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Unusual causes of gastric displacement in children
88
INTERNATIONAL
carcinoma were treated at the University of Texas Medical Branch. The lone survivor had a right hepatic lobeetomy for embryonal hepatocarcinoma at the age of 8 months and is alive and well at 44 months. The authors conclude that whereas the adult hepatocarcinoma is commonly associated with cirrhosis of the liver, multicentric origin and early metastasis, the childhood type is rarely associated with cirrhosis, is generally a single although large tumor mass within the liver, is associated with late metastases and presents a fair prognosis following surgical excision. In a review of the literature it was found that 15 of 37 children who survived the operative procedure were alive without evidence of metastases and 7 of these are now 5 year survivals. Radiation therapy was given in 23 cases but its effect was indeterminate due to scanty information given. Chemotherapy was of no benefit in 5 cases. An aggressive surgical approach is advocated.~E. 1. Berman. NONCALCULOUS DISTENSION OF THE GALLBLADDER IN CHILDHOOD. R. A. Bloom and V. A. J.
Swain. Arch. Dis. Child. 41:503-507, 1966. In a review of the literature, 21 cases were found of noncalculous distension of the gallbladder, and 5 further cases are described. The only constant feature was marked distension without obvious acute infection of the gallbladder. Nearly all the cases presented as an acute illness with abdominal pain and right-sided abdominal tenderness, usually accompanied by vomiting. Almost invariably, preoperative diagnosis was inaccurate and the laparotomy was performed for a probable diagnosis of acute appendicitis or intussusception; however, in 2 of the total of 9,6 cases, slight jaundice had been noted and in 16 cases a mass was palpated in the right upper quadrant. The uncommon preoperative diagnosis is explained by the uncommon occurrence of the disease. In the large majority of cases there had been no anatomical blockage of the cystic duct and in these cases it is suggested that the etiology is a transient inttammation of the cystic duct associated with mesenteric lymph adenitis caused by the virus of infectious hepatitis; it was significant that half of the recorded cases had a marked generalized mesenteric adenitis. These eases with no anatomical obstruction are effectively treated by simple aspiration of the gallbladder. In the presence of anatomical obstruction, however, it is suggested that cholecystostomy should be established and postoperative cholangiogram can then be used to demonstrate the ductal pattern. Cholecystectomy can be done on the basis of these eholangiogram findings, but there is no indication
A B S T R A C T S O F P E D I A T R I C SURGERY
for cholecystectomy as a primary procedure.--/. Lister. PANCREATODUODENECTOMY FOR I S L E T - C E L L T U MOR OF THE PANCREAS IN INFANCY AND CHILDHOOD; CASE REPORT WITH FIVE-YEAR SUR-
WVAL. E. W. Fonkals~'ud, J. A. Wilkerson, and W. P. Longmire, Jr. J.A.M.A. 197:586-588, August 15, 1966. Only 18 cases of carcinoma of the pancreas have been previously reported in children; 4 of these patients had jaundice and 5 had ulceration and hemorrhage. Three of the 4 patients treated by radical surgical extirpation of the tumor have survived, while all the remaining 14 have died. The case reported is that of an almost 3 year old white boy who had a radical panereatoduodenectomy for nonfunctioning islet-cell carcinoma after gastroenterostomy and x-ray therapy elsewhere. The tail of the pancreas was anastomosed to the jejunum, as was the gallbladder. Now at 8 years of age he has a mild malabsorption defect but weighs 48 pounds and requires no medication.--R. Spencer. RUPTURE OF THE SPLEEN IN A NEWBORN. G . C .
Parenti and A. Ciardini. Riv. Chir. Fed. 8:511516, July-Sept. 1966. A laparotomy was performed in a newborn 48 hours after birth because of acute progressive anemia, shock, distended abdomen and appearance of collection of body fluid in the left scrotum. A large hemoperitoneum and a ruptured spleen were found. Splenectomy was followed by uneventful recovery. The mechanism of trauma was obscure; the delivery was normal. Rough handling and patting of the baby's back, although not present in this case, are sometimes held responsible for the trauma.--C. A. M ontagnani. UNUSUAL CAUSES OF GASTmC DISPLACEMENT IN CHmDaEN. H. Grossman and F. Redo. Radiology 87:725-729, October 1966. Consideration of 4 unusual causes of abdominal masses creating pressure defects on the stomach should be included in the diagnostic possibilities of abdominal masses in children. Gastric duplications can create a continuum of symptoms ranging from none to obstruction and/or hemorrhage. They usually occur along the greater curvature near the antrum. Pseudocysts of the pancreas in children are generally secondary to trauma. Widening of the duodenal sweep in association with symptoms of abdominal pain, fullness, nausea, vomiting, and weight loss strongly suggest this possibility. Left-
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
sided gallbladder, although very rare can create a pressure defect on the stomach as can solitary cysts of the left lobe of liver, another possible but unusual lesion. Both are asymptomatic but creation of pressure defects on the stomach do occur. A radioactive liver scan with I L~I may be helpfid if the latter is cousidered.--W. L. Schey. GENITOURINARY
TRACT
THE ASSOCIATION OF LUMBOSACRAL SPINE AND
GENITOUmNARY ANOMALIES WITH IMPERFORATE ANVS. W. E. Berdon, B. Hoehberg, D. Baker, H. Grossman and T. V. Santulli. Amer. J. Roentgenol. 98:181-191, September 1966. Patients with imperforate anus have a high percentage of genitourinary tract anomalies and lumbosacral spine abnormalities. Lumbosacral anomalies and their degree of variation from normal are not directly related to the severity of the G.U. tract anomaly, functional (neurogenic) or anatomic. Dysplasias of the sacrum (exclusive of occult spina bifida), lumbar malsegmentation, hemivertebrae and lumbar episasis (extra lumbar vertebra), all suggest G.U. anomalies. Also related are narrowed disc spaces and coronal clefts in the lumbar a r e a . ~ W . L. Schey. ROENTGENOLOGIC EVALUATION OF RENAL TRAUMA WITH EMPHASIS ON RENAL ANGIOGRAPHY. M.
Elkin, C. H. Meng and R. G. deParedes. Amer. J. Roentgenol. 98:1-250 September 1966. The 3 major types of trauma are: (1) blunt trauma, (2) penetrating wounds and (3) operative injuries. Methods of classification include pathologic-anatomic, clinical, and roentgenologic. Each method of classification allows the patient to be placed in one of the following categories indicating the profundity of the injury: minor, major, or catastrophic. Minor injury infers short lasting hematuria with no alteration in vital signs. Major injury includes gross hematuria for several days, pain and a palpable mass. Catastrophic injury indicates obvious rapid deterioration and shock. Although the I.V.P. is the most significant study in evaluating these conditions, 24 cases are presented demonstrating the distinct advantages and value of aortography and selective renal angiography. Vascular and parenehymal abnormalities which are not evident on the I.V.P. are clearly demonstrated by the vascular studies in the cases presented.--W. L. Schey. URETERAL ECTOPIA, HYDEOCOLFOS, AND UTERUS
DIDELPHYS. H. M. Constantain. J.A.M.A. 197: 54-57, July 4, 1966.
89
This is the case of a 6 year old girl with dribbling of urine and a bulging membrane at the introitus. Appropriate investigation revealed a membranous septmn between the 2 halves of the double vagina with an almost complete obstruction of the orifice on the left. The left vaginal "cyst" was opened and the septum excised. At subsequent laparotomy the 2.5 cm. left kidney was removed along with its ureter, which had been found to empty into the left half of the vagina. The right kidney and ureter were normal, as were the ovaries. No identical case had previously been reported.--R. Spencer. INTER PYELO-ANASTOMOSISIN THE TREATIVLENTOF DOUBLE KIDNEYS. N. Genton. Z. Kinderchir. Suppl 101-115, 1966. Anastamosis of the renal pelvis (pyelopyelostomy) is preferably today to heminephrectomy. The author reports 11 patients of whom 9 were followed np to 2 years and showed satisfactory results. Using this method makes complete preservation of the renal parenchyma possible. The operative technic is reported in detail.--S. Hofman and H. B. Eckstein. URETEEIC POLYP IN CHILDREN. V. Grob-Vontobel Z. Kinderchir. Suppl. 115-121, 1966. The author describes the rare case of a benign ureteric polyp in a 13 year old boy. This was a 4 cm. long lesion occupying the upper prat of the left ureter in a child who also had a duplex right kidney. The polyp had more than 20 tentacles which were up to 21~ cm. long. Resection of the affected ureteric segment with end-to-end anastomosis resulted in a cure. The symptomatology, treatment and pathology are briefly discussed.--S. Hofman and H. B. Eckstein. DIVERTICULUA~[OF THE POSTERIOR URETHRA IN A CASE OF AGENESIS OF THE LEFT KIDNEY AND RETENTION OF THE LEFT TESTICLE. C, I. ]. Ponsioen. Arch. Chir. Neerl. 18:231, 1965. A congenital diverticulum of the posterior urethra is very rare and in many cases is associated with agenesis of a kidney and also with anomalies of the homolateral genital tract. An example of this anomaly in a 20 year old male patient, who underwent left orchiectomy at the age of 11, is described. As in many other cases, the anomaly was asymptomatic although causing pyuria. The author regards the diverticulum as a remnant of the
INTERNATIONAL
carcinoma were treated at the University of Texas Medical Branch. The lone survivor had a right hepatic lobeetomy for embryonal hepatocarcinoma at the age of 8 months and is alive and well at 44 months. The authors conclude that whereas the adult hepatocarcinoma is commonly associated with cirrhosis of the liver, multicentric origin and early metastasis, the childhood type is rarely associated with cirrhosis, is generally a single although large tumor mass within the liver, is associated with late metastases and presents a fair prognosis following surgical excision. In a review of the literature it was found that 15 of 37 children who survived the operative procedure were alive without evidence of metastases and 7 of these are now 5 year survivals. Radiation therapy was given in 23 cases but its effect was indeterminate due to scanty information given. Chemotherapy was of no benefit in 5 cases. An aggressive surgical approach is advocated.~E. 1. Berman. NONCALCULOUS DISTENSION OF THE GALLBLADDER IN CHILDHOOD. R. A. Bloom and V. A. J.
Swain. Arch. Dis. Child. 41:503-507, 1966. In a review of the literature, 21 cases were found of noncalculous distension of the gallbladder, and 5 further cases are described. The only constant feature was marked distension without obvious acute infection of the gallbladder. Nearly all the cases presented as an acute illness with abdominal pain and right-sided abdominal tenderness, usually accompanied by vomiting. Almost invariably, preoperative diagnosis was inaccurate and the laparotomy was performed for a probable diagnosis of acute appendicitis or intussusception; however, in 2 of the total of 9,6 cases, slight jaundice had been noted and in 16 cases a mass was palpated in the right upper quadrant. The uncommon preoperative diagnosis is explained by the uncommon occurrence of the disease. In the large majority of cases there had been no anatomical blockage of the cystic duct and in these cases it is suggested that the etiology is a transient inttammation of the cystic duct associated with mesenteric lymph adenitis caused by the virus of infectious hepatitis; it was significant that half of the recorded cases had a marked generalized mesenteric adenitis. These eases with no anatomical obstruction are effectively treated by simple aspiration of the gallbladder. In the presence of anatomical obstruction, however, it is suggested that cholecystostomy should be established and postoperative cholangiogram can then be used to demonstrate the ductal pattern. Cholecystectomy can be done on the basis of these eholangiogram findings, but there is no indication
A B S T R A C T S O F P E D I A T R I C SURGERY
for cholecystectomy as a primary procedure.--/. Lister. PANCREATODUODENECTOMY FOR I S L E T - C E L L T U MOR OF THE PANCREAS IN INFANCY AND CHILDHOOD; CASE REPORT WITH FIVE-YEAR SUR-
WVAL. E. W. Fonkals~'ud, J. A. Wilkerson, and W. P. Longmire, Jr. J.A.M.A. 197:586-588, August 15, 1966. Only 18 cases of carcinoma of the pancreas have been previously reported in children; 4 of these patients had jaundice and 5 had ulceration and hemorrhage. Three of the 4 patients treated by radical surgical extirpation of the tumor have survived, while all the remaining 14 have died. The case reported is that of an almost 3 year old white boy who had a radical panereatoduodenectomy for nonfunctioning islet-cell carcinoma after gastroenterostomy and x-ray therapy elsewhere. The tail of the pancreas was anastomosed to the jejunum, as was the gallbladder. Now at 8 years of age he has a mild malabsorption defect but weighs 48 pounds and requires no medication.--R. Spencer. RUPTURE OF THE SPLEEN IN A NEWBORN. G . C .
Parenti and A. Ciardini. Riv. Chir. Fed. 8:511516, July-Sept. 1966. A laparotomy was performed in a newborn 48 hours after birth because of acute progressive anemia, shock, distended abdomen and appearance of collection of body fluid in the left scrotum. A large hemoperitoneum and a ruptured spleen were found. Splenectomy was followed by uneventful recovery. The mechanism of trauma was obscure; the delivery was normal. Rough handling and patting of the baby's back, although not present in this case, are sometimes held responsible for the trauma.--C. A. M ontagnani. UNUSUAL CAUSES OF GASTmC DISPLACEMENT IN CHmDaEN. H. Grossman and F. Redo. Radiology 87:725-729, October 1966. Consideration of 4 unusual causes of abdominal masses creating pressure defects on the stomach should be included in the diagnostic possibilities of abdominal masses in children. Gastric duplications can create a continuum of symptoms ranging from none to obstruction and/or hemorrhage. They usually occur along the greater curvature near the antrum. Pseudocysts of the pancreas in children are generally secondary to trauma. Widening of the duodenal sweep in association with symptoms of abdominal pain, fullness, nausea, vomiting, and weight loss strongly suggest this possibility. Left-
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
sided gallbladder, although very rare can create a pressure defect on the stomach as can solitary cysts of the left lobe of liver, another possible but unusual lesion. Both are asymptomatic but creation of pressure defects on the stomach do occur. A radioactive liver scan with I L~I may be helpfid if the latter is cousidered.--W. L. Schey. GENITOURINARY
TRACT
THE ASSOCIATION OF LUMBOSACRAL SPINE AND
GENITOUmNARY ANOMALIES WITH IMPERFORATE ANVS. W. E. Berdon, B. Hoehberg, D. Baker, H. Grossman and T. V. Santulli. Amer. J. Roentgenol. 98:181-191, September 1966. Patients with imperforate anus have a high percentage of genitourinary tract anomalies and lumbosacral spine abnormalities. Lumbosacral anomalies and their degree of variation from normal are not directly related to the severity of the G.U. tract anomaly, functional (neurogenic) or anatomic. Dysplasias of the sacrum (exclusive of occult spina bifida), lumbar malsegmentation, hemivertebrae and lumbar episasis (extra lumbar vertebra), all suggest G.U. anomalies. Also related are narrowed disc spaces and coronal clefts in the lumbar a r e a . ~ W . L. Schey. ROENTGENOLOGIC EVALUATION OF RENAL TRAUMA WITH EMPHASIS ON RENAL ANGIOGRAPHY. M.
Elkin, C. H. Meng and R. G. deParedes. Amer. J. Roentgenol. 98:1-250 September 1966. The 3 major types of trauma are: (1) blunt trauma, (2) penetrating wounds and (3) operative injuries. Methods of classification include pathologic-anatomic, clinical, and roentgenologic. Each method of classification allows the patient to be placed in one of the following categories indicating the profundity of the injury: minor, major, or catastrophic. Minor injury infers short lasting hematuria with no alteration in vital signs. Major injury includes gross hematuria for several days, pain and a palpable mass. Catastrophic injury indicates obvious rapid deterioration and shock. Although the I.V.P. is the most significant study in evaluating these conditions, 24 cases are presented demonstrating the distinct advantages and value of aortography and selective renal angiography. Vascular and parenehymal abnormalities which are not evident on the I.V.P. are clearly demonstrated by the vascular studies in the cases presented.--W. L. Schey. URETERAL ECTOPIA, HYDEOCOLFOS, AND UTERUS
DIDELPHYS. H. M. Constantain. J.A.M.A. 197: 54-57, July 4, 1966.
89
This is the case of a 6 year old girl with dribbling of urine and a bulging membrane at the introitus. Appropriate investigation revealed a membranous septmn between the 2 halves of the double vagina with an almost complete obstruction of the orifice on the left. The left vaginal "cyst" was opened and the septum excised. At subsequent laparotomy the 2.5 cm. left kidney was removed along with its ureter, which had been found to empty into the left half of the vagina. The right kidney and ureter were normal, as were the ovaries. No identical case had previously been reported.--R. Spencer. INTER PYELO-ANASTOMOSISIN THE TREATIVLENTOF DOUBLE KIDNEYS. N. Genton. Z. Kinderchir. Suppl 101-115, 1966. Anastamosis of the renal pelvis (pyelopyelostomy) is preferably today to heminephrectomy. The author reports 11 patients of whom 9 were followed np to 2 years and showed satisfactory results. Using this method makes complete preservation of the renal parenchyma possible. The operative technic is reported in detail.--S. Hofman and H. B. Eckstein. URETEEIC POLYP IN CHILDREN. V. Grob-Vontobel Z. Kinderchir. Suppl. 115-121, 1966. The author describes the rare case of a benign ureteric polyp in a 13 year old boy. This was a 4 cm. long lesion occupying the upper prat of the left ureter in a child who also had a duplex right kidney. The polyp had more than 20 tentacles which were up to 21~ cm. long. Resection of the affected ureteric segment with end-to-end anastomosis resulted in a cure. The symptomatology, treatment and pathology are briefly discussed.--S. Hofman and H. B. Eckstein. DIVERTICULUA~[OF THE POSTERIOR URETHRA IN A CASE OF AGENESIS OF THE LEFT KIDNEY AND RETENTION OF THE LEFT TESTICLE. C, I. ]. Ponsioen. Arch. Chir. Neerl. 18:231, 1965. A congenital diverticulum of the posterior urethra is very rare and in many cases is associated with agenesis of a kidney and also with anomalies of the homolateral genital tract. An example of this anomaly in a 20 year old male patient, who underwent left orchiectomy at the age of 11, is described. As in many other cases, the anomaly was asymptomatic although causing pyuria. The author regards the diverticulum as a remnant of the