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Antiperistaltic segments after massive intestinal resections
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
A 4 year old boy with a presumptive diagnosis of celiac disease was submitted to intestinal niucosal biopsy with the standard adult Crosby capsule. He complained of pain immediately and 4 days later went into shock after an episode of hematemesis and melena. At operation the reseeted segment of intestine showed perforation into the mesentery. The child recovered. Review of the literature reveals an increased risk of this procedure in children. The author advises against the use of the adult capsule in children.--B. Spencer. ANTIPERISTALTIC SEGMENTS AFTER MASSIVE INTESTINAL RESECTIONS. C. V~r. Venables, H. El-
lis and A. D. M. Smith. Lancet 2:1390, December 24, 1966.
Following massive intestinal resection for mesenteric embolism, a reversed segment of jejunum was inserted between the jejunum and the colon. The procedure led to an improvement in bowel habits, a striking fall in fat excretion, delayed emptying of the small intestine on barium meal and a slight rise in sermn protein. In controlled experiments in rats following extensive bowel resection, the insertion of reversed segments was effective in preventing weight loss and in maintaining vitamin Bjo absorption at normal levels. The patient described in this article was a man aged 58 years but the principles appear to be applicable to all age groups.--]. H. Johnston. INTESTINAL GANGRENE WITH INFANTILE DIARRHEA: SURVIVAL FOLLOWING RESECTION AND
ILEORECTOSTOMY. H. Rath, O. Rath, J. M. Marvolin and J. Schenken. Surgery 60:1271-1274, December 1966. A ease is presented of a 1O month old infant with fulminating E. coli diarrhea in which diffuse intestinal gangrene involving the distal onefourth of the small intestine and the entire colon to the rectum at the peritoneal reflection developed. The patient was successfully treated by one-stage resection of the entire length of gangrenous intestine, with ileorectostomy. In the case reported, and in similar cases reviewed in the literature, a localized Schwartzman reaction is identified as the possible etiologic mechanism. - - D . T. Cloud. ACUTE APPENDICITIS IN CHILDHOOD. I. D. Brickman and ~V. Leon. Surgery 60:1083-1089, November 1966.
187
A study of 737 patients under 12 years of age with acute appendicitis occurring during a 10 year period in a single hospital is presented. 66 per cent had an advanced form of appendicitis defined as pathologically showing suppuration and gangrene or perforation. There was a progressively increasing incidence with age. Abdominal pain was the outstanding symptom with vomiting, anorexia and nausea following. Rectal and abdominal tenderness, abdominal rigidity and rebound tenderness were the most frequently observed physical findings. The presence of an elevated temperature was not found to be significant in diagnosis. The only laboratory test of importance was the leukocyte differential count. 280 patients had perforation in some form. The most common complication was wound infection, occurring in 52 patients, with pelvic abscess and wound separation occurring in 28 and 15 cases respectively. Intraperitoneal Kanamycin was thought to produce a marked decrease in the incidence of wound infection postoperatively. - - D . T. Cloud. BENIGN LYMPHOID POLYPOSIS 0F COLON. J. O.
Collins, M. Falk and R. Guibone. Pediatrics 38:897-899, November 1966. Subtotal colectomy and ileo-proctostomy were performed in a 31/2 year old child for benign lymphoid polyposis of the colon. 4x,~ months later all but two rectal polyps had disappeared. - - W . K. Sieber. DEVELOPMENT OF COLONIC POLYPS AT THE SITE OF URETERAL IMPLANTATION. A. M. Marko-
witz and P. Koontz. Surgery 60:761-767, September 1966. Three cases are presented in which polyps developed at the site of ureteral implantation, which was performed for congenital exstrophy of the bladder. In two cases rectal bleeding occurred, and in the third case evidence of unilateral urinary tract obstruction occurred. The treatment is excision of the polyp with re-implantation of the ureter. The polyps were histologically of the juvenile variety, and the etiology of their formation in this type case in unknown. - - D . T. Cloud. A PHYSIOLOGICALAPPROACH TO THE PROBLEM OF ANAL INCONTINENCE THROUGH USE OF TIlE LEVATOR ANI AS A SLING. P. K. Kottmeier. Surgery 60:1262-1266, December 1966. The author describes a "modified levator sling" for the purpose of improving anal incontinence.
A 4 year old boy with a presumptive diagnosis of celiac disease was submitted to intestinal niucosal biopsy with the standard adult Crosby capsule. He complained of pain immediately and 4 days later went into shock after an episode of hematemesis and melena. At operation the reseeted segment of intestine showed perforation into the mesentery. The child recovered. Review of the literature reveals an increased risk of this procedure in children. The author advises against the use of the adult capsule in children.--B. Spencer. ANTIPERISTALTIC SEGMENTS AFTER MASSIVE INTESTINAL RESECTIONS. C. V~r. Venables, H. El-
lis and A. D. M. Smith. Lancet 2:1390, December 24, 1966.
Following massive intestinal resection for mesenteric embolism, a reversed segment of jejunum was inserted between the jejunum and the colon. The procedure led to an improvement in bowel habits, a striking fall in fat excretion, delayed emptying of the small intestine on barium meal and a slight rise in sermn protein. In controlled experiments in rats following extensive bowel resection, the insertion of reversed segments was effective in preventing weight loss and in maintaining vitamin Bjo absorption at normal levels. The patient described in this article was a man aged 58 years but the principles appear to be applicable to all age groups.--]. H. Johnston. INTESTINAL GANGRENE WITH INFANTILE DIARRHEA: SURVIVAL FOLLOWING RESECTION AND
ILEORECTOSTOMY. H. Rath, O. Rath, J. M. Marvolin and J. Schenken. Surgery 60:1271-1274, December 1966. A ease is presented of a 1O month old infant with fulminating E. coli diarrhea in which diffuse intestinal gangrene involving the distal onefourth of the small intestine and the entire colon to the rectum at the peritoneal reflection developed. The patient was successfully treated by one-stage resection of the entire length of gangrenous intestine, with ileorectostomy. In the case reported, and in similar cases reviewed in the literature, a localized Schwartzman reaction is identified as the possible etiologic mechanism. - - D . T. Cloud. ACUTE APPENDICITIS IN CHILDHOOD. I. D. Brickman and ~V. Leon. Surgery 60:1083-1089, November 1966.
187
A study of 737 patients under 12 years of age with acute appendicitis occurring during a 10 year period in a single hospital is presented. 66 per cent had an advanced form of appendicitis defined as pathologically showing suppuration and gangrene or perforation. There was a progressively increasing incidence with age. Abdominal pain was the outstanding symptom with vomiting, anorexia and nausea following. Rectal and abdominal tenderness, abdominal rigidity and rebound tenderness were the most frequently observed physical findings. The presence of an elevated temperature was not found to be significant in diagnosis. The only laboratory test of importance was the leukocyte differential count. 280 patients had perforation in some form. The most common complication was wound infection, occurring in 52 patients, with pelvic abscess and wound separation occurring in 28 and 15 cases respectively. Intraperitoneal Kanamycin was thought to produce a marked decrease in the incidence of wound infection postoperatively. - - D . T. Cloud. BENIGN LYMPHOID POLYPOSIS 0F COLON. J. O.
Collins, M. Falk and R. Guibone. Pediatrics 38:897-899, November 1966. Subtotal colectomy and ileo-proctostomy were performed in a 31/2 year old child for benign lymphoid polyposis of the colon. 4x,~ months later all but two rectal polyps had disappeared. - - W . K. Sieber. DEVELOPMENT OF COLONIC POLYPS AT THE SITE OF URETERAL IMPLANTATION. A. M. Marko-
witz and P. Koontz. Surgery 60:761-767, September 1966. Three cases are presented in which polyps developed at the site of ureteral implantation, which was performed for congenital exstrophy of the bladder. In two cases rectal bleeding occurred, and in the third case evidence of unilateral urinary tract obstruction occurred. The treatment is excision of the polyp with re-implantation of the ureter. The polyps were histologically of the juvenile variety, and the etiology of their formation in this type case in unknown. - - D . T. Cloud. A PHYSIOLOGICALAPPROACH TO THE PROBLEM OF ANAL INCONTINENCE THROUGH USE OF TIlE LEVATOR ANI AS A SLING. P. K. Kottmeier. Surgery 60:1262-1266, December 1966. The author describes a "modified levator sling" for the purpose of improving anal incontinence.