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Choledochal cysts in children: Radiologic features
320
INTERNATIONAL ABSTRACTS
the 3 month waiting period. It is felt that conservative management of the appendiceal mass is successful in most cases and that the complication rate is lower than early operative treatment.--Richard J. Andrassy Perforation of the Intussuscepted Colon. A. Hurnphry, S.
H. Ein, and P. M. Mok. Am J Roentgenol 137:1135-1138, (December), 1981.
Over a 25-year period 850 barium enemas performed for reduction of an intussusception resulted in six colonic perforations. The pertinent statistics included: age (3 to 6 months), sex (5 males), preceding illness (4 viral), vomiting (6), rectal bleeding (5), palpable mass (1), clinical and radiographic evidence of complete small-bowel obstruction (6), duration of symptoms (36 to 120 hours, average 78 hours), and clinical signs of hypovolemia (pale, dehydrated, lethargic, and mottling of extremity skin). Five of the perforations occurred within 30 sec of the barium reaching the intussusception; the other occurred after partial reduction with the bag elevated to 120 cm (normally at 91 cm). All six patients underwent right hemicolectomy with primary anastomosis. Uneventful recovery occurred in three, two developed wound infections, and one developed a gangrenous volvulus which required resection of a large amount of small bowel. The latter child required home TPN. The authors feel that young patients (3 to 6 months) with intussusception, a long history (>36 hr), complete small-bowel obstruction, and clinical signs of hypovolemia are at increased risk for colon perforation, and barium enema reduction should not be attempted.--Randall 14:. Powell Megaeystis-Microcolon-lntestinal Hypoperistalsis Syndrome: Additional Clinical, Radiologic, Surgical, and Histopathologic Aspects. L. W. Young, E. J. Yunis, B. R. Girda-
ny, et al. Am J Roentgenol 137:749-755, (October, 1981).
Four patients with M M I H S form the basis for this report and include one male (one of two reported in the literature) and a long-term survivor (14 years). One patient also experienced a distal small-bowel obstruction due to volvulus. New histopathologic findings included an apparent increase in ganglion cells in early biopsies and normal or decreased numbers in later biopsies, a neuroma-like layer of nerve trunks in the bowel wall of two patients, and in two of three neonates elastosis was noted in the bladder wall.--Randall IV. Powell Acquired Aganglionosis After Soave's
Procedure for
Hirschsprung's Disease. T. G. Cogbill and J. R. Lilly. Arch Surg 117:1346-1347, (October), 1982.
A patient had acquired aganglionosis after Soave's procedure for Hirschsprung's disease. Vascular compromise of the sigmoid pull-through at the time of the operation was the probable cause.--George Rowe, M.D. ABDOMEN The Effect of Splenectomy on Gram-Negative Bacteremia.
K. S. Scher, F. Wroczynski, and J. A. Coil, Jr. J Trauma 22:407409, (May), 1982.
After an intraperitoneal injection of 106 E. coli shamoperated rats cleared the bacteremia. This was ascertained by
tail-vein blood cultures with no cultures positive at 240 minutes. In splenectomized rats, bacteria persisted at statistically significant levels at 90, 120, and 240 minutes. The authors feel that splenectomy definitely alters the animal's ability to clear a gram-negative bacteremia. They note that in Singer's review of fatal postsplenectomy sepsis, 12% involved E coiL--Randall W. Powell Choledochal Cysts in Children: Radiologic Features. G. O.
Atkinson, Jr. and B. B. Gay, Jr. South Med J 75:1215-1221, (October), 1982.
Radiologic studies have always played an important role in diagnosis of choledochal cysts because of the nonspecific clinical features. The classical clinical triad of abdominal pain, palpable abdominal mass, and jaundice is rarely present. Before 1960, preoperative diagnosis was made in less than one third of patients. Realtime sonography and cholescintigraphy with technetium Tc 99m iminodiacetic acid derivative allow specific preoperative diagnosis and will eliminate the need for more invasive studies such as arteriography, endoscopic cholangiopancreatography, and percutaneous transhepatic cholangiography. The radiologic findings in six children less than 3~/2years of age are s u m m a r i z e d . George Holcomb, Jr. Choledochal Cyst in Siblings. N. Ohkohchi, N. Koike, 7".
Uchida, et al. GEKA (Surgery) 44:1443-1446, (November), 1982.
Choledochal cyst was found in successive siblings. The first case, a 4-year, 10-month-old girl, presented with jaundice and fever. Laboratory examinations disclosed obstructive jaundice and high serum and urine amylase. Hepatobiliary scintigraphy revealed fusiform dilatation of the common bile duct and the left intrahepatic bile duct. Resection of the dilated extrahepatic bile duct and hepaticojejunostomy were carried out with satisfactory result. The second case, a 3-year, 9-month-old girl, was the younger sister of the first case. She presented with vomiting and abdominal pain. Laboratory examinations showed normal serum amylase and slight liver damage. Fusiform dilatation of the common bile duct was disclosed by hepatobiliary scintigraphy and drip infusion cholangiography. Resection of the dilated extrahepatic bile duct and hepaticojejunostomy were carried out with satisfactory result. The authors collected cases of familial occurrence of hepatobiliary malformations from the world literature but could not find any cases of familial occurrence of choledochal cyst.--H. S u z u k i Ultrasound Screening for Abdominal Masses in the Neonatal Period. D. A. Wilson. Am J Dis Child 136:147-151,
(February), 1982. A total of 36 patients, 6 weeks of age or younger, were examined by ultrasound for suspected abdominal mass during the 4-year period between May 1977 and May 1981. A total of 46 abdominal masses were detected in 29 patients. The ultrasound diagnosis was correct or directly contributory to the diagnosis in 96% (43/45) of the cases. The diagnosis was incorrect or misleading in only 4% (2/45) of the cases. When no pathologic mass was demonstrated by ultrasound, this observation was confirmed to be correct in every case. The study was safe, reliable, and quickly performed with no
INTERNATIONAL ABSTRACTS
the 3 month waiting period. It is felt that conservative management of the appendiceal mass is successful in most cases and that the complication rate is lower than early operative treatment.--Richard J. Andrassy Perforation of the Intussuscepted Colon. A. Hurnphry, S.
H. Ein, and P. M. Mok. Am J Roentgenol 137:1135-1138, (December), 1981.
Over a 25-year period 850 barium enemas performed for reduction of an intussusception resulted in six colonic perforations. The pertinent statistics included: age (3 to 6 months), sex (5 males), preceding illness (4 viral), vomiting (6), rectal bleeding (5), palpable mass (1), clinical and radiographic evidence of complete small-bowel obstruction (6), duration of symptoms (36 to 120 hours, average 78 hours), and clinical signs of hypovolemia (pale, dehydrated, lethargic, and mottling of extremity skin). Five of the perforations occurred within 30 sec of the barium reaching the intussusception; the other occurred after partial reduction with the bag elevated to 120 cm (normally at 91 cm). All six patients underwent right hemicolectomy with primary anastomosis. Uneventful recovery occurred in three, two developed wound infections, and one developed a gangrenous volvulus which required resection of a large amount of small bowel. The latter child required home TPN. The authors feel that young patients (3 to 6 months) with intussusception, a long history (>36 hr), complete small-bowel obstruction, and clinical signs of hypovolemia are at increased risk for colon perforation, and barium enema reduction should not be attempted.--Randall 14:. Powell Megaeystis-Microcolon-lntestinal Hypoperistalsis Syndrome: Additional Clinical, Radiologic, Surgical, and Histopathologic Aspects. L. W. Young, E. J. Yunis, B. R. Girda-
ny, et al. Am J Roentgenol 137:749-755, (October, 1981).
Four patients with M M I H S form the basis for this report and include one male (one of two reported in the literature) and a long-term survivor (14 years). One patient also experienced a distal small-bowel obstruction due to volvulus. New histopathologic findings included an apparent increase in ganglion cells in early biopsies and normal or decreased numbers in later biopsies, a neuroma-like layer of nerve trunks in the bowel wall of two patients, and in two of three neonates elastosis was noted in the bladder wall.--Randall IV. Powell Acquired Aganglionosis After Soave's
Procedure for
Hirschsprung's Disease. T. G. Cogbill and J. R. Lilly. Arch Surg 117:1346-1347, (October), 1982.
A patient had acquired aganglionosis after Soave's procedure for Hirschsprung's disease. Vascular compromise of the sigmoid pull-through at the time of the operation was the probable cause.--George Rowe, M.D. ABDOMEN The Effect of Splenectomy on Gram-Negative Bacteremia.
K. S. Scher, F. Wroczynski, and J. A. Coil, Jr. J Trauma 22:407409, (May), 1982.
After an intraperitoneal injection of 106 E. coli shamoperated rats cleared the bacteremia. This was ascertained by
tail-vein blood cultures with no cultures positive at 240 minutes. In splenectomized rats, bacteria persisted at statistically significant levels at 90, 120, and 240 minutes. The authors feel that splenectomy definitely alters the animal's ability to clear a gram-negative bacteremia. They note that in Singer's review of fatal postsplenectomy sepsis, 12% involved E coiL--Randall W. Powell Choledochal Cysts in Children: Radiologic Features. G. O.
Atkinson, Jr. and B. B. Gay, Jr. South Med J 75:1215-1221, (October), 1982.
Radiologic studies have always played an important role in diagnosis of choledochal cysts because of the nonspecific clinical features. The classical clinical triad of abdominal pain, palpable abdominal mass, and jaundice is rarely present. Before 1960, preoperative diagnosis was made in less than one third of patients. Realtime sonography and cholescintigraphy with technetium Tc 99m iminodiacetic acid derivative allow specific preoperative diagnosis and will eliminate the need for more invasive studies such as arteriography, endoscopic cholangiopancreatography, and percutaneous transhepatic cholangiography. The radiologic findings in six children less than 3~/2years of age are s u m m a r i z e d . George Holcomb, Jr. Choledochal Cyst in Siblings. N. Ohkohchi, N. Koike, 7".
Uchida, et al. GEKA (Surgery) 44:1443-1446, (November), 1982.
Choledochal cyst was found in successive siblings. The first case, a 4-year, 10-month-old girl, presented with jaundice and fever. Laboratory examinations disclosed obstructive jaundice and high serum and urine amylase. Hepatobiliary scintigraphy revealed fusiform dilatation of the common bile duct and the left intrahepatic bile duct. Resection of the dilated extrahepatic bile duct and hepaticojejunostomy were carried out with satisfactory result. The second case, a 3-year, 9-month-old girl, was the younger sister of the first case. She presented with vomiting and abdominal pain. Laboratory examinations showed normal serum amylase and slight liver damage. Fusiform dilatation of the common bile duct was disclosed by hepatobiliary scintigraphy and drip infusion cholangiography. Resection of the dilated extrahepatic bile duct and hepaticojejunostomy were carried out with satisfactory result. The authors collected cases of familial occurrence of hepatobiliary malformations from the world literature but could not find any cases of familial occurrence of choledochal cyst.--H. S u z u k i Ultrasound Screening for Abdominal Masses in the Neonatal Period. D. A. Wilson. Am J Dis Child 136:147-151,
(February), 1982. A total of 36 patients, 6 weeks of age or younger, were examined by ultrasound for suspected abdominal mass during the 4-year period between May 1977 and May 1981. A total of 46 abdominal masses were detected in 29 patients. The ultrasound diagnosis was correct or directly contributory to the diagnosis in 96% (43/45) of the cases. The diagnosis was incorrect or misleading in only 4% (2/45) of the cases. When no pathologic mass was demonstrated by ultrasound, this observation was confirmed to be correct in every case. The study was safe, reliable, and quickly performed with no