstruction. Predisposing factors are mental retardation, dysmotility disorders, chronic constipation, and congenital megacolon. Case report: We presented a transverse colon volvulus in a 14-year-old girl with mental retardation. Chronic constipation in neurologically impaired patients was a risk factor predisposing to volvulus. The girl was admitted to our Clinic because of problems that last 4-5 days and was followed by abdominal pain, vomiting and lack of stool. Vomiting was once a day. She was sub febrile up to 37.6°C. On examination, the abdomen was distended, tense, diffusely painful. During the surgery, a 360° clockwise volvulus of the transverse colon was found. After the reduction of volvulus, an enormous transverse colon was resected and protective ileostomy was formed. In the postoperative period, ileostoma functioned a good. The definitive surgical treatment was done on the 20th postoperative day when the occlusion of the ileostomy and transanal biopsy of the rectum was done, which showed the presence of ganglia cells. The patient was discharged from our institution after 1 month. Conclusion: Pediatric patients with neurological conditions and mental retardation present an increased risk of colon transversum volvulus due to chronic obstruction.

Background: An extensive burn is one of the most serious injuries. The modern treatment of pediatric burns is a logical exercise in resuscitation, infection control, surgical wound care, nutrition and psychologic and physical rehabilitation. The conventional methods of local therapy, especially in extensive and deep burns, cannot prevent infection. The fact is that the necrotic burn tissue always gives rise to infection and must therefore be excised. Tangential excision is a diagnostic procedure as well as a surgical preparation of a recipient bed for skin graft.  Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infenction, laboratory values. Aim of research: The aim of our research was to demonstrate the efficacy of early tangential necrectomy in the treatment of extensive burns in children as well as in preventing the burn diseases. Material and methods: Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infection, laboratory values. Results: The boys comprised 58.3% of the respondents and the girls were 41,7% of the respondents. The most common cause was the hot liquid of 73.3%, open flame 23.3% and the contact with hot metal 3.3%. The body temperature was significantly higher in control group compared to the examined group (p <0.001) significantly lower hematocrit values in the control group compared to the examined group (p = 0.002).      The results show that hospitalization lasted considerably longer in patients in the control group than in the examined group (p = 0.003). The incidence of bacterial infection of the burns is significantly higher in control compared to the examined group of patients (p = 0.007). The most commonly isolated bacteria in the study group was Staphylococcus aureus (15/30 or 50% of all subjects). Acinetobacter spp. was isolated in 9 patients (30% of respondents). Serratia spp. And Enterococcus Foecalis were isolated in 6 patients (20%). Pseudomonas aeruginosa was isolated in 3 patients (10%). Three patients (10%) did not isolate any bacteria during hospitalization Conclusions: The method of early tangential necrectomy of extensively burned children significantly reduce morbidity and mortality (it improves the general condition of the patient, improves clinical and laboratory parameters, reduces the possibility of infection of the wound, reduces the possibility of sepsis, reduces the length of hospitalization).The most optimal time to perform an early tangential necrectomy is the period between the 4th and the 6th day after the injury. In extensively burned children over 30% of the total body surface, an early tangential necrectomy should be performed on an area of about 20% of the total body surface as a prevention of blood loss due to necrectomy and autotransplantation. With extensively burned children over 40% of the total body surface, taking homotransplants from parents or close relatives reduces morbidity and mortality.

The pseudocyst wall is covered with inflammatory fibrotic tissue, unlike true cysts whose wall is covered with mesothelium. Treatment of abdominal pseudocysts involves resection of the pseudocyst wall and shunt replacement. The above procedure can be done by open or minimal access to the surgical procedure. A 10-year-old girl to whom the VPS is placed comes from long-term abdominal colic and symptoms similar to an acute abdomen. We treated the girl with minimal access to the procedure, performed a resection from the abdominal pseudocyst, and did a VPS replacement. The patient’s postoperative course was satisfactory.

Isolated female epispadias without bladder exstrophy is a rare congenital anomaly affecting 1 in 484,000 females. The presenting features of female epispadias are urinary incontinence and abnormal anatomical features. A 6-year-old girl presented with primary urinary incontinence who on physical examination had a bifid clitoris and labia minora. The vagina and hymen were normal. Voiding cystourethrogram showed no reflux and a funnel shaped proximal urethra. With the diagnosis of isolated female epispadias, one-stage reconstruction of the urethra, bladder neck, labia minora and clitoris was performed.