Divided loop colostomy that does not prolapse

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There was significant correlation between altered motility or frank atony on cine study and eventual stricture. If the cine study was normal, even with endoscopic evidence of extensive deep circumferential burns, there was no stricture formation. The authors conclude that cineesophagography is the most reliable index of long-term problems after caustic ingestion.-- Thomas V. Whalen, Jr

normal esophagus and a contracted and scarred stomach. At laparotomy, corrosive strictures of the entire stomach with an almost complete pyloric obstruction were found. Esophagus and duodenum were normal. Total gastrectomy with esophagoduodenostomy was performed. The postoperative course was uneventful. Two years later the child was well and without abdominal complaints.--Thomas A. Angerpointner

Percutaneous Endoscopic Gastrostomy Following Previous

A Natural Spreader For The Pylorus. J.G. Raffensperger and

Abdominal Surgery. T.A. Stellato, M.W.L. Gauderer, and

B.H. Kaufman. Surg Gynecol Obstet 159: 77-78, (July), 1984.

J.L. Ponsky. A n n Surg 200:46-50, (July), 1984. Eighty-nine patients have undergone percutaneous endoscopic gastrostomy by the authors. Of these patients, 25 (13 infants and children, 12 adults) had prior abdominal procedures. All except 2 patients had the procedure done under local anesthesia. Two children were below 1 year of age and 6 were between the ages of 1 to 5 years. There was one major complication, a gastrocolic fistula, that developed 3 months after placement in a 3 year old. This patient had undergone a previous ventriculoperitoneal shunt and open liver biopsy. This was successfully managed by repeating the endoscopic gastrostomy procedure at a location more cephalad in the stomach. The fistula closed in 1 week without sequelae. The second tube is still in place and functioning well 31 months later. The average operating time was 33.6 minutes, and the authors have a total experience of 255 patient months. There were no other serious complications. Percutaneous endoscopic gastrostomy is recommended as the procedure of choice in all patients requiring gastrostomy tube feedings and may be especially helpful in high-risk patients with multisystem disease or prior abdominal surgery.--Richard J. Andrassy Carcinoma of the Stomach in a 7-Year-Old B o y - - A Case Report and a Review of the Literature on Children under 10

Years of Age. S. Goto, K. lkeda, E. lshii, et al. Z Kinderchir

39:137 140, (April), 1984. A 7-year-old boy with gastric cancer is presented. Total gastrectomy with Roux-en-Y-esophagojejunostomy was performed. There was no evidence of organ metastases at time of the first operation. Histologic examination revealed an anaplastic adenocarcinoma. Despite postoperative chemotherapy, tumor recurred in the retroperitoneum requiring repeat laparotomy 2 months later. The patient deteriorated gradually thereafter and died of severe bleeding 5 months following the first operation. Postmortem examination revealed multiple metastases. Carcinoma of the stomach in children under 10 years is exceedingly rare. Searching the literature, the authors found only 9 cases, the youngest being a 2-year-old girl.-- Thomas A. Angerpointner

The authors report favorable results from the use of a "natural spreader" in the performance of pyloromyotomy for pyloric stenosis. The instrument is easy to make and relatively inexpensive.--George Holcomb, Jr. The Nipple Valve as a Sphincter Substitute for the Ileocecal Valve: Prevention of Bacterial Overgrowth in the Small Bowel. H. Myrvold, M.S. Tindel, H.D. lsenberg, et aL

Surgery 96:42 47, (July, 1984. The authors describe the creation of a nipple valve by intussuscepting small bowel into the colon at the anastomotic site. This model was studied in 10 dogs who underwent resection of ileocecal valve with the distal 40% of the jejunoileum. In 5 dogs a simple end-to-end anastomosis was accomplished, while in the other 5 the nipple valve was created. Cultures were obtained at operation of the ascending colon and at 3 sites in the small intestine at the time of initial operation and then at reoperation 4 weeks later. These revealed a dramatic increase in anaerobic bacteria in the distal jejunum following simple anastomosis but no increase following nipple valve construction. Results of aerobic cultures were similar but less dramatic. The authors conclude that the nipple valve is effective in preventing anaerobic colonization of the proximal small bowel and may, therefore, be useful in the m a n a g e m e n t of patients with short bowel situations. Eugene S. Wiener Divided Loop Colostomy That Does Not Prolapse, S.H. Ein.

A m J Surg 147:250-252, (February), 1984. The author describes a technique for a right transverse loop divided colostomy utilized in 13 infants and children. A single right upper quadrant transverse transrectus incision is used. After the fascial closure around the loop, the distal limb is brought through a short subcutaneous tunnel to the left and sutured to the skin after division of the loop. Closure of the ostomy approximates that of any other ostomy closure in the author's experience. Thomas V. Whalen, Jr Ornithine Decarboxylase as a Biologic Marker in Familial Colonic Polyposis. G.D. Luk and S.B. Bay~in. N Eng J Med

311:80-83, (July 12), 1984. Total Gastrectomy in an Infant with Corrosive Gastritis.

S.M. Zivkovib, D. Rakik, V. Miloserib, et al. Z Kinderchir 39:141-142 (April), 1984. An 18-month-old boy is presented who swallowed an unknown quantity of hydrochloric acid. Two months after ingestion, he was admitted to a pediatric surgical unit in poor general condition. Upper gastrointestinal series showed a

Mucosal ornithine decarboxylase activity ( M O D A ) is increased in hyper-proliferative mucosa. With this knowledge, the authors studied biopsy specimens of normal appearing fiat mucosa and polyps obtained during routine screening with flexible fiberoptic sigmoidoscopy in 3 groups of patients: Group I (16), normal controls; Group II (31), first degree family members of patients with polyposis who

100

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were unaffected but at risk of carrying the genotype; Group 1II, (13) affected family members with colonic polyps. The biopsy specimens from Group III were separated into 3 categories: (1) normal-appearing fiat mucosa away from the polyp, (2) adenomatous polyp, (3) polyps found to contain marked dysplasia. None of the polyps contained carcinoma. Ages ranged from 13 to 53 years with a mean of 28. The mean MODA was lowest in normal controls but successively higher in morphologically normal, flat mucosa from patients with polyps, in adenomatous polyps, and in dysplastic polyps. There was a statistically significant difference between the mean values for each of these 4 biopsy categories (P > 0.05). Using a value of 2.5 nmol per milligram per hour as a cutoff point, MODA had a specificity of 100% and a sensitivity of 85% in separating patients with polyposis from normal controls. An important finding revealed a bimodal distribution of MODA in at-risk, first-degree family members with no clinical disease (Group lI); the second peak being similar to that of clinically affected patients (Group III). This study suggests that MODA taken from biopsies of colonic mueosa may identify the abnormal proliferative state in familial polyposis and identify clinically normal family members who carry the genotype. Eugene S. Wiener ABDOMEN Long-term Results in Children with Omphalocele and Gastroschisis--A Follow-up Study S. Lindham. Z Kinderchir

39:164-167, (June), 1984. The authors report on a series of 46 children operated on for omphalocele or gastroschisis who were followed for an average of 8.8 years. The majority of the children were in excellent general condition. They had developed normally, and length and weight were within normal limits. However, there was an increased incidence of intestinal obstruction during the first year of life. Seven children reported recurrent abdominal pain, but plain abdominal x-rays showed no abnormalities. Girls, primarily, complained of disfiguring scars or the absence of the navel. It is concluded that the children investigated had no serious consequences of their severe congenital malformation.--Thomas A. Angerpointner Gastroschisis in a Case of Dizygotic Twins: The Possible Role of Maternal Alcohol Consumption. P. Sarda and H.

Bard. Pediatrics 74:94-96, (July), 1984. The authors present a case of dizygotic twins both born with typical gastroschisis. They suggest that the common teratogenic factor may have been the consumption of large amounts of alcohol by the mother during the first trimester of pregnancy. Alcohol may have myocardial and vascular side effects that cause abnormalities of the omphalomesenteric artery leading to gastroschisis. Both of the children had various stigmata of fetal alcohol syndrome.--Howard B. Ginsburg

the hepatic intestinal limb through a sterile rubber catheter after cleansing the enterostomy stoma with antiseptic solution. These patients had unequivocal bile excretion after the operation and subsequently experienced cholangitis characterized by fever, decreasing bile output, and rising serum bilirubin levels. This complication occurred before the end of the first postoperative month in 3, during the second month in 2, and during the fifth month in 1 infant. Culture evaluation revealed aerobic bacteria in all 6 specimens and anaerobic organisms in 3. The predominant aerobic organisms were Klebsielta pneumoniae, enterocoecus, and Escheriehia coll. The anaerobes recovered were Bacteroidesfragilis and Clostridium perfringens. All patients experienced a favorable clinical response to 10 to 14 days of parenteral clindamycin and gentamicin. The authors recommend that infants who develop cholangitis after the Kasai procedure receive anaerobic and aerobic coverage until the results of cultures are obtained.--Eugene S. Wiener Reduced-Sized Orthotopic Liver Graft in Hepatic Transplantation in Children. H. Bismuth and D. Houssin. Surgery

95:367-370, (March), 1984. The authors describe an orthotopic liver transplant using an adult liver in a 26 kg, I0-year-old male with Byler's disease. A right hepatic Iobectomy on the donor liver was performed preserving the left lobe and its portal structures. This, in turn, was transplanted successfully and is functioning 25 months after transplantation. There is, however, persistent jaundice.--Eugene S. Wiener Idiopathic Thrombocytopenia: Initial Illness and Long Term

Follow-Up. R.W. Walker and IV. Walker. Arch Dis Child 59:316-322, (April), 1984.

Of 182 children with idiopathic thrombocytopenia, 135 had an "acute" onset and 46 a "chronic" onset. Splenectomy was carried out in 32 children with a history greater than one year. Seven with "acute" onset all maintained normal platelet counts thereafter, whereas only 17 of 25 with "chronic" onset did so. Those with a permanent response showed significantly higher platelet counts within the fortnight following surgery, achieving counts greater than 500 • 109/L. An unfavorable response is expected if the platelet count does not exceed 200 • 109/L by the end of week 1. Nonresponse to corticosteroids was not correlated to the postsplenectomy response. Two patients had recurrent thrombocytopenia secondary to hypertrophy of ectopic splenic tissue. One patient died of overwhelming pneumococcal septicaemia 2 years following surgery. He had not received penicillin prophylaxis.--Alasdair H.B. Fyfe Splenic Trauma: Therapeutical Orientation. Report on 46 Cases. O. Bose, A.L. Bensoussan, J.F. Morin, et al. Chit

P&tiatr 25:1-5, (January-February), 1984. The Significance of Anaerobic Bacteria in Biliary Tract Infection after Hepatic Portoenterostomy for Biiiary Atresia. 1. Brook and R.P. Altman. Surgery 95:281-283,

(March), 1984. Six infants who developed cholangitis after the Kasai portoenterostomy were studied by collecting specimens from

Forty-six cases of splenic trauma are analyzed over a 4-year period at Ste-Justine Hospital (Montreal). Thirty-five were managed nonoperatively. The authors emphasize ultrasound for the diagnosis and splenic scintigraphy in assessing the resolution of splenic lesions (1 to 4 months). Of the 8 splenectomies, 3 from their early experience (1979) would