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Incidental appendectomies
104 The Neutrophil Count in Childhood Acute Appendicitis. N. V. Daraiswamy. Br J Surg 64:342 (May). 1977.
A study was made of the total leucocyte count, neutrophil percentage, and absolute neutrophil count in 100 cases of appendicitis and in 25 children, in whom at laparotomy a normal appendix was found. In acute appendicitis, there was a raised total leucocyte count in 42%, a raised net~trophil percentage in 93 %, and a raised absolute neutrophil count in 77% of cases, compared with 4%, 24%, and 16% in the control group. The finding of normal values in 7% of children with acute appendicitis reaffirms the overriding importance of the clinical assessment.--Lewis Spitz Incidental Appendectomies, R. J. Hays. JAMA 238:31 (July), 1977.
The author circularized 467 directors of surgical residencies and 396 directors of obstetrics-gynecology residencies to ask what their teaching was with regard to incidental appendectomy. Three-quarters of the directors replied and 64%-69% recommended appendectomy during the course of uncomplicated hysterectomy and 55% 66% recommended incidental appendectomy during other abdominal operations.--David L. Collins Acute Necrotizing Enterocolitis in Neonates. A. R. Roty, Jr., J. B. Kilway, and A. L. Brown, II. Am Surg 43:392-394 (June), 1977.
Sixty-one cases were collected and, of these, 26 were treated without surgery. Of the 26, 14 died and 12 survived. Of 35 patients operated upon, 24 died and 11 survived. In 16 patients the entire bowel was gangrenous. It is also noted that in the medically treated group, 10 of the 14 patients who died could not be saved because of problems other than necrotizing enterocolitis. The usual surgical treatment consisted of resection with exteriorization of the free ends. Primary anastomosis was not attempted. Although most of the patients had umbilical artery catheters, development of necrotizing enterocolitis could not be attributed to this. Although a low platelet count was an ominous finding, there was no statistical correlation between surgical and nonsurgical cases in platelet counts.--EdwardJ. Berman Ulcerative Colitis and Crohn's Diseases: Results After Colectomy and Ileorectal Anastomosis. J. McK, Watts and E. S. R. Hughes~ BrJ Surg 64:77-83 (February), 1977.
Eighty-one patients who had had colectomy and ileorectal anastomosis for ulcerative colitis (66) or Crohn's disease of the colon (15) from 1 to 13 yr previously were assessed. Sixty-four patients (79%) had a satisfactory result. In 12 patients, the operation had failed and an ileostomy had been established, and in a further 5 patients the result was considered unsatisfactory. Ileorectal anastomosis is contraindicated in patients with a patulous anus or severe rectal suppuration or stricture, but the presence of severe rectal disease is not considered an absolute contraindication. Of the 69 patients remaining with an ileorectal anastomosis, 41% had fecal precipitance, 45% fecal incontinence, and 39% blood and mucous in the stools. Eleven patients developed a rectal stricture, 7 an anal or rectal fistula, and 5 anorectal abscess. Patients with Crohn's disease had similar results to those with ulcerative colitis. Provided that the
ABSTRACTS
rectum is examined regularly for premalignant or malignant change, colectomy and ileorectal anastomosis offer a satisfactory alternative to proctocolectomy and ileostomy for many patients with ulcerative colitis or Crohn's
disease.--Lewis Spitz Manometric and Histochemical Studies on Patients With Hirschsprung's Disease and Idiopathic Constipation, M. Yamamoto, K./mamura, S. Saji, A. Sato, Y. Kashiki, T. Kunieda, and K. Sakata. J Jpn Soc Pediatr Surg 13:529-536 (June), 1977.
Manometric and histochemical studies were carried out on 13 normal infants and children (aged 10 days-6 yr), 21 patients with Hirschsprung's disease (aged 20 days-7 yr), 17 cases of idiopathic constipation (aged 1 14 yr), and 5 patients with meningomyelocele. Studies were also carried out postoperatively on 18 patients with Hirschsprung's disease, of which one had Swenson's pull-through procedure and 17 had Duhamel's procedure or its modifications. All 13 normal infants and children, 17 cases with idiopathic constipation, and 5 cases with meningomyelocele showed normal rectoanal reflex on anorectal manometry. Acetylcholine esterase activity in the rectal mucosa was negative in all of these 35 patients. All 21 patients with Hirschsprung's disease, on the other hand, showed lack of rectoanal reflex and all of 8 cases studied showed positive acetylcholine esterase activity in the rectal mucosa. Although operative results were satisfactory in all 18 patients who underwent radical operations for Hirschsprung's disease, rectoanal reflex turned to positive postoperatively in only 2 of 18 cases, and acetylcholine esterase activity remained positive in all of 3 cases studied.--H. Suzuki Modified Duhamel Operation for Hirschsprung's Disease. R. A. Parrish. Am Sur9 43:283-286 (May), 1977.
The technique of Steichen, Talbert, and Ravitch is preferred, wherein the Duhamel operation is modified by performing primary side-to-side colorectal anastomosis using the GIA stapling instrument. Of 20 Duhamel procedures for Hirschsprung's disease, seven were of this va-
riety.--Edward J. Berman Adult Hirschsprung's Disease. I. P, Todd. 8r J Surg 64:311 (May), 1977.
A series of 26 cases of confirmed aganglionosis seen at St. Mark's Hospital since 1954 is reviewed. Even though the average age was 28 yr when first seen (range 17-62 years), almost all patients had had symptoms since birth. The operation of choice was the Martin modification of the Duhamel procedure using a covering tube cecostomy that closed spontaneously in all cases.--L ewis Spitz Magnetic Pull-Through Procedure in Imperforate Anus. G. Wi//ita/, G. Hennig, H. Groit/i, H. Meier, and J. Gauger. Z Kinderchir 20:378-384 (April), 1977.
Similar to the management in esophageal atresia, a magnetic pull-through procedure is described in a 4-wk-old newborn with high anal atresia and rectourethral fistula. After primary colostomy, a cylinder of Samarium-cobalt was placed in the distal pouch of the colon. An electromagnet was positioned at the site of the anus. Five days
A study was made of the total leucocyte count, neutrophil percentage, and absolute neutrophil count in 100 cases of appendicitis and in 25 children, in whom at laparotomy a normal appendix was found. In acute appendicitis, there was a raised total leucocyte count in 42%, a raised net~trophil percentage in 93 %, and a raised absolute neutrophil count in 77% of cases, compared with 4%, 24%, and 16% in the control group. The finding of normal values in 7% of children with acute appendicitis reaffirms the overriding importance of the clinical assessment.--Lewis Spitz Incidental Appendectomies, R. J. Hays. JAMA 238:31 (July), 1977.
The author circularized 467 directors of surgical residencies and 396 directors of obstetrics-gynecology residencies to ask what their teaching was with regard to incidental appendectomy. Three-quarters of the directors replied and 64%-69% recommended appendectomy during the course of uncomplicated hysterectomy and 55% 66% recommended incidental appendectomy during other abdominal operations.--David L. Collins Acute Necrotizing Enterocolitis in Neonates. A. R. Roty, Jr., J. B. Kilway, and A. L. Brown, II. Am Surg 43:392-394 (June), 1977.
Sixty-one cases were collected and, of these, 26 were treated without surgery. Of the 26, 14 died and 12 survived. Of 35 patients operated upon, 24 died and 11 survived. In 16 patients the entire bowel was gangrenous. It is also noted that in the medically treated group, 10 of the 14 patients who died could not be saved because of problems other than necrotizing enterocolitis. The usual surgical treatment consisted of resection with exteriorization of the free ends. Primary anastomosis was not attempted. Although most of the patients had umbilical artery catheters, development of necrotizing enterocolitis could not be attributed to this. Although a low platelet count was an ominous finding, there was no statistical correlation between surgical and nonsurgical cases in platelet counts.--EdwardJ. Berman Ulcerative Colitis and Crohn's Diseases: Results After Colectomy and Ileorectal Anastomosis. J. McK, Watts and E. S. R. Hughes~ BrJ Surg 64:77-83 (February), 1977.
Eighty-one patients who had had colectomy and ileorectal anastomosis for ulcerative colitis (66) or Crohn's disease of the colon (15) from 1 to 13 yr previously were assessed. Sixty-four patients (79%) had a satisfactory result. In 12 patients, the operation had failed and an ileostomy had been established, and in a further 5 patients the result was considered unsatisfactory. Ileorectal anastomosis is contraindicated in patients with a patulous anus or severe rectal suppuration or stricture, but the presence of severe rectal disease is not considered an absolute contraindication. Of the 69 patients remaining with an ileorectal anastomosis, 41% had fecal precipitance, 45% fecal incontinence, and 39% blood and mucous in the stools. Eleven patients developed a rectal stricture, 7 an anal or rectal fistula, and 5 anorectal abscess. Patients with Crohn's disease had similar results to those with ulcerative colitis. Provided that the
ABSTRACTS
rectum is examined regularly for premalignant or malignant change, colectomy and ileorectal anastomosis offer a satisfactory alternative to proctocolectomy and ileostomy for many patients with ulcerative colitis or Crohn's
disease.--Lewis Spitz Manometric and Histochemical Studies on Patients With Hirschsprung's Disease and Idiopathic Constipation, M. Yamamoto, K./mamura, S. Saji, A. Sato, Y. Kashiki, T. Kunieda, and K. Sakata. J Jpn Soc Pediatr Surg 13:529-536 (June), 1977.
Manometric and histochemical studies were carried out on 13 normal infants and children (aged 10 days-6 yr), 21 patients with Hirschsprung's disease (aged 20 days-7 yr), 17 cases of idiopathic constipation (aged 1 14 yr), and 5 patients with meningomyelocele. Studies were also carried out postoperatively on 18 patients with Hirschsprung's disease, of which one had Swenson's pull-through procedure and 17 had Duhamel's procedure or its modifications. All 13 normal infants and children, 17 cases with idiopathic constipation, and 5 cases with meningomyelocele showed normal rectoanal reflex on anorectal manometry. Acetylcholine esterase activity in the rectal mucosa was negative in all of these 35 patients. All 21 patients with Hirschsprung's disease, on the other hand, showed lack of rectoanal reflex and all of 8 cases studied showed positive acetylcholine esterase activity in the rectal mucosa. Although operative results were satisfactory in all 18 patients who underwent radical operations for Hirschsprung's disease, rectoanal reflex turned to positive postoperatively in only 2 of 18 cases, and acetylcholine esterase activity remained positive in all of 3 cases studied.--H. Suzuki Modified Duhamel Operation for Hirschsprung's Disease. R. A. Parrish. Am Sur9 43:283-286 (May), 1977.
The technique of Steichen, Talbert, and Ravitch is preferred, wherein the Duhamel operation is modified by performing primary side-to-side colorectal anastomosis using the GIA stapling instrument. Of 20 Duhamel procedures for Hirschsprung's disease, seven were of this va-
riety.--Edward J. Berman Adult Hirschsprung's Disease. I. P, Todd. 8r J Surg 64:311 (May), 1977.
A series of 26 cases of confirmed aganglionosis seen at St. Mark's Hospital since 1954 is reviewed. Even though the average age was 28 yr when first seen (range 17-62 years), almost all patients had had symptoms since birth. The operation of choice was the Martin modification of the Duhamel procedure using a covering tube cecostomy that closed spontaneously in all cases.--L ewis Spitz Magnetic Pull-Through Procedure in Imperforate Anus. G. Wi//ita/, G. Hennig, H. Groit/i, H. Meier, and J. Gauger. Z Kinderchir 20:378-384 (April), 1977.
Similar to the management in esophageal atresia, a magnetic pull-through procedure is described in a 4-wk-old newborn with high anal atresia and rectourethral fistula. After primary colostomy, a cylinder of Samarium-cobalt was placed in the distal pouch of the colon. An electromagnet was positioned at the site of the anus. Five days