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Acute abdomen in children with infected ventriculoperitoneal shunts
984
ABSTRACTS
and proper parental instruction are emphasized in preventing morbidity associated with the pediatric colostomy.--George A. Rowe ABDOMEN Computed Tomographic Imaging of Abdominal Abnormalities in Infancy and Childhood. jr. p. Kuhn and P. E. Berger.
Pediatr Ann 9(5):44-60, (May), 1980. The authors state that C T provides imaging superior to that possible with other techniques in 3 ways: (1) The axial tomographic view is free of confusing shadows or shapes caused by structures lying between the imaging instrument and the target organ, (2) there is increased contrast resolution, and (3) the technique makes it possible to measure tissue densities. Thus, organ margins such as renal borders not seen on conventional radiographs are clearly visible. The disadvantages include the radiation dose that perhaps is 2-10 times than that of an intravenous pyelogram, the cost, the limitations of the technique which are that it gives only cross-sectional pictures, and a problem peculiar to children in that many of the organs are not surrounded by fat as they are in adults and are thus a little harder to demonstrate. The authors recommend a scanner with a short scan time (2 sec) that makes general anesthesia usually unnecessary. Gastrografin may be used to help demonstrate the bowel. Indications include diagnosis of an abdominal mass such as a Wilm's tumor which is illustrated, and adrenal neuroblastoma, lymphatic involvement with tumor, pelvic masses, paraspinal masses, abdominal abscesses, serious blunt abdominal trauma in which C T can be useful examining for renal injury more accurately than the IVP can. Injury to the liver, spleen, and pancreas can also be well delineated.--David L. Collins Giant Exomphalos--Conservative or Operative Treatment? David C. S. Gough and Alex W. Auldisl. Arch Dis
Child 54:441-444, (June), 1979. In the 10-yr period 1967 1977, 17 of 87 patients admitted to a neonatal unit with exomphalos had a defect greater than 5 cm in diameter at its base (giant exomphalos). Of these, 3 were suitable for primary closure, 6 were treated by the Shuster silon pouch technique, and 8 were managed nonoperatively by 2% aqueous mercurochrome applications. In the silon pouch treated group, no patient had any other major malformation but all patients required parenteral feeding. Two patients died within 2 wk from gram-negative sepsis and, of the 4 survivors, 2 required major reconstructive surgery. The stay in hospital ranged from 4 to 7 wk. O f the 8 patients treated conservatively, 2 died early from major associated anomalies and 1 died from achromobacter sepsis. Of the 5 survivors, 4 needed minor reconstructive surgery. One patient failed to thrive while mercurochrome was being applied but gained weight well when pure alcohol solution was substituted. The failure was ascribed to mercury intoxication and this possibility was considered in a second patient who was mentally retarded with microcephaly. Hospital stay in the group was from 6 to 16 wk. The improved mortality from 10 of 13 patients (1952-1962) to 5 of 17 patients (1967 1977) in this neonatal unit was related mainly to better respiratory support, intravenous nutrition and new antibiotics rather than to changing techniques of manage-
ment of the lesion. The authors consider that secondary surgery is of lesser extent in the conservatively treated patients; that sepsis is a greater threat when a silon pouch is in place; that risks of mercury intoxication can be minimised by removal of the impurity of free mercury from mercurochrome; but that hospital stay is shorter in the surgicallytreated group. They conclude that mortality differs little between patients managed conservatively and those treated by staged surgery with a silon pouch. P . A . M . Raine Cholecystitis, Cholelithiasis, and Common Duct Stenosis in Children a n d A d o l e s c e n t s . G. I4I. Holcomb, J. A. O'Neill Jr., and G. IJL Holcomb IlL A n n Surg 19I :626-635, (May), 1980.
A retrospective study of 100 patients between the ages of 5 wk and 18 yr were studied from 1950 through 1975 for acalculous cholecystitis, cholelithiasis, and common duct obstruction secondary to stones or stenosis with or without pancreatitis. In the seven children aged 14 mo through 15 yr, there was a 5:2 male to female patient ratio. Obstruction of the cystic duct with subsequent inflammation appeared to be the most common cause. Fever, nausea, vomiting, diarrhea, dehydration, and subhepatic tenderness were the most common findings. This was treated successfully by cholecystectomy. Seventy-four patients without hemolytic disease aged 5-18 yr had cholelithiasis. There were 69 females in this group, which was predominantly caucasian, and only 5 had a family history. Eleven children had hemolytic disorders as the basis for their cholelithiasis. Of the females with cholelithiasis, 65% had been pregnant; none had hemolytic disease. Oral cholecystography was the most useful diagnostic test. Cholecystectomy was the treatment of choice. Five boys between 4 mo and 8 yr, and one 9-yr-old girl were evaluated for chronic relapsing pancreatitis associated with stenosis of the ampulla of Vater. All of these children were jaundiced. Two oat of the six children had hyperamylasemia. Cholecystectomy with appropriate drainage of the common bile duct was done in all cases. An additional two children had stenosis of the common hepatic duct at its junction with the cystic duct. Both children were thought to have chronic acute hepatitis and were symptom-free. Surgical procedures were tailored to the specific anatomic configurations of the congenitally deformed ducts.--Jane F. Goldthorn Acute Abdomen in Children With Infected Ventriculoperitoneal Shunts. O. R. Hubschmann and R. IF. Countee. Arch
Surg 115:305-307, (March), 1980. Seven children with infected ventriculoperitoneal shunts presented themselves with signs and symptoms of an acute abdomen. Three children underwent a negative laparotomy for acute appendicitis. Four children had initial diagnosis of gastroenteritis, possible appendicitis. In all, there was a delay in diagnosis and treatment. The correct diagnosis was made by ventricular fluid analysis from the shunt reservoir. Immediate analysis of ventricular fluid should be carried out in a child who has a shunt and an acute abdomen. If gram positive organisms are identified laparotomy is not indicated. However, finding gram negative organisms suggests an inflamed or perforated abdominal viscus as the likely etiology.--George A. Rowe
ABSTRACTS
and proper parental instruction are emphasized in preventing morbidity associated with the pediatric colostomy.--George A. Rowe ABDOMEN Computed Tomographic Imaging of Abdominal Abnormalities in Infancy and Childhood. jr. p. Kuhn and P. E. Berger.
Pediatr Ann 9(5):44-60, (May), 1980. The authors state that C T provides imaging superior to that possible with other techniques in 3 ways: (1) The axial tomographic view is free of confusing shadows or shapes caused by structures lying between the imaging instrument and the target organ, (2) there is increased contrast resolution, and (3) the technique makes it possible to measure tissue densities. Thus, organ margins such as renal borders not seen on conventional radiographs are clearly visible. The disadvantages include the radiation dose that perhaps is 2-10 times than that of an intravenous pyelogram, the cost, the limitations of the technique which are that it gives only cross-sectional pictures, and a problem peculiar to children in that many of the organs are not surrounded by fat as they are in adults and are thus a little harder to demonstrate. The authors recommend a scanner with a short scan time (2 sec) that makes general anesthesia usually unnecessary. Gastrografin may be used to help demonstrate the bowel. Indications include diagnosis of an abdominal mass such as a Wilm's tumor which is illustrated, and adrenal neuroblastoma, lymphatic involvement with tumor, pelvic masses, paraspinal masses, abdominal abscesses, serious blunt abdominal trauma in which C T can be useful examining for renal injury more accurately than the IVP can. Injury to the liver, spleen, and pancreas can also be well delineated.--David L. Collins Giant Exomphalos--Conservative or Operative Treatment? David C. S. Gough and Alex W. Auldisl. Arch Dis
Child 54:441-444, (June), 1979. In the 10-yr period 1967 1977, 17 of 87 patients admitted to a neonatal unit with exomphalos had a defect greater than 5 cm in diameter at its base (giant exomphalos). Of these, 3 were suitable for primary closure, 6 were treated by the Shuster silon pouch technique, and 8 were managed nonoperatively by 2% aqueous mercurochrome applications. In the silon pouch treated group, no patient had any other major malformation but all patients required parenteral feeding. Two patients died within 2 wk from gram-negative sepsis and, of the 4 survivors, 2 required major reconstructive surgery. The stay in hospital ranged from 4 to 7 wk. O f the 8 patients treated conservatively, 2 died early from major associated anomalies and 1 died from achromobacter sepsis. Of the 5 survivors, 4 needed minor reconstructive surgery. One patient failed to thrive while mercurochrome was being applied but gained weight well when pure alcohol solution was substituted. The failure was ascribed to mercury intoxication and this possibility was considered in a second patient who was mentally retarded with microcephaly. Hospital stay in the group was from 6 to 16 wk. The improved mortality from 10 of 13 patients (1952-1962) to 5 of 17 patients (1967 1977) in this neonatal unit was related mainly to better respiratory support, intravenous nutrition and new antibiotics rather than to changing techniques of manage-
ment of the lesion. The authors consider that secondary surgery is of lesser extent in the conservatively treated patients; that sepsis is a greater threat when a silon pouch is in place; that risks of mercury intoxication can be minimised by removal of the impurity of free mercury from mercurochrome; but that hospital stay is shorter in the surgicallytreated group. They conclude that mortality differs little between patients managed conservatively and those treated by staged surgery with a silon pouch. P . A . M . Raine Cholecystitis, Cholelithiasis, and Common Duct Stenosis in Children a n d A d o l e s c e n t s . G. I4I. Holcomb, J. A. O'Neill Jr., and G. IJL Holcomb IlL A n n Surg 19I :626-635, (May), 1980.
A retrospective study of 100 patients between the ages of 5 wk and 18 yr were studied from 1950 through 1975 for acalculous cholecystitis, cholelithiasis, and common duct obstruction secondary to stones or stenosis with or without pancreatitis. In the seven children aged 14 mo through 15 yr, there was a 5:2 male to female patient ratio. Obstruction of the cystic duct with subsequent inflammation appeared to be the most common cause. Fever, nausea, vomiting, diarrhea, dehydration, and subhepatic tenderness were the most common findings. This was treated successfully by cholecystectomy. Seventy-four patients without hemolytic disease aged 5-18 yr had cholelithiasis. There were 69 females in this group, which was predominantly caucasian, and only 5 had a family history. Eleven children had hemolytic disorders as the basis for their cholelithiasis. Of the females with cholelithiasis, 65% had been pregnant; none had hemolytic disease. Oral cholecystography was the most useful diagnostic test. Cholecystectomy was the treatment of choice. Five boys between 4 mo and 8 yr, and one 9-yr-old girl were evaluated for chronic relapsing pancreatitis associated with stenosis of the ampulla of Vater. All of these children were jaundiced. Two oat of the six children had hyperamylasemia. Cholecystectomy with appropriate drainage of the common bile duct was done in all cases. An additional two children had stenosis of the common hepatic duct at its junction with the cystic duct. Both children were thought to have chronic acute hepatitis and were symptom-free. Surgical procedures were tailored to the specific anatomic configurations of the congenitally deformed ducts.--Jane F. Goldthorn Acute Abdomen in Children With Infected Ventriculoperitoneal Shunts. O. R. Hubschmann and R. IF. Countee. Arch
Surg 115:305-307, (March), 1980. Seven children with infected ventriculoperitoneal shunts presented themselves with signs and symptoms of an acute abdomen. Three children underwent a negative laparotomy for acute appendicitis. Four children had initial diagnosis of gastroenteritis, possible appendicitis. In all, there was a delay in diagnosis and treatment. The correct diagnosis was made by ventricular fluid analysis from the shunt reservoir. Immediate analysis of ventricular fluid should be carried out in a child who has a shunt and an acute abdomen. If gram positive organisms are identified laparotomy is not indicated. However, finding gram negative organisms suggests an inflamed or perforated abdominal viscus as the likely etiology.--George A. Rowe