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Abdominal masses in the newborn: 63 cases
740 sion. Abdominally, the pulled-through colon is sutured loosely to the rectal stump circumferentially. Finger bouginage is begun on the second postoperative day. Within 2 wk the colon retracts into the rectum. The procedure has been used in eight patients aged 2-14 mo. Seven are completely well; one continues to be constipated. The authors believe the division of the internal sphincter relieves the abnormal tonicity of the internal sphincter. -William K. Sieber Juvenile Polyps of the Colon and Rectum. R. Franklin and B. h&Swain. Ann. Surg. 175397-891 (June), 1972. Microscopic study of all polypoid lesions of the colon and rectum received in the Vanderbilt University Hospital Surgical Pathology Laboratory from 1925 to 1970 revealed 100 cases that fit their pathologic criteria of juvenile polyps. The authors report no detectable microscopic difference between the polyps in children and those in adults. In 100 patients, 64 were less than IO yr of age, and 79 less than 20 yr of age. There were 21 patients over 20 yr old and five who were over 50. The eldest was 61. The sex distribution was 58 males and 42 females. The most common complaint was bright red blood from the rectum. Anemia was found in three patients. The sites of juvenile polyps are similar to those of adenomatous polyps or carcinoma. The rectum was most common site, with the rectosigmoid next in frequency. Most of the polyps were removed through the rectum or through the sigmoidoscope. Seventy patients had single polyps and 30 had two or more. Twenty-six of the 30 patients with multiple polyps were less than 20 yr of age. In no patient did polypoid or villous adenoma exist with juvenile polyps. COexisting adenomatous polyps or villous adenomas were not seen in the group of 30 patients with multiple polyps. In view of this fact, and because of the high incidence of autoamputation, the authors believe that excision is less imperative in a patient with juvenile polyps beyond the reach of the sigmoidoscope.-Frank G. DeLuca. Benign Lymphatic Hyperplasla of the Rectum. J. R. Po/ey and E. I. Smith. Southern Med. J. W420-422 (April), 1972.
ABSTRACTS Benign lymphatic hyperplasia of the rectum is rare but occasionally is seen in childhood and can be a presenting cause of rectal bleeding. The authors report a lo-yrold child who previously was thought to have ulcerative colitis and was treated for 2% yr for this condition. A repeat proctoscopy revealed a cobbly granular surface in the rectum. A full-thickness rectal biopsy showed benign follicular lymphoid hyperplasia with local superficial ulceration. Azuliidine medication was discontinued and a stool softener was prescribed. A folIow-up visit 6 mo later revealed no further complaints. The authors report that the prognosis of this condition is good, but it is not known at what time and to what extent one should expect regression of lymphatic tissue. -George Holcomb
ABDOMEN The Airless Abdomen In the Newborn Infant. Joseph M. LoPresit, Massound Meld, and Judson G. Randolph. Southern Med. J. 65:3CW311 (March), 1972. A deficient amount of air or an “airless abdomen” in a neonate is abnormal and the authors add another previously not recognized etiology to this list. They report five neonates who had incomplete rotation of the colon with an associated midgut volvulus. Thus, the authors conclude it is possible to make a presumptive presurgical diagnosis on the basis of the clinical features together with the radiographic changes.-George Holcomb Abdominal Masses in the Newborn: 63 Cases. J. J. Wedge, J. &. Grosfeld, and J. D. Smith. J. Ural. 106:77&775 (November), 1971. Forty-seven of 63 newborn infants were noted to have masses of renal origin. The remainder included six in the gastrointestinal tract, live in the retroperitoneum. three in the female genital tract, and two in the liver. Of the 47 renal masses, 27 were hydronephrosis, 17 were cystic disease, two were renal vein thrombosis, and one was a benign leiomyoma. All the retroperitoneal masses were neuroblastoma. The female genital masses were two ovarian cysts and
741
ABSTRACTS one hydrometrocolpos. The hepatic masses were vascular tumors. The gastrointestinal tract had three duplications, two meconinum peritonitis, and one cystic teratoma of the stomach. The authors emphasize the predominence of renal origin lesions, and advocate early i.v.p. and vena cavagram. -S. Kim Subscapsular Hematoma of the Liver. Herome P. Richie and Eric W. Fonkalsrud. Arch. Surg. l&4:781 (June), 1972. Indications for laporatomy following trauma are nonclotting blood after paracentesis, pneumoperitoneum, continuing hemorrhage and shock, persistent unexplained abdominal pain and tenderness, retroperitoneal bleeding or gas, increasing distention, rising pulse, and loss of bowel sounds. If hepatic trauma is suspected and immediate exploration is not indicated, the patient should have a liver scan. Lesions 3-5 cm in diameter can be demonstrated. If subscapular hematoma is present, the patient is followed with careful observation, hematocrit determinations, and liver function studies. Four patients (of whom two are children) are presented. -Edward
1. Berman
Auxiliary Transplantation of the Canine Liver. K. K. Pandey, P. Puri, S. K. Grover, S. M. Choudhury, D. M. Gupta, and R. Nigram. Indian J. Surg. 33:255-263 (July), 1971.
Using adult mongrel dogs, a comparative study of three different techniques of auxiliary liver transplantation was carried out: in the right lumbar region, in the pelvis, and in the left hypochondrium. Transplantation into the pelvis, in which the liver was revascularized with the iliac vessels, was distinctly superior and less traumatic than the ,other two procedures, as evidenced by the longer survivals.-R. K. Ghandi Portal Hypertension in Childhood. J. A. Pinkerton, G. W. Holcomb, and J. H. Foster. Ann. Surg. 175:87Q-883 (June), 1972. The authors review the course and management of 33 children under the age of 15 yr treated for portal hypertension in the
Vanderbilt Medical Center. Thrombosis of the portal vein was the cause of portal hypertension in u patients. The major differences of the course and management of those patients with cirrhosis and portal vein thrombosis are stressed. In both groups splenoportography was the definitive diagnostic study. A portal-systemic shunt is advocated as most likely to produce a lasting good result. The best results (100% patency) were obtained with portocaval shunts in children with cirrhosis. The worse results (30% patency) were obtained with splenorenal shunts in children with portal vein thrombosis. Shunt thrombosis in the latter group was related to age and size of vessels. It is recommended that a portosystemic shunt be performed after the age of 9 yr in the group with portal vein thrombosis. Conservative measures to control bleeding are outlined, and, in the authors’ experience, will control most bleeding episodes so that a portosystemic shunt can be deferred until after 6 yr of age. The results of splenorenal and mesocaval shunts are reported and compared; the mesocaval shunt may be the procedure of choice in most cases. Splenectomy alone is not indicated. The authors report that although shunt patency in the cirrhotic children in their series was 90%, the ultimate prognosis is
closely related to the hepatic reserve, much as in the adult cirrhotic. There were five .ieaths in the ten patients with cirrhosis. Of the 23 patients with portal vein thrombo-
sis, 19 are living. Prognosis is excellent in patients with portal vein thrombosis if a successful portal-systemic shunt can be constructed.-Frank G. DeLuca Elevated Inferior Vena Cava Pressure In Ascites. Therapeutic Implications in Portacaval Shunt. V. A. Vix and T. K. Payne. Amer. J. Surg. 123:721 (June), 1972. Ascites not controlled by medical therapy developed in a patient after portacaval shunting. The shunt was demonstrated to be patent. A pressure gradient of 20 mm Hg was measured between the inferior vena cava and the right atrium. Paracentesis abolished this gradient and returned the vena cava pressure to normal. Ascites was then readily controlled. Under these cir-
ABSTRACTS Benign lymphatic hyperplasia of the rectum is rare but occasionally is seen in childhood and can be a presenting cause of rectal bleeding. The authors report a lo-yrold child who previously was thought to have ulcerative colitis and was treated for 2% yr for this condition. A repeat proctoscopy revealed a cobbly granular surface in the rectum. A full-thickness rectal biopsy showed benign follicular lymphoid hyperplasia with local superficial ulceration. Azuliidine medication was discontinued and a stool softener was prescribed. A folIow-up visit 6 mo later revealed no further complaints. The authors report that the prognosis of this condition is good, but it is not known at what time and to what extent one should expect regression of lymphatic tissue. -George Holcomb
ABDOMEN The Airless Abdomen In the Newborn Infant. Joseph M. LoPresit, Massound Meld, and Judson G. Randolph. Southern Med. J. 65:3CW311 (March), 1972. A deficient amount of air or an “airless abdomen” in a neonate is abnormal and the authors add another previously not recognized etiology to this list. They report five neonates who had incomplete rotation of the colon with an associated midgut volvulus. Thus, the authors conclude it is possible to make a presumptive presurgical diagnosis on the basis of the clinical features together with the radiographic changes.-George Holcomb Abdominal Masses in the Newborn: 63 Cases. J. J. Wedge, J. &. Grosfeld, and J. D. Smith. J. Ural. 106:77&775 (November), 1971. Forty-seven of 63 newborn infants were noted to have masses of renal origin. The remainder included six in the gastrointestinal tract, live in the retroperitoneum. three in the female genital tract, and two in the liver. Of the 47 renal masses, 27 were hydronephrosis, 17 were cystic disease, two were renal vein thrombosis, and one was a benign leiomyoma. All the retroperitoneal masses were neuroblastoma. The female genital masses were two ovarian cysts and
741
ABSTRACTS one hydrometrocolpos. The hepatic masses were vascular tumors. The gastrointestinal tract had three duplications, two meconinum peritonitis, and one cystic teratoma of the stomach. The authors emphasize the predominence of renal origin lesions, and advocate early i.v.p. and vena cavagram. -S. Kim Subscapsular Hematoma of the Liver. Herome P. Richie and Eric W. Fonkalsrud. Arch. Surg. l&4:781 (June), 1972. Indications for laporatomy following trauma are nonclotting blood after paracentesis, pneumoperitoneum, continuing hemorrhage and shock, persistent unexplained abdominal pain and tenderness, retroperitoneal bleeding or gas, increasing distention, rising pulse, and loss of bowel sounds. If hepatic trauma is suspected and immediate exploration is not indicated, the patient should have a liver scan. Lesions 3-5 cm in diameter can be demonstrated. If subscapular hematoma is present, the patient is followed with careful observation, hematocrit determinations, and liver function studies. Four patients (of whom two are children) are presented. -Edward
1. Berman
Auxiliary Transplantation of the Canine Liver. K. K. Pandey, P. Puri, S. K. Grover, S. M. Choudhury, D. M. Gupta, and R. Nigram. Indian J. Surg. 33:255-263 (July), 1971.
Using adult mongrel dogs, a comparative study of three different techniques of auxiliary liver transplantation was carried out: in the right lumbar region, in the pelvis, and in the left hypochondrium. Transplantation into the pelvis, in which the liver was revascularized with the iliac vessels, was distinctly superior and less traumatic than the ,other two procedures, as evidenced by the longer survivals.-R. K. Ghandi Portal Hypertension in Childhood. J. A. Pinkerton, G. W. Holcomb, and J. H. Foster. Ann. Surg. 175:87Q-883 (June), 1972. The authors review the course and management of 33 children under the age of 15 yr treated for portal hypertension in the
Vanderbilt Medical Center. Thrombosis of the portal vein was the cause of portal hypertension in u patients. The major differences of the course and management of those patients with cirrhosis and portal vein thrombosis are stressed. In both groups splenoportography was the definitive diagnostic study. A portal-systemic shunt is advocated as most likely to produce a lasting good result. The best results (100% patency) were obtained with portocaval shunts in children with cirrhosis. The worse results (30% patency) were obtained with splenorenal shunts in children with portal vein thrombosis. Shunt thrombosis in the latter group was related to age and size of vessels. It is recommended that a portosystemic shunt be performed after the age of 9 yr in the group with portal vein thrombosis. Conservative measures to control bleeding are outlined, and, in the authors’ experience, will control most bleeding episodes so that a portosystemic shunt can be deferred until after 6 yr of age. The results of splenorenal and mesocaval shunts are reported and compared; the mesocaval shunt may be the procedure of choice in most cases. Splenectomy alone is not indicated. The authors report that although shunt patency in the cirrhotic children in their series was 90%, the ultimate prognosis is
closely related to the hepatic reserve, much as in the adult cirrhotic. There were five .ieaths in the ten patients with cirrhosis. Of the 23 patients with portal vein thrombo-
sis, 19 are living. Prognosis is excellent in patients with portal vein thrombosis if a successful portal-systemic shunt can be constructed.-Frank G. DeLuca Elevated Inferior Vena Cava Pressure In Ascites. Therapeutic Implications in Portacaval Shunt. V. A. Vix and T. K. Payne. Amer. J. Surg. 123:721 (June), 1972. Ascites not controlled by medical therapy developed in a patient after portacaval shunting. The shunt was demonstrated to be patent. A pressure gradient of 20 mm Hg was measured between the inferior vena cava and the right atrium. Paracentesis abolished this gradient and returned the vena cava pressure to normal. Ascites was then readily controlled. Under these cir-