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Cholellthiasis and cholecystitis in children
458
ABSTRACTS
panel in Melbourne, which classifies children with anorectal malformations into four main groups: (I) high or Supralevator anomalies; (2) intermediate anomalies; (3) low or translevator anomalies; (4) miscellaneous. Both clinical evaluation and x-ray studies may be necessary to establish the exact diagnosis. Attention is drawn to the fact that the pubococcygeal line is well above the levator sling and therefore these authors favor using the M point to distinguish between high and low anomalies by means of x-rays, the M point being at the junction of the middle and lower thirds of the ischium. High anomalies accounted for 40% of the cases. These are usually associated with severe obstruction, even in the presence of a fistula. Vertebral and urinary tract anomalies are common. Innervation of the pelvic musculature is often defective. Colostomies are performed at birth, with definitive repair at a later date. The best approach is the sacro-abdomino-perineal. Low anomalies also account for 40% of the total. Obstruction is seldom severe. Associated anomalies are not common and the nerve supply is usually intact. Intermediate anomalies account for 15% of the cases. These patients are treated with a preliminary colostomy and an abdominoperineal approach is used for later reconstruction. Plain x-rays will reveal the terminal gas shadow well below the M point. The miscellaneous group accounts for less than 5% and includes perineal groove and anal membrane. The latter condition can be confusing as the membrane is at the anorectal junction. Early obstruction results. X-rays will show the terminal gas shadow to be below the M point. The membrane can be seen through a proctoscope and it may be possible to pass a catheter through the opening of a ruptured membrane. A contrast enema done in cases with a ruptured membrane will reveal the exact diagnosis. The subgroups in each category are discussed in detail-Donald Nuss
ABDOMEN Cholelithiasis and Cholecystitis in Children. R. G. Johnson and L. A. Longino. Amer. Surg. 37:651-652 (October), 1971.
Thirteen cases of cholelithiasis and cholecystitis in patients less than 18 yr of age are reported. All 13 had cholelithiasis; four had acute cholecystitis. Because sickle cell crisis with abdominal pain may be impossible to distinguish from biliary tract colic, patients with sickle cell disease and abdominal pain should have cholecystography.-E. 7. Berman Acalculous Cholecystitis in Infancy and Childhood. J. J. Rossouw and E. Davies. S. Afr. Med. J. 45:699-700 (June), 1971.
A case of acute acalculous cholecystitie in a 17-mo-old baby is described. No cause was found. Histology of the gallbladder was that of a mucocele of the gallbladder with marked edema and chronic inflammation. In reviewing the literature the authors noted that 570 cases had been described in children 10-15 yr of age by 1964. The maximum age incidence is o-13 yr, although it has been described in a 25-dayold infant. Male or female preponderance varies in different series. The cause may be an associated parasitic infestation, congenital anomalies of the cystic or common ducts, hemolytic streptococcal septicemia, glomerulonephritis, erysipelas, metabolic disorders, hemolytic anemias, and bile stasis. Pain in the right upper quadrant is the most remarkable feature. Jaundice, fattyfood intolerance, nausea, vomiting, and anorexia may be present. A mass was palpable in IO% of cases. Appendicitis must be excluded. A danger is that appendicitis is diagnosed and the abdomen is then not properly explored through a McBurney incision. Cholecystectomy is the treatment of choice after adequate preoperative preparation.-Donald Nuss Hydatid-peritoneum. G. Esposito, R. Posateri, A. Campanelli, C. Cantalupo, M. Improta, and V. Lupo. Osped. Ital. Pediat. 5:197-220 (July-August), 1970.
Out of four observed cases of intraperitoneal rupture of echinococcus cyst, two involved a 12-yr-old girl and a 13-yr-old boy. The first patient had no previous symptoms, and while in perfect health was suddenly stricken by severe abdominal pain and vomiting. On the following 2 days the patient was not well and anorexic, and on
ABSTRACTS
panel in Melbourne, which classifies children with anorectal malformations into four main groups: (I) high or Supralevator anomalies; (2) intermediate anomalies; (3) low or translevator anomalies; (4) miscellaneous. Both clinical evaluation and x-ray studies may be necessary to establish the exact diagnosis. Attention is drawn to the fact that the pubococcygeal line is well above the levator sling and therefore these authors favor using the M point to distinguish between high and low anomalies by means of x-rays, the M point being at the junction of the middle and lower thirds of the ischium. High anomalies accounted for 40% of the cases. These are usually associated with severe obstruction, even in the presence of a fistula. Vertebral and urinary tract anomalies are common. Innervation of the pelvic musculature is often defective. Colostomies are performed at birth, with definitive repair at a later date. The best approach is the sacro-abdomino-perineal. Low anomalies also account for 40% of the total. Obstruction is seldom severe. Associated anomalies are not common and the nerve supply is usually intact. Intermediate anomalies account for 15% of the cases. These patients are treated with a preliminary colostomy and an abdominoperineal approach is used for later reconstruction. Plain x-rays will reveal the terminal gas shadow well below the M point. The miscellaneous group accounts for less than 5% and includes perineal groove and anal membrane. The latter condition can be confusing as the membrane is at the anorectal junction. Early obstruction results. X-rays will show the terminal gas shadow to be below the M point. The membrane can be seen through a proctoscope and it may be possible to pass a catheter through the opening of a ruptured membrane. A contrast enema done in cases with a ruptured membrane will reveal the exact diagnosis. The subgroups in each category are discussed in detail-Donald Nuss
ABDOMEN Cholelithiasis and Cholecystitis in Children. R. G. Johnson and L. A. Longino. Amer. Surg. 37:651-652 (October), 1971.
Thirteen cases of cholelithiasis and cholecystitis in patients less than 18 yr of age are reported. All 13 had cholelithiasis; four had acute cholecystitis. Because sickle cell crisis with abdominal pain may be impossible to distinguish from biliary tract colic, patients with sickle cell disease and abdominal pain should have cholecystography.-E. 7. Berman Acalculous Cholecystitis in Infancy and Childhood. J. J. Rossouw and E. Davies. S. Afr. Med. J. 45:699-700 (June), 1971.
A case of acute acalculous cholecystitie in a 17-mo-old baby is described. No cause was found. Histology of the gallbladder was that of a mucocele of the gallbladder with marked edema and chronic inflammation. In reviewing the literature the authors noted that 570 cases had been described in children 10-15 yr of age by 1964. The maximum age incidence is o-13 yr, although it has been described in a 25-dayold infant. Male or female preponderance varies in different series. The cause may be an associated parasitic infestation, congenital anomalies of the cystic or common ducts, hemolytic streptococcal septicemia, glomerulonephritis, erysipelas, metabolic disorders, hemolytic anemias, and bile stasis. Pain in the right upper quadrant is the most remarkable feature. Jaundice, fattyfood intolerance, nausea, vomiting, and anorexia may be present. A mass was palpable in IO% of cases. Appendicitis must be excluded. A danger is that appendicitis is diagnosed and the abdomen is then not properly explored through a McBurney incision. Cholecystectomy is the treatment of choice after adequate preoperative preparation.-Donald Nuss Hydatid-peritoneum. G. Esposito, R. Posateri, A. Campanelli, C. Cantalupo, M. Improta, and V. Lupo. Osped. Ital. Pediat. 5:197-220 (July-August), 1970.
Out of four observed cases of intraperitoneal rupture of echinococcus cyst, two involved a 12-yr-old girl and a 13-yr-old boy. The first patient had no previous symptoms, and while in perfect health was suddenly stricken by severe abdominal pain and vomiting. On the following 2 days the patient was not well and anorexic, and on