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Granulomatous appendicitis: A case report
INTERNATIONAL
ABSTRACTS
OF PEDLATBIC
163
SURGERY gastrointestinal
disturbance. Of the 33 patients in series, 21 patients were under 21
entire colon wall has been removed, and that this aganglionic colon may serve a useful reabsorptive purpose to obviate the difficulties with anal ileostomy.-A. M. S&berg.
nolly.
THE SURGICAL SIGNIFICANCEOF THE ILEO-CAECAL JUNCTION, J. C. Guzet. Ann. Roy. Coll. Surg. Eng. 43:19-38 (July) 1968.
GRANUL~MATOUS APPENDICITIS: A CASE REPORT. J. C. FuZZis.Canad. J. Surg. 11:449-451 (Oct.) 1968.
By studying the anatomy and response to drugs of the ileocecal junction it has been convincingly demonstrated that the latter is guarded by a sphincter. This sphincter may protect the cecum from perforation in cases of large bowel obstruction by either contracting and thus preventing further passage of fluid into the colon or relaxing and thus preventing a critical intracecal pressure ever being reached. The bowel habits of 156 patients who had had large bowel resections (58 of them involving the ileocecal junction) were studied. Frequency was defined as 3 or more stools per day, constipation as one motion every 3 or more days. Over 50 per cent of the patients in whom the ileocecal sphincter was included in the resection had persistent frequent loose motions as a complication, whereas over ‘70 per cent of patients in whom the colectomy was left sided had no change in bowel habit. In a series of animal experiments the effect of excision of the ileocecal sphincter of vitamin B,, absorption was studied. Although the capacity of isolated segments of the small bowel to absorb vitamin B,, was not affected, the overall absorption of vitamin Bra when given my mouth was defective. This was not due solely to bacterial contamination and it is suggested that it was due to the absence of the ileocecal sphincter.-./. J. Corkery.
A I2-year-old girl is reported with Crohn’s disease involving primarily the appendix. A right hemicolectomy was performed. The pathologic report concluded “Crohn’s disease of the appendix and ileocecal valve with superimposed acute appendicitis.” The child made an uneventful recovery and one year postoperatively was asymptomatic, although the author expresses concern about the ultimate prognosis-c. C. Ferguson.
PINWORM INFESTATION OF THE APPENDIX. G. E. Tolstedt. Amer. J. Surg. 16:454455 (September) 1968. Thirty-three patients with Enterobus uermic&r& of the appendix were seen during 20 years. The symptomatology of those patients coming to appendectomy is described. There were 20 such patients and the pain was in the lower part of the abdomen usually intermittent in nature. There was tenderness in the right lower quadrant but not always confined to McBurney’s point. Rebound tenderness was not found. Eosinophilia was noted only in 5 of these patients. After appendectomy 18 had complete relief of their symptoms. Of the remaining 2, one was subsequently thought to have abdominal epilepsy and the other functional
the
original
years of age, the youngest
being
3.-N.
K. Con-
APPENDICITISIN A CHILD WITH CYSTINOSIS.Gerry A. Schneider, Stanton P. Nolan, and J. Edwin Seegmi&r. Arch. Surg. 97:565-567 (October) 1968. Cystinosis is a very unusual disease, in which children rarely live beyond 10 years of age. Accordingly, this would appear to be the first report of appendicitis occurring in a child with cystinosis. The occurrence of both disease processes in the same patient presented a difficult diagnostic problem, since symptoms overlap. A white count of 29,000 with 80 per cent polymorphonuclear cells influenced the decision to operate.-A. M. Sulzberg. THE JUVENILE POLYP OF THE COLON. James G. Ward, Jr., and H. Biemunn Othersen, Jr. Amer. Surg. 34:56&571 (August) 1968. The familial, Peutz-Jeghers, adenomatous and juvenile polyps of the colon are compared and the latter two are differentiated by a rather detailed description of their gross and microscopic characteristics. A plan of attack is described for the management of adenomatous polyps and juvenile polyps. The adenomatous polyps should be removed by either sigmoidoscopy or laparotomy. In contrast, juvenile polyps may be treated without abdominal operation, if an adequate biopsy has been obtained through the sigmoidoscope, since juvenile polyps of the colon may disappear spontaneously or be passed per rectum. Operation for removal of a juvenile colon polyp, whose diagnosis has been assumed on the basis of a biopsy of a
ABSTRACTS
OF PEDLATBIC
163
SURGERY gastrointestinal
disturbance. Of the 33 patients in series, 21 patients were under 21
entire colon wall has been removed, and that this aganglionic colon may serve a useful reabsorptive purpose to obviate the difficulties with anal ileostomy.-A. M. S&berg.
nolly.
THE SURGICAL SIGNIFICANCEOF THE ILEO-CAECAL JUNCTION, J. C. Guzet. Ann. Roy. Coll. Surg. Eng. 43:19-38 (July) 1968.
GRANUL~MATOUS APPENDICITIS: A CASE REPORT. J. C. FuZZis.Canad. J. Surg. 11:449-451 (Oct.) 1968.
By studying the anatomy and response to drugs of the ileocecal junction it has been convincingly demonstrated that the latter is guarded by a sphincter. This sphincter may protect the cecum from perforation in cases of large bowel obstruction by either contracting and thus preventing further passage of fluid into the colon or relaxing and thus preventing a critical intracecal pressure ever being reached. The bowel habits of 156 patients who had had large bowel resections (58 of them involving the ileocecal junction) were studied. Frequency was defined as 3 or more stools per day, constipation as one motion every 3 or more days. Over 50 per cent of the patients in whom the ileocecal sphincter was included in the resection had persistent frequent loose motions as a complication, whereas over ‘70 per cent of patients in whom the colectomy was left sided had no change in bowel habit. In a series of animal experiments the effect of excision of the ileocecal sphincter of vitamin B,, absorption was studied. Although the capacity of isolated segments of the small bowel to absorb vitamin B,, was not affected, the overall absorption of vitamin Bra when given my mouth was defective. This was not due solely to bacterial contamination and it is suggested that it was due to the absence of the ileocecal sphincter.-./. J. Corkery.
A I2-year-old girl is reported with Crohn’s disease involving primarily the appendix. A right hemicolectomy was performed. The pathologic report concluded “Crohn’s disease of the appendix and ileocecal valve with superimposed acute appendicitis.” The child made an uneventful recovery and one year postoperatively was asymptomatic, although the author expresses concern about the ultimate prognosis-c. C. Ferguson.
PINWORM INFESTATION OF THE APPENDIX. G. E. Tolstedt. Amer. J. Surg. 16:454455 (September) 1968. Thirty-three patients with Enterobus uermic&r& of the appendix were seen during 20 years. The symptomatology of those patients coming to appendectomy is described. There were 20 such patients and the pain was in the lower part of the abdomen usually intermittent in nature. There was tenderness in the right lower quadrant but not always confined to McBurney’s point. Rebound tenderness was not found. Eosinophilia was noted only in 5 of these patients. After appendectomy 18 had complete relief of their symptoms. Of the remaining 2, one was subsequently thought to have abdominal epilepsy and the other functional
the
original
years of age, the youngest
being
3.-N.
K. Con-
APPENDICITISIN A CHILD WITH CYSTINOSIS.Gerry A. Schneider, Stanton P. Nolan, and J. Edwin Seegmi&r. Arch. Surg. 97:565-567 (October) 1968. Cystinosis is a very unusual disease, in which children rarely live beyond 10 years of age. Accordingly, this would appear to be the first report of appendicitis occurring in a child with cystinosis. The occurrence of both disease processes in the same patient presented a difficult diagnostic problem, since symptoms overlap. A white count of 29,000 with 80 per cent polymorphonuclear cells influenced the decision to operate.-A. M. Sulzberg. THE JUVENILE POLYP OF THE COLON. James G. Ward, Jr., and H. Biemunn Othersen, Jr. Amer. Surg. 34:56&571 (August) 1968. The familial, Peutz-Jeghers, adenomatous and juvenile polyps of the colon are compared and the latter two are differentiated by a rather detailed description of their gross and microscopic characteristics. A plan of attack is described for the management of adenomatous polyps and juvenile polyps. The adenomatous polyps should be removed by either sigmoidoscopy or laparotomy. In contrast, juvenile polyps may be treated without abdominal operation, if an adequate biopsy has been obtained through the sigmoidoscope, since juvenile polyps of the colon may disappear spontaneously or be passed per rectum. Operation for removal of a juvenile colon polyp, whose diagnosis has been assumed on the basis of a biopsy of a