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Colonic polyps and coloduodenal fistula: Unusual complications in patients with cystic fibrosis
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ing the barium swallow, sphincter pressure measurements, pH probe monitoring, and radionuclide gastroesophagraphy. Most series report the acide reflux test (pH probe) as correlating best with symptoms of GER. The pathophysiology of GER, not well understood, may be related to delayed maturation of lower esophageal neuromuscular function or impaired local hormonal control. Delayed gastric emptying plays a major role in some patients while hypogastrinemia, a factor in adults, appears not to be so in G E R during infancy. Experimental studies in animals related to aspiration pneumonia and laryngospasm are also discussed.--Randall IV. Powell Spontaneous Oesophageal Rupture With Duodenal Atresia in a Newborn Infant, Hajime Nakamura, Yoshihiko Kana-
zawa, Masaki Hayano, and Shinichiro Mimasu. Arch Dis Child 56:71 72, (January), 1981. A 2.75 kg, 38-wk gestation male baby presented at 19 hr with respiratory distress, cyanosis, distended abdomen and diminished right chest movement. X-ray showed a hydropneumothorax and distended stomach and duodenum without distal gas. Thoracentesis revealed bile-stained fluid and further x-ray revealed a pneumoperitoneum. At exploration, a rupture of the esophagogastric junction (longitudinal, anterolateral, 1.5 cm) and a duodenal atresia were found. Despite repair of the rupture, gastrostomy and duodenojejunostomy, the baby died 43 hr later in cardiac failure. In the absence of resuscitation or passage of a nasogastric tube at birth, the rupture was considered to be spontaneous.--P. A. M. Raine Management of Mucosal Perforation During Pyloromyotomy for Infantile Pyloric Stenosis. D. E. Hight. C. D.
Benson, A. I. Philippart, and J. H. Hertzler. Surgery 90:8586, (July), 1981. The authors describe a technique for closure of inadvertent mucosal perforation at the time of pyloromyotomy. A single absorbable suture imbricates the intact pyloric mucosa beneath the seromuscular layer of duodenum in a horizontal mattress fashion. A m o n g 1777 cases seen from 1940 to 1979 there were 42 mucosal perforations. An unrecognized perforation led to the one operative related death in the series. All 42 patients treated with this technique survived without morbidity.--Eugene S. Wiener Neonatal Necrotizing Entarocolitis: Comparative Study in Three Large Maternity Hospitals. P. Purl and E. J. Guiney.
Br Med J. 281:482~,83, (August), 1980. During a 2 yr prospective study in Dublin, 14 neonates were diagnosed as having necrotizing enterocolitis among the 42,992 babies born during this period. The most interesting point that emerges from this study is the remarkably low overall incidence of necrotizing enterocolitis and the striking difference in the incidence in three large maternity hospitals in Dublin--G. Zervos Perforated Appendicitis in Children: Use of Metronidazole for the Reduction of Septic Complications. P. Puri,
L. Rangecroft, G. Zervos, et al. Z Kinderchir 32:111-115, (February), 1981.
ABSTRACTS
Fifty-four consecutive children with perforated appendicitis were treated with intravenous and rectal metronidazole combined with another antimicrobial agent. Positive cultures were obtained from peritoneal swabs from all children except from four patients who produced no growth on culture. Mixed growth of aerobic and anaerobic organisms were isolated from 44 patients. Four patients had pure growth of aerobes and two had pure growth of anaerobes. Results were compared with 49 cases of perforated appendicitis treated with a combination of Gentamicin and Cephradine, who did not receive metronidazole. The overall incidence of complications was reduced from 44.9% to 14.8%. A significant reduction in the incidence of wound infection (p < 0.001) and pelvic abscess (p < 0.025) was observed in the metronidazole treated group. The period of hospitalization averaged 13.8 days in patients treated with metronidazole as compared to 18.2 days in those treated without metronidazole.-G. Zervos Colonic Polyps and Coloduodenal Fistula: Unusual Complications in Patients With Cystic Fibrosis. O. A. Mahogunje,
J. F. Goldthorn. C. I. Wang, and G. H. Mahour. Surgery 90:114 116,(July),1981. This is a case report of a patient with cystic fibrosis who had meconium peritonitis requiring intestinal anastomosis as a newborn and who 6 yr later presented with abdomina~ pain, anorexia, fever, weight loss and vomiting. X-ray evidence of duodenal obstruction was found. This was caused by colonic polyps arising in the right side of the colon which eroded through the colonic and duodenal walls. The polyps were inflammatory in nature and probably followed stercoral ulcerations. She was treated with total parenteral nutrition, right colectomy, gastric diversion, and a controlled duodenal fistula which ultimately healed and she is well 1 yr l a t e r . Eugene S. Wiener Modified Endorectal Procedure for Management of Long
Segment Aganglionosis. F. T. Jordern, A. G. Coran, and J. R. Wesley. Ann Surg 194:70 75, (July), 1981. Eleven patients with long segment Hirschsprung's disease underwent endorectal pull-throughs between 1974 and 1979. Follow-up has been for an average of 42.6 me. Preoperative preparation, surgical technique, and postoperative care are briefly discussed. Postoperative complications included one incorrect levelling which resulted in a second pull-through, two wound infections, and two cases of postoperative enterocolitis. Those patients who were toilet trained had a stabilization of bowel function within 6 me of surgery. The authors had no definite explanation as to why their patients had less diarrhea than those in previously reported series.--Jane F. Gotdthorn Simple Modification of Duhamel's Operation for the Treatment of Hirschsprung's Disease. E. @kamoto and
S. Ohashi. A m e r J Surg 142:302-304, (August), 1981. A modification of the Duhamel procedure which eliminates the blind rectal pouch is described. The technique in which a spur crushing clamp (Okamoto's crushing clamp) is
ing the barium swallow, sphincter pressure measurements, pH probe monitoring, and radionuclide gastroesophagraphy. Most series report the acide reflux test (pH probe) as correlating best with symptoms of GER. The pathophysiology of GER, not well understood, may be related to delayed maturation of lower esophageal neuromuscular function or impaired local hormonal control. Delayed gastric emptying plays a major role in some patients while hypogastrinemia, a factor in adults, appears not to be so in G E R during infancy. Experimental studies in animals related to aspiration pneumonia and laryngospasm are also discussed.--Randall IV. Powell Spontaneous Oesophageal Rupture With Duodenal Atresia in a Newborn Infant, Hajime Nakamura, Yoshihiko Kana-
zawa, Masaki Hayano, and Shinichiro Mimasu. Arch Dis Child 56:71 72, (January), 1981. A 2.75 kg, 38-wk gestation male baby presented at 19 hr with respiratory distress, cyanosis, distended abdomen and diminished right chest movement. X-ray showed a hydropneumothorax and distended stomach and duodenum without distal gas. Thoracentesis revealed bile-stained fluid and further x-ray revealed a pneumoperitoneum. At exploration, a rupture of the esophagogastric junction (longitudinal, anterolateral, 1.5 cm) and a duodenal atresia were found. Despite repair of the rupture, gastrostomy and duodenojejunostomy, the baby died 43 hr later in cardiac failure. In the absence of resuscitation or passage of a nasogastric tube at birth, the rupture was considered to be spontaneous.--P. A. M. Raine Management of Mucosal Perforation During Pyloromyotomy for Infantile Pyloric Stenosis. D. E. Hight. C. D.
Benson, A. I. Philippart, and J. H. Hertzler. Surgery 90:8586, (July), 1981. The authors describe a technique for closure of inadvertent mucosal perforation at the time of pyloromyotomy. A single absorbable suture imbricates the intact pyloric mucosa beneath the seromuscular layer of duodenum in a horizontal mattress fashion. A m o n g 1777 cases seen from 1940 to 1979 there were 42 mucosal perforations. An unrecognized perforation led to the one operative related death in the series. All 42 patients treated with this technique survived without morbidity.--Eugene S. Wiener Neonatal Necrotizing Entarocolitis: Comparative Study in Three Large Maternity Hospitals. P. Purl and E. J. Guiney.
Br Med J. 281:482~,83, (August), 1980. During a 2 yr prospective study in Dublin, 14 neonates were diagnosed as having necrotizing enterocolitis among the 42,992 babies born during this period. The most interesting point that emerges from this study is the remarkably low overall incidence of necrotizing enterocolitis and the striking difference in the incidence in three large maternity hospitals in Dublin--G. Zervos Perforated Appendicitis in Children: Use of Metronidazole for the Reduction of Septic Complications. P. Puri,
L. Rangecroft, G. Zervos, et al. Z Kinderchir 32:111-115, (February), 1981.
ABSTRACTS
Fifty-four consecutive children with perforated appendicitis were treated with intravenous and rectal metronidazole combined with another antimicrobial agent. Positive cultures were obtained from peritoneal swabs from all children except from four patients who produced no growth on culture. Mixed growth of aerobic and anaerobic organisms were isolated from 44 patients. Four patients had pure growth of aerobes and two had pure growth of anaerobes. Results were compared with 49 cases of perforated appendicitis treated with a combination of Gentamicin and Cephradine, who did not receive metronidazole. The overall incidence of complications was reduced from 44.9% to 14.8%. A significant reduction in the incidence of wound infection (p < 0.001) and pelvic abscess (p < 0.025) was observed in the metronidazole treated group. The period of hospitalization averaged 13.8 days in patients treated with metronidazole as compared to 18.2 days in those treated without metronidazole.-G. Zervos Colonic Polyps and Coloduodenal Fistula: Unusual Complications in Patients With Cystic Fibrosis. O. A. Mahogunje,
J. F. Goldthorn. C. I. Wang, and G. H. Mahour. Surgery 90:114 116,(July),1981. This is a case report of a patient with cystic fibrosis who had meconium peritonitis requiring intestinal anastomosis as a newborn and who 6 yr later presented with abdomina~ pain, anorexia, fever, weight loss and vomiting. X-ray evidence of duodenal obstruction was found. This was caused by colonic polyps arising in the right side of the colon which eroded through the colonic and duodenal walls. The polyps were inflammatory in nature and probably followed stercoral ulcerations. She was treated with total parenteral nutrition, right colectomy, gastric diversion, and a controlled duodenal fistula which ultimately healed and she is well 1 yr l a t e r . Eugene S. Wiener Modified Endorectal Procedure for Management of Long
Segment Aganglionosis. F. T. Jordern, A. G. Coran, and J. R. Wesley. Ann Surg 194:70 75, (July), 1981. Eleven patients with long segment Hirschsprung's disease underwent endorectal pull-throughs between 1974 and 1979. Follow-up has been for an average of 42.6 me. Preoperative preparation, surgical technique, and postoperative care are briefly discussed. Postoperative complications included one incorrect levelling which resulted in a second pull-through, two wound infections, and two cases of postoperative enterocolitis. Those patients who were toilet trained had a stabilization of bowel function within 6 me of surgery. The authors had no definite explanation as to why their patients had less diarrhea than those in previously reported series.--Jane F. Gotdthorn Simple Modification of Duhamel's Operation for the Treatment of Hirschsprung's Disease. E. @kamoto and
S. Ohashi. A m e r J Surg 142:302-304, (August), 1981. A modification of the Duhamel procedure which eliminates the blind rectal pouch is described. The technique in which a spur crushing clamp (Okamoto's crushing clamp) is