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Comparison of oxygen and barium reduction of ileocolic intussusception
137
INTERNATIONAL ABSTRACTS
died. Overall survival was 59%. Risk with reoperation was felt to be ascribable to the primary disease process and not to the repeat laparotomy itself. Mortality from N E C was no different from that of perforation from other disease processes.--Thomas V. Whalen Intussusception Reduction in Children by Rectal Insufflation of Air.
L. Gu, D.J. Alton, A. Daneman, et al. AJR 150:1345-1348, (June), 1988. This report begins by noting that a textbook published in 1897 recounted the successful reduction of intussusception by use of an ordinary hand bellows. This is followed by a recounting of a prospective study of the use of air insufflation for reduction of intussusception. The initial pressure was set at 80 mmHg, but was carried to 120 mmHg in patients who were not "considered at high risk for perforation." Fluoroscopy was employed. Failure of pneumatic reduction led to an attempt by barium enema. There were 118 intussusceptions identified and entered into the study. Reduction was accomplished in 75%. No patient whose pneumatic reduction was unsuccessful was able to be reduced by the barium enema. Of the 29 patients who were then operated on, 12 were said to be easily reduced, seven were reduced with "great difficulty," and seven required resection. There were three perforations; all were instantly recognized. There were four patients referred to the authors after unsuccessful reduction with a barium enema, who were reduced pneumostatically. The authors also note that the average fluoroscopic time was just 30 seconds, and the average procedure time was five minutes.--Thomas V. Whalen
reduction, with a 50% success. Hydrostatic reduction was requested by the surgeon after careful clinical assessment, and was not attempted where the history was longer than 48 hours or associated with bleeding, peritonism, or perforation. Recurrences were all treated surgically. Bleeding and obstruction were not regarded as contraindications to hydrostatic reduction. Fifty-one patients had a laparotomy; 11 required resection. Only one patient who had a failed hydrostatic reduction required resection. The highest incidence of resection was in infants 3 to 6 months of age with complete obstruction--a group in which hydrostatic reduction is not advised. There was one death from pseudomembranous colitis. The authors recommend hydrostatic reduction of intussusception in selected cases.--W.G. Scobie Individualized Management of Colonic Atresia. E.C. Pohlson, E.L Hatch, P.L. Glick, eta. Am J Surg 155:690-692, (May), 1988.
Eleven patients with colonic atresia were surgically treated over a 5-year period. Two patients had associated gastroschisis, one of whom had associated ileal atresia. Multiple atresias were seen in two patients, and arthrogryposis and malrotation were each seen in one patient. Four patients (one with type I and three with type III atresia) had primary repair and did well. Three deaths occurred in three premature neonates, Each of them had associated anomalies that were the proximate cause of death. Associated conditions, gestational age, and the patient's general condition should be taken into account when planning operative correction of colonic atresia.-Thomas V. Whalen
Pneumatic Reduction of Ileocolic Intussusception in Children. S.G.
Miles, W.A. Cumming, and J.L. Williams. Pediatr Radiol 18:3-5, (January), 1988. While acknowledging that colleagues in Asia and South America have used pneumatic reduction in the therapy of intussusception for many years, the authors ~'eport four cases of use of this technique as a new option in the United States. Each of the four briefly recounted cases had prompt and successful reduction of an ileocolic intussusception. Pressure in the system was regulated so as not to exceed 120 mmHg, and fluoroscopic observation was constantly used. The authors enthusiastically endorse this technique, stating it will now become their preferred method of treatment.--Thomas V. Whalen Comparison of Oxygen and Barium Reduction of Ileocolic Intussusception. E. Phelan, J.F. de Campo, and G. Malecky. A JR 150:1349-
1352, (June), 1988. This Australian hospital treated 57 patients with 61 episodes of intussusception over an 8-month period beginning in late 1986. Six patients were thought to be unacceptable risks for attempted reduction, leaving 55 attempted reductions. The authors used oxygen at a flow rate of 2 L/rain, and at a pressure of 80 mmHg. This is stated to be equivalent to a l-m column of barium. Fluoroscopy was employed and reduction was attempted in a similar fashion as with barium (three attempts of three minutes each). Reduction was successful in 40 of 55 attempts, for a success rate of 73%. This compares quite favorably with the authors' own series of attempted barium reductions (379 attempts over 15 years, with a 53% success rate). There were no perforations during the oxygen enemas. The authors state that oxygen reduction has gained "unanimous acceptance" among the pediatric surgeons at their institution.--Thomas V. Whalen Intussusception: The Case for Barium Reduction. J.H.R. Winstan-
ley, C.M. Doig, and H. Brydon. J R Coil Surg Edinb 32:285-287, (November), 1987. The authors report a 5-year experience with 78 cases of intussusception. Fifty-four patients were treated initially by hydrostatic
Hirschsprung's Disease: Alpha-naphthylesterase Activity for Enzyme-Histochemical Evaluation of the Extent of the Aganglionic Segment During Surgery. P. Dodero and G. Martucciello. Pediatr
Surg Internat 3:269-274, (May), 1988. The authors present their experience with the histotopochemical a-naphthylesterase reaction for intraoperative evaluation of the length of the aganglionic segment in Hirschsprung's disease (HD). The activity of nonspecific esterases was used to demonstrate the presence or absence of intramural ganglion cells in seromuscular intestinal biopsies taken at various levels in 50 patients with the preoperative diagnosis of HD. In 44 cases, the biopsies were taken during a definitive HD operation (endorectal pull-through,' Spare technique). In the remaining six patients, who presented with intestinal obstruction, the biopsies were taken during a laparotomy. The authors consider this histochemical technique a reliable, quick, simple, and economical method for intraoperative evaluation of the length of the aganglionic segment. It is also useful for confirming the diagnosis of HD, and is of help in the study of so-called pseudoHD.--Prem Purl of 4 Cases. C. Janneck and W. Holthusen. Z Kinderchir 43:112-116, (April), 1988.
The Currarino Triad--Review
Four cases of the rare syndrome known as Currarino Triad are reported, consisting of a coincidence between anorectal malformation, presacral mass, and a curved defect of the sacrum (scimitar sacrum). Each congenital or chronic constipation should prompt early radiologic examination of the sacrum and the anorectum. The finding of a scimitar sacrum necessitates a contrast enema and a CT scan in the patient and his family, since autosomal inheritance is known in 50% of the Currarino Triad. The surgical problems are discussed. It is emphasized that a careful division of the rectal and spinal tissues must be achieved to prevent a dangerous and lifethreatening infection of the meningeal sac.--Thomas A. Angerpointner
INTERNATIONAL ABSTRACTS
died. Overall survival was 59%. Risk with reoperation was felt to be ascribable to the primary disease process and not to the repeat laparotomy itself. Mortality from N E C was no different from that of perforation from other disease processes.--Thomas V. Whalen Intussusception Reduction in Children by Rectal Insufflation of Air.
L. Gu, D.J. Alton, A. Daneman, et al. AJR 150:1345-1348, (June), 1988. This report begins by noting that a textbook published in 1897 recounted the successful reduction of intussusception by use of an ordinary hand bellows. This is followed by a recounting of a prospective study of the use of air insufflation for reduction of intussusception. The initial pressure was set at 80 mmHg, but was carried to 120 mmHg in patients who were not "considered at high risk for perforation." Fluoroscopy was employed. Failure of pneumatic reduction led to an attempt by barium enema. There were 118 intussusceptions identified and entered into the study. Reduction was accomplished in 75%. No patient whose pneumatic reduction was unsuccessful was able to be reduced by the barium enema. Of the 29 patients who were then operated on, 12 were said to be easily reduced, seven were reduced with "great difficulty," and seven required resection. There were three perforations; all were instantly recognized. There were four patients referred to the authors after unsuccessful reduction with a barium enema, who were reduced pneumostatically. The authors also note that the average fluoroscopic time was just 30 seconds, and the average procedure time was five minutes.--Thomas V. Whalen
reduction, with a 50% success. Hydrostatic reduction was requested by the surgeon after careful clinical assessment, and was not attempted where the history was longer than 48 hours or associated with bleeding, peritonism, or perforation. Recurrences were all treated surgically. Bleeding and obstruction were not regarded as contraindications to hydrostatic reduction. Fifty-one patients had a laparotomy; 11 required resection. Only one patient who had a failed hydrostatic reduction required resection. The highest incidence of resection was in infants 3 to 6 months of age with complete obstruction--a group in which hydrostatic reduction is not advised. There was one death from pseudomembranous colitis. The authors recommend hydrostatic reduction of intussusception in selected cases.--W.G. Scobie Individualized Management of Colonic Atresia. E.C. Pohlson, E.L Hatch, P.L. Glick, eta. Am J Surg 155:690-692, (May), 1988.
Eleven patients with colonic atresia were surgically treated over a 5-year period. Two patients had associated gastroschisis, one of whom had associated ileal atresia. Multiple atresias were seen in two patients, and arthrogryposis and malrotation were each seen in one patient. Four patients (one with type I and three with type III atresia) had primary repair and did well. Three deaths occurred in three premature neonates, Each of them had associated anomalies that were the proximate cause of death. Associated conditions, gestational age, and the patient's general condition should be taken into account when planning operative correction of colonic atresia.-Thomas V. Whalen
Pneumatic Reduction of Ileocolic Intussusception in Children. S.G.
Miles, W.A. Cumming, and J.L. Williams. Pediatr Radiol 18:3-5, (January), 1988. While acknowledging that colleagues in Asia and South America have used pneumatic reduction in the therapy of intussusception for many years, the authors ~'eport four cases of use of this technique as a new option in the United States. Each of the four briefly recounted cases had prompt and successful reduction of an ileocolic intussusception. Pressure in the system was regulated so as not to exceed 120 mmHg, and fluoroscopic observation was constantly used. The authors enthusiastically endorse this technique, stating it will now become their preferred method of treatment.--Thomas V. Whalen Comparison of Oxygen and Barium Reduction of Ileocolic Intussusception. E. Phelan, J.F. de Campo, and G. Malecky. A JR 150:1349-
1352, (June), 1988. This Australian hospital treated 57 patients with 61 episodes of intussusception over an 8-month period beginning in late 1986. Six patients were thought to be unacceptable risks for attempted reduction, leaving 55 attempted reductions. The authors used oxygen at a flow rate of 2 L/rain, and at a pressure of 80 mmHg. This is stated to be equivalent to a l-m column of barium. Fluoroscopy was employed and reduction was attempted in a similar fashion as with barium (three attempts of three minutes each). Reduction was successful in 40 of 55 attempts, for a success rate of 73%. This compares quite favorably with the authors' own series of attempted barium reductions (379 attempts over 15 years, with a 53% success rate). There were no perforations during the oxygen enemas. The authors state that oxygen reduction has gained "unanimous acceptance" among the pediatric surgeons at their institution.--Thomas V. Whalen Intussusception: The Case for Barium Reduction. J.H.R. Winstan-
ley, C.M. Doig, and H. Brydon. J R Coil Surg Edinb 32:285-287, (November), 1987. The authors report a 5-year experience with 78 cases of intussusception. Fifty-four patients were treated initially by hydrostatic
Hirschsprung's Disease: Alpha-naphthylesterase Activity for Enzyme-Histochemical Evaluation of the Extent of the Aganglionic Segment During Surgery. P. Dodero and G. Martucciello. Pediatr
Surg Internat 3:269-274, (May), 1988. The authors present their experience with the histotopochemical a-naphthylesterase reaction for intraoperative evaluation of the length of the aganglionic segment in Hirschsprung's disease (HD). The activity of nonspecific esterases was used to demonstrate the presence or absence of intramural ganglion cells in seromuscular intestinal biopsies taken at various levels in 50 patients with the preoperative diagnosis of HD. In 44 cases, the biopsies were taken during a definitive HD operation (endorectal pull-through,' Spare technique). In the remaining six patients, who presented with intestinal obstruction, the biopsies were taken during a laparotomy. The authors consider this histochemical technique a reliable, quick, simple, and economical method for intraoperative evaluation of the length of the aganglionic segment. It is also useful for confirming the diagnosis of HD, and is of help in the study of so-called pseudoHD.--Prem Purl of 4 Cases. C. Janneck and W. Holthusen. Z Kinderchir 43:112-116, (April), 1988.
The Currarino Triad--Review
Four cases of the rare syndrome known as Currarino Triad are reported, consisting of a coincidence between anorectal malformation, presacral mass, and a curved defect of the sacrum (scimitar sacrum). Each congenital or chronic constipation should prompt early radiologic examination of the sacrum and the anorectum. The finding of a scimitar sacrum necessitates a contrast enema and a CT scan in the patient and his family, since autosomal inheritance is known in 50% of the Currarino Triad. The surgical problems are discussed. It is emphasized that a careful division of the rectal and spinal tissues must be achieved to prevent a dangerous and lifethreatening infection of the meningeal sac.--Thomas A. Angerpointner