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Medical management of pyloric stenosis
INTERNATIONAL
ABSTRACI-S
OF PEDIATRIC
of the pylorus into the antrum, and varying degrees of obstruction were considered diagnostic. Tumors were palpated in 8 patients. In 3 patients the initial roentgenographic examination was not diagnostic and a second examination was required for diagnosis. Feedings were withheld, intravenous fluids were given and gastric lavage 3 to 4 times daily was done. Between admission and the beginning of oral feeding 0.12 to 0.15 mg. of methscopolamine nitrate (Skopyl) was administered every 4 to 6 hours intramuscularly until feedings were tolerated by mouth. Glucose water feedings were started in 24 to 36 hours and feedings gracluall~~ increased with boiled skim milk and dilute formula to full strength formula feedings. The infant was discharged when 3 ounce feedings were tolerated. Methscopolamine was administered at home before each feeding for 3 months. Eleven patients treated medically were discharg!ed in 5 to 16 days. The average hospitalizntion was 9 days. However, 8 patients were hospitalized 7 to 16 days. Of these 11 patients only 4 hsd palpable tumors and 2 of these required a second roentgenographic er:rmination for diagnosis. Five patients required surgery. Hospitalization in these pntientr a\-eraged 14 days.--J. Eugen.e Letcis, Jr. CONGENITAL ATHESI~ AND STENOSIS OF THE DUODENUM-A REVIEW COMPILED FROM THE h$EMBEHS OF THE SURGICAL SECTION OF THE AMEHICAN ACADEMY OF PEDIATIWX Eric W. Fon.kaLsrud, Alfred A. deLorimier, and Daniel hl. Hays. Pediatrics 43:79-83 (January), 1969. This review concerns 503 infants with congenital duodenal obstruction cared for in 65 hospitals by members of the surgical section of the Academy of Pediatrics during the lo-year period ending August 1967. Four hundred and eighty seven infants were operated upon with an overall 36 per cent mortality. Of the 503 patients 48.7 per cent (245) had atresia, 10.0 per cent (50) stenosis, 41 per cent (206) a diaphragm, and in 0.3 per cent (2) the exact anatomy was not specified. Associated anomalies were present in 48 per cent of these infants, the most frequent being Down’s syndrome which was present in 30 per cent ( 150). Complications from associated anomalies accounted for most of the deaths. Particu-
SURGERY
385
larly dangerous was the association with esophageal atresia and tracheoesophageal fistula. This lesion occurred in 34 infants and had a mortality of 70.6 per cent. The operative procedure most commonly preferred was the side to side duodenoduodenostomy or duodenojejunostomy. Excision of the duodenal diaphragms appeared to be effective. Gastrostomy was preferred and done by most surgeons-w. K. Sieber. PREDUODENAL PORTAL VEIN. J. Kopeckj and A. Halatoh. Rozhlchir. 47~785-789, 1968. Repeated slightly bile-stained vomiting from birth in an infant led to x-ray examination. The diagnosis of duodenal stenosis was made and surgery performed at the age of one month. At laparotomy the subhepatic position of caecuni fixed by fibrotic bands to the inferior part of the right liver lobe was revealed. After dissection of these peritoneal bands a large vein (t&4 mm.@) was seen compressing the duodenum just above its descending part. A gastrojejunostomy was done. The abnormal vein was identified as a preduodenal portal vein. The postoperative course was uneventful. The child was seen 3 years later in full health, normal weight and height, without any symptoms. The authors give a brief account of the embryology of the portal vein from which the formal genesis of anomalies of the portal vein may be clearly explained.-V. Kafka. APPENDICEAL ABSCESS CAUSING URINARY OBSTRUCTION. G. 7'.Cook. J. Urol. 101: 212-215 (February), 1969. This is an analysis of 93 cases of appendiceal abscess in patients aged 1 to 14 years of whom 16 developed urinary symptoms 4 to 14 days after the gastrointestinal symptoms. Four of these developed retention. Of 14 excretory urograms made 8 were abnormal, there being right ureteral obstruction in 6 cases and bilateral obstruction in 2. When the abscesses were drained and the mass causing ureteral compression subsided radiographic evidence of obstruction also disappeared.-B. M. Henderson. THE EARLY DIAGNOSIS AND SURGICAL TREATMENT OF HIRSCHSPRUNG'S DISEASE IN INFANCY. J. D. Atwell. Proc. Roy. Sot. Med. 61:339-340 (April), 1968. In a series
of 24 cases of Hirschsprung’s
ABSTRACI-S
OF PEDIATRIC
of the pylorus into the antrum, and varying degrees of obstruction were considered diagnostic. Tumors were palpated in 8 patients. In 3 patients the initial roentgenographic examination was not diagnostic and a second examination was required for diagnosis. Feedings were withheld, intravenous fluids were given and gastric lavage 3 to 4 times daily was done. Between admission and the beginning of oral feeding 0.12 to 0.15 mg. of methscopolamine nitrate (Skopyl) was administered every 4 to 6 hours intramuscularly until feedings were tolerated by mouth. Glucose water feedings were started in 24 to 36 hours and feedings gracluall~~ increased with boiled skim milk and dilute formula to full strength formula feedings. The infant was discharged when 3 ounce feedings were tolerated. Methscopolamine was administered at home before each feeding for 3 months. Eleven patients treated medically were discharg!ed in 5 to 16 days. The average hospitalizntion was 9 days. However, 8 patients were hospitalized 7 to 16 days. Of these 11 patients only 4 hsd palpable tumors and 2 of these required a second roentgenographic er:rmination for diagnosis. Five patients required surgery. Hospitalization in these pntientr a\-eraged 14 days.--J. Eugen.e Letcis, Jr. CONGENITAL ATHESI~ AND STENOSIS OF THE DUODENUM-A REVIEW COMPILED FROM THE h$EMBEHS OF THE SURGICAL SECTION OF THE AMEHICAN ACADEMY OF PEDIATIWX Eric W. Fon.kaLsrud, Alfred A. deLorimier, and Daniel hl. Hays. Pediatrics 43:79-83 (January), 1969. This review concerns 503 infants with congenital duodenal obstruction cared for in 65 hospitals by members of the surgical section of the Academy of Pediatrics during the lo-year period ending August 1967. Four hundred and eighty seven infants were operated upon with an overall 36 per cent mortality. Of the 503 patients 48.7 per cent (245) had atresia, 10.0 per cent (50) stenosis, 41 per cent (206) a diaphragm, and in 0.3 per cent (2) the exact anatomy was not specified. Associated anomalies were present in 48 per cent of these infants, the most frequent being Down’s syndrome which was present in 30 per cent ( 150). Complications from associated anomalies accounted for most of the deaths. Particu-
SURGERY
385
larly dangerous was the association with esophageal atresia and tracheoesophageal fistula. This lesion occurred in 34 infants and had a mortality of 70.6 per cent. The operative procedure most commonly preferred was the side to side duodenoduodenostomy or duodenojejunostomy. Excision of the duodenal diaphragms appeared to be effective. Gastrostomy was preferred and done by most surgeons-w. K. Sieber. PREDUODENAL PORTAL VEIN. J. Kopeckj and A. Halatoh. Rozhlchir. 47~785-789, 1968. Repeated slightly bile-stained vomiting from birth in an infant led to x-ray examination. The diagnosis of duodenal stenosis was made and surgery performed at the age of one month. At laparotomy the subhepatic position of caecuni fixed by fibrotic bands to the inferior part of the right liver lobe was revealed. After dissection of these peritoneal bands a large vein (t&4 mm.@) was seen compressing the duodenum just above its descending part. A gastrojejunostomy was done. The abnormal vein was identified as a preduodenal portal vein. The postoperative course was uneventful. The child was seen 3 years later in full health, normal weight and height, without any symptoms. The authors give a brief account of the embryology of the portal vein from which the formal genesis of anomalies of the portal vein may be clearly explained.-V. Kafka. APPENDICEAL ABSCESS CAUSING URINARY OBSTRUCTION. G. 7'.Cook. J. Urol. 101: 212-215 (February), 1969. This is an analysis of 93 cases of appendiceal abscess in patients aged 1 to 14 years of whom 16 developed urinary symptoms 4 to 14 days after the gastrointestinal symptoms. Four of these developed retention. Of 14 excretory urograms made 8 were abnormal, there being right ureteral obstruction in 6 cases and bilateral obstruction in 2. When the abscesses were drained and the mass causing ureteral compression subsided radiographic evidence of obstruction also disappeared.-B. M. Henderson. THE EARLY DIAGNOSIS AND SURGICAL TREATMENT OF HIRSCHSPRUNG'S DISEASE IN INFANCY. J. D. Atwell. Proc. Roy. Sot. Med. 61:339-340 (April), 1968. In a series
of 24 cases of Hirschsprung’s