- Email: [email protected]
Duodenal motility after tapering duodenoplasty for high jejunal and multiple intestinal atresia
1208
INTERNATIONAL
children with grade III esophagitis developed stenoses and were treated with endoscopically guided balloon dilatations beginning on the 20th day and continuing at intervals of 10 days. For 3 of 5 children, complete resolution of the stenosis was achieved with a mean of 9 dilatations. In one patient, the esophagus was perforated during dilatation and required repair. The stenosis in this patient resolved with 6 more dilatations. In another patient, retrograde dilatations were unsuccessful. However, an excellent result was obtained with a silastic transesophageal tutor. The authors conclude that esophagogastroduodenoscopy should be carried out within 12 to 24 hours to assess the extent and degree of the lesion. Children with grade I lesions may be discharged after 24 to 48 hours. Patients with grade II or III lesions are treated conservatively and endoscopy performed after 20 days. If stenosis is present, dilatation should be performed every 10 to I5 days until the stenosis is resolved. If stenosis recurs, the authors recommend transesophageal silastic tutor for 20-30 days. Operation should be reserved for patients with multiple, extensive stenoses or failure to respond to a dilatation program.--RX Suruna Gastric Perforation in the Neonate. J. Bruce, A. Biunchi, CM Do& et al. Pediatr Surg Int 8:17-19, (January), 1993. Ten neonates with gastric perforation are presented. Of the 10 patients, 8 were hand masked prior to intubation. The gestational ages of these patients ranged from 27 to 39 weeks and birth weights 800 to 3,060 g. All patients underwent laparotomy with closure of the perforation. Seven patients had gastrostomy to facilitate drainage. Four of these patients died-one because of renal failure and intraventricular hemorrhage (TOF 800 g), one with candidiasis, one with septicemia, and one with respiratory failure and bronchopneumonia. The authors suggest that vigorous respiratory resuscitation can lead to gastric perforation. They do not furnish data regarding the time interval between mask resuscitation and development of perforation and the primary condition for which these neonates required resuscitation.-Prem Pun’ Duodenal Atresia. 7:435-437, (October),
B. Coppens and A. Vos. Pediatr 1992.
Surg
Int
The authors present their data on 44 patients with intrinsic duodenal obstruction treated between 1975 and 1989. Forty-four patients were managed during this period. Mean birthweight was 2,294 2 638 g (range, 925 to 3,800 g). Eleven patients (25%) had Down’s syndrome. Prenatal diagnosis was made in 8 patients. Twenty-four patients had a complete obstruction, and 14 of these also had an annular pancreas. In 18 patients there was a membrane. Two patients died without operation or autopsy. Operation was not undertaken in 8 patients because of severe associated anomalies. Of the 36 patients undergoing operation, 8 patients died within the first 18 months, mostly of associated congenital anomalies. One patient died of peritonitis due to anastomotic leak. From this review, it appears that the eventual outcome in children with duodenal atresia depends on the associated anomalies.-JW. Surana Operative and Postoperative Management of Congenital Duodenal Obstruction: A 10 Year Experience. S. Gavopoulos, C. Lirnas, P. Avtzoglou, et al. Pediatr Surg Int 8:122-124, (February), 1993. In this paper, 45 neonates and infants are presented. Group A included 25 atresia or complete diaphragm, 3 with III atresia, 4 with stenosis or incomplete pancreas, and 1 with aberrant vessel.
with duodenal obstruction neonates: 10 with type I type II atresia, 1 with type diaphragm, 6 with annular Operative procedures in-
ABSTRACTS
cluded 7 duodenoduodenostomies, 14 duodenoplasty with occasional excision of the diaphragm, and 4 duodenojejunostomies. Three of these patients died, 1 because of congenital heart disease and 2 as a result of sepsis, which the authors feel could have been avoided. Three patients had trisomy 21. Six patients had prolonged postoperative ileus and eventually were commenced on oral feeding between the 18th and 45th days. One patient had anastomotic obstruction because of a technical error and underwent duodenojejunostomy. The remaining 15 patients were commenced on oral feedings between 5th and 10th postoperative day. Twenty infants had duodenal obstruction secondary to bands and associated malrotation they underwent Ladd’s procedure. All were commenced on oral feedings by 4th day and were discharged by 8th postoperative day. There were no associated anomalies in this group of patients. The authors have not used gastrostomy, transanastomotic tubes, plication, or tapering duodenoplasty-Prem Pun’ Duodenal Motility After Tapering Duodenoplasty for High Jejunal and Multiple Intestinal Atresia. M. Honzumi, A. Okuda, and H. Suzuki. Pediatr Surg Int 8:116-l 18, (February), 1993. Duodenal motility was investigated by radiography and videothoroscopy in 2 patients who underwent tapering duodenoplasty. One patient underwent duodenoplasty at the time of duodenojejunostomy for double high jejunal atresia and the other 6.5 months after restoration of intestinal continuity for multiple intestinal atresia. The authors state that the tapered position of the duodenum has its own effective peristalsis, whereas the proximal dilated portion remains atonic but improves later.-Prem Puti Complications and Long-Term Results of the Nissen Fundoplication. B. Hanimann, P Sacher, and U.G. Stauffer. Eur J Pediatr Surg 3:12-14, (February), 1993. Nissen’s fundoplication is regarded as the operative therapy of choice in children with symptomatic gastroesophageal reflux. In recent years, several reports on specific complications of the Nissen fundoplication have been published. This report summarizes the complications in 45 patients who underwent this procedure. Eighteen patients (40%) showed early or late complications. In 10 patients (22%) reoperation became necessary. However, at follow-up (mean, 4% years after operation) 36 patients (92%) showed good results without any residual symptoms. Thus Nissen’s fundoplication had a rather high rate of complications. However, late results were excellent, and cure rate (92%) was higher than reported in other series in which different techniques had been used.-ThomasA. Angevointner Gastrointestinal Manifestations of Neurofibromatosis Childhood. P. Los& C. Hu, F Quinn, et al. Eur J Pediatr 3:57-58, (February), 1993.
in Surg
Von Recklinghausen’s neurofibromatosis (VRN) is a familiar disorder characterized by a generalized neuroectodermal dysplasia. Symptomatic involvement of the gastrointestinal tract is rare. The authors report on two children who had proven gastrointestinal neurofibromatomas. They stress the need for careful assessment in children with VRN who develop abdominal pain.Thomas A. Angerpointner Necrotising Enterocolitis in Very Low Birth Weight Infants. G. Fasching, M. Hoflwurth, B. Schmidt, ef ai. Pediatr Surg Int 7:428430, (October), 1992. The authors present their experience in managing neonates with birth weights of < 1,500 g with necrotizing enterocolitis (NEC). Of 27 infants, 26 had exposure to perinatal risk factors including
INTERNATIONAL
children with grade III esophagitis developed stenoses and were treated with endoscopically guided balloon dilatations beginning on the 20th day and continuing at intervals of 10 days. For 3 of 5 children, complete resolution of the stenosis was achieved with a mean of 9 dilatations. In one patient, the esophagus was perforated during dilatation and required repair. The stenosis in this patient resolved with 6 more dilatations. In another patient, retrograde dilatations were unsuccessful. However, an excellent result was obtained with a silastic transesophageal tutor. The authors conclude that esophagogastroduodenoscopy should be carried out within 12 to 24 hours to assess the extent and degree of the lesion. Children with grade I lesions may be discharged after 24 to 48 hours. Patients with grade II or III lesions are treated conservatively and endoscopy performed after 20 days. If stenosis is present, dilatation should be performed every 10 to I5 days until the stenosis is resolved. If stenosis recurs, the authors recommend transesophageal silastic tutor for 20-30 days. Operation should be reserved for patients with multiple, extensive stenoses or failure to respond to a dilatation program.--RX Suruna Gastric Perforation in the Neonate. J. Bruce, A. Biunchi, CM Do& et al. Pediatr Surg Int 8:17-19, (January), 1993. Ten neonates with gastric perforation are presented. Of the 10 patients, 8 were hand masked prior to intubation. The gestational ages of these patients ranged from 27 to 39 weeks and birth weights 800 to 3,060 g. All patients underwent laparotomy with closure of the perforation. Seven patients had gastrostomy to facilitate drainage. Four of these patients died-one because of renal failure and intraventricular hemorrhage (TOF 800 g), one with candidiasis, one with septicemia, and one with respiratory failure and bronchopneumonia. The authors suggest that vigorous respiratory resuscitation can lead to gastric perforation. They do not furnish data regarding the time interval between mask resuscitation and development of perforation and the primary condition for which these neonates required resuscitation.-Prem Pun’ Duodenal Atresia. 7:435-437, (October),
B. Coppens and A. Vos. Pediatr 1992.
Surg
Int
The authors present their data on 44 patients with intrinsic duodenal obstruction treated between 1975 and 1989. Forty-four patients were managed during this period. Mean birthweight was 2,294 2 638 g (range, 925 to 3,800 g). Eleven patients (25%) had Down’s syndrome. Prenatal diagnosis was made in 8 patients. Twenty-four patients had a complete obstruction, and 14 of these also had an annular pancreas. In 18 patients there was a membrane. Two patients died without operation or autopsy. Operation was not undertaken in 8 patients because of severe associated anomalies. Of the 36 patients undergoing operation, 8 patients died within the first 18 months, mostly of associated congenital anomalies. One patient died of peritonitis due to anastomotic leak. From this review, it appears that the eventual outcome in children with duodenal atresia depends on the associated anomalies.-JW. Surana Operative and Postoperative Management of Congenital Duodenal Obstruction: A 10 Year Experience. S. Gavopoulos, C. Lirnas, P. Avtzoglou, et al. Pediatr Surg Int 8:122-124, (February), 1993. In this paper, 45 neonates and infants are presented. Group A included 25 atresia or complete diaphragm, 3 with III atresia, 4 with stenosis or incomplete pancreas, and 1 with aberrant vessel.
with duodenal obstruction neonates: 10 with type I type II atresia, 1 with type diaphragm, 6 with annular Operative procedures in-
ABSTRACTS
cluded 7 duodenoduodenostomies, 14 duodenoplasty with occasional excision of the diaphragm, and 4 duodenojejunostomies. Three of these patients died, 1 because of congenital heart disease and 2 as a result of sepsis, which the authors feel could have been avoided. Three patients had trisomy 21. Six patients had prolonged postoperative ileus and eventually were commenced on oral feeding between the 18th and 45th days. One patient had anastomotic obstruction because of a technical error and underwent duodenojejunostomy. The remaining 15 patients were commenced on oral feedings between 5th and 10th postoperative day. Twenty infants had duodenal obstruction secondary to bands and associated malrotation they underwent Ladd’s procedure. All were commenced on oral feedings by 4th day and were discharged by 8th postoperative day. There were no associated anomalies in this group of patients. The authors have not used gastrostomy, transanastomotic tubes, plication, or tapering duodenoplasty-Prem Pun’ Duodenal Motility After Tapering Duodenoplasty for High Jejunal and Multiple Intestinal Atresia. M. Honzumi, A. Okuda, and H. Suzuki. Pediatr Surg Int 8:116-l 18, (February), 1993. Duodenal motility was investigated by radiography and videothoroscopy in 2 patients who underwent tapering duodenoplasty. One patient underwent duodenoplasty at the time of duodenojejunostomy for double high jejunal atresia and the other 6.5 months after restoration of intestinal continuity for multiple intestinal atresia. The authors state that the tapered position of the duodenum has its own effective peristalsis, whereas the proximal dilated portion remains atonic but improves later.-Prem Puti Complications and Long-Term Results of the Nissen Fundoplication. B. Hanimann, P Sacher, and U.G. Stauffer. Eur J Pediatr Surg 3:12-14, (February), 1993. Nissen’s fundoplication is regarded as the operative therapy of choice in children with symptomatic gastroesophageal reflux. In recent years, several reports on specific complications of the Nissen fundoplication have been published. This report summarizes the complications in 45 patients who underwent this procedure. Eighteen patients (40%) showed early or late complications. In 10 patients (22%) reoperation became necessary. However, at follow-up (mean, 4% years after operation) 36 patients (92%) showed good results without any residual symptoms. Thus Nissen’s fundoplication had a rather high rate of complications. However, late results were excellent, and cure rate (92%) was higher than reported in other series in which different techniques had been used.-ThomasA. Angevointner Gastrointestinal Manifestations of Neurofibromatosis Childhood. P. Los& C. Hu, F Quinn, et al. Eur J Pediatr 3:57-58, (February), 1993.
in Surg
Von Recklinghausen’s neurofibromatosis (VRN) is a familiar disorder characterized by a generalized neuroectodermal dysplasia. Symptomatic involvement of the gastrointestinal tract is rare. The authors report on two children who had proven gastrointestinal neurofibromatomas. They stress the need for careful assessment in children with VRN who develop abdominal pain.Thomas A. Angerpointner Necrotising Enterocolitis in Very Low Birth Weight Infants. G. Fasching, M. Hoflwurth, B. Schmidt, ef ai. Pediatr Surg Int 7:428430, (October), 1992. The authors present their experience in managing neonates with birth weights of < 1,500 g with necrotizing enterocolitis (NEC). Of 27 infants, 26 had exposure to perinatal risk factors including