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ABSTRACTS
The Detection of Acute Gastrointestinal Bleeding Using In Vivo Technetium 99M Pertechnetate-Labeled Erythrocytes. E. J. Rift, P. IV. Hayden, and J. K. Stevenson. J
forate anus, mesenteric cyst, giant Meckel's diverticulum, and the megacystic-microcolon-intestinal hypoperistalsis syndrome.--Randall W. Powell
Pediatr 97:956-958, (December), 1980. The authors report experience with in vivo labeling method to localize the site of active bleeding in the colon of a 3-yr-old boy with hemolytic uremic syndrome. Thirty minutes following intravenous administration of 0.5 mg stannous chloride, the patient was positioned supine beneath a gamma camera and 5 mCi of 99mTc perteehnetate injected into a femoral cannula. Continuous l-sec abdominal images were acquired on magnetic tape and observed on a videoscope. During the arterial flow phase a focus of radioactivity was seen in the right upper quadrant below the liver image. As red cells were labeled the entire transverse colon became apparent and the labeled blood rapidly accumulated in the colostomy bag. This was interpreted as hemorrhagic colitis primarily involving the transverse colon. The in vivo 99mTc labeling of erythrocytes is a simple, noninvasive procedure that has advantages over other tracer techniques in detecting the presence of active gastrointestinal bleeding. The 6-hr half-life of 99mTc is sufficiently long to allow delayed imaging if necessary, and yet is sufficiently short to minimize radiation exposure. George Holcomb, Jr.
Hypertrophic Pyloric Stenosis With
Adenomyoma. C.
Matsumoto, T. Hirai, and T. Oshio. J Jpn Soc Pediatr Surg 16:1217-1219, (December), 1980.
A 15-day-old female baby was operated upon for hypertrophic pyloric stenosis. After completion of pyloromyotomy, a hard mass, the size of which was 5 x 5 • 5 mm, was found in the hypertrophic pyloric muscle and exstirpated. Histopathologic diagnosis was adenomyoma. Adenomyoma found in a newborn baby is extremely rare and the authors claim that this is the first reported case of hypertrophic pyloric stenosis with adenomyoma.--H. Suzuki
Size of Gas-Filled Bowel Loops in Infants. D. K. Edwards.
Am J Roentgenol 135:331 334, (August), 1980. In 375 infants a ratio of the measurement of vertebral spine elements to bowel width was utilized to determine significant bowel distention. The author states that the width of the first lumbar vertebral body represents the upper limit of normal bowel diameter.--Randall W. Powell
Small Bowel Obstruction Caused by Gaseous Distension of t h e Cantor Tuba Balloon. B. R. Smoger, R. J. Rosen, S. K.
Teplick, G. A. Mandell, and J. G. Teplick. Am J Roentgenol 135:612-613, (September), 1980.
A 10-yr-old male, transferred 4 days after a supposed negative laparotomy for small bowel obstruction, developed recurrent abdominal distension, and radiographs revealed gaseous distension of the mercury balloon and proximal bowel obstruction. Nonsurgical attempts failed and a repeat laparotomy was required. The chief cause of this complication is failure to follow the directions when filling the balloon. Other conditions that have been associated with this problem include high intraluminal pressure in obstructed bowel, prolonged intubation, and hyperosmolar feedings. This abnormal distension of the balloon can result in partial or complete bowel obstruction and pressure necrosis of the bowel wall. Nonsurgical forms of treatment advocated in the literature include gentle traction, proximal bowel decompression with a second tube, hyperbaric chamber treatments, and direct transabdominal needle puncture. The main direction to follow is to use a 21 gauge needle to instill the mercury so that the hole acts as a vent for air.--Randall IV. Powell
Chronic Primary Intestinal Pseudo-obstruction. J. B. Neonatal Gastrointestinal Masses Arising Late in Gestation. E. L. Effmann, N. T. Griscom, A. H. Colodny, and
G. F. Vawter. Am J Roentgenol 135:681-686, (October), 1980.
Thirteen infants presented in the first day of life with abdominal distention and/or an abdominal mass. All of the patients had radiographic evidence of an abdominal mass and intestinal obstruction and a t surgery or autopsy were found to have a mass containing meconium, liquid, or necrotic bowel located proximal to a site of intestinal obstruction. All had varying degrees of peritonitis. Five patients survived. Two patients succumbed prior to surgery while the others died as a result of postoperative complications of the disease process. Two infants had typical findings of cystic meconium peritonitis, while three had findings consistent with volvulus with pseudocyst formation. One infant appeared to have an extremely dilated segment of bowel proximal to an obstruction. Seven infants did not correspond to any of the above while two combined aspects of two of the processes. The radiology differential would include intestinal duplication, hydrometroeolpos with imper-
Hanks, W. C. Meyers, D. K. Anderson, B. H. Woodward, IV. P. J. Peete, J. T. Garbutt, and R. S. Jones. Surgery 89:175-182, (February), 1981.
The authors describe a 14-yr-old girl with chronic primary intestinal pseudo-obstruction (CPIP) and review 30 case reports from the literature. Age of onset of initial symptoms ranged from 1 to 70 yr; 12 were male and 18 female. There were multiple GI complaints, the most common being vomiting, abdominal pain, and diarrhea. X-rays revealed such findings as air-fluid levels, esophageal aperistalsis, dilated duodenum, dilated small bowel with delayed transit, and colonic dilatation. Motility disorders were frequently noted when studied. Pathologic examinations revealed ganglion cell degenerative changes in 4 of 22 small bowel studies and in 5 of 12 colonic biopsies. Twenty-eight of the patients had at least one abdominal operation; most had multiple. Medical treatment included cholinergic drugs, antibiotics, steroids, and hyperalimentation. Forty-eight percent improved with operative or nonoperative therapy while 30% died. CPIP is a perplexing often fatal syndrome which often mimics mechanical intestinal obstruction. There is no definite e t i o l o g y . Eugene S. Wiener