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Management of duodenal injuries
1004
INTERNATIONAL
Spinal Deformity in Patients With Desophageal Atresia and Tracheo-Oesophageal Fist&a. P. Cheteuti,
D.R.V.
Dickens,
and P.D.
Phelan. Arch Dis Child 64:1427-1430, (October), 1989.
In this review of 302 infants with esophageal atresia and tracheoesophageal fistula, the incidence of spinal deformity was found to be 19%. This deformity was divided into that due to congenital vertebral anomalies (51 patients) and that in whom no anomaly other than the esophageal abnormality was present (34 patients). In those with congenital vertebral anomalies, 47% had clinically apparent deformity, mostly scoliosis. Eight patients required surgical stabilization in adolescence or adult life, but further patients were thought probably to merit surgery at some stage in the future. The authors concluded that two thirds of patients with congenital scoliosis have had or are likely to require surgery. In those patients with normal vertebrae, the prognosis was thought to be excellent, although surgery was required in two patients and might be needed in a further three. The relationship of this abnormality to previous surgery for esophageal atresia is discussed. The overall incidence of congenital spinal anomalies in esophageal atresia was only 15% in this series. However, the authors conclude that routine x-rays of the spine at birth for congenital anomalies is required and that careful follow-up into adult life will be necessary.--D.M. Burge Esophageal Acid Exposure in One Single Parameter: Area Under pH Curve. M.A.
Izquierdo.
J.A.
Tovar,
and I. Eizaguirre.
Chir
Pediatr 30:1-S, (February), 1989. This is a prospective study comparing the four classical pH metering variables (percentage of time under pH 4, number of reflux episodes, number of those lasting more than 5 minutes, and duration of the longer one) with the area under pH curve. Two groups were selected: one of refluxing children (n = 50) and one control group (n = 20) who have a value of 4% or less time under pH 4. Sensitivity, specificity, and accuracy of all values of each parameter have been tested and the optimum threshold values have been determined. Results demonstrate that area under curve is at least as informant as percentage of time below pH 4 and better than the other parameters. This area reflects, in addition, the depth of pH falls and the clearance. Its measurement can be done by computer and should be included in the currently available software for pH reading. It will be very interesting for the future to have a single figure to summarizes degree of gastroesophageal reflux.--J.M. Guys Wound Sepsis Following Ramstedt Pyloromyotomy. N. Rao and
G.G. Youngson. Br J Surg 76:1144-l 146, (November), 1989.
Wound sepsis is common following pyloromyotomy in children. The authors reviewed retrospectively 178 cases and found 21 cases of wound infection (11.8%). On preliminary analysis, three variables were associated with wound sepsis: age, duration of projectile vomiting, and surgical technique. Only surgical technique was found to be statistically significant on sequential multivariate analysis. Mass closure of the incision with polydioxanone was associated with a 1% (l/70) wound sepsis rate. Therefore, it is recommended as the technique of choice. In the authors’ opinion, the routine use of tension sutures should be abandoned.-Lewis Spitz
ABSTRACTS
missed. The extent of the duodenal injury often precluded primary reconstruction, requiring the surgeon to use his or her ingenuity to restore gastrointestinal continuity. The authors observe that primary repair with tube decompression versus primary repair without tube decompression has a fistula rate of 2% versus 12% (19% in this series). They also state that fistulas can occur in up to 20% of cases, especially with blunt trauma (I 7% in this series). Death rates from these injuries are reported to range from 6% to 12% (14% in this series). The main determinant of morbidity and mortality is related to delayed diagnosis or delayed surgical repair.-Sigmund H. Ein Intestinal Perforations Related to Blunt Abdominal Trauma in Children. P. DeBeugny,
L. Canarelli.
hf. Bonevalle,
et al. Chir
Pediatr 29:7-10, (March), 1988. Sixteen cases of intestinal perforation following blunt abdominal trauma spanning an 1I-year period are reported. There were 14 boys and two girls ranging in age from 3.5 to 15 years. Twelve sustained injury to the small bowel, two had colonic perforation, and two sustained duodenal injuries. Associated injuries included hepatic lacerations (2). splenic trauma (2), diaphragmatic hernia (1), unilateral renal injury (1). cranial trauma (2). and bone fractures (1). Except in cases with hypovolemia and/or traumatic coma, diagnosis was made on abdominal examination and clinical evaluation rather than by radiological or laboratory studies. Ten abdominal plain films, three ultrasonographies, and one abdominal scan were not found to be helpful in 14 patients. Surgical management was delayed from 1 hour to 11 days (mean, 35 hours), especially in the last 4 years because of the nonoperative management of most pediatric blunt trauma. Surgical treatment was: simple closure (7), cases, resection with anastomosis (7) or colostomy or ileostomy (2). Two deaths were noted but none directly due to the intestinal injuries. There was also noted to be one anastomotic fistula that closed spontaneously with parenteral nutrition alone. Complications and morbidity do not seem to increase with therapeutic delay and primary nonoperative management of blunt abdominal trauma.--J.M. Guys Intestinal Obstruction Caused by Malrotation of the Gut in Atrial Isomerism. M.R. Sharland,
N.L. Chowcat, S.A. Qureshi. et al. Arch
Dis Child 64:1623-1624, (November), 1969. Five children with atria1 isomerism developed intestinal obstruction caused by intestinal malrotation. The authors highlight the fact that although malrotation has been well-reported in this type of congenital cardiac abnormality in the past, the complications associated with malrotation in previous reports have been uncommon. These five cases demonstrate the danger of intestinal malrotation in this condition. Four of the five patients died, two as a direct result of cardiac problems, one as a result of sepsis, and one of necrotizing enterocolitis. They comment that the occurrence of gastrointestinal symptoms in children with this type of abnormality should merit early investigations and consideration of surgery but do not specifically recommend correction of the malrotation if detected incidentally.--D.M. Burge Gastrointestinal Bleeding Due to Mukiple lleal Duplications Diegnosed by Scintigraphy and Barium Studies. A.M.
Gilchrist, J.M. C.J.H. Logan. et al. Clin Radio1 41:134-l 36, (February),
Management of Duodenal Injuries. G. Cuddington. C.H. Rusnak, R.D.A. Cameron, et al. Can J Surg 33:41-44, (February), 1990.
Sloan,
This paper reviews 42 patients with duodenal injuries seen over a 12-year period (1975 to 1986) at six major hospitals in a western Canadian province. The patients ranged in age from 1 to 78 years (mean, 25 years). All but four were male. Most were associated with other injuries. X-ray findings, including those on CT scan, were often
A case of gastrointestinal bleeding is reported in a 1‘i-year-old girl with 10 ileal duplications, each containing ectopic gastric mucosa. Technetium 99m pertechnetate scintigraphy in conjunction with barium studies provided the initial clue and accurately localized the abnormality preoperatively.-Amir Azmy
1990.
INTERNATIONAL
Spinal Deformity in Patients With Desophageal Atresia and Tracheo-Oesophageal Fist&a. P. Cheteuti,
D.R.V.
Dickens,
and P.D.
Phelan. Arch Dis Child 64:1427-1430, (October), 1989.
In this review of 302 infants with esophageal atresia and tracheoesophageal fistula, the incidence of spinal deformity was found to be 19%. This deformity was divided into that due to congenital vertebral anomalies (51 patients) and that in whom no anomaly other than the esophageal abnormality was present (34 patients). In those with congenital vertebral anomalies, 47% had clinically apparent deformity, mostly scoliosis. Eight patients required surgical stabilization in adolescence or adult life, but further patients were thought probably to merit surgery at some stage in the future. The authors concluded that two thirds of patients with congenital scoliosis have had or are likely to require surgery. In those patients with normal vertebrae, the prognosis was thought to be excellent, although surgery was required in two patients and might be needed in a further three. The relationship of this abnormality to previous surgery for esophageal atresia is discussed. The overall incidence of congenital spinal anomalies in esophageal atresia was only 15% in this series. However, the authors conclude that routine x-rays of the spine at birth for congenital anomalies is required and that careful follow-up into adult life will be necessary.--D.M. Burge Esophageal Acid Exposure in One Single Parameter: Area Under pH Curve. M.A.
Izquierdo.
J.A.
Tovar,
and I. Eizaguirre.
Chir
Pediatr 30:1-S, (February), 1989. This is a prospective study comparing the four classical pH metering variables (percentage of time under pH 4, number of reflux episodes, number of those lasting more than 5 minutes, and duration of the longer one) with the area under pH curve. Two groups were selected: one of refluxing children (n = 50) and one control group (n = 20) who have a value of 4% or less time under pH 4. Sensitivity, specificity, and accuracy of all values of each parameter have been tested and the optimum threshold values have been determined. Results demonstrate that area under curve is at least as informant as percentage of time below pH 4 and better than the other parameters. This area reflects, in addition, the depth of pH falls and the clearance. Its measurement can be done by computer and should be included in the currently available software for pH reading. It will be very interesting for the future to have a single figure to summarizes degree of gastroesophageal reflux.--J.M. Guys Wound Sepsis Following Ramstedt Pyloromyotomy. N. Rao and
G.G. Youngson. Br J Surg 76:1144-l 146, (November), 1989.
Wound sepsis is common following pyloromyotomy in children. The authors reviewed retrospectively 178 cases and found 21 cases of wound infection (11.8%). On preliminary analysis, three variables were associated with wound sepsis: age, duration of projectile vomiting, and surgical technique. Only surgical technique was found to be statistically significant on sequential multivariate analysis. Mass closure of the incision with polydioxanone was associated with a 1% (l/70) wound sepsis rate. Therefore, it is recommended as the technique of choice. In the authors’ opinion, the routine use of tension sutures should be abandoned.-Lewis Spitz
ABSTRACTS
missed. The extent of the duodenal injury often precluded primary reconstruction, requiring the surgeon to use his or her ingenuity to restore gastrointestinal continuity. The authors observe that primary repair with tube decompression versus primary repair without tube decompression has a fistula rate of 2% versus 12% (19% in this series). They also state that fistulas can occur in up to 20% of cases, especially with blunt trauma (I 7% in this series). Death rates from these injuries are reported to range from 6% to 12% (14% in this series). The main determinant of morbidity and mortality is related to delayed diagnosis or delayed surgical repair.-Sigmund H. Ein Intestinal Perforations Related to Blunt Abdominal Trauma in Children. P. DeBeugny,
L. Canarelli.
hf. Bonevalle,
et al. Chir
Pediatr 29:7-10, (March), 1988. Sixteen cases of intestinal perforation following blunt abdominal trauma spanning an 1I-year period are reported. There were 14 boys and two girls ranging in age from 3.5 to 15 years. Twelve sustained injury to the small bowel, two had colonic perforation, and two sustained duodenal injuries. Associated injuries included hepatic lacerations (2). splenic trauma (2), diaphragmatic hernia (1), unilateral renal injury (1). cranial trauma (2). and bone fractures (1). Except in cases with hypovolemia and/or traumatic coma, diagnosis was made on abdominal examination and clinical evaluation rather than by radiological or laboratory studies. Ten abdominal plain films, three ultrasonographies, and one abdominal scan were not found to be helpful in 14 patients. Surgical management was delayed from 1 hour to 11 days (mean, 35 hours), especially in the last 4 years because of the nonoperative management of most pediatric blunt trauma. Surgical treatment was: simple closure (7), cases, resection with anastomosis (7) or colostomy or ileostomy (2). Two deaths were noted but none directly due to the intestinal injuries. There was also noted to be one anastomotic fistula that closed spontaneously with parenteral nutrition alone. Complications and morbidity do not seem to increase with therapeutic delay and primary nonoperative management of blunt abdominal trauma.--J.M. Guys Intestinal Obstruction Caused by Malrotation of the Gut in Atrial Isomerism. M.R. Sharland,
N.L. Chowcat, S.A. Qureshi. et al. Arch
Dis Child 64:1623-1624, (November), 1969. Five children with atria1 isomerism developed intestinal obstruction caused by intestinal malrotation. The authors highlight the fact that although malrotation has been well-reported in this type of congenital cardiac abnormality in the past, the complications associated with malrotation in previous reports have been uncommon. These five cases demonstrate the danger of intestinal malrotation in this condition. Four of the five patients died, two as a direct result of cardiac problems, one as a result of sepsis, and one of necrotizing enterocolitis. They comment that the occurrence of gastrointestinal symptoms in children with this type of abnormality should merit early investigations and consideration of surgery but do not specifically recommend correction of the malrotation if detected incidentally.--D.M. Burge Gastrointestinal Bleeding Due to Mukiple lleal Duplications Diegnosed by Scintigraphy and Barium Studies. A.M.
Gilchrist, J.M. C.J.H. Logan. et al. Clin Radio1 41:134-l 36, (February),
Management of Duodenal Injuries. G. Cuddington. C.H. Rusnak, R.D.A. Cameron, et al. Can J Surg 33:41-44, (February), 1990.
Sloan,
This paper reviews 42 patients with duodenal injuries seen over a 12-year period (1975 to 1986) at six major hospitals in a western Canadian province. The patients ranged in age from 1 to 78 years (mean, 25 years). All but four were male. Most were associated with other injuries. X-ray findings, including those on CT scan, were often
A case of gastrointestinal bleeding is reported in a 1‘i-year-old girl with 10 ileal duplications, each containing ectopic gastric mucosa. Technetium 99m pertechnetate scintigraphy in conjunction with barium studies provided the initial clue and accurately localized the abnormality preoperatively.-Amir Azmy
1990.