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Genito-urinary malformations and vertebral anomalies in ano-rectal malformations
597
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
facilities exist biopsy in metachromatie leucodystrophy may become unnecessary, and in time may become obsolete in many cases of neurolipidosis.-James Lister.
authors emphasize that "abnormality of bowel habit" may imply either constipation or bouts of diarrhea.--]ames Lister. MEGACOLON CONGENITUM HIRSCHSPntlNG B. Freth-
NEONATAL HIRSCHSPRUNG'SDISEASE. G. C. Fraser and A. W. Wilkinson. Brit. Med. J. 3:7, 1967. This report is based on a review of 54 babies admitted to the Hospital for Sick Children, Great Ormond Street, between Janua13, I, 1958, and December 31, 1965, all under the age of 1 month on admission. Hirsehsprung's disease was confirmed histologically in each case, and emphasis is laid on the clinical features of the disease in the newborn period. Almost all these children presented with vomiting, abnormality of bowel habit and abdominal distention. Abnormality of bowel habit was usually manifested by failure to pass normal meeonium and was a more common disturbance on the first day of life than was vomiting. Persistent bile-stained vomiting led to prompt referral to hospital, but this did not affect the mortality rate. Confirmation of the diagnosis was obtained in half of the eases by x-ray examination after barium enema, which was unassoeiatecl with any complications. Diagnosis was confirmed by histological examination of a rectal biopsy specimen in 21 of the 54 patients, but 2 of these patients died of peritonitis due to perforation during or soon after the biopsy was done. Eighteen of the 54 patients died, and in all but one of these some severe infection had occurred. In 8 this infection was a direct consequence of surgical treatment: 2 had perforations following colonic washouts, in addition to the 2 who developed peritonitis following rectal biopsy. Four ethers died following repeated adhesion obstructions. Five patients died of enterocolitis, 2 after a colostomy had been made. The authors suggest that the best and safest way of confirming the clinical diagnosis is by radiologica1 examination after a barium enema, provided that the bowel has not been washed out. This examination should be possible in all but a few babies whose general condition is too poor for radiologieal examination, and in whom the barium enema must be postponed until after the bowel has been decompressed by eolostomy. When Hirsehsprung's disease is diagnosed in the neonatal period, the safest form of treatment is decompression of the obstruetecl bowel by eolostomy or ileostomy in the long segment cases. Enteroeolitis endangers life not only from its own effects, but also from the fact that the diarrhea produced by it may delay the diagnosis of the disease; the
eim and O. Knutrud. Z. Kinderchir. 4:333-337, 1967. In the past 5 years 33 cases of megacolon have been treated. Of these 27 were treated by the method described by Duhamel, This was preferred as it was simple in infancy and produced the best results in their series. They observed very few complications. There was no mortality. Other surgical procedures were used in relatively few cases so that a comparison of methods of treatment is not possible. The authors advocate an elective colostomy.--S. Hofmann and H. B. Eckstein. GENITO-URINARY MALFORMATIONS AND VERTEBRAL ANOMALIES IN ANO-RECTAL MALFORMATIONS.
D. Pellerin and P. Bertin. Z. Kinderchir. 4 : 3 7 5 383, 1967. The authors review 212 cases of anorectal malformation seen in the years 1952-1965. Nineteen per cent of these had abnormalities of the vertebrae and 22 per cent had genito-urinary abnormalities. Vertebral abnormalities which were seen usually in the lumbosacral region were predominently observed in cases with high anoreetal anomalies. The genito-urinary abnormalities, abnormalities of the kidney and ureter (megaureter), were the most important. In 53 per cent of the patients both these types of abnormalities were found together. It was therefore advised that in children with anorectal anomalies associated with abnormalities o~ the vertebral column, urography should be carried out.--S. Hofmann and H. B. Eckstein. ABDOMEN POSTOPERATIVE PNEU1VfOPERITONEUIVs IN CI-IILDREN.
Jerome F. Wiot, Coming Benton and William H. McAlister. Radiology 89:285-288, Aug. 1967. An investigation to determine the duration of free intraperitoneal air and its significance was performed involving 94 patients. The ages ranged from newborn to 16 years, and each patient had recently undergone laparotomy for various reasons. Films in the upright or left lateral deeubitus were obtained in 20 immediately postoperatively and at 12 or 24 hour intervals until disappearance. In the remainder films were obtained beginning at 12 or 24 hours, Age, type of proceedure, presence of peritonitis or drains and method of anesthesia were noted and tabulated.
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
facilities exist biopsy in metachromatie leucodystrophy may become unnecessary, and in time may become obsolete in many cases of neurolipidosis.-James Lister.
authors emphasize that "abnormality of bowel habit" may imply either constipation or bouts of diarrhea.--]ames Lister. MEGACOLON CONGENITUM HIRSCHSPntlNG B. Freth-
NEONATAL HIRSCHSPRUNG'SDISEASE. G. C. Fraser and A. W. Wilkinson. Brit. Med. J. 3:7, 1967. This report is based on a review of 54 babies admitted to the Hospital for Sick Children, Great Ormond Street, between Janua13, I, 1958, and December 31, 1965, all under the age of 1 month on admission. Hirsehsprung's disease was confirmed histologically in each case, and emphasis is laid on the clinical features of the disease in the newborn period. Almost all these children presented with vomiting, abnormality of bowel habit and abdominal distention. Abnormality of bowel habit was usually manifested by failure to pass normal meeonium and was a more common disturbance on the first day of life than was vomiting. Persistent bile-stained vomiting led to prompt referral to hospital, but this did not affect the mortality rate. Confirmation of the diagnosis was obtained in half of the eases by x-ray examination after barium enema, which was unassoeiatecl with any complications. Diagnosis was confirmed by histological examination of a rectal biopsy specimen in 21 of the 54 patients, but 2 of these patients died of peritonitis due to perforation during or soon after the biopsy was done. Eighteen of the 54 patients died, and in all but one of these some severe infection had occurred. In 8 this infection was a direct consequence of surgical treatment: 2 had perforations following colonic washouts, in addition to the 2 who developed peritonitis following rectal biopsy. Four ethers died following repeated adhesion obstructions. Five patients died of enterocolitis, 2 after a colostomy had been made. The authors suggest that the best and safest way of confirming the clinical diagnosis is by radiologica1 examination after a barium enema, provided that the bowel has not been washed out. This examination should be possible in all but a few babies whose general condition is too poor for radiologieal examination, and in whom the barium enema must be postponed until after the bowel has been decompressed by eolostomy. When Hirsehsprung's disease is diagnosed in the neonatal period, the safest form of treatment is decompression of the obstruetecl bowel by eolostomy or ileostomy in the long segment cases. Enteroeolitis endangers life not only from its own effects, but also from the fact that the diarrhea produced by it may delay the diagnosis of the disease; the
eim and O. Knutrud. Z. Kinderchir. 4:333-337, 1967. In the past 5 years 33 cases of megacolon have been treated. Of these 27 were treated by the method described by Duhamel, This was preferred as it was simple in infancy and produced the best results in their series. They observed very few complications. There was no mortality. Other surgical procedures were used in relatively few cases so that a comparison of methods of treatment is not possible. The authors advocate an elective colostomy.--S. Hofmann and H. B. Eckstein. GENITO-URINARY MALFORMATIONS AND VERTEBRAL ANOMALIES IN ANO-RECTAL MALFORMATIONS.
D. Pellerin and P. Bertin. Z. Kinderchir. 4 : 3 7 5 383, 1967. The authors review 212 cases of anorectal malformation seen in the years 1952-1965. Nineteen per cent of these had abnormalities of the vertebrae and 22 per cent had genito-urinary abnormalities. Vertebral abnormalities which were seen usually in the lumbosacral region were predominently observed in cases with high anoreetal anomalies. The genito-urinary abnormalities, abnormalities of the kidney and ureter (megaureter), were the most important. In 53 per cent of the patients both these types of abnormalities were found together. It was therefore advised that in children with anorectal anomalies associated with abnormalities o~ the vertebral column, urography should be carried out.--S. Hofmann and H. B. Eckstein. ABDOMEN POSTOPERATIVE PNEU1VfOPERITONEUIVs IN CI-IILDREN.
Jerome F. Wiot, Coming Benton and William H. McAlister. Radiology 89:285-288, Aug. 1967. An investigation to determine the duration of free intraperitoneal air and its significance was performed involving 94 patients. The ages ranged from newborn to 16 years, and each patient had recently undergone laparotomy for various reasons. Films in the upright or left lateral deeubitus were obtained in 20 immediately postoperatively and at 12 or 24 hour intervals until disappearance. In the remainder films were obtained beginning at 12 or 24 hours, Age, type of proceedure, presence of peritonitis or drains and method of anesthesia were noted and tabulated.