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Giant umbilical cord associated with cord hemangioma
1210
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approach. Several other authors quoted in the paper have also cautioned against conservative management of a ruptured spleen associated with infectious mononucleosis because of a higher death rate than in traumatic rupture of the spleen. The mechanism of splenic rupture in infectious mononucleosis is not completely understood. Splenomegaly appears to be a common accompaniment of splenic rupture in this disorder. Edema, increase in cell size, intense inflammatory reaction, vasculitis, and lifting and stretching of the splenic capsule may all combine to cause spontaneous hemorrhage. As seen in both of these cases, splenomegaly can occur very rapidly in infectious mononucleosis (in contrast to other causes) and this (in and of itself) may predispose to splenic rupture. In contrast, a history of trauma usually precedes splenic rupture in splenomegaly from other causes. Furthermore, it has been claimed that splenic rupture is unlikely during the first 2 weeks of infectious mononucleosis. The two cases in this report demonstrate that rupture can occur within 1 week. Although spontaneous rupture of the spleen in infectious mononucleosis is rare (OS%), it is the most common cause of death in patients with this disease (30%). A reasonable recommendation is that vigorous activity should not be resumed until the spleen has returned to normal size as determined by imaging techniques. Because of the usually benign course of infectious mononucleosis, complacency may exist both with patient and doctor. Therefore, the patient should be alerted to this potential serious complication and kept away from vigorous sports. Any significant abdominal pain requires ultrasonography and/or computed tomography. Splenomegaly should be treated with bed rest, and splenic rupture necessitates close observation with immediate surgery if deterioration develops.-Sigmund
H. Ein
Prenatal Diagnosis and Management of Gastroschisis. E. Sapin, F. Lewin, J.M. Baron, et al. Pediatr Surg Int 8:31-33, (Janu-
ary), 1993. The authors present 48 patients with gastroschisis, 27 of whom were diagnosed prenatally, Of the 27 patients, 21 had primary closure (three after initial silo pouch) with two deaths. The six remaining patients had silastic sheet reinforcement and silon chimney. Three of these patients died. They did not find any difference in the duration of ventilatory support, start of enteral feeding, or hospital stay in the two groups. The authors have not provided data concerning prenatal measurements of defect, herniated viscera volume, and mural thickening so as to determine the predictability of primary closure and gastrointestinal peristalsis. The authors have, however, shown no difference in the outcome of patients delivered before 38 weeks and after, as well as those who were delivered at the centre as compared to those who were transferred from elsewhere, assuming that these groups are comparable in all other aspects.-Prem Puri Gastroschisis: Primary Closure is Possible in Most Newborns. L. Olsen, U. Ewald, and S. Meurling. Pediatr Surg Int
7:431-434, (October), 1992. A retrospective review of neonates with gastroschisis is presented. Twenty-five consecutive infants were evaluated. Four infants had associated anomalies (1 chromosomal aberration (46, XX lq+), 1 vertebral anomaly, 2 intestinal atresia). The authors used gastrograffin enema preoperatively and/or intraoperatively. At operation, the bowel was emptied by milking or enterotomy with suction. The abdominal wall was forcefully stretched and a gastrostomy performed for effective decompression. Primary closure was possible in 22 (88%) patients. In two patients, silastic patch was used temporarily, and in one patient a silo was used. Seven infants were disconnected from the ventilator immediately after operation and the remaining 18 after a mean interval of 26.7 hours (range, 3
ABSTRACTS
to 96 hours). Two patients died, one of liver failure secondary to long-term total parenteral nutrition for short-bowel syndrome and the other of cerebra1 hemorrhage. Oral feeding was commenced on an average of 21 days. On the basis of their experience, the authors feel that the primary repair can be performed in most patients with gastroschisis.-R.H. Surana Giant Umbilical Cord Associated With Cord Hemangioma. G.T. Tekant, A. Kasabaligil, L. Abbasoglu, et al. Pediatr Surg Int
8:82-83, (January), 1993. An unusual case of umbilical cord hemangioma is reported by the authors. A 39-cm-long edematous tubular structure with a 7-cm diameter was noted to insert into the umbilicus with a bulbous dilation adjacent to umbilical end. Micturating cystourethrogram ruled out the possibility of a patent urachus with lower urinary tract obstruction. The lesion was surgically excised through an infraumbilical incision. Umbilical arteries and veins appeared to be normal. Histology showed hemangioma with loose, myxoid, edematous stroma.-R.H. Surana Recurrent Abdominal Pain in Children in Developing Countries Frequently Has an Organic Basis. H. Wardhan, P. Ojha, and R. Kulshrestha. Pediatr Surg Int 8:20-22, (January), 1993.
Recurrent abdominal pain (RAP) is a frequent problem encountered in pediatric practice. The authors present a large series of 1,602 patients. In 89.5% of the patients the cause of the pain was firmly established and included worm infestation, abdominal tuberculosis, parasitic infestations, and urinary tract disease. In only 18 patients were psychogenic and psychosocial factors identified, and 149 patients had no identifiable causative factor. The authors point out that in developing countries such as India, RAP is a different entity with an organic basis in 90% of patients as opposed to 5% in developed countries.-Prem Puti GENITOURINARY
TRACT
Testicular Torsion Following Torsion of a Hydatid of Morgagni. R. Surana and E.J. Guiney. Pediatr Surg Int 8:65, (January), 1993.
The authors present a patient who developed testicular torsion following surgery for torsion of hydatid of Morgagni 1% years previously. They also allude to previous reports of testicular torsion following orchidopexy for undescended testes, previous torsion, or contralateral testis. They emphasize the importance of formal orchidopexy in a group of high risk patients who have “bell clapper” anomaly or a long mesorchium to prevent subsequent catastrophe.-R.H. Surana Ectopic Vasal Insertion Into the Posterior Urethra: Report of Two Cases.J. Sens Chacko, J. Ponniah, N. Zachariah, et al. Pediatr
Surg Int 8:87-89, (January), 1993. The authors describe two cases of ectopic vasal insertion into the posterior urethra. The commonly reported insertion site of ectopic vas is in the ureter. Both these patients presented with hemiscrotal abscesses. IVP and MCU did not help in establishing the diagnosis. The authors suggest that cystourethroscopy be part of the routine workup in patients with epididymitis as this condition may be otherwise missed. They also recommend vasectomy because an ectopic vas deferens lacks a seminal vesicle and does not contribute to fertility.-R.H. Surana Agenesis of the Bladder: A Rare Clinical Entity in a Male Child. S. Chooramani Gopal, A.N. Gangopadhyay, P. Sharma. et al.
Pediatr Surg Int 8:60-61, (January), 1993. A rare case of agenesis of the bladder is reported in a 2%.yearold boy. The urethra was well formed. The left kidney was pelvic
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approach. Several other authors quoted in the paper have also cautioned against conservative management of a ruptured spleen associated with infectious mononucleosis because of a higher death rate than in traumatic rupture of the spleen. The mechanism of splenic rupture in infectious mononucleosis is not completely understood. Splenomegaly appears to be a common accompaniment of splenic rupture in this disorder. Edema, increase in cell size, intense inflammatory reaction, vasculitis, and lifting and stretching of the splenic capsule may all combine to cause spontaneous hemorrhage. As seen in both of these cases, splenomegaly can occur very rapidly in infectious mononucleosis (in contrast to other causes) and this (in and of itself) may predispose to splenic rupture. In contrast, a history of trauma usually precedes splenic rupture in splenomegaly from other causes. Furthermore, it has been claimed that splenic rupture is unlikely during the first 2 weeks of infectious mononucleosis. The two cases in this report demonstrate that rupture can occur within 1 week. Although spontaneous rupture of the spleen in infectious mononucleosis is rare (OS%), it is the most common cause of death in patients with this disease (30%). A reasonable recommendation is that vigorous activity should not be resumed until the spleen has returned to normal size as determined by imaging techniques. Because of the usually benign course of infectious mononucleosis, complacency may exist both with patient and doctor. Therefore, the patient should be alerted to this potential serious complication and kept away from vigorous sports. Any significant abdominal pain requires ultrasonography and/or computed tomography. Splenomegaly should be treated with bed rest, and splenic rupture necessitates close observation with immediate surgery if deterioration develops.-Sigmund
H. Ein
Prenatal Diagnosis and Management of Gastroschisis. E. Sapin, F. Lewin, J.M. Baron, et al. Pediatr Surg Int 8:31-33, (Janu-
ary), 1993. The authors present 48 patients with gastroschisis, 27 of whom were diagnosed prenatally, Of the 27 patients, 21 had primary closure (three after initial silo pouch) with two deaths. The six remaining patients had silastic sheet reinforcement and silon chimney. Three of these patients died. They did not find any difference in the duration of ventilatory support, start of enteral feeding, or hospital stay in the two groups. The authors have not provided data concerning prenatal measurements of defect, herniated viscera volume, and mural thickening so as to determine the predictability of primary closure and gastrointestinal peristalsis. The authors have, however, shown no difference in the outcome of patients delivered before 38 weeks and after, as well as those who were delivered at the centre as compared to those who were transferred from elsewhere, assuming that these groups are comparable in all other aspects.-Prem Puri Gastroschisis: Primary Closure is Possible in Most Newborns. L. Olsen, U. Ewald, and S. Meurling. Pediatr Surg Int
7:431-434, (October), 1992. A retrospective review of neonates with gastroschisis is presented. Twenty-five consecutive infants were evaluated. Four infants had associated anomalies (1 chromosomal aberration (46, XX lq+), 1 vertebral anomaly, 2 intestinal atresia). The authors used gastrograffin enema preoperatively and/or intraoperatively. At operation, the bowel was emptied by milking or enterotomy with suction. The abdominal wall was forcefully stretched and a gastrostomy performed for effective decompression. Primary closure was possible in 22 (88%) patients. In two patients, silastic patch was used temporarily, and in one patient a silo was used. Seven infants were disconnected from the ventilator immediately after operation and the remaining 18 after a mean interval of 26.7 hours (range, 3
ABSTRACTS
to 96 hours). Two patients died, one of liver failure secondary to long-term total parenteral nutrition for short-bowel syndrome and the other of cerebra1 hemorrhage. Oral feeding was commenced on an average of 21 days. On the basis of their experience, the authors feel that the primary repair can be performed in most patients with gastroschisis.-R.H. Surana Giant Umbilical Cord Associated With Cord Hemangioma. G.T. Tekant, A. Kasabaligil, L. Abbasoglu, et al. Pediatr Surg Int
8:82-83, (January), 1993. An unusual case of umbilical cord hemangioma is reported by the authors. A 39-cm-long edematous tubular structure with a 7-cm diameter was noted to insert into the umbilicus with a bulbous dilation adjacent to umbilical end. Micturating cystourethrogram ruled out the possibility of a patent urachus with lower urinary tract obstruction. The lesion was surgically excised through an infraumbilical incision. Umbilical arteries and veins appeared to be normal. Histology showed hemangioma with loose, myxoid, edematous stroma.-R.H. Surana Recurrent Abdominal Pain in Children in Developing Countries Frequently Has an Organic Basis. H. Wardhan, P. Ojha, and R. Kulshrestha. Pediatr Surg Int 8:20-22, (January), 1993.
Recurrent abdominal pain (RAP) is a frequent problem encountered in pediatric practice. The authors present a large series of 1,602 patients. In 89.5% of the patients the cause of the pain was firmly established and included worm infestation, abdominal tuberculosis, parasitic infestations, and urinary tract disease. In only 18 patients were psychogenic and psychosocial factors identified, and 149 patients had no identifiable causative factor. The authors point out that in developing countries such as India, RAP is a different entity with an organic basis in 90% of patients as opposed to 5% in developed countries.-Prem Puti GENITOURINARY
TRACT
Testicular Torsion Following Torsion of a Hydatid of Morgagni. R. Surana and E.J. Guiney. Pediatr Surg Int 8:65, (January), 1993.
The authors present a patient who developed testicular torsion following surgery for torsion of hydatid of Morgagni 1% years previously. They also allude to previous reports of testicular torsion following orchidopexy for undescended testes, previous torsion, or contralateral testis. They emphasize the importance of formal orchidopexy in a group of high risk patients who have “bell clapper” anomaly or a long mesorchium to prevent subsequent catastrophe.-R.H. Surana Ectopic Vasal Insertion Into the Posterior Urethra: Report of Two Cases.J. Sens Chacko, J. Ponniah, N. Zachariah, et al. Pediatr
Surg Int 8:87-89, (January), 1993. The authors describe two cases of ectopic vasal insertion into the posterior urethra. The commonly reported insertion site of ectopic vas is in the ureter. Both these patients presented with hemiscrotal abscesses. IVP and MCU did not help in establishing the diagnosis. The authors suggest that cystourethroscopy be part of the routine workup in patients with epididymitis as this condition may be otherwise missed. They also recommend vasectomy because an ectopic vas deferens lacks a seminal vesicle and does not contribute to fertility.-R.H. Surana Agenesis of the Bladder: A Rare Clinical Entity in a Male Child. S. Chooramani Gopal, A.N. Gangopadhyay, P. Sharma. et al.
Pediatr Surg Int 8:60-61, (January), 1993. A rare case of agenesis of the bladder is reported in a 2%.yearold boy. The urethra was well formed. The left kidney was pelvic