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Air reduction of intussusception in infants and children
876
"syndrome'might be related to gastric dysmotility, nuclear evaluation was routinely quantified. Essentially half of the patients were labeled as abnormal (> 50% retention of radionuclide at 90 minutes). This was, however, different from what was thought to be significantly abnormal for consideration of combining pyloroplasty with fundoplication. In the later comments section of the article, 50% to 65% retention at 90 minutes is considered to be borderline gastric dysmotility. The addition of a pyloroplasty is only considered when retention is >65% to 90 minutes.--Thomas V. Whalen Nissen Fundoplication and Pyloroplasty in the Management of Gastro-Oesophageal Reflux in Children, B.R. Davidson, Diana M.
INTERNATIONAL ABSTRACTS
a palpable pyloric mass at some time prior to surgery. Eighty-one percent had at least one imaging study (upper gastrointestinal series or sonogram); 9% had both. A comparison with three outlying hospitals showed similar figures, with a tendency toward UGI rather than sonogram. Most of the imaging studies were ordered by non-surgeons. The researchers suggest that imaging studies be reserved for a select group of infants with vomiting, in whom (1) no olive is felt by an experienced examiner, (2) persistent vomiting occurs without obstructive signs, (3) persistent vomiting in those infants in whom prior surgery or disease handicaps the physical exam, and (4) infants with bilious vomiting or conditions not suspected to be pyloric stenosis.--Jeffrey L. Zitsman
Hurd, and M.S. Johnstone. Br J Surg 74:488-490, (June), 1987. A retrospective study was carried out of children undergoing Nissen fundoplication and pyloroplasty for the correction of gastroesophageal reflux. Twenty children (13 males, 7 females) aged 8 months to 12 years underwent surgery over a 10-year period. Forty percent were mentally retarded. Presentation was failure to thrive in 19 (95%), recurrent vomiting in 18 (90%), and hematemesis in 14 (70%). Four children had Barrett's esophagus. There were no operative or perioperative mortalities. Follow-up (mean period, 3 years, 9 months) showed no further symptoms of reflux. The "normal" children gained weight postoperatively, whereas the "retarded" group did not. Adhesion obstruction (10%) was the major late postoperative complication. Regression of Barrett's epithelium was noted endoscopically. "Gas-bloat" syndrome, a major complication following fundoplication, was not encountered.--Lewis Spitz Gastroesophageal Reflux Associated With Nemaline Myopathy of Infancy. S. Berezin, L.J. Newman, S.M. Schwarz, et al. Pediatrics
81:111-115, (January), 1988. The researchers present three cases of infants with nemaline myopathy, an inherited skeletal muscle disorder associated with weakness and hypotonia. Each patient suffered from failure to thrive and lower respiratory tract infections, pH studies documented prolonged gastroesophageal reflux in each. All three patients failed medical therapy with bethanechol and metoclopramide. Nissen fundoplication resulted in correction of reflux with subsequent weight gain.--Jeffrey L. Zitsman Adhesion Obstruction Following Nissan Fundoplication in Children.
B.M. Wilkins and L. Spitz. Br J Surg 74:777-779, (September), 1987. The incidence of postoperative adhesion obstruction among 156 children who had undergone Nissen fundoplication for intractable gastroesophageal relux was determined. There were 18 episodes of obstruction in 16 patients (10.3%) requiring surgical treatment. The mean interval between fundoplication and adhesion obstruction was 10 months (range 10 days to 4 years). Additional procedures performed at the original laparotomy increased the risk of developing obstruction. Laparotomy for adhesion obstruction was required in 21% of patients who had a Ladd's procedure, 18% who had a gastrostomy, and 12% who had an appendicectomy. The incidence of obstruction in those with no additional procedure was 2%. Presenting symptoms were atypical because many of these children were unable to vomit. Only three did vomit, but all had radiologic appearances suggestive of small bowel obstruction. There were two deaths directly related to adhesion obstruction.--P. Malone Changing Patterns in the Diagnosis of Hypertrophic Pyloric Stenosis. C.W. Breaux, Jr, K.E. Georgeion, S.A. Royal, et al. Pediatrics
81:213-217, (February), 1988. The investigators reviewed 216 cases of surgically-corrected hypertrophic pyloric stenosis. Eighty-nine percent of the infants had
Pyloromyotomy: Can the Morbidity Be Improved? J. Beynon, R. Brown, C. James, et al. J R Coil Surg (Edinb) 32:291-292, (November), 1987.
The complications seen in 100 cases of pyloric stenosis treated by pyloromyotomy are reviewed. The diagnosis was made on palpation of a "tumor" in 90 cases. The remainder required a barium meal. All had intravenous fluids and nasogastric aspiration prior to surgery. Sixty-six had a right paramedian and 34 had a transverse skin incision. Sixty operations were performed by senior surgeons and 40 by training grades. Complications occurred in 19 and included wound infection (14), dehiscence (5), and mucosal breach (3). There was one death due to a missed mucosal breach. The surgeons' experience had no influence on the results. The one significant finding was a much lower infection rate in the group with a transverse incision. The use of this incision with prophylactic antibiotics is recommended.--W.G. Scobie
Air Reduction of Intussusception in Infants and Children. K.
Tamanaha, K. Wimbish, Y.B. Talwalker et al. J Pediatr 111:733736, (November), 1987, The authors describe their technique for air reduction of intussusception. A success rate of 81% (167/207 episodes) is reported. The tentative diagnosis of intussusception was made by evaluation of the clinical findings and initial radiographs. Ages ranged from 1 month to 7 years. There were 18 recurrences in 11 patients, and all of these were reduced again successfully. Of the 40 patients in whom air reduction was not successful, five were reduced immediately by barium enema. Of the 35 remaining patients, barium enema immediately following air reduction failure also was unsuccessful, and operative reduction was accomplished. Of the remaining 18 patients, operative reduction was performed immediately after the air reduction failure. The authors recommend air insufflation reduction because it is rapid, easily performed, and easily learned.--George Holcomb, Jr
Intussusception in Children 5 to 15 Years of Age. J.A.M. Reijnen,
H.J.M. Joosten, and C. Festen. Br J Surg 74:692-693, (August), 1987. Twenty cases of intussusception in children between the ages of 5 and 15 years were found in a series of 108 intussusceptions (18.5%). The diagnosis was delayed in most cases. Forty-five percent had a small bowel intussusception, and in 55% a definite predisposing cause was found. Attempted hydrostatic reduction was performed in 11 patients and was successful in six. After hydrostatic reduction, careful follow-up is required to exclude an organic lesion. Operation is indicated in cases of chronically recurrent abdominal symptoms.--P. Malone
"syndrome'might be related to gastric dysmotility, nuclear evaluation was routinely quantified. Essentially half of the patients were labeled as abnormal (> 50% retention of radionuclide at 90 minutes). This was, however, different from what was thought to be significantly abnormal for consideration of combining pyloroplasty with fundoplication. In the later comments section of the article, 50% to 65% retention at 90 minutes is considered to be borderline gastric dysmotility. The addition of a pyloroplasty is only considered when retention is >65% to 90 minutes.--Thomas V. Whalen Nissen Fundoplication and Pyloroplasty in the Management of Gastro-Oesophageal Reflux in Children, B.R. Davidson, Diana M.
INTERNATIONAL ABSTRACTS
a palpable pyloric mass at some time prior to surgery. Eighty-one percent had at least one imaging study (upper gastrointestinal series or sonogram); 9% had both. A comparison with three outlying hospitals showed similar figures, with a tendency toward UGI rather than sonogram. Most of the imaging studies were ordered by non-surgeons. The researchers suggest that imaging studies be reserved for a select group of infants with vomiting, in whom (1) no olive is felt by an experienced examiner, (2) persistent vomiting occurs without obstructive signs, (3) persistent vomiting in those infants in whom prior surgery or disease handicaps the physical exam, and (4) infants with bilious vomiting or conditions not suspected to be pyloric stenosis.--Jeffrey L. Zitsman
Hurd, and M.S. Johnstone. Br J Surg 74:488-490, (June), 1987. A retrospective study was carried out of children undergoing Nissen fundoplication and pyloroplasty for the correction of gastroesophageal reflux. Twenty children (13 males, 7 females) aged 8 months to 12 years underwent surgery over a 10-year period. Forty percent were mentally retarded. Presentation was failure to thrive in 19 (95%), recurrent vomiting in 18 (90%), and hematemesis in 14 (70%). Four children had Barrett's esophagus. There were no operative or perioperative mortalities. Follow-up (mean period, 3 years, 9 months) showed no further symptoms of reflux. The "normal" children gained weight postoperatively, whereas the "retarded" group did not. Adhesion obstruction (10%) was the major late postoperative complication. Regression of Barrett's epithelium was noted endoscopically. "Gas-bloat" syndrome, a major complication following fundoplication, was not encountered.--Lewis Spitz Gastroesophageal Reflux Associated With Nemaline Myopathy of Infancy. S. Berezin, L.J. Newman, S.M. Schwarz, et al. Pediatrics
81:111-115, (January), 1988. The researchers present three cases of infants with nemaline myopathy, an inherited skeletal muscle disorder associated with weakness and hypotonia. Each patient suffered from failure to thrive and lower respiratory tract infections, pH studies documented prolonged gastroesophageal reflux in each. All three patients failed medical therapy with bethanechol and metoclopramide. Nissen fundoplication resulted in correction of reflux with subsequent weight gain.--Jeffrey L. Zitsman Adhesion Obstruction Following Nissan Fundoplication in Children.
B.M. Wilkins and L. Spitz. Br J Surg 74:777-779, (September), 1987. The incidence of postoperative adhesion obstruction among 156 children who had undergone Nissen fundoplication for intractable gastroesophageal relux was determined. There were 18 episodes of obstruction in 16 patients (10.3%) requiring surgical treatment. The mean interval between fundoplication and adhesion obstruction was 10 months (range 10 days to 4 years). Additional procedures performed at the original laparotomy increased the risk of developing obstruction. Laparotomy for adhesion obstruction was required in 21% of patients who had a Ladd's procedure, 18% who had a gastrostomy, and 12% who had an appendicectomy. The incidence of obstruction in those with no additional procedure was 2%. Presenting symptoms were atypical because many of these children were unable to vomit. Only three did vomit, but all had radiologic appearances suggestive of small bowel obstruction. There were two deaths directly related to adhesion obstruction.--P. Malone Changing Patterns in the Diagnosis of Hypertrophic Pyloric Stenosis. C.W. Breaux, Jr, K.E. Georgeion, S.A. Royal, et al. Pediatrics
81:213-217, (February), 1988. The investigators reviewed 216 cases of surgically-corrected hypertrophic pyloric stenosis. Eighty-nine percent of the infants had
Pyloromyotomy: Can the Morbidity Be Improved? J. Beynon, R. Brown, C. James, et al. J R Coil Surg (Edinb) 32:291-292, (November), 1987.
The complications seen in 100 cases of pyloric stenosis treated by pyloromyotomy are reviewed. The diagnosis was made on palpation of a "tumor" in 90 cases. The remainder required a barium meal. All had intravenous fluids and nasogastric aspiration prior to surgery. Sixty-six had a right paramedian and 34 had a transverse skin incision. Sixty operations were performed by senior surgeons and 40 by training grades. Complications occurred in 19 and included wound infection (14), dehiscence (5), and mucosal breach (3). There was one death due to a missed mucosal breach. The surgeons' experience had no influence on the results. The one significant finding was a much lower infection rate in the group with a transverse incision. The use of this incision with prophylactic antibiotics is recommended.--W.G. Scobie
Air Reduction of Intussusception in Infants and Children. K.
Tamanaha, K. Wimbish, Y.B. Talwalker et al. J Pediatr 111:733736, (November), 1987, The authors describe their technique for air reduction of intussusception. A success rate of 81% (167/207 episodes) is reported. The tentative diagnosis of intussusception was made by evaluation of the clinical findings and initial radiographs. Ages ranged from 1 month to 7 years. There were 18 recurrences in 11 patients, and all of these were reduced again successfully. Of the 40 patients in whom air reduction was not successful, five were reduced immediately by barium enema. Of the 35 remaining patients, barium enema immediately following air reduction failure also was unsuccessful, and operative reduction was accomplished. Of the remaining 18 patients, operative reduction was performed immediately after the air reduction failure. The authors recommend air insufflation reduction because it is rapid, easily performed, and easily learned.--George Holcomb, Jr
Intussusception in Children 5 to 15 Years of Age. J.A.M. Reijnen,
H.J.M. Joosten, and C. Festen. Br J Surg 74:692-693, (August), 1987. Twenty cases of intussusception in children between the ages of 5 and 15 years were found in a series of 108 intussusceptions (18.5%). The diagnosis was delayed in most cases. Forty-five percent had a small bowel intussusception, and in 55% a definite predisposing cause was found. Attempted hydrostatic reduction was performed in 11 patients and was successful in six. After hydrostatic reduction, careful follow-up is required to exclude an organic lesion. Operation is indicated in cases of chronically recurrent abdominal symptoms.--P. Malone