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Operative management of stress ulcers in children
95
ABSTRACTS
spells, cyanotic spells, iron-deficiency anemia, chronic asthma, esophageal stricture and Sandifer syndrome. Recommended diagnostic studies include barium swallow with the water-siphon test, scintographic studies, and esophageal manometry. The 24-hour intraesophageal pH monitoring is felt to be particularly useful. Nissen fundoplication, among other procedures, is utilized in the surgical management, and felt to be required in children who have significant sequelae such as severe failure to thrive, gross esophagitis, and recurrent apnea, cyanosis or pneumonia. Mention is made of the little known syndrome of antral dysmotility. A long Ramstedt-type procedure with extension of the myotomy up over the gastric antrum is effective.--David L. Collins
control of bleeding and may be dangerous in the unstable, hypovolemic child.--Richard J. Andrassy Complete Gastric Duplication. F. P. Agha, O. 1:. Gabriele, and F. H. Abdulla. Am J Roentgenol 137:406-407, (August), 1981. A 25-yr-old male presented with vague epigastric fullness and discomfort dating to early childhood. An UGI revealed a complete double lumen stomach (esophagogastricjunction to pylorus). In a review of 88 patients in the literature the authors state that this patient represents the first report of a complete gastric duplication.--Randall IV. Powell Congenital Pyloric Atresia. H. Kadowaki, S. Takeuchi,
Complications of Gastroesophageal Reflux in Patients with
Cystic Fibrosis. D. IV. Bendig, D. K. Seilheimer, M. L. Wagner, et al. J. Pediatr 100:536-540, (April), 1982. Seven patients with cystic fibrosis (CF) who had complications of gastroesophageal reflux (GER) including abdominal pain, peptic esophagitis, upper gastrointestinal hemorrhage, and esophageal stricture are described. The authors believe these are gastrointestinal complications of CF and that they may be responsible for significant morbidity. The mechanical influence of a depressed diaphragm caused by lung hyperinflation, along with increased abdominal pressure with chronic coughing, may contribute to GER in CF. Early detection and treatment are important not only to prevent esophageal complications but also to improve the quality of life by relief of pain and by avoiding the resultant decrease in appetite, which can contribute to malnutrition.--George Holcomb, Jr. Operative Management of Stress Ulcers in Children. R. S.
Morden, J. N. Schullinger, D. L. Mollitt, et al. Ann Surg 196:18-20, 1982. Ten children operated on for stress ulcer disease during a 12 year period are reported. Diseases for which these children were being treated included connective tissue disorders (3), Reye's Syndrome (1), renal failure (1), hemolytic uremic syndrome (1), leukemia (1), sepsis (2), and closed head injury (1). Operative indications were uncontrolled hemorrhage in 8 patients and perforation in 2. Four patients underwent embolization of a feeding artery and/or selective vasopressin infusion without success prior to surgical intervention. Multiple ulcerations or mucosal erosions of the stomach or duodenum were seen in six of the eight patients operated on for bleeding. Among the eight patients who bled, three underwent partial gastrectomy and bilateral truncal vagotomy, three underwent partial gastrectomy alone, and two underwent suture ligation of the bleeding vessel with vagotomy and pyloroplasty. Of the two children who perforated, one underwent plication of a solitary duodenal ulcer. The other underwent a partial gastrectomy for multiple gastric ulcers, one of which had perforated. The authors present the following conclusions: (1) Stress ulcers in children are commonly multiple when associated with major medical illnesses. (2) Partial gastrectomy with or without vagotomy affords maximum protection against recurrent bleeding. Lesser procedures are effective for solitary bleeding duodenal ulcers or perforation. (3) Selective arterial embolization or pitressin infusion are unreliable methods for the
M. Nakahira, et al. Am J Gastroent 76:449-452, (November), 1981. Three cases of congenital pyloric atresia are described. In one case the pylorus was replaced by a 2 cm. long solid band of smooth muscle; the patient was treated with a Billroth I operation with a satisfactory outcome. The other two cases had membranous obstructions, one complete and one incomplete. Both patients were treated with excision of the membrane and pyloroplasty with satisfactory outcomes. All three cases had gastrostomies and transgastric catheter jejunostomies. A literature review documents 100 cases of congenital gastric outlet obstruction. The sex ratio is approximately equal. Familial occurrence has been reported and an autosomal recessive mode of inheritance suggested, especially since this anomaly has been associated with epidermolysis bullosa in a few cases. A pyloric membrane accounts for 67% of the cases. Other forms of obstruction include pyloric atresia (27%), antral membranes (5%), and antral atresia (1%). The type of surgical treatment employed depends upon the type of obstruction found. The authors suggest preservation of pyloric function by transgastric circular excision of the membrane and avoidance of pyloroplasty if possible.Richard R. Ricketts The Problem of Congenital Duodenal Obstruction. A Report of 123 Cases. R. Daum, H. Roth, B. Sch~der, et al. Z
Kinderchir 35:125-129, 1982. A series of 123 children (57 males, 66 females) operated for duodenal obstruction from 1962 to 1980 is presented. Seventy-eight children (64%) had an extrinsic obstruction (annular pancreas, malrotation) and 45 (36%) an intrinsic one (atresia, membranaceous stenosis). Standardized operative techniques were applied. Seventy-four out of the 123 children (60%) were mature and had no associated malformations. Their mortality rate was 5%. Forty-nine children (40%) were either premature or had associated malformations, including Down's syndrome. In this group mortality was 27%. Due to better diagnosis and operative and postoperative therapy, prognosis improved considerably since the authors report no postoperative death since 1972.--Thomas A. Angerpointner Crohn's Disease of the Stomach and Duodenum. R. H.
Marshak, D. Maklansky, J. D. Kurzban, et al. Am J Gastroent 77:340-343, (May), 1982. Crohn's disease of the stomach is an uncommon lesion, and the diagnosis can be made with certainty only if there is
ABSTRACTS
spells, cyanotic spells, iron-deficiency anemia, chronic asthma, esophageal stricture and Sandifer syndrome. Recommended diagnostic studies include barium swallow with the water-siphon test, scintographic studies, and esophageal manometry. The 24-hour intraesophageal pH monitoring is felt to be particularly useful. Nissen fundoplication, among other procedures, is utilized in the surgical management, and felt to be required in children who have significant sequelae such as severe failure to thrive, gross esophagitis, and recurrent apnea, cyanosis or pneumonia. Mention is made of the little known syndrome of antral dysmotility. A long Ramstedt-type procedure with extension of the myotomy up over the gastric antrum is effective.--David L. Collins
control of bleeding and may be dangerous in the unstable, hypovolemic child.--Richard J. Andrassy Complete Gastric Duplication. F. P. Agha, O. 1:. Gabriele, and F. H. Abdulla. Am J Roentgenol 137:406-407, (August), 1981. A 25-yr-old male presented with vague epigastric fullness and discomfort dating to early childhood. An UGI revealed a complete double lumen stomach (esophagogastricjunction to pylorus). In a review of 88 patients in the literature the authors state that this patient represents the first report of a complete gastric duplication.--Randall IV. Powell Congenital Pyloric Atresia. H. Kadowaki, S. Takeuchi,
Complications of Gastroesophageal Reflux in Patients with
Cystic Fibrosis. D. IV. Bendig, D. K. Seilheimer, M. L. Wagner, et al. J. Pediatr 100:536-540, (April), 1982. Seven patients with cystic fibrosis (CF) who had complications of gastroesophageal reflux (GER) including abdominal pain, peptic esophagitis, upper gastrointestinal hemorrhage, and esophageal stricture are described. The authors believe these are gastrointestinal complications of CF and that they may be responsible for significant morbidity. The mechanical influence of a depressed diaphragm caused by lung hyperinflation, along with increased abdominal pressure with chronic coughing, may contribute to GER in CF. Early detection and treatment are important not only to prevent esophageal complications but also to improve the quality of life by relief of pain and by avoiding the resultant decrease in appetite, which can contribute to malnutrition.--George Holcomb, Jr. Operative Management of Stress Ulcers in Children. R. S.
Morden, J. N. Schullinger, D. L. Mollitt, et al. Ann Surg 196:18-20, 1982. Ten children operated on for stress ulcer disease during a 12 year period are reported. Diseases for which these children were being treated included connective tissue disorders (3), Reye's Syndrome (1), renal failure (1), hemolytic uremic syndrome (1), leukemia (1), sepsis (2), and closed head injury (1). Operative indications were uncontrolled hemorrhage in 8 patients and perforation in 2. Four patients underwent embolization of a feeding artery and/or selective vasopressin infusion without success prior to surgical intervention. Multiple ulcerations or mucosal erosions of the stomach or duodenum were seen in six of the eight patients operated on for bleeding. Among the eight patients who bled, three underwent partial gastrectomy and bilateral truncal vagotomy, three underwent partial gastrectomy alone, and two underwent suture ligation of the bleeding vessel with vagotomy and pyloroplasty. Of the two children who perforated, one underwent plication of a solitary duodenal ulcer. The other underwent a partial gastrectomy for multiple gastric ulcers, one of which had perforated. The authors present the following conclusions: (1) Stress ulcers in children are commonly multiple when associated with major medical illnesses. (2) Partial gastrectomy with or without vagotomy affords maximum protection against recurrent bleeding. Lesser procedures are effective for solitary bleeding duodenal ulcers or perforation. (3) Selective arterial embolization or pitressin infusion are unreliable methods for the
M. Nakahira, et al. Am J Gastroent 76:449-452, (November), 1981. Three cases of congenital pyloric atresia are described. In one case the pylorus was replaced by a 2 cm. long solid band of smooth muscle; the patient was treated with a Billroth I operation with a satisfactory outcome. The other two cases had membranous obstructions, one complete and one incomplete. Both patients were treated with excision of the membrane and pyloroplasty with satisfactory outcomes. All three cases had gastrostomies and transgastric catheter jejunostomies. A literature review documents 100 cases of congenital gastric outlet obstruction. The sex ratio is approximately equal. Familial occurrence has been reported and an autosomal recessive mode of inheritance suggested, especially since this anomaly has been associated with epidermolysis bullosa in a few cases. A pyloric membrane accounts for 67% of the cases. Other forms of obstruction include pyloric atresia (27%), antral membranes (5%), and antral atresia (1%). The type of surgical treatment employed depends upon the type of obstruction found. The authors suggest preservation of pyloric function by transgastric circular excision of the membrane and avoidance of pyloroplasty if possible.Richard R. Ricketts The Problem of Congenital Duodenal Obstruction. A Report of 123 Cases. R. Daum, H. Roth, B. Sch~der, et al. Z
Kinderchir 35:125-129, 1982. A series of 123 children (57 males, 66 females) operated for duodenal obstruction from 1962 to 1980 is presented. Seventy-eight children (64%) had an extrinsic obstruction (annular pancreas, malrotation) and 45 (36%) an intrinsic one (atresia, membranaceous stenosis). Standardized operative techniques were applied. Seventy-four out of the 123 children (60%) were mature and had no associated malformations. Their mortality rate was 5%. Forty-nine children (40%) were either premature or had associated malformations, including Down's syndrome. In this group mortality was 27%. Due to better diagnosis and operative and postoperative therapy, prognosis improved considerably since the authors report no postoperative death since 1972.--Thomas A. Angerpointner Crohn's Disease of the Stomach and Duodenum. R. H.
Marshak, D. Maklansky, J. D. Kurzban, et al. Am J Gastroent 77:340-343, (May), 1982. Crohn's disease of the stomach is an uncommon lesion, and the diagnosis can be made with certainty only if there is