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Antenatal diagnosis of fetal intestinal obstruction by ultrasonography
440
ABSTRACTS
with a 3-wk history of poor feeding with weight loss and mild diarrhea. Diagnosis was confirmed by echo cardiography, electro cardiography and cardiac catheterisation. Successful surgical correction was performed when a synthetic conduit was placed betwen the left atrium and the lower end of a vertical vein which drained the confluence of the pulmonary veins from the left lung, the atrial m e m b r a n e being completely excised. Post operative course was satisfactory. The synthetic shunt employed had a diameter of 6 m m s and may require replacement as the infant grows.--A. MacKeltar Supranumerary Mitral Valve Producing Subaortic Stenosis.
J. Hatem, R. M. Sade, A. Taylor, et al. Chest 79:483-486, (April), 1981. The authors describe a 10-yr-old female with subaortic stenosis from a "supranumerary mitral valve." At the initial surgery a sheet-like mass opposite the mitral valve with attachments by chord-like fibers to an apparent papillary muscle caused obstruction of the aortic outflow tract and was resected. Due to persistent abnormalities in the cardiac e x a m i n a t i o n and echocardiogram repeat a n g i o g r a p h y revealed hypertrophy of the septum but a discrete subaortic mass was not seen. At surgery hypertrophied septal muscle was resected and another sheetlike structure attached to the anterior mitral leaflet near its base was resected. No gradient could be demonstrated after bypass was discontinued. Subaortic outflow obstruction can result from discrete subaortic membranes, fibrous tunnels, hypertrophied muscle and A-V valve anomalies. In another report involving a patient with a similar lesion, death occurred because all of the obstructing tissue was not identified and resected and in this report a second operation was necessary to remove all of the obstruction.--Randall IV. Powell ALIMENTARY TRACT Isolated Tracheoesophageal Fistula. M. Kabelka. Bratisl lek
Listy 76:567-600, (November), 1981. Nine cases of congenital isolated / H - t y p e / t r a c h e o e s o p h a geal fistula are reported. Difficulties in establishing the diagnosis by x-ray and endoscopy are stressed. The author reports a good experience with a modified Koop's test. In three children in whom by previous roentgenographic examination localisation of the fistula was unsuccessful an exact localisation by esophageal catheterisation was achieved. A thin Nelathon catheter is inserted into stomach and air from the stomach is evacuated. The other end of the catheter is submerged into water and the catheter is slowly withdrawn. When the end of the catheter is opposite the fistula air bubbles from the other end of the catheter are observed.--E. Pekarovi~. Antenatal Diagnosis of Fetal Intestinal Obstruction by Ultrasonography. B. M. Mogilner, Z. Apelman, M. Lancet, et al.
Harefuah 101:5-6, (September), 1981. Ultrasonography is a noninvasive procedure which can he used for antenatal diagnosis of fetal malformations. Easier recognition of the fetal anatomy and more accurate assessment of malformations has been achieved by the introduction of the gray scale and real-time ultrasound units. In this case polyhydramnios, a common indication for maternal ultraso-
nography, led to a diagnosis of intestinal obstruction. Ultrasound revealed several dilated, tubular, fluid-filled structures in the fetal abdominal cavity, suggesting bowel atresia. X-ray of the abdomen was consistent with jejunal obstruction. Early surgical intervention disclosed multiple jejunal atresia, confirming the antenatal diagnosis.--Shemuel Nissan Duodenal Radiographic Findings in Hemophilia. J. S. Rose, L
Hertz, B. Weinberg, et al. A m J Gastroenterol 76:160-165, (August), 1981. Two patients, one a 35-yr-old male and the second a 5-yr-old male, both with known factor VIII deficiency, presented with signs and symptoms of an upper gastrointestinal tract obstruction. Both had duodenal h e m a t o m a s demonstrated radiographically using ultrasound and contrast studies. Both were treated conservatively and the h e m a t o m a resolved in each case within 1 wk. Duodenal h e m a t o m a s are usually caused by trauma. Other precipitating causes include Henoch-Schoenlein purpura, periarteritis nodosa, primary amyloidosis, scurvy, or a deficiency in platelets or plasma clotting factors such as is found in hemophilia. T h e radiologic features of intramural bleeding are well demonstrated in the accompanying photographs.--Richard R. Ricketts The Well Nourished Infant With Intussusception. J. S. Janik, J. Cranford, S. H. Ein. A m J Dis Child 135:600-602, (July), 1981.
To assess the nutritional status of children with intussusception, the weight, length and weight-for-length percentiles of 100 children with intussusception and 100 children admitted to the hospital for elective surgery were determined and compared with the National Center for Health Statistics standards. Of the children with intussusception, 26% were found to have a weight for length ratio below the fifth percentile while only 11% of the children admitted for elective surgery had ratios below the fifth percentile. This difference could not be explained by duration of symptoms, vomiting or diarrhea. Therefore, although children with intussusception may appear "well nourished" they are no better nourished than the general population and, in fact, a significant number exhibit anthropometric data suggestive of malnutrition.--J. J. Tepas Neonatal Intramural Bowel Calcification Without Atresia.
P. Winchester, M. Heneghan, P. W. Brill, et al. A J R 136:826-827, (April), 1981. A premature male with multiple congenital malformations was found to have intramural calcification in a loop of small bowel on a radiograph taken for respiratory distress. Feedings by nipple and garage were tolerated until 21 days of age when abdominal distention and vomiting began. Barium studies revealed a partial small bowel obstruction and at exploration a stenotic portion of matted bowel was removed. Pathologic examination revealed ischemic damage to the mucosa and submucosa with calcifications. The infant died after surgery due to sepsis and renal failure. The authors state that all previously reported cases of intramural calcification have been associated with obstruction at birth due to atresia, meconium ileus or intrauterine volvulus.--Randall W. Powell
ABSTRACTS
with a 3-wk history of poor feeding with weight loss and mild diarrhea. Diagnosis was confirmed by echo cardiography, electro cardiography and cardiac catheterisation. Successful surgical correction was performed when a synthetic conduit was placed betwen the left atrium and the lower end of a vertical vein which drained the confluence of the pulmonary veins from the left lung, the atrial m e m b r a n e being completely excised. Post operative course was satisfactory. The synthetic shunt employed had a diameter of 6 m m s and may require replacement as the infant grows.--A. MacKeltar Supranumerary Mitral Valve Producing Subaortic Stenosis.
J. Hatem, R. M. Sade, A. Taylor, et al. Chest 79:483-486, (April), 1981. The authors describe a 10-yr-old female with subaortic stenosis from a "supranumerary mitral valve." At the initial surgery a sheet-like mass opposite the mitral valve with attachments by chord-like fibers to an apparent papillary muscle caused obstruction of the aortic outflow tract and was resected. Due to persistent abnormalities in the cardiac e x a m i n a t i o n and echocardiogram repeat a n g i o g r a p h y revealed hypertrophy of the septum but a discrete subaortic mass was not seen. At surgery hypertrophied septal muscle was resected and another sheetlike structure attached to the anterior mitral leaflet near its base was resected. No gradient could be demonstrated after bypass was discontinued. Subaortic outflow obstruction can result from discrete subaortic membranes, fibrous tunnels, hypertrophied muscle and A-V valve anomalies. In another report involving a patient with a similar lesion, death occurred because all of the obstructing tissue was not identified and resected and in this report a second operation was necessary to remove all of the obstruction.--Randall IV. Powell ALIMENTARY TRACT Isolated Tracheoesophageal Fistula. M. Kabelka. Bratisl lek
Listy 76:567-600, (November), 1981. Nine cases of congenital isolated / H - t y p e / t r a c h e o e s o p h a geal fistula are reported. Difficulties in establishing the diagnosis by x-ray and endoscopy are stressed. The author reports a good experience with a modified Koop's test. In three children in whom by previous roentgenographic examination localisation of the fistula was unsuccessful an exact localisation by esophageal catheterisation was achieved. A thin Nelathon catheter is inserted into stomach and air from the stomach is evacuated. The other end of the catheter is submerged into water and the catheter is slowly withdrawn. When the end of the catheter is opposite the fistula air bubbles from the other end of the catheter are observed.--E. Pekarovi~. Antenatal Diagnosis of Fetal Intestinal Obstruction by Ultrasonography. B. M. Mogilner, Z. Apelman, M. Lancet, et al.
Harefuah 101:5-6, (September), 1981. Ultrasonography is a noninvasive procedure which can he used for antenatal diagnosis of fetal malformations. Easier recognition of the fetal anatomy and more accurate assessment of malformations has been achieved by the introduction of the gray scale and real-time ultrasound units. In this case polyhydramnios, a common indication for maternal ultraso-
nography, led to a diagnosis of intestinal obstruction. Ultrasound revealed several dilated, tubular, fluid-filled structures in the fetal abdominal cavity, suggesting bowel atresia. X-ray of the abdomen was consistent with jejunal obstruction. Early surgical intervention disclosed multiple jejunal atresia, confirming the antenatal diagnosis.--Shemuel Nissan Duodenal Radiographic Findings in Hemophilia. J. S. Rose, L
Hertz, B. Weinberg, et al. A m J Gastroenterol 76:160-165, (August), 1981. Two patients, one a 35-yr-old male and the second a 5-yr-old male, both with known factor VIII deficiency, presented with signs and symptoms of an upper gastrointestinal tract obstruction. Both had duodenal h e m a t o m a s demonstrated radiographically using ultrasound and contrast studies. Both were treated conservatively and the h e m a t o m a resolved in each case within 1 wk. Duodenal h e m a t o m a s are usually caused by trauma. Other precipitating causes include Henoch-Schoenlein purpura, periarteritis nodosa, primary amyloidosis, scurvy, or a deficiency in platelets or plasma clotting factors such as is found in hemophilia. T h e radiologic features of intramural bleeding are well demonstrated in the accompanying photographs.--Richard R. Ricketts The Well Nourished Infant With Intussusception. J. S. Janik, J. Cranford, S. H. Ein. A m J Dis Child 135:600-602, (July), 1981.
To assess the nutritional status of children with intussusception, the weight, length and weight-for-length percentiles of 100 children with intussusception and 100 children admitted to the hospital for elective surgery were determined and compared with the National Center for Health Statistics standards. Of the children with intussusception, 26% were found to have a weight for length ratio below the fifth percentile while only 11% of the children admitted for elective surgery had ratios below the fifth percentile. This difference could not be explained by duration of symptoms, vomiting or diarrhea. Therefore, although children with intussusception may appear "well nourished" they are no better nourished than the general population and, in fact, a significant number exhibit anthropometric data suggestive of malnutrition.--J. J. Tepas Neonatal Intramural Bowel Calcification Without Atresia.
P. Winchester, M. Heneghan, P. W. Brill, et al. A J R 136:826-827, (April), 1981. A premature male with multiple congenital malformations was found to have intramural calcification in a loop of small bowel on a radiograph taken for respiratory distress. Feedings by nipple and garage were tolerated until 21 days of age when abdominal distention and vomiting began. Barium studies revealed a partial small bowel obstruction and at exploration a stenotic portion of matted bowel was removed. Pathologic examination revealed ischemic damage to the mucosa and submucosa with calcifications. The infant died after surgery due to sepsis and renal failure. The authors state that all previously reported cases of intramural calcification have been associated with obstruction at birth due to atresia, meconium ileus or intrauterine volvulus.--Randall W. Powell