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Lymphoid hyperplasia causing recurrent rectal prolapse
1180
INTERNATIONAL
tal malformations or esophageal atresia combined with tracheoesophageal fistula were not included; those with isolated oesophageal atresia were included in the study. The results were compared with those reported in the literature. Ten babies had esophageal atresia without tracheoesophageal fistula, 41 had duodenal atresia or stenosis, and 35 had jejuno-ileal atresias. Eight of the 10 patients with esophageal atresia had other anomalies. In 40% of the cases, cardiovascular anomalies were found; 20% of the patients had anomalies of urinary tract. Associated malformations of the gastrointestinal system occurred in 3 of the 10 cases, and orthopaedic abnormalities were found in 50% of cases. Various other anomalies such as tracheomalacia, Down’s syndrome, and undescended testes were found in 60% of patients. With respect to duodenal atresia or stenosis, 78% had at least one associated anomaly. Cardiovascular defects were found in 39% of cases. Urinary tract and associated gastrointestinal tract anomalies were encountered in 12% and 59% of the cases, respectively. Malrotation and annular pancreas were particularly common. Orthopedic abnormalities were seen in 15% of the patients, and various other abnormalities occurred in 61%. Down’s syndrome was particularly common and occurred in 12 of the 41 cases. Associated anomalies occurred in 60% of patients with jejuno-ileal atresia, including cardiac malformations (ll%), urinary tract anomalies (14%), gastrointestinal tract malformations (26%), orthopaedic malformations (14%), and various other anomalies (40%). Cystic fibrosis was encountered in 6 of 3.5 patients. The authors propose a protocol for evaluation of associated anomalies and suggest that cardiac ultrasonography, renal ultrasonography, and lateral and anterioposterior x-rays of the chest and abdomen should be performed in all cases with esophageal atresia without tracheoesophageal fistula and duodenal atresia or stenosis. If renal ultrasonography findings are abnormal, micturating cystourethrography should be performed. Urinary tract investigation is particularly important in cases with associated anorectal anomalies. In patients with duodenal atresia combined with Down’s syndrome, rectal biopsies are suggested to exclude Hirschsprung’s disease. In jejuno-ileal atresia cases, radiographs of the chest and abdomen are suggested as well as a sweat test.-? Puri
Bowel Obstruction Anal Anastomosis. Surg 40:471-473,
in a Pregnant Patient M. Walker, J. Sylvain, (December), 1997.
With heal Pouchand H. Stern. Can J
Bowel obstruction is a rare but serious complication of pregnancy for both the mother and the developing fetus. This report describes the case of 17-year-old girl with ileal pouch-anal anastomosis (IPAA). She presented at 36 weeks’ gestation with a complete small bowel obstruction. Because conservative management was unsuccessful, labor was induced to relieve the obstruction or simplify surgery. Soon after the spontaneous vaginal delivery, she began to pass copious amounts of flatus and stool. The bowel obstruction resolved within hours. This report illustrates how IPAA alters the anatomy of the gastrointestinal tract, placing the ileal pouch at risk from compressive obstruction by the gravid uterus. Induction of labor in a near-term fetus is a reasonable initial method of management in such women.-Sigmund H. Ein
Lymphoid Hyperplasia Causing Recurrent Rittmeyer, D. Nakayama, and M. H. Ulshen. 488, (September), 1997.
Rectal Prolapse. C. J Pediatr 131:487-
The authors report a case of circumferential rectal prolapse in an &year-old child with an otherwise normal history. Sweat chloride was normal. Physical examination was notable for a polypoid mass found during rectal examination. Colonoscopy revealed two broad-based submucosal masses in the distal rectal area. A biopsy specimen was obtained and showed benign lymphoid hyperplasia. The child was treated with steroids, without success, and subsequently underwent transrectal excision of the lesions. Postoperatively, prolapse has not
ABSTRACTS
returned in the 2 years of follow-up, suggesting that the lesions were the cause rather than the result of the problem.-Jeffrey L. Zitsman
ABDOMEN LaparoscopicVersus Open Cholecystectomy Al-Salem, S. Qaisaruddin, H. Al-Abkari, 12:587-590, (November), 1997.
in Children. A.H. et a/. Pediatr Surg Int
This study is retrospective review of 21 patients who received laparoscopic cholecystectomy and 31 who underwent cholecystectomy. Two patients who had open cholecystectomy group were excluded because they had undergone simultaneous cholecystectomy and splenectomy. Sickle cell disease was the most common indication for cholecystectomy, occurring in 69% and 72% of patients who underwent open and laparoscopic procedures, respectively. Twenty-eight percent of patients undergoing open cholecystectomy had common bile duct stones, all of whom received common bile duct exploration. Twentyfour percent of laparoscopically treated cases had common bile duct stones, which were treated by ERCP, papillotomy, and stone extraction before laparoscopic cholecystectomy. The laparoscopic procedure was converted to open surgery in one case. All patients survived the operation. Six of the 3 1 patients who underwent the open technique had complications, such as minor respiratory difficulty, splenic infarction, postoperative pancreatitis, mild wound infection, and postoperative haematoma. Among the laparoscopically treated patients, 4 of 21 suffered complications, including minor respiratory difficulty, atelectasis. and reaction to blood transfusion. The hospital stay was shorter for the laparoscopically treated patients (5.9 days versus 12.8 days for the open group). On the other hand, operating time was longer for the laparoscopic cases (123 minutes versus 91 minutes). The authors suggest that laparoscopic cholecystectomy should be the procedure of choice for childhood cholelithiasis, particularly when associated with sickle cell disease.--l: Wester Ectopic Gallbladder Revisited, port. C.C. Chung, K.L. Leung, 40:464-466, (December), 1977.
Laparoscopically: A Case ReW.\/: Lau, et al. Can J Surg
A case of the rare congenital anomaly ectopic gallbladder is presented. A 16.year-old girl suffered attacks of epigastric pain unrelated to eating. On abdominal ultrasonography, the gallbladder could not be found in its usual position. Endoscopic retrograde cholangiography demonstrated the gallbladder on the left side of the common duct, and the cystic duct arising from the right hepatic duct. Laparoscopic cholecystectomy was performed without complication. This appears to be the first reported case of laparoscopic removal of an ectopic gallbladder. The importance of preoperative cholangiography is emphasized for accurate diagnosis and preoperative location of the gallbladder.Sigmund H. Ein Are Babies With Gastroschisis R.T: Blakelock, V. Upadhyay, Int 12:580-582, (November),
Small for I?W.D. Pease, 1997.
Gestational et al. Pediatr
Age? Surg
The purposes of this study were to (1) evaluate whether babies with gastroschisis have lower birth weight compared with the normal population and (2) compare the birth weight of patients with gastroschisis treated at different centers. Forty-four patients operated on at Auckland Children’s Hospital, Auckland, New Zealand, and 69 babies operated at Birmingham Children’s Hospital, Birmingham, England, were studied. Birth weight was expressed as weight standard deviation scores (actual birth weight-expected birth weight)/standard deviation of expected birth weight) to avoid the influence of gestational age. In the normal population, the score should be zero. For the children operated in Auckland the score was -0.806; in Birmingham the score was -0.762.
INTERNATIONAL
tal malformations or esophageal atresia combined with tracheoesophageal fistula were not included; those with isolated oesophageal atresia were included in the study. The results were compared with those reported in the literature. Ten babies had esophageal atresia without tracheoesophageal fistula, 41 had duodenal atresia or stenosis, and 35 had jejuno-ileal atresias. Eight of the 10 patients with esophageal atresia had other anomalies. In 40% of the cases, cardiovascular anomalies were found; 20% of the patients had anomalies of urinary tract. Associated malformations of the gastrointestinal system occurred in 3 of the 10 cases, and orthopaedic abnormalities were found in 50% of cases. Various other anomalies such as tracheomalacia, Down’s syndrome, and undescended testes were found in 60% of patients. With respect to duodenal atresia or stenosis, 78% had at least one associated anomaly. Cardiovascular defects were found in 39% of cases. Urinary tract and associated gastrointestinal tract anomalies were encountered in 12% and 59% of the cases, respectively. Malrotation and annular pancreas were particularly common. Orthopedic abnormalities were seen in 15% of the patients, and various other abnormalities occurred in 61%. Down’s syndrome was particularly common and occurred in 12 of the 41 cases. Associated anomalies occurred in 60% of patients with jejuno-ileal atresia, including cardiac malformations (ll%), urinary tract anomalies (14%), gastrointestinal tract malformations (26%), orthopaedic malformations (14%), and various other anomalies (40%). Cystic fibrosis was encountered in 6 of 3.5 patients. The authors propose a protocol for evaluation of associated anomalies and suggest that cardiac ultrasonography, renal ultrasonography, and lateral and anterioposterior x-rays of the chest and abdomen should be performed in all cases with esophageal atresia without tracheoesophageal fistula and duodenal atresia or stenosis. If renal ultrasonography findings are abnormal, micturating cystourethrography should be performed. Urinary tract investigation is particularly important in cases with associated anorectal anomalies. In patients with duodenal atresia combined with Down’s syndrome, rectal biopsies are suggested to exclude Hirschsprung’s disease. In jejuno-ileal atresia cases, radiographs of the chest and abdomen are suggested as well as a sweat test.-? Puri
Bowel Obstruction Anal Anastomosis. Surg 40:471-473,
in a Pregnant Patient M. Walker, J. Sylvain, (December), 1997.
With heal Pouchand H. Stern. Can J
Bowel obstruction is a rare but serious complication of pregnancy for both the mother and the developing fetus. This report describes the case of 17-year-old girl with ileal pouch-anal anastomosis (IPAA). She presented at 36 weeks’ gestation with a complete small bowel obstruction. Because conservative management was unsuccessful, labor was induced to relieve the obstruction or simplify surgery. Soon after the spontaneous vaginal delivery, she began to pass copious amounts of flatus and stool. The bowel obstruction resolved within hours. This report illustrates how IPAA alters the anatomy of the gastrointestinal tract, placing the ileal pouch at risk from compressive obstruction by the gravid uterus. Induction of labor in a near-term fetus is a reasonable initial method of management in such women.-Sigmund H. Ein
Lymphoid Hyperplasia Causing Recurrent Rittmeyer, D. Nakayama, and M. H. Ulshen. 488, (September), 1997.
Rectal Prolapse. C. J Pediatr 131:487-
The authors report a case of circumferential rectal prolapse in an &year-old child with an otherwise normal history. Sweat chloride was normal. Physical examination was notable for a polypoid mass found during rectal examination. Colonoscopy revealed two broad-based submucosal masses in the distal rectal area. A biopsy specimen was obtained and showed benign lymphoid hyperplasia. The child was treated with steroids, without success, and subsequently underwent transrectal excision of the lesions. Postoperatively, prolapse has not
ABSTRACTS
returned in the 2 years of follow-up, suggesting that the lesions were the cause rather than the result of the problem.-Jeffrey L. Zitsman
ABDOMEN LaparoscopicVersus Open Cholecystectomy Al-Salem, S. Qaisaruddin, H. Al-Abkari, 12:587-590, (November), 1997.
in Children. A.H. et a/. Pediatr Surg Int
This study is retrospective review of 21 patients who received laparoscopic cholecystectomy and 31 who underwent cholecystectomy. Two patients who had open cholecystectomy group were excluded because they had undergone simultaneous cholecystectomy and splenectomy. Sickle cell disease was the most common indication for cholecystectomy, occurring in 69% and 72% of patients who underwent open and laparoscopic procedures, respectively. Twenty-eight percent of patients undergoing open cholecystectomy had common bile duct stones, all of whom received common bile duct exploration. Twentyfour percent of laparoscopically treated cases had common bile duct stones, which were treated by ERCP, papillotomy, and stone extraction before laparoscopic cholecystectomy. The laparoscopic procedure was converted to open surgery in one case. All patients survived the operation. Six of the 3 1 patients who underwent the open technique had complications, such as minor respiratory difficulty, splenic infarction, postoperative pancreatitis, mild wound infection, and postoperative haematoma. Among the laparoscopically treated patients, 4 of 21 suffered complications, including minor respiratory difficulty, atelectasis. and reaction to blood transfusion. The hospital stay was shorter for the laparoscopically treated patients (5.9 days versus 12.8 days for the open group). On the other hand, operating time was longer for the laparoscopic cases (123 minutes versus 91 minutes). The authors suggest that laparoscopic cholecystectomy should be the procedure of choice for childhood cholelithiasis, particularly when associated with sickle cell disease.--l: Wester Ectopic Gallbladder Revisited, port. C.C. Chung, K.L. Leung, 40:464-466, (December), 1977.
Laparoscopically: A Case ReW.\/: Lau, et al. Can J Surg
A case of the rare congenital anomaly ectopic gallbladder is presented. A 16.year-old girl suffered attacks of epigastric pain unrelated to eating. On abdominal ultrasonography, the gallbladder could not be found in its usual position. Endoscopic retrograde cholangiography demonstrated the gallbladder on the left side of the common duct, and the cystic duct arising from the right hepatic duct. Laparoscopic cholecystectomy was performed without complication. This appears to be the first reported case of laparoscopic removal of an ectopic gallbladder. The importance of preoperative cholangiography is emphasized for accurate diagnosis and preoperative location of the gallbladder.Sigmund H. Ein Are Babies With Gastroschisis R.T: Blakelock, V. Upadhyay, Int 12:580-582, (November),
Small for I?W.D. Pease, 1997.
Gestational et al. Pediatr
Age? Surg
The purposes of this study were to (1) evaluate whether babies with gastroschisis have lower birth weight compared with the normal population and (2) compare the birth weight of patients with gastroschisis treated at different centers. Forty-four patients operated on at Auckland Children’s Hospital, Auckland, New Zealand, and 69 babies operated at Birmingham Children’s Hospital, Birmingham, England, were studied. Birth weight was expressed as weight standard deviation scores (actual birth weight-expected birth weight)/standard deviation of expected birth weight) to avoid the influence of gestational age. In the normal population, the score should be zero. For the children operated in Auckland the score was -0.806; in Birmingham the score was -0.762.