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Congenital atresia of the common bile duct
89
ABSTRACTS
Simpson. 1969.
Surgery 66:798-801,
(October)
The mortality in surgical treatment of congenital diaphragmatic hernias of the Bochdalek type varies from 30 to 50 per cent, and is especiaIly high in infants under 72 hours in age. The major cause of this high mortality is poor pulmonary ventilation which produces severe respiratory acidosis with associated tissue hypoxia, metabolic acidosis and a right-to-left shunt. Increased abdominal pressure, which is produced by moving the displaced abdominal viscera from the pleural cavity into the abdomen, compromises respiration. In two cases the viscera contained in the left pleural cavity were placed in a ventral silon pouch after transabdominal repair of the diaphragmatic hernia was performed. On about the third day postoperative, when the infant’s general condition was satisfactory, daily reduction in size of the pouch was begun. The pouch was eventually removed when the viscera were all returned to the peritoneal cavity. One patient survived uneventfully. The other patient died on the fourth day after surgery, and autopsy failed to reveal an exact cause of death. In both patients satisfactory pulmonary ventilation was obtained.Daniel T. Cloud. TREATMENT
OF OMPHALOCPLE
BASED ON IN-
DIVIDUAL
CHARACTERISTICS
OF
FEC~. Conrad
G.
Rattdolph.
(July)
W. Wessefhoeft
Pediatrics
THE
DE-
and Judson
44: 101-108.
1969.
In the treatment of 27 infants with omphalocele at the Children’s Hospital of Washington, D.C., the appropriate therapy was chosen according to the anatomical problem presented. When the sac was intact, no serious associated anomalies present and the size less than 5 cm. in diameter, primary surgical closure was accomplished with complete musculofascial repair. Skin closure only was done when such a repair could not be accomplished. Those omphaloceles with associated serious anomalies or that were larger than 5 cm. in diameter were treated nonsurgically initially using Mercurochrome painting. Ruptured omphaloceles or gastrochisis were treated by skin closure when possible, and more recently by closing the defect with silastic or plastic
prosthesis, removeable in stages within a few weeks as the abdominal cavity enlarged. Illustrative cases are presented. Nineteen of the 21 infants survived.William
K. Sieber.
CONGENITAL ATRESIA OF THE COMMON DUCT. D. E. Sturdy.
445, (June)
BILE
Brit. J. Surg. 56:443-
1969.
A case of atresia of the common bile duct is presented. The infant was jaundiced at birth and subsequent investigation showed an obstructive pattern. Laparotomy at the age of 10 weeks showed a dilated biliary tract, including the gall bladder and cystic duct, proximal to the atresic terminal centimeter of common bile duct. An end-to-side was performed choledochoduodenostomy with a fine polythene splint tube through the anastomosis brought out through the common duct at a higher level and let out through a separate stab incision. He made an uneventful recovery and last seen at the age of three years was well and symptomless.--l. Lari. CONGENITAL DUCT
STENOSIS
AS A CAUSE
OF
AND EMESIS. Stcphetc
66:398-400,
THE
COMMON
OF ABDOMINAL
(August)
P. Grayer.
PAIN
Surgery
1969.
A 14-year-old girl presented with symptoms of postprandial nausea, epigastric pain and vomiting occurring several times a week. These complaints apparently started in early infancy. An exploratory laparotomy at the age of five years failed to reveal pathology. There was no history of jaundice or blood disease. Multiple x-ray studies, liver chemistries and amylase values had been normal. There was no mass on physical examination. The oral cholecystogram revealed a markedly dilated gallbladder without evidence of stones. At operation the gallbladder was removed. It was not possible to pass a probe through the ampulla of Vater. A T-tube was left in the common duct. A postoperative T-tube cholangiogram revealed stenosis in the distal common duct. proximal lo the ampulla. Six weeks after the cholecystectomy, another operation was performed. A side-toside choledochoduodenostomy was estahlished. The T-tube was removed on the 12th
ABSTRACTS
Simpson. 1969.
Surgery 66:798-801,
(October)
The mortality in surgical treatment of congenital diaphragmatic hernias of the Bochdalek type varies from 30 to 50 per cent, and is especiaIly high in infants under 72 hours in age. The major cause of this high mortality is poor pulmonary ventilation which produces severe respiratory acidosis with associated tissue hypoxia, metabolic acidosis and a right-to-left shunt. Increased abdominal pressure, which is produced by moving the displaced abdominal viscera from the pleural cavity into the abdomen, compromises respiration. In two cases the viscera contained in the left pleural cavity were placed in a ventral silon pouch after transabdominal repair of the diaphragmatic hernia was performed. On about the third day postoperative, when the infant’s general condition was satisfactory, daily reduction in size of the pouch was begun. The pouch was eventually removed when the viscera were all returned to the peritoneal cavity. One patient survived uneventfully. The other patient died on the fourth day after surgery, and autopsy failed to reveal an exact cause of death. In both patients satisfactory pulmonary ventilation was obtained.Daniel T. Cloud. TREATMENT
OF OMPHALOCPLE
BASED ON IN-
DIVIDUAL
CHARACTERISTICS
OF
FEC~. Conrad
G.
Rattdolph.
(July)
W. Wessefhoeft
Pediatrics
THE
DE-
and Judson
44: 101-108.
1969.
In the treatment of 27 infants with omphalocele at the Children’s Hospital of Washington, D.C., the appropriate therapy was chosen according to the anatomical problem presented. When the sac was intact, no serious associated anomalies present and the size less than 5 cm. in diameter, primary surgical closure was accomplished with complete musculofascial repair. Skin closure only was done when such a repair could not be accomplished. Those omphaloceles with associated serious anomalies or that were larger than 5 cm. in diameter were treated nonsurgically initially using Mercurochrome painting. Ruptured omphaloceles or gastrochisis were treated by skin closure when possible, and more recently by closing the defect with silastic or plastic
prosthesis, removeable in stages within a few weeks as the abdominal cavity enlarged. Illustrative cases are presented. Nineteen of the 21 infants survived.William
K. Sieber.
CONGENITAL ATRESIA OF THE COMMON DUCT. D. E. Sturdy.
445, (June)
BILE
Brit. J. Surg. 56:443-
1969.
A case of atresia of the common bile duct is presented. The infant was jaundiced at birth and subsequent investigation showed an obstructive pattern. Laparotomy at the age of 10 weeks showed a dilated biliary tract, including the gall bladder and cystic duct, proximal to the atresic terminal centimeter of common bile duct. An end-to-side was performed choledochoduodenostomy with a fine polythene splint tube through the anastomosis brought out through the common duct at a higher level and let out through a separate stab incision. He made an uneventful recovery and last seen at the age of three years was well and symptomless.--l. Lari. CONGENITAL DUCT
STENOSIS
AS A CAUSE
OF
AND EMESIS. Stcphetc
66:398-400,
THE
COMMON
OF ABDOMINAL
(August)
P. Grayer.
PAIN
Surgery
1969.
A 14-year-old girl presented with symptoms of postprandial nausea, epigastric pain and vomiting occurring several times a week. These complaints apparently started in early infancy. An exploratory laparotomy at the age of five years failed to reveal pathology. There was no history of jaundice or blood disease. Multiple x-ray studies, liver chemistries and amylase values had been normal. There was no mass on physical examination. The oral cholecystogram revealed a markedly dilated gallbladder without evidence of stones. At operation the gallbladder was removed. It was not possible to pass a probe through the ampulla of Vater. A T-tube was left in the common duct. A postoperative T-tube cholangiogram revealed stenosis in the distal common duct. proximal lo the ampulla. Six weeks after the cholecystectomy, another operation was performed. A side-toside choledochoduodenostomy was estahlished. The T-tube was removed on the 12th