I am blue: a toddler’s Raynaud’s phenomenon

Raynaud’s phenomenon (RP) is a well-known disorder of self-limiting paroxysmal vasospasms occurring in small arteries of the digits, in the order of skin pallor (white), followed by cyanosis (blue), ending with hyperemia (red). These designative triphasic colour changes with exposure to cold, or emotional response is diagnostic in adults. RP is a very rare phenomenon in the young paediatric population as noted by Nigrovic et al with 123 patients <19 year old in a large children’s centre over 10 years and only 4 patients being <2 years old, with 69% of these being primary RP. To our knowledge, this is the youngest documented case of Raynaud’s disease that has not required treatment.

SURGICAL TREATMENT IN RAYNAUD'S DISEASE

INTRODUCTION In primary or refractory cases of Raynaud's Disease (RD), with severe symptoms (pain, ulcers, and disability), minimally invasive surgical treatments such as thoracoscopic sympathectomy have recently been proposed. The objective of this study will be to evaluate the viability, feasibility and results of this therapeutic option in this type of patient. MATERIAL AND METHODS Descriptive prospective study from January 2017 to January 2019 where all patients with a diagnosis of RD, with poor clinical control and disability, and refractory to medical treatment are collected. RESULTS Seven girls (9-15 years old) were collected. All underwent bilateral thoracoscopic sympathectomy, T2-T4, with a mean surgical time of 55 min. No need for pleural drainage. All of them were discharged before 36 hours after surgery (12-36 hours) without any immediate intra or postoperative complications. All reported an immediate postoperative period without incident, without new episodes of pain or intense vasoconstriction. However, 6 months after surgery, 3 of the 7 (42.85%) presented partial reappearance of the symptoms. However, the 7 presented 100% satisfaction with the surgical results. CONCLUSIONS There are currently very few published studies regarding this surgical option. We believe that our series is the first pediatric series to be collected, although it is very limited. However, the results obtained to date, in global terms, are encouraging. We consider that thoracoscopic sympathectomy is a feasible and safe surgical technique to consider in patients with RD refractory to conservative treatment.