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Excision of rectal stricture with end-to-end anastomosis
INTERNATIONAL ABSTRACTS OF PEDIATRIC SUlqGERY
ciated with mongolism were reported in the literature. The coincidental occurrence of Hirschsprung's disease in mongolism is thought to be greater than can be accounted for by chance. Constipation occurring in mongoloid children should be evaluated for the possibility of associated Hirschsprung's disease.---Daniel T. Cloud. TREATMENT OF CONGENITAL MEGACOLON IN 50 INFANTS. TvV. K. T. Shim, and O. Swenson. Pediatrics 38:185-193, August, 1966. Fifty infants under 1 year of age treated at the Children's Memorial Hospital of Chicago during the past 6 years constitute the basis of this report and sumnaary of current management of congenital megaeolon in infants. The difficulties of early diagnosis, the unreliability of the barium enema examination in diagnosis in infants under 6 weeks of age, the importance of rectal biopsy in diagnosis, and the prevalence of diarrhea in this age group are stressed. Fourteen (35 per cent) of the infants in this series did have a significant history of diarrhea. The danger of enterocolitis, it's diagnosis clinically and by roentgen studies and the importance of prompt treatment are noted. Irrigation through a large rectal tube (28 to 32F.) injecting 20 to 30 ce. saline with an "asepto" bulb syringe is carefully described and recommended for treatment and preoperative preparation of the infant with enterocolitis. That colostomy is not always the answer to enterocolitis in the sick infant is emphasized by 6 deaths following 34 colostomies in this series. Of the 50 patients, in 31 (62 per cent) the aganglionosis was confined to the rectosigmold. The aganglionosis involved the entire colon in 3, extended to the jejunum in 1. Of these 50 patients, 3 died before surgery. Operative procedures were performed in 47. There were 38 resections. Twelve primary resections were performed in "infants 12.5 pounds in weight--the youngest being 7 days old. The decision as to primary resection or colostomy in each instance was based upon the nutrition of the infant and the absence of enterocolitis.
609
The follow-up results of definitive surgery indicated 29 excellent results, 5 good, one fair and no poor results. The improvement from an initially poor or fair result to an excellent result over a period of months to years has been repeatedly observed. The overall mortality of 10 patients (20 per cent) is comparable to other reported series. A surgical mortality of 7 of 47 cases or 15 per cent is recorded with no mortality with resection.--William K. Sieber. EXCISION OF lq.ECTAL STRICTURE WITH ENDTo-END ANASTOMOSIS. O. Swenson, and
F. S. Idriss. Arch. Surg. 93:154, July, 1966. Eight patients treated for Hirschsprung's disease by resection and pull-through anastomosis developed impermeable strictures. In over 300 cases operated upon b y Swenson this complication occurred only once. The other 7 patients had this operation done elsewhere. It is suggested that the cause of these strictures is an anastomotic leak and that prevention of stricture formation is possible if a diverting colostomy is promptly performed as soon as it is discovered that a leak has occurred. The surgical treatment consists of resection of the stricture with a new pullthrough anastomosis. A two-team approach saves time and is recommended.--Edward J~ Berman. A STAGED PROCEDURE OF THE DUHAMEL TYPE FOR THE CORRECTION OF A POORLY FUNCTIONING SWENSON PULL-THROUGH.
Kenneth Kenigsberg, Burton Bronsther, Martin W. Abrams, and Elizabeth Coryllos. Surgery 60:462-464, August, 1966. The authors present a patient with a poorly functioning Swenson pull-through operation which was converted into a wellfunctioning Duhamel procedure. The operative procedures were staged as follows: (1) colostomy, (2) retrorectal anastomosis, and (3) division of the terminal bowel and formation of a rectal pouch. Staging provided a means of retaining adequate blood supply to the rectal pouch in the post-Swenson state and allowed for eventual completion of the Duhamel procedure without the complication of rectal necrosis.--Daniel T, Cloud.
ciated with mongolism were reported in the literature. The coincidental occurrence of Hirschsprung's disease in mongolism is thought to be greater than can be accounted for by chance. Constipation occurring in mongoloid children should be evaluated for the possibility of associated Hirschsprung's disease.---Daniel T. Cloud. TREATMENT OF CONGENITAL MEGACOLON IN 50 INFANTS. TvV. K. T. Shim, and O. Swenson. Pediatrics 38:185-193, August, 1966. Fifty infants under 1 year of age treated at the Children's Memorial Hospital of Chicago during the past 6 years constitute the basis of this report and sumnaary of current management of congenital megaeolon in infants. The difficulties of early diagnosis, the unreliability of the barium enema examination in diagnosis in infants under 6 weeks of age, the importance of rectal biopsy in diagnosis, and the prevalence of diarrhea in this age group are stressed. Fourteen (35 per cent) of the infants in this series did have a significant history of diarrhea. The danger of enterocolitis, it's diagnosis clinically and by roentgen studies and the importance of prompt treatment are noted. Irrigation through a large rectal tube (28 to 32F.) injecting 20 to 30 ce. saline with an "asepto" bulb syringe is carefully described and recommended for treatment and preoperative preparation of the infant with enterocolitis. That colostomy is not always the answer to enterocolitis in the sick infant is emphasized by 6 deaths following 34 colostomies in this series. Of the 50 patients, in 31 (62 per cent) the aganglionosis was confined to the rectosigmold. The aganglionosis involved the entire colon in 3, extended to the jejunum in 1. Of these 50 patients, 3 died before surgery. Operative procedures were performed in 47. There were 38 resections. Twelve primary resections were performed in "infants 12.5 pounds in weight--the youngest being 7 days old. The decision as to primary resection or colostomy in each instance was based upon the nutrition of the infant and the absence of enterocolitis.
609
The follow-up results of definitive surgery indicated 29 excellent results, 5 good, one fair and no poor results. The improvement from an initially poor or fair result to an excellent result over a period of months to years has been repeatedly observed. The overall mortality of 10 patients (20 per cent) is comparable to other reported series. A surgical mortality of 7 of 47 cases or 15 per cent is recorded with no mortality with resection.--William K. Sieber. EXCISION OF lq.ECTAL STRICTURE WITH ENDTo-END ANASTOMOSIS. O. Swenson, and
F. S. Idriss. Arch. Surg. 93:154, July, 1966. Eight patients treated for Hirschsprung's disease by resection and pull-through anastomosis developed impermeable strictures. In over 300 cases operated upon b y Swenson this complication occurred only once. The other 7 patients had this operation done elsewhere. It is suggested that the cause of these strictures is an anastomotic leak and that prevention of stricture formation is possible if a diverting colostomy is promptly performed as soon as it is discovered that a leak has occurred. The surgical treatment consists of resection of the stricture with a new pullthrough anastomosis. A two-team approach saves time and is recommended.--Edward J~ Berman. A STAGED PROCEDURE OF THE DUHAMEL TYPE FOR THE CORRECTION OF A POORLY FUNCTIONING SWENSON PULL-THROUGH.
Kenneth Kenigsberg, Burton Bronsther, Martin W. Abrams, and Elizabeth Coryllos. Surgery 60:462-464, August, 1966. The authors present a patient with a poorly functioning Swenson pull-through operation which was converted into a wellfunctioning Duhamel procedure. The operative procedures were staged as follows: (1) colostomy, (2) retrorectal anastomosis, and (3) division of the terminal bowel and formation of a rectal pouch. Staging provided a means of retaining adequate blood supply to the rectal pouch in the post-Swenson state and allowed for eventual completion of the Duhamel procedure without the complication of rectal necrosis.--Daniel T, Cloud.