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Nontransplant surgical options for management of the short bowel syndrome
468
Laparoscopic Maisel. Pediatr
INTERNATIONAL
Gastrostomy. G. Stringel. E. Robinson, and S. Surg Int 8~382-384, (July), 1993.
The authors describe the use of laparoscopic-guided gastrostomy for feeding purposes in a 7-year-old child with swallowing incoordination after head injury. This technique was adopted in a patient following animal experimental work. In animals, the authors have inserted a gastrostomy with or without the use of endoscopy. They believe that laparoscopy enables them to place the gastrostomy in the lesser curvature to prevent gastroesophaeal reflux. Laparoscopy also eliminates the possibility of inadvertent injury to other viscera during gastrostomy placement.-R. Surana
Acute Mesenteroaxial Gastric Volvulus in an Infant: A Case Report. W. Brzezinski, M.M. Laskin, and KS. Wang. Can J Surg 36:233-235. (June), 1993. The authors report a case of an 11 month old who presented with an &hour history of retching and lethargy. Abdominal distension and left upper quadrant tenderness were the predominant physical findings. An attempt at stomach decompression with a nasogastric tube was unsuccessful. The diagnosis of mesenteroaxial gastric volvulus with eventration of the left hemidiaphragm was made by means of plain abdominal x-rays of the abdomen and an upper gastrointestinalseries that showedgastricoutletobstruction caused by an upside-down stomach. The infant underwent laparotomy and gastrostomy and had a smooth recovery; the gastrostomy was removed 2 weeks after the operation. There are more than 50 reported cases of pediatric gastric volvulus. The pathophysiology is related to associated congenital abnormalities: failure of fixation of the stomach because of poorly developed gastrocolic or gastrosplenic ligaments and a diaphragmatic defect such as paraesophageal hernia or eventration. However, one third of these patients have no such abnormalities (primary gastric volvulus). There are three types of volvulus: mesenteroaxial, organoaxial (lengthwise), or a combination of the two. If rotation is more than 180”. there is a chance that stomach obstruction with strangulation, ischemia, and perforation may occur. Symptoms include retching and inability to vomit. severe epigastric pain. and inability to insert a nasogastric tube. An upper gastrointestinal contrast study will show a rotated or upside-down stomach with varying degrees of inlet and outlet obstruction. Treatment consists of reduction of the volvulus with anterior gastropexy or gastrostomy.-Sigmztnd H. Ein
Predicting the Clinical Response to Cisapride in Children With Chronic Intestinal Pseudo-obstruction. P.E. Hyman. C. Di Lorenzo, L. McAdams, etal. Am J Gastroenterol88:832-836. (June). 1993. The role of cisapride in treating children with chronic intestinal pseudo-obstruction (UP) is not clear. Forty-nine children with a variety of conditions leading to CIP were treated with cisapride (0.2 mgikgldose TID) and evaluated every 2 months for up to 1 year. Excellent results (changing from total parenteral nutrition to enteral feeding) were achieved in seven children; 17 had fair improvement, and 25 showed had no improvement. Cases with demonstrable migrating motor complexes (MMC) responded to cisapride more often than those without MMCs. Cases with normaldiameter bowel responded more often than those with dilated bowel. The authors suggest that these two criteria could be used to identify patients whose conditions would be more likely to respond to cisapride therapy for chronic intestinal pseudo-obstruction.Richard R. Ricketts
ABSTRACTS
Nontransplant Surgical Options for Management of the Short Bowel Syndrome. B. Warner and M.S. Chaet. J Pediatr Gastroenterol Nulr 17:1-l?. (July), 1993. The authors present a complete review of clinical and experimental methods for the surgical management of short bowel syndrome. The article has excellent diagrams of all operative procedures and describes algorithms may lead eventually
for management and experimental data that to a more promising outcome.--Thomas F.
Tracy, Jr
Use of EndoGlA Stapling Device in Duhamel-Martin Procedure for Hirschsprung’s Disease. D.C. van der Zee, N.M.A. Bax, A.J. Pull ter Gunne, et al. Pediatr Surg Int 8:447-448, (July), 1993. The authors describe their experience using the endoGlA stapler for side-to-side colorectal anastomosis in the Duhamel-Martin procedure. The advantages include ease of use and ability to rotate through 360”. It may also allow early operation. This device forms a safe anastomosis. No postoperative complications associated with endoGIA
stapler
were encountered
in their patients.--P.
Pun’
Perineal Canal-Repair by a New Surgical Technique. K L. N. Rao, S.R. Choudhury, R. Sarnujh, if al. Pediatr Surg Int 8:449-450, (July), 1993. Perineal canal is a rare malformation and is more frequently seen in Asian countries. Various surgical approaches have been advocated. The authors reported on a patient for whom they used a technique in which the perineal canal (including skin, subcutaneous tissue, a few fibers of the external sphincter muscle and one wall of the mucosal tract) is opened over a probe. The mucosal tract is then dissected off from the underlying muscle, starting at the vestibular end. This is repositioned posteriorly in continuity with the anus, and is sutured to complete the anoplasty after the external sphincter complex and perineal body have been repaired with Vicyrl. After colostomy closure, the patient’s bowel activity was normal.
as was the cosmetic
appearance.-P.
Pzzn’
ABDOMEN
Biliary Atresia Splenic Malformation Syndrome: An Etiologic and Prognostic Subgroup. M. Davenport. M. Sal,age, A.P. Mowat. et al. Surgery 113:662-668, (June), 1993. Of 308 infants
treated
for biliary atresia,
23 had polysplenia
and
biliary atresia. Four others had different types of splenic malformations. Along with the splenic malformations, there were other anomalies such as situs inversus and portal vein abnormalities. The clinical presentation of jaundice was the same in patients with splenic malformations and in other patients without these malformations. More infants with splenic malformation were born to mothers with diabetes. Survival of these infants was less likely than for those without other anatomic anomalies. The constellation of anomalies presented in this report is proposed by the authors to come under the term “biliary atresia-splenic malformation syndrome,” which appears to occur in a distinct subgroup of infants with biliary atresia. The etiology of biliary atresia may be different in these patients, who appear to have a poorer prognosis than the patients with biliary atresia who do not have anatomic and splenic abnormalities.-Thomas F. Trtrq, Jt
Laparoscopic Maisel. Pediatr
INTERNATIONAL
Gastrostomy. G. Stringel. E. Robinson, and S. Surg Int 8~382-384, (July), 1993.
The authors describe the use of laparoscopic-guided gastrostomy for feeding purposes in a 7-year-old child with swallowing incoordination after head injury. This technique was adopted in a patient following animal experimental work. In animals, the authors have inserted a gastrostomy with or without the use of endoscopy. They believe that laparoscopy enables them to place the gastrostomy in the lesser curvature to prevent gastroesophaeal reflux. Laparoscopy also eliminates the possibility of inadvertent injury to other viscera during gastrostomy placement.-R. Surana
Acute Mesenteroaxial Gastric Volvulus in an Infant: A Case Report. W. Brzezinski, M.M. Laskin, and KS. Wang. Can J Surg 36:233-235. (June), 1993. The authors report a case of an 11 month old who presented with an &hour history of retching and lethargy. Abdominal distension and left upper quadrant tenderness were the predominant physical findings. An attempt at stomach decompression with a nasogastric tube was unsuccessful. The diagnosis of mesenteroaxial gastric volvulus with eventration of the left hemidiaphragm was made by means of plain abdominal x-rays of the abdomen and an upper gastrointestinalseries that showedgastricoutletobstruction caused by an upside-down stomach. The infant underwent laparotomy and gastrostomy and had a smooth recovery; the gastrostomy was removed 2 weeks after the operation. There are more than 50 reported cases of pediatric gastric volvulus. The pathophysiology is related to associated congenital abnormalities: failure of fixation of the stomach because of poorly developed gastrocolic or gastrosplenic ligaments and a diaphragmatic defect such as paraesophageal hernia or eventration. However, one third of these patients have no such abnormalities (primary gastric volvulus). There are three types of volvulus: mesenteroaxial, organoaxial (lengthwise), or a combination of the two. If rotation is more than 180”. there is a chance that stomach obstruction with strangulation, ischemia, and perforation may occur. Symptoms include retching and inability to vomit. severe epigastric pain. and inability to insert a nasogastric tube. An upper gastrointestinal contrast study will show a rotated or upside-down stomach with varying degrees of inlet and outlet obstruction. Treatment consists of reduction of the volvulus with anterior gastropexy or gastrostomy.-Sigmztnd H. Ein
Predicting the Clinical Response to Cisapride in Children With Chronic Intestinal Pseudo-obstruction. P.E. Hyman. C. Di Lorenzo, L. McAdams, etal. Am J Gastroenterol88:832-836. (June). 1993. The role of cisapride in treating children with chronic intestinal pseudo-obstruction (UP) is not clear. Forty-nine children with a variety of conditions leading to CIP were treated with cisapride (0.2 mgikgldose TID) and evaluated every 2 months for up to 1 year. Excellent results (changing from total parenteral nutrition to enteral feeding) were achieved in seven children; 17 had fair improvement, and 25 showed had no improvement. Cases with demonstrable migrating motor complexes (MMC) responded to cisapride more often than those without MMCs. Cases with normaldiameter bowel responded more often than those with dilated bowel. The authors suggest that these two criteria could be used to identify patients whose conditions would be more likely to respond to cisapride therapy for chronic intestinal pseudo-obstruction.Richard R. Ricketts
ABSTRACTS
Nontransplant Surgical Options for Management of the Short Bowel Syndrome. B. Warner and M.S. Chaet. J Pediatr Gastroenterol Nulr 17:1-l?. (July), 1993. The authors present a complete review of clinical and experimental methods for the surgical management of short bowel syndrome. The article has excellent diagrams of all operative procedures and describes algorithms may lead eventually
for management and experimental data that to a more promising outcome.--Thomas F.
Tracy, Jr
Use of EndoGlA Stapling Device in Duhamel-Martin Procedure for Hirschsprung’s Disease. D.C. van der Zee, N.M.A. Bax, A.J. Pull ter Gunne, et al. Pediatr Surg Int 8:447-448, (July), 1993. The authors describe their experience using the endoGlA stapler for side-to-side colorectal anastomosis in the Duhamel-Martin procedure. The advantages include ease of use and ability to rotate through 360”. It may also allow early operation. This device forms a safe anastomosis. No postoperative complications associated with endoGIA
stapler
were encountered
in their patients.--P.
Pun’
Perineal Canal-Repair by a New Surgical Technique. K L. N. Rao, S.R. Choudhury, R. Sarnujh, if al. Pediatr Surg Int 8:449-450, (July), 1993. Perineal canal is a rare malformation and is more frequently seen in Asian countries. Various surgical approaches have been advocated. The authors reported on a patient for whom they used a technique in which the perineal canal (including skin, subcutaneous tissue, a few fibers of the external sphincter muscle and one wall of the mucosal tract) is opened over a probe. The mucosal tract is then dissected off from the underlying muscle, starting at the vestibular end. This is repositioned posteriorly in continuity with the anus, and is sutured to complete the anoplasty after the external sphincter complex and perineal body have been repaired with Vicyrl. After colostomy closure, the patient’s bowel activity was normal.
as was the cosmetic
appearance.-P.
Pzzn’
ABDOMEN
Biliary Atresia Splenic Malformation Syndrome: An Etiologic and Prognostic Subgroup. M. Davenport. M. Sal,age, A.P. Mowat. et al. Surgery 113:662-668, (June), 1993. Of 308 infants
treated
for biliary atresia,
23 had polysplenia
and
biliary atresia. Four others had different types of splenic malformations. Along with the splenic malformations, there were other anomalies such as situs inversus and portal vein abnormalities. The clinical presentation of jaundice was the same in patients with splenic malformations and in other patients without these malformations. More infants with splenic malformation were born to mothers with diabetes. Survival of these infants was less likely than for those without other anatomic anomalies. The constellation of anomalies presented in this report is proposed by the authors to come under the term “biliary atresia-splenic malformation syndrome,” which appears to occur in a distinct subgroup of infants with biliary atresia. The etiology of biliary atresia may be different in these patients, who appear to have a poorer prognosis than the patients with biliary atresia who do not have anatomic and splenic abnormalities.-Thomas F. Trtrq, Jt