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Pediatric abdominal injuries
139
ABSTRACTS
medical contraindication. Colostomy is used only for supralevator anomalies and where long delay in referral and complicated medical and surgical problems exist. The authors emphasize the importance of safe, skillfully administered anesthesia, pre- and postoperative nursing care, and precise surgical technique. With this approach, 7-10 days of hospitalization followed by several months of dilatations of the new anus have produced excellent results. Editorial comment: This commentary will stimulate much comment. Many feel that should a fistula be present, dilatation until 3 mo of age and a subsequent definitive procedure allows a more precise definitive operation. Others be!ieve that transplantation procedures in infralevator anomalies are valueless since the patients are continent and the only surgical treatment should be directed toward providing an adequate orifice. It is unfortunate that this paper is not supported by statistical information and facts. The postoperative care of these infants is not referred to in this article. In our experience it is essential that the rectum remain empty by irrigations until the healing has been completed; this is a controversial and very important subject.WiNiam K. Sieber Perineal
Anal
Tmnrplant
in Anorectol
Mol-
formation in Female Patients. K. M. Noincm, S. K. hlitra, and 1. C. Pathak. Surgery 77:697-702
(May),
1975.
This report concerns 70 female patients seen at the Nehru Hospital, Chandigarh, India, from January I, 1969 to July 31, 1973. Of these, 25 were treated by perineal-anal transplantation, following the procedure of Swenson and Donnellan. Immediate complications included anastomotic dehiscence, retraction, recurrent fistula, and stenosis. These complications were severe in 4 of the 7 cases where they occurred. Late results were assessed with regard to functional ability and the site of the anus in relation to the vagina. The site of the anus was considered good in 11 patients, fair in 6, and poor in 2, with 3 failures. Sixteen of the 22 patients were assessed for functional results of the transplants. Five of those not assessed were under 3 yr of age and the sixth had a colostomy awaiting revision. Of the 16 assessed, three had undergone a second major revision for transplant failure. The functional results in these 16 patients were good in I3 and fair in 3. Of the 8 patients who had the procedure done early in childhood, the functional result was good in 5 and fair in 3. The remaining 8 who underwent
the procedure after they were 5 yr of age all had good functional results. The authors conclude that the best results were obtained when the transplant in female patients was performed after the age of 5 yr, and that immediate postoperative complications were lessened by preliminary or concurrent transverse colostomy.-~William K. Sieber Validity of Simple Radiogmphic Techniques in Misdiagnosed Anorectal Malformations. E. Balzclr and G. Weissenbocher. Poediatr
54 (January),
Paedol l&40-
1975.
The anterior perineal anus is frequently overlooked in the neonatal period. With a change of diet this malformation leads to chronic constipation. On fluoroscopy a horizontal caudal limitation of the rectum, a dorsal pouch, a beak-shaped fistula, and an elevation of the anorectal transitional area are diagnostic. Out of a series of 50 anorectal malformations, I2 were diagnosed months and years after birth. Early surgery is recommended since functionally good results are to be expected in these cases. In normal defecation the anorectal angle is stretched. This stretching is impossible in ventral fistulas with rigid walls, thus most of the defecation forces are absorbed and the rectal ampulla is dilated. This leads to further impairment of the neuromuscular reflex mechanisms. -G. Brandesky
ABDOMEN Pediatric Abdominal Injuries. Michael C. Sinclair, Thomas C. Moore, and Morris 1. Asch. Am Surg 41: 342-346 (June), 1975.
Of 107 children and adolescents undergoing laparotomies for penetrating abdominal injuries, 64 suffered stab wounds and 43 suffered gunshot wounds. Eight percent of the patients were under I2 yr of age. There were three deaths. Most of the injuries were related to crimes of violence or were self-inflicted.--Edward J. Berman Selective ligation
of the Hepatic Artery for
Trauma of the liver. S. Aaron,
R. F&on,
and E.
Moyr. Surg Gynecol Obrtet 141:187 (August), 1975.
The authors report their experiences with 60 patients with severe liver wounds who had various hepatic arteries ligated. The youngest was 3 yr of age and the eldest 71 yr old. In 55 patients the artery was ligated on the day of the injury at the time of the initial laparotomy.
ABSTRACTS
medical contraindication. Colostomy is used only for supralevator anomalies and where long delay in referral and complicated medical and surgical problems exist. The authors emphasize the importance of safe, skillfully administered anesthesia, pre- and postoperative nursing care, and precise surgical technique. With this approach, 7-10 days of hospitalization followed by several months of dilatations of the new anus have produced excellent results. Editorial comment: This commentary will stimulate much comment. Many feel that should a fistula be present, dilatation until 3 mo of age and a subsequent definitive procedure allows a more precise definitive operation. Others be!ieve that transplantation procedures in infralevator anomalies are valueless since the patients are continent and the only surgical treatment should be directed toward providing an adequate orifice. It is unfortunate that this paper is not supported by statistical information and facts. The postoperative care of these infants is not referred to in this article. In our experience it is essential that the rectum remain empty by irrigations until the healing has been completed; this is a controversial and very important subject.WiNiam K. Sieber Perineal
Anal
Tmnrplant
in Anorectol
Mol-
formation in Female Patients. K. M. Noincm, S. K. hlitra, and 1. C. Pathak. Surgery 77:697-702
(May),
1975.
This report concerns 70 female patients seen at the Nehru Hospital, Chandigarh, India, from January I, 1969 to July 31, 1973. Of these, 25 were treated by perineal-anal transplantation, following the procedure of Swenson and Donnellan. Immediate complications included anastomotic dehiscence, retraction, recurrent fistula, and stenosis. These complications were severe in 4 of the 7 cases where they occurred. Late results were assessed with regard to functional ability and the site of the anus in relation to the vagina. The site of the anus was considered good in 11 patients, fair in 6, and poor in 2, with 3 failures. Sixteen of the 22 patients were assessed for functional results of the transplants. Five of those not assessed were under 3 yr of age and the sixth had a colostomy awaiting revision. Of the 16 assessed, three had undergone a second major revision for transplant failure. The functional results in these 16 patients were good in I3 and fair in 3. Of the 8 patients who had the procedure done early in childhood, the functional result was good in 5 and fair in 3. The remaining 8 who underwent
the procedure after they were 5 yr of age all had good functional results. The authors conclude that the best results were obtained when the transplant in female patients was performed after the age of 5 yr, and that immediate postoperative complications were lessened by preliminary or concurrent transverse colostomy.-~William K. Sieber Validity of Simple Radiogmphic Techniques in Misdiagnosed Anorectal Malformations. E. Balzclr and G. Weissenbocher. Poediatr
54 (January),
Paedol l&40-
1975.
The anterior perineal anus is frequently overlooked in the neonatal period. With a change of diet this malformation leads to chronic constipation. On fluoroscopy a horizontal caudal limitation of the rectum, a dorsal pouch, a beak-shaped fistula, and an elevation of the anorectal transitional area are diagnostic. Out of a series of 50 anorectal malformations, I2 were diagnosed months and years after birth. Early surgery is recommended since functionally good results are to be expected in these cases. In normal defecation the anorectal angle is stretched. This stretching is impossible in ventral fistulas with rigid walls, thus most of the defecation forces are absorbed and the rectal ampulla is dilated. This leads to further impairment of the neuromuscular reflex mechanisms. -G. Brandesky
ABDOMEN Pediatric Abdominal Injuries. Michael C. Sinclair, Thomas C. Moore, and Morris 1. Asch. Am Surg 41: 342-346 (June), 1975.
Of 107 children and adolescents undergoing laparotomies for penetrating abdominal injuries, 64 suffered stab wounds and 43 suffered gunshot wounds. Eight percent of the patients were under I2 yr of age. There were three deaths. Most of the injuries were related to crimes of violence or were self-inflicted.--Edward J. Berman Selective ligation
of the Hepatic Artery for
Trauma of the liver. S. Aaron,
R. F&on,
and E.
Moyr. Surg Gynecol Obrtet 141:187 (August), 1975.
The authors report their experiences with 60 patients with severe liver wounds who had various hepatic arteries ligated. The youngest was 3 yr of age and the eldest 71 yr old. In 55 patients the artery was ligated on the day of the injury at the time of the initial laparotomy.