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Appendicitis after blunt abdominal trauma: Cause or coincidence?
1128
INTERNATIONAL
the latex-containing objects are in contact with mucous membranes. Those potentially at risk for latex allergy include patients with prolonged or frequent exposure to rubber products (spina bifida. congenital urologic abnormalities), those requiring frequent enemas, health care workers, and rubber-industry personnel. Six months later. after taking steroids and antihistaminic drugs prophylactically and avoiding all latex-containing products, the boy underwent uncomplicated thymectomy.-Szgmund H. Eiu Pancreatic Trauma in Children. MS. Arkowtz, Garcza. J Trauma 42:49-53, [January), 1997.
N. Johnson,
and V:F:
The authors reviewed the findings for 26 children with blunt pancreatic injury (2% of all children with blunt abdominal trauma) over a 15.year period. attempting to identify markers of pancreatic injury and create a &agnostic algorithm. “Handlebar injuries” and child abuse were the most common mechanisms of injury. Twenty-one (85%) patients had abdominal CT scans: however. only 14 CT scans were obtained within 24 hours of injury. The sensitivity of abdominal CT performed within 24 hours of injury was 85%. Serum amylase values were elevated in 25 of 26 patients but did not correlate with grade of injury, length of stay, or development of a pseudocyst. Thirteen of the 26 patients had exploratory celiotomy. Exploration was done within 24 hours of injury in seven. Pseudocysts developed m eight (3 1%) of the 26 patients. The diagnostic algorithm proposed emphasizes the benefits and sensitivity of double-contrast abdommal CT in the setting of abdominal pain and elevated serum amylase.--Steven Stylianos
ALIMENTARY
TRACT
Management and Ultrasonographic Appearance of Infantile Hypertrophic Pyloric Stenosis With Intravenous Atropine Sulfate. A. Nngitn, L Yamngrtciri, 1% Anremoto. er al. J Pediatr Gastroenterol Nutr 23:172-177. (August). 1996. The authors examine the changes m the pylorlc muscle of hypertrophic pyloric stenosis during and after intravenous administration of atropine. Twenty-three infants were studied, and atropme sulfate was administered in a dose of 0.04 mg/kg/d IV. The dose was increased by 0.01 mg/kg/d until the vomiting ceased. Once vomiting ceased. all mfants received atropine sulfate at twice the effective intravenous dose by oral administration for two weeks. Twenty-two infants were free of vormting after 1 to 8 days of mtravenous atropme sulfate treatment with doses; that ranged from 0.04 to 0.11 mg/kg/d. Only two infants required pyloromyotomy because of either prolonged medical treatment or undefdosing of oral atropme. Normalization of the pyloric muscle caliber occurred 4 to 6 months after treatment. In this paper. as well as in a subsequent editorial comment, there is a recommendation for a well-controlled prospective trial comparing the outcomes and costs of intravenous atropine medication versus standard surgical therapy.Thor& E Tracy, h Appendicitis After Blunt Abdominal Trauma: dence? A.O. Cificz. KC. Tanyel, N. Biiyiikpnmukcu. Surg 6:350-353. (December). 1996.
Cause or Coinciet al. Eur J Pediatr
The association of appendiclts with blunt abdominal trauma (BAT) is an exceptionally rare occurrence with only a few cases reported in the literature. The main question of whether this association is a result of causative or coincidental relationsship had not been evaluated in children. A retrospective clinical study was performed to clarify the pathogenesis. incidence, clinical characteristics, and outcome of appendicitis diagnosed during hospitalization for BAT in 554 children. Five children (0.9%; 3 boys, 2 girlsi were found to have appendicitis that was not present before the BAT. Bruismg and rupture of the mesoappendlx were noted in three patients; edema and hematoma of the appendix were
ABSTRACTS
found in two. The incidence of 0.9% is significantly tngher than the highest incidence rate of appendicitis stated in the literature (P < .05). Thus. a causative relationship between appendicits and BAT should be considered.-Tizornas A. Ange~pointner Volvulus of the Sigmoid Colon as a Complication of Segmental Dilatation of the Colon. Report of 2 Cases. P. Ra~sse, Z Petzt, D. Cau, et al. Eur J Perhatr Surg 6:375-377. (December). 1996. Sigmoid volvulus is an unusual cause of Intestinal obstruction in children. The authors present two cases (females aged 9 months and 9 years) of sigmoid volvulus as a complication of segmental dilatation of the colon. In both cases, chronic constipation had been recognized since the neonatal period. mimicking Hirschsprung’s disease. which could be excluded after rectal biopsy. An earlier diagnosis of segmental dilatation of the colon possibly could have prevented the volvulus. Segmental colonic resection resulted in total cure and relief of the constipation.Thomas A. Angerpointner Management of Uncommon erations of Hirschsprung’s Hicsoumez, et nl. Eur .I Pediatr
Complications of Definitive OpDisease. A. Strrioglu. M. Senocak, A. Surg 6:358-361. (December). 1996.
Two hundred twenty-nine children who had undergone definitive operations for Hirschsprung’s disease were evaluated for the occurrence of uncommon complications. These were rectourmary, rectovaginal, lleorectal. and perlana fistulae. One patient acquired rectourethral fistula secondary to a Swenson operation. He had to undergo a redo Swenson operation after an unsuccessful attempt to close the fistula. Another two patients were identified in whom ileorectal fistulae developed: one of them also had a perianal fistula. These two patients presented with intractable enterocolms. Both had successful fistula repair. Another two patients acquired rectovagmal listula, which could be repaired successfully. One patient had perianal fistula. The management of fistulae by means other than redo operation proved unsuccessful except for ileorectal fistulae.--ThomnsA. Angerpointner Gastrointestinal Perforation and Peritonitis in Infants and Children: Experience With 179 Cases Over Ten Years. J. Grosfeld E Molir~ari, P. Mark, et al. Surgery 120:650-656, (October), 1996. This is the report of a varied group of patients with perforation extending from the newborn period through The authors reviewed the causes of perforations and mortality rate for perforation secondary to necrotizing (NEC) was 48%. versus 27.2% for non-NEC infants older children. This report again confirms the significant mortahty associated with necrotizing enterocolitis.-Thonzas The Role of Luminal Nutrients in Intestinal enteric Reperfusion and Platelet-Activating Developing Rat. A.M. Bhana, R. Feddersen, J Surg Res 63:152-156, (June), 1996.
gastrointestinal the teen years. found that the enterocolms and 15.1% for morbidity and F: Tracy, Jr
Injury
From MesFactor in the and C.A. Muserneche.
Prematurity and formula feeding are the two most common risk factors for necrotlzmg enterocohtis (NE0 The pathophysiology of the relationship between feeding and the development of NEC has not been well defined. One theory proposes that rate. acidity. and osmolarity of the feedings are the important factors. A second theory proposes that oral feedings serve as a substrate for bacteria. A third theory is that the luminal nutrients may be directly toxic to the newborn intestine, and the fourth theory is that the presence of luminal substrates may alter local mtestinal Immunity. This study evaluated the influence of intestinal luminal nutrients on histological mjury and oxidant response in a rat model of NEC. The experimental rats received a smgle mtraluminal injection of various formulas and underwent mesenteric occlusion for 1 hour. Necropsies were performed, and the histology was graded m a
INTERNATIONAL
the latex-containing objects are in contact with mucous membranes. Those potentially at risk for latex allergy include patients with prolonged or frequent exposure to rubber products (spina bifida. congenital urologic abnormalities), those requiring frequent enemas, health care workers, and rubber-industry personnel. Six months later. after taking steroids and antihistaminic drugs prophylactically and avoiding all latex-containing products, the boy underwent uncomplicated thymectomy.-Szgmund H. Eiu Pancreatic Trauma in Children. MS. Arkowtz, Garcza. J Trauma 42:49-53, [January), 1997.
N. Johnson,
and V:F:
The authors reviewed the findings for 26 children with blunt pancreatic injury (2% of all children with blunt abdominal trauma) over a 15.year period. attempting to identify markers of pancreatic injury and create a &agnostic algorithm. “Handlebar injuries” and child abuse were the most common mechanisms of injury. Twenty-one (85%) patients had abdominal CT scans: however. only 14 CT scans were obtained within 24 hours of injury. The sensitivity of abdominal CT performed within 24 hours of injury was 85%. Serum amylase values were elevated in 25 of 26 patients but did not correlate with grade of injury, length of stay, or development of a pseudocyst. Thirteen of the 26 patients had exploratory celiotomy. Exploration was done within 24 hours of injury in seven. Pseudocysts developed m eight (3 1%) of the 26 patients. The diagnostic algorithm proposed emphasizes the benefits and sensitivity of double-contrast abdommal CT in the setting of abdominal pain and elevated serum amylase.--Steven Stylianos
ALIMENTARY
TRACT
Management and Ultrasonographic Appearance of Infantile Hypertrophic Pyloric Stenosis With Intravenous Atropine Sulfate. A. Nngitn, L Yamngrtciri, 1% Anremoto. er al. J Pediatr Gastroenterol Nutr 23:172-177. (August). 1996. The authors examine the changes m the pylorlc muscle of hypertrophic pyloric stenosis during and after intravenous administration of atropine. Twenty-three infants were studied, and atropme sulfate was administered in a dose of 0.04 mg/kg/d IV. The dose was increased by 0.01 mg/kg/d until the vomiting ceased. Once vomiting ceased. all mfants received atropine sulfate at twice the effective intravenous dose by oral administration for two weeks. Twenty-two infants were free of vormting after 1 to 8 days of mtravenous atropme sulfate treatment with doses; that ranged from 0.04 to 0.11 mg/kg/d. Only two infants required pyloromyotomy because of either prolonged medical treatment or undefdosing of oral atropme. Normalization of the pyloric muscle caliber occurred 4 to 6 months after treatment. In this paper. as well as in a subsequent editorial comment, there is a recommendation for a well-controlled prospective trial comparing the outcomes and costs of intravenous atropine medication versus standard surgical therapy.Thor& E Tracy, h Appendicitis After Blunt Abdominal Trauma: dence? A.O. Cificz. KC. Tanyel, N. Biiyiikpnmukcu. Surg 6:350-353. (December). 1996.
Cause or Coinciet al. Eur J Pediatr
The association of appendiclts with blunt abdominal trauma (BAT) is an exceptionally rare occurrence with only a few cases reported in the literature. The main question of whether this association is a result of causative or coincidental relationsship had not been evaluated in children. A retrospective clinical study was performed to clarify the pathogenesis. incidence, clinical characteristics, and outcome of appendicitis diagnosed during hospitalization for BAT in 554 children. Five children (0.9%; 3 boys, 2 girlsi were found to have appendicitis that was not present before the BAT. Bruismg and rupture of the mesoappendlx were noted in three patients; edema and hematoma of the appendix were
ABSTRACTS
found in two. The incidence of 0.9% is significantly tngher than the highest incidence rate of appendicitis stated in the literature (P < .05). Thus. a causative relationship between appendicits and BAT should be considered.-Tizornas A. Ange~pointner Volvulus of the Sigmoid Colon as a Complication of Segmental Dilatation of the Colon. Report of 2 Cases. P. Ra~sse, Z Petzt, D. Cau, et al. Eur J Perhatr Surg 6:375-377. (December). 1996. Sigmoid volvulus is an unusual cause of Intestinal obstruction in children. The authors present two cases (females aged 9 months and 9 years) of sigmoid volvulus as a complication of segmental dilatation of the colon. In both cases, chronic constipation had been recognized since the neonatal period. mimicking Hirschsprung’s disease. which could be excluded after rectal biopsy. An earlier diagnosis of segmental dilatation of the colon possibly could have prevented the volvulus. Segmental colonic resection resulted in total cure and relief of the constipation.Thomas A. Angerpointner Management of Uncommon erations of Hirschsprung’s Hicsoumez, et nl. Eur .I Pediatr
Complications of Definitive OpDisease. A. Strrioglu. M. Senocak, A. Surg 6:358-361. (December). 1996.
Two hundred twenty-nine children who had undergone definitive operations for Hirschsprung’s disease were evaluated for the occurrence of uncommon complications. These were rectourmary, rectovaginal, lleorectal. and perlana fistulae. One patient acquired rectourethral fistula secondary to a Swenson operation. He had to undergo a redo Swenson operation after an unsuccessful attempt to close the fistula. Another two patients were identified in whom ileorectal fistulae developed: one of them also had a perianal fistula. These two patients presented with intractable enterocolms. Both had successful fistula repair. Another two patients acquired rectovagmal listula, which could be repaired successfully. One patient had perianal fistula. The management of fistulae by means other than redo operation proved unsuccessful except for ileorectal fistulae.--ThomnsA. Angerpointner Gastrointestinal Perforation and Peritonitis in Infants and Children: Experience With 179 Cases Over Ten Years. J. Grosfeld E Molir~ari, P. Mark, et al. Surgery 120:650-656, (October), 1996. This is the report of a varied group of patients with perforation extending from the newborn period through The authors reviewed the causes of perforations and mortality rate for perforation secondary to necrotizing (NEC) was 48%. versus 27.2% for non-NEC infants older children. This report again confirms the significant mortahty associated with necrotizing enterocolitis.-Thonzas The Role of Luminal Nutrients in Intestinal enteric Reperfusion and Platelet-Activating Developing Rat. A.M. Bhana, R. Feddersen, J Surg Res 63:152-156, (June), 1996.
gastrointestinal the teen years. found that the enterocolms and 15.1% for morbidity and F: Tracy, Jr
Injury
From MesFactor in the and C.A. Muserneche.
Prematurity and formula feeding are the two most common risk factors for necrotlzmg enterocohtis (NE0 The pathophysiology of the relationship between feeding and the development of NEC has not been well defined. One theory proposes that rate. acidity. and osmolarity of the feedings are the important factors. A second theory proposes that oral feedings serve as a substrate for bacteria. A third theory is that the luminal nutrients may be directly toxic to the newborn intestine, and the fourth theory is that the presence of luminal substrates may alter local mtestinal Immunity. This study evaluated the influence of intestinal luminal nutrients on histological mjury and oxidant response in a rat model of NEC. The experimental rats received a smgle mtraluminal injection of various formulas and underwent mesenteric occlusion for 1 hour. Necropsies were performed, and the histology was graded m a