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Significance of age, duration, obstruction and the dissection sign in intussusception
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tion of gut for children with Crohn’s disease and growth retardation has been controversial, the authors feel that if a child with Crohn’s disease, complicated by absolute or relative growth failure, cannot be helped by a combination of medical and nutritional support and the disease remains localized, resection and postoperative support would appear to have beneficial effects on growth and symptoms. In some of their patients this improvement occurred although puberty had already commenced.-D.M. Burge Pathology Mimicking Distal Intestinal Obstruction Syndrome in Cystic Fibrosis. A.M. Dalzell, D.P. Heax and H. Car@ Arch Dis
Child 65540-541, (May), 1990. The authors report eight patients with cystic fibrosis and recurrent abdominal pain who were suspected as having the diagnosis of distal intestinal obstruction syndrome (meconium ileus equivalent). Six of these eight patients had coexistent abdominal pathology: small bowel volvulus (2), Crohn’s disease (l), small bowel tistula (l), appendicitis (l), and an ovarian dermoid (1). Three of these patients initially had presented with meconium ileus. The authors stress the need to be aware of other causes of abdominal pain in children suspected of having meconium ileus equivalent, especially if their initial presentation was with meconium ileus.D.M. Burge
False-Positive Diagnosis of lntussusception in the Older Child by Contrast Enema. D. W Goh and S. Chapman. J R Co11Surg
(Edinb) 35:188-190, (June), 1990. Three children more than 2 years of age are reported, in whom contrast enema gave the false impression of reducing an intussusception. In one case an abdominal mass persisted after reduction of an ileocecal intussusception, and at laparotomy an abscess was found behind the ascending colon close to a perforated gangrenous appendix. In a second case an enema appeared to reduce an ileocecal intussusception. However, because only a short segment of ileum was filled with air, reduction was considered to be incomplete. At laparotomy there was an inflamed Meckel’s diverticulum. A 3-year-old child with acute lymphoblastic leukemia developed a mass and small bowel obstruction in association with gastrointestinal bleeding. An air enema was negative. Edematous distal small bowel found at Iaparotomy was thought to indicate a spontaneously reduced intussusception. Eight days later air enema was repeated because of a recurrent mass, and an intussusception in the transverse colon was reduced. Further rectal bleeding occurred, and another air enema suggested an irreducible intussusception in the transverse colon. A second laparotomy was performed and showed a hemorrhagic cecum and ascending colon. A right hemicolectomy was performed. Intussusception in older children is uncommon and an underlying cause should always be considered. The diagnostic difficulties in interpreting the contrast enemas in the three cases recorded are discussed. The possibility of a false-positive diagnosis should always be considered in atypical intussusceptiori-Zan K Drainer
Pneumatic Reduction: Advantages, Risks and Indications. D.A. Stringer and S.H. Ein. Pediatr Radio1 20:475-477, (July), 1990.
The authors discuss guidelines for pneumatic reduction of intussusception based on their experience with 364 children suspected of intussusception and studied with air enema. They found the pneumatic reduction technique to be quicker, safer, and more effective than barium enemas. The authors describe in detail the advantages, risks, and indications for pneumatic reduction.-Bern Pun’
INTERNATIONAL
ABSTRACTS
Significance of Age, Duration, Obstruction and the Dissection Sign in Intussusception. L.L. Barr, SD. Stansbeny, and L.E. Swichuk. Pediatr Radio1 20:454-456, (July), 1990.
This is a retrospective study of 60 consecutive patients with proven intussusception in whom an attempt was made to reduce intussusception by contrast enema. The study was undertaken to evaluate currently proposed contraindications to contrast enema reduction of intussusception. In regard to patient age, the authors found little difference between infants and those patients older than 2 years. The reduction rate in these groups was 75% and 67%, respectively. They found that intestinal obstruction and duration of symptoms over 48 hours are not contraindications to contrast enema reduction of childhood intussusception. Similarly, the dissection sign of barium tracking between the intussusceptum and intussuscipiens for a length of greater than 4 cm is not a contraindication either. Only when they encountered a combination of symptoms being present for greater than 48 hours and the presence of both small bowel obstruction and a dissection sign was reduction likely to be unsuccessful.-Prem Puti Triplication of the Intestine-Case Report for the Embryogenesis of Tubular and Cystic Duplications of the Small Intestine. H. Klumpp and J. Engert. Z Kinderchir 45:117-119, (April), 1990.
The authors report a 3-year-old boy with tubular and cystic triplication of the ileum that has not been described previously. Laparotomy was performed for recurrent massive bleeding and the entire involved ileum was resected. The source of bleeding was a lo- to g-mm ulceration within ectopic gastric mucosa that extended to the submucosa. Theories of pathogenesis are discussed, implying that there is no uniform genesis of this disorder. Clinical patterns, diagnosis, and treatment are the same as in the usual intestinal duplication.--Thomas A. Angerpointner Intestinal Atresia and Hirschsprung’s Disease. S. W! Moore, H. Rode, A.J. W. Millar, et al. Pediatr Surg Int 5:182-184, (May), 1990.
The authors report on three cases of intestinal atresia associated with Hirschsprung’s disease and review 26 cases in the literature. Nineteen of these cases involved the small bowel, six involved the colon, and four had multiple atresias. The implication of the myelomeningocele and potential etiological mechanisms of these associations are reviewed and the role of a vascular accident or the embryological failure of migration of nerve cells is discussed. The authors conclude that a volvulus proximal to the aganglionic bowel is most likely to result in the associated atresia.--Prem Pun’ Endorectal Pull-Through for Hirschsprung’s Disease: Report of 78 Cases. M. Schiller, IL Abu-Dalu, A. Gorenstein, et al. Pediatr
Surg Int 5:185-187, (May), 1990. The authors report on 78 patients with Hirschsprung’s disease who had a Soave endorectal pull-through procedure. Sixty-three patients (80%) had classical rectosigmoid disease; 15 (20%) had long-segment disease, and 1 had total colonic aganglionosis. Fortyfive patients (58%) were diagnosed as neonates, 28 (36%) as infants, and five when they were more than 1 year of age. Initial colostomy was performed proximal to the “transition zone” in 75 patients (96%). The majority of patients underwent the Soave endorectal pull-through before 1 year of age. The authors favor this procedure for Hirschsprung’s disease in infants and young children because their series showed no mortality, relatively low morbidity, and continence in all patients after follow-up periods ranging from 1 to 13 years.-Prem Pun‘
tion of gut for children with Crohn’s disease and growth retardation has been controversial, the authors feel that if a child with Crohn’s disease, complicated by absolute or relative growth failure, cannot be helped by a combination of medical and nutritional support and the disease remains localized, resection and postoperative support would appear to have beneficial effects on growth and symptoms. In some of their patients this improvement occurred although puberty had already commenced.-D.M. Burge Pathology Mimicking Distal Intestinal Obstruction Syndrome in Cystic Fibrosis. A.M. Dalzell, D.P. Heax and H. Car@ Arch Dis
Child 65540-541, (May), 1990. The authors report eight patients with cystic fibrosis and recurrent abdominal pain who were suspected as having the diagnosis of distal intestinal obstruction syndrome (meconium ileus equivalent). Six of these eight patients had coexistent abdominal pathology: small bowel volvulus (2), Crohn’s disease (l), small bowel tistula (l), appendicitis (l), and an ovarian dermoid (1). Three of these patients initially had presented with meconium ileus. The authors stress the need to be aware of other causes of abdominal pain in children suspected of having meconium ileus equivalent, especially if their initial presentation was with meconium ileus.D.M. Burge
False-Positive Diagnosis of lntussusception in the Older Child by Contrast Enema. D. W Goh and S. Chapman. J R Co11Surg
(Edinb) 35:188-190, (June), 1990. Three children more than 2 years of age are reported, in whom contrast enema gave the false impression of reducing an intussusception. In one case an abdominal mass persisted after reduction of an ileocecal intussusception, and at laparotomy an abscess was found behind the ascending colon close to a perforated gangrenous appendix. In a second case an enema appeared to reduce an ileocecal intussusception. However, because only a short segment of ileum was filled with air, reduction was considered to be incomplete. At laparotomy there was an inflamed Meckel’s diverticulum. A 3-year-old child with acute lymphoblastic leukemia developed a mass and small bowel obstruction in association with gastrointestinal bleeding. An air enema was negative. Edematous distal small bowel found at Iaparotomy was thought to indicate a spontaneously reduced intussusception. Eight days later air enema was repeated because of a recurrent mass, and an intussusception in the transverse colon was reduced. Further rectal bleeding occurred, and another air enema suggested an irreducible intussusception in the transverse colon. A second laparotomy was performed and showed a hemorrhagic cecum and ascending colon. A right hemicolectomy was performed. Intussusception in older children is uncommon and an underlying cause should always be considered. The diagnostic difficulties in interpreting the contrast enemas in the three cases recorded are discussed. The possibility of a false-positive diagnosis should always be considered in atypical intussusceptiori-Zan K Drainer
Pneumatic Reduction: Advantages, Risks and Indications. D.A. Stringer and S.H. Ein. Pediatr Radio1 20:475-477, (July), 1990.
The authors discuss guidelines for pneumatic reduction of intussusception based on their experience with 364 children suspected of intussusception and studied with air enema. They found the pneumatic reduction technique to be quicker, safer, and more effective than barium enemas. The authors describe in detail the advantages, risks, and indications for pneumatic reduction.-Bern Pun’
INTERNATIONAL
ABSTRACTS
Significance of Age, Duration, Obstruction and the Dissection Sign in Intussusception. L.L. Barr, SD. Stansbeny, and L.E. Swichuk. Pediatr Radio1 20:454-456, (July), 1990.
This is a retrospective study of 60 consecutive patients with proven intussusception in whom an attempt was made to reduce intussusception by contrast enema. The study was undertaken to evaluate currently proposed contraindications to contrast enema reduction of intussusception. In regard to patient age, the authors found little difference between infants and those patients older than 2 years. The reduction rate in these groups was 75% and 67%, respectively. They found that intestinal obstruction and duration of symptoms over 48 hours are not contraindications to contrast enema reduction of childhood intussusception. Similarly, the dissection sign of barium tracking between the intussusceptum and intussuscipiens for a length of greater than 4 cm is not a contraindication either. Only when they encountered a combination of symptoms being present for greater than 48 hours and the presence of both small bowel obstruction and a dissection sign was reduction likely to be unsuccessful.-Prem Puti Triplication of the Intestine-Case Report for the Embryogenesis of Tubular and Cystic Duplications of the Small Intestine. H. Klumpp and J. Engert. Z Kinderchir 45:117-119, (April), 1990.
The authors report a 3-year-old boy with tubular and cystic triplication of the ileum that has not been described previously. Laparotomy was performed for recurrent massive bleeding and the entire involved ileum was resected. The source of bleeding was a lo- to g-mm ulceration within ectopic gastric mucosa that extended to the submucosa. Theories of pathogenesis are discussed, implying that there is no uniform genesis of this disorder. Clinical patterns, diagnosis, and treatment are the same as in the usual intestinal duplication.--Thomas A. Angerpointner Intestinal Atresia and Hirschsprung’s Disease. S. W! Moore, H. Rode, A.J. W. Millar, et al. Pediatr Surg Int 5:182-184, (May), 1990.
The authors report on three cases of intestinal atresia associated with Hirschsprung’s disease and review 26 cases in the literature. Nineteen of these cases involved the small bowel, six involved the colon, and four had multiple atresias. The implication of the myelomeningocele and potential etiological mechanisms of these associations are reviewed and the role of a vascular accident or the embryological failure of migration of nerve cells is discussed. The authors conclude that a volvulus proximal to the aganglionic bowel is most likely to result in the associated atresia.--Prem Pun’ Endorectal Pull-Through for Hirschsprung’s Disease: Report of 78 Cases. M. Schiller, IL Abu-Dalu, A. Gorenstein, et al. Pediatr
Surg Int 5:185-187, (May), 1990. The authors report on 78 patients with Hirschsprung’s disease who had a Soave endorectal pull-through procedure. Sixty-three patients (80%) had classical rectosigmoid disease; 15 (20%) had long-segment disease, and 1 had total colonic aganglionosis. Fortyfive patients (58%) were diagnosed as neonates, 28 (36%) as infants, and five when they were more than 1 year of age. Initial colostomy was performed proximal to the “transition zone” in 75 patients (96%). The majority of patients underwent the Soave endorectal pull-through before 1 year of age. The authors favor this procedure for Hirschsprung’s disease in infants and young children because their series showed no mortality, relatively low morbidity, and continence in all patients after follow-up periods ranging from 1 to 13 years.-Prem Pun‘