Congenital choledochal cyst (cystic dilatation of the common bile duct)

ABSTRACTS being due occasionally to cirrhosis but more often to ductal pathology that was not identified at the initial exploration. Of 57 patients treated by simple portoenterostomy, eight died postoperatively, 21 showed no significant excretion of bile, and 19 showed good or fair bile excretion. Of these 19, 11 died of hepatic failure or esophageal varices, eight are well and not jaundiced 3 17 yr postoperatively. Modified double-Y R o u x loops of various forms to prevent cholangitis have improved results with six successful cases out of 12 patients. Operation at less than 10 wk of age seems essential to longterm success. R. C. M. Cook Long-term Results of Hepatic Portoenterostomy for Biliary Atresia: Special Reference to PostOperative Portal Hypertension. Masahiko Miyato, Minoru Satan/, Takashi Ueda, and Eizo Okamoto. Surgery 76:234-237 (August) 1974. This report concerns follow-up information on 51 infants with biliary atresia treated by hepatic portojejunostomy during the past 5 yr at the Children's Medical Center of Osaka City, Japan. Bile appeared in the stool in 31 of the 51 patients postoperatively, but in only 15 of these did the jaundice completely disappear. These 15 were all under 4 m o of age at the time of surgical treatment. Ten patients died within a m o n t h postoperatively. Twenty-two of the jaundiced patients died 2 to 18 mo postoperatively. The remaining three are alive 4 to 39 mo postoperatively. Four of the infants in w h o m jaundice had disappeared died 18 to 41 mo postoperatively. The other eleven are alive 12 to 71 m o postoperatively. Portal hypertension was documented in seven of the 15 infants in whom the jaundice cleared, first appearing 6 to 36 mo postoperatively and associated with an episode of cholangitis in five instances. Recurring transient cholangitis was noted in 71~,, of those surviving patients whose jaundice cleared. The a u t h o r s emphasize that while m a n y patients with biliary atresia are benefited by hepatic portojejunostomy, recurring cholangitis and subsequent portal hypertension are comm o n postoperative problems preventing complete recovery.-- William K. Sieber Congenital Choledochal Cyst (Cystic Dilatation of the Common Bile Duct). S. Saito and M. Ishida. Prog. Pediatr. Surg. 6:63-90, 1974. A wide historical review suggests that this is not a specific entity but related to neonatal

1sg hepatitis and biliary atresia. It is possibly due to congenital weakness of parts of the bile duct wall combined with a distal obstruction that could be an acquired inflammatory condition. Only nine out of 39 cases were in males. M o s t presented in infancy with jaundice, pain, a n d a mass. Histologically, the biliary wall was replaced by fibrous tissue and often had no epithelial lining, although early biliary carcin o m a is reported and the a u t h o r s m e n t i o n one case of their own. Scattered units of muscle are found distally in the wall of the duct. Complete excision of the cyst and a Roux-en-Y a n a s t o m o s i s of the intestine to the remaining part is recommended. A n a s t o m o s i s of the cyst itself to the intestine is sometimes the only available course. Cbolangitis (two out of 24 cases) and anastomotic stricture (one out of 24) occurred after cyst excision but were m u c h more c o m m o n after c y s t o d u o d e n o s t o m y or c y s t o j e j u n o s t o m y . - - R . C. M. Cook Classic Cholelithiasis and Choledocholithiasis in a lO-Year-OId Girl. R. C. Moffat. Can. J. Surg. 17:152-154 (May) 1974. A single case report is presented.--Colin C. Ferguson Hepatic and Splenic Lymphangiamatosis With Skeletal Involvement: Report of a Case and Review of the Literature. Morris J. Asch, Arthur H. Cohen, and Thomas C. Moore. Surgery 76:334339 (August) 1974. A case of l y m p h a n g i o m a t o s i s with massive hepatosplenomegaly and lytic lesions of second and fourth ribs in a 10-yr-old girl is reported and compared with 11 similar reported cases. Splenectomy and hepatic biopsy were done. The child remains in good health 1 yr postoperatively. Her ultimate prognosis, however, is poor. William K. Sieber G E N I T O U R I N A R Y TRACT Neonatal Urinary Ascites: A Report of Two Cases of Unusual Etiology and a Review of the Literature. C. M. Mann, L. L. Leape, and T. M. Holder. J. Urol. 111:124-128 (January) 1974. Two patients and a review of 36 cases in the literature are presented. The causes in the two patients were a subcapsular leak from the kidney secondary to bladder neck obstruction and a ruptured neurogenic bladder from spinal cord compression secondary to neuroblastoma, in the literature, 23 of 36 showed a definite site o f perforation and 17 of 23 were in the kidney.