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Intestinal atresia
162
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obstructing lesions can also be a source of error. One patient had a second duodenal web, 3 had imperforate anus, and 1 had Hirschsprung’s disease. The importance of the site of web in relation to the ampulla of Vater is pointed out. The importance of recognizing situs inversus, which seemed to have an unusual frequency in this series, is mentioned. It is suggested that at operation any duodenal bands should be divided if incomplete rotation is present and then the site of caliber transition of the duodenum carefully inspected. The presence or absence of annual pancreas should be noted. If the duodenum is dilated, the authors recommended passage of a firm catheter from a gastrotomy through the duodenum into the narrow area to find the site of obstruction. If a web is present, the web may be very long and stretched out. After the web has been excised, it is recommended that 5 cc saline tinted with methylene blue be injected distally and be observed as it passes to the caecum to prove the patency of the small intestine. In the preoperative work-up a barium enema should have been performed to see the position of the large bowel and this will also prove its patency.-N. K. Connolly. INTESTINAL OBSTRUCTIONIN INFANCY AND CHILDHOOD. 0. P. Taneja, S. Taneja, and A. Lal. Arch. Surg. 97:554-552 (October) 1968. A review of numerous causes of intestinal obstruction in the neonate, infancy and childhood is presented in a relatively small series of cases from New Delhi, India. A rather high incidence of tuberculosis and intraluminal obstruction due to ascariasis and bezoars was encountered. Intussusception was managed by surgery in 9 of 12 instances. This may have been attributed to a prolonged delay in admission and diagnosis. The authors attribute a gross mortality of 45 per cent to delay in diagnosis, inadequate supportive therapy, faulty anesthetic management, improper nursing, and lack of surgical experience. -A. M. Salzberg. INTESTINAL ATRESIA. Gerben Dykstra, William K. Sieber, and William B. Kiesewetter. Arch. Surg. 97: 175-181 (August) 1968. Ninety-eight newborns with intestinal atresia seen at the Children’s Hospital of Pittsburgh from January 1947 through December 1966 form the basis of this report, Associated neonatal problems with duodenal atresias are primarily systemic, such as Down’s
ABSTRACTS
OF
PEDIATRIC
SURGERY
syndrome, while jejuno-ileal atresias are associated with additional anomalies of a more local nature. This may help to explain the less favorable survival rate in duodenal atresia, as compared to jejuno-ileal atresias. The survival rate has steadily increased with each 5-year period. At the present time a 75 per cent survival rate has been obtained. This is attributed to more experienced personnel, better supportive care and much improved operative technics.-A. M. Salzberg. NON-OPERATIVE TREATMENT OF MECONIUM ILEUS. REPORT OF A CASE. T. E. Simpson, H. B. Lynn, and E. 0. Burger& Mayo Clinic Proc. 43:725 (October) 1968. A newborn with meconium ileus was given multiple small enemas of a mixture of 30 ml. of 26 per cent acetylcysteine and 30 ml. of saline. The infant received five such enemas in a period of 14 hours. Flat plate of the abdomen showed marked improvement with only one loop of distended bowel remaining. Under fluoroscopic control 29 ml. of the same mixture was injected in the upper jejunum and 6 hours later patient passed a huge stool and became completely decompressed. The authors stress the point that operation should not be delayed unless progress is being made, especially since there is a high incidence of atresia, volvulus, or peritonitis seen in meconium ileus. On the basis of the experimental work of Shaw (presented at the Surgical Section of the American Academy of Pediatrics, Chicago 1968) the authors will use a 4 per cent solution of acetylcysteine rather than 10 per cent. -M. Gilbert. SURGICAL MANAGEMENT OF HIRSCHSPRUNG’SDrsEASE INVOLVING THE SMALL INTESTINE. Lester W. Martin. Arch. Surg. 97:183-189 (August) 1968. Reported in this paper are 5 infants with aganglionosis of the colon and terminal small bowel, in whom uniform success was obtained by long side-to-side anastomosis between the normal ileum and the aganglionic colon and rectum, extending from the splenic flexure of the colon to 1 cm. above the anus. If necessary, the operation may be staged without difficulty and the resection of the defunctioned aganglionic segment can be deferred until a later date. The results of this operative approach suggests that adequate propulsion of the feca1 stream can be accomplished by a segment of colon without ganglion cells, from which a longitudinal strip of
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obstructing lesions can also be a source of error. One patient had a second duodenal web, 3 had imperforate anus, and 1 had Hirschsprung’s disease. The importance of the site of web in relation to the ampulla of Vater is pointed out. The importance of recognizing situs inversus, which seemed to have an unusual frequency in this series, is mentioned. It is suggested that at operation any duodenal bands should be divided if incomplete rotation is present and then the site of caliber transition of the duodenum carefully inspected. The presence or absence of annual pancreas should be noted. If the duodenum is dilated, the authors recommended passage of a firm catheter from a gastrotomy through the duodenum into the narrow area to find the site of obstruction. If a web is present, the web may be very long and stretched out. After the web has been excised, it is recommended that 5 cc saline tinted with methylene blue be injected distally and be observed as it passes to the caecum to prove the patency of the small intestine. In the preoperative work-up a barium enema should have been performed to see the position of the large bowel and this will also prove its patency.-N. K. Connolly. INTESTINAL OBSTRUCTIONIN INFANCY AND CHILDHOOD. 0. P. Taneja, S. Taneja, and A. Lal. Arch. Surg. 97:554-552 (October) 1968. A review of numerous causes of intestinal obstruction in the neonate, infancy and childhood is presented in a relatively small series of cases from New Delhi, India. A rather high incidence of tuberculosis and intraluminal obstruction due to ascariasis and bezoars was encountered. Intussusception was managed by surgery in 9 of 12 instances. This may have been attributed to a prolonged delay in admission and diagnosis. The authors attribute a gross mortality of 45 per cent to delay in diagnosis, inadequate supportive therapy, faulty anesthetic management, improper nursing, and lack of surgical experience. -A. M. Salzberg. INTESTINAL ATRESIA. Gerben Dykstra, William K. Sieber, and William B. Kiesewetter. Arch. Surg. 97: 175-181 (August) 1968. Ninety-eight newborns with intestinal atresia seen at the Children’s Hospital of Pittsburgh from January 1947 through December 1966 form the basis of this report, Associated neonatal problems with duodenal atresias are primarily systemic, such as Down’s
ABSTRACTS
OF
PEDIATRIC
SURGERY
syndrome, while jejuno-ileal atresias are associated with additional anomalies of a more local nature. This may help to explain the less favorable survival rate in duodenal atresia, as compared to jejuno-ileal atresias. The survival rate has steadily increased with each 5-year period. At the present time a 75 per cent survival rate has been obtained. This is attributed to more experienced personnel, better supportive care and much improved operative technics.-A. M. Salzberg. NON-OPERATIVE TREATMENT OF MECONIUM ILEUS. REPORT OF A CASE. T. E. Simpson, H. B. Lynn, and E. 0. Burger& Mayo Clinic Proc. 43:725 (October) 1968. A newborn with meconium ileus was given multiple small enemas of a mixture of 30 ml. of 26 per cent acetylcysteine and 30 ml. of saline. The infant received five such enemas in a period of 14 hours. Flat plate of the abdomen showed marked improvement with only one loop of distended bowel remaining. Under fluoroscopic control 29 ml. of the same mixture was injected in the upper jejunum and 6 hours later patient passed a huge stool and became completely decompressed. The authors stress the point that operation should not be delayed unless progress is being made, especially since there is a high incidence of atresia, volvulus, or peritonitis seen in meconium ileus. On the basis of the experimental work of Shaw (presented at the Surgical Section of the American Academy of Pediatrics, Chicago 1968) the authors will use a 4 per cent solution of acetylcysteine rather than 10 per cent. -M. Gilbert. SURGICAL MANAGEMENT OF HIRSCHSPRUNG’SDrsEASE INVOLVING THE SMALL INTESTINE. Lester W. Martin. Arch. Surg. 97:183-189 (August) 1968. Reported in this paper are 5 infants with aganglionosis of the colon and terminal small bowel, in whom uniform success was obtained by long side-to-side anastomosis between the normal ileum and the aganglionic colon and rectum, extending from the splenic flexure of the colon to 1 cm. above the anus. If necessary, the operation may be staged without difficulty and the resection of the defunctioned aganglionic segment can be deferred until a later date. The results of this operative approach suggests that adequate propulsion of the feca1 stream can be accomplished by a segment of colon without ganglion cells, from which a longitudinal strip of