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Perforated choledochal cyst in children
ABSTRACTS
48 had incisional hernia at 3 yr follow-up. Their results compare favorably with those of other reported series in adults.-- Dushyant Mohla Fetus In Fetu. M. Yamamoto, 1t. Kondo, 1). Fukuda, et al. J
Jpn Soc Pediatr Surg 14:433-441 (April), 1978 A fetus in fetu, appearing as a retroperitoneal mass in a 3-me-old boy, was surgically removed. The authors collected 12 cases of fetus in fetu from the Japanese literature. Ten were found in males and two in females. Eleven of 12 cases originated in the retroperitoneal cavity, but one was found in the scrotum.--H. Suzuki Incarcerated Inguinal Hernia in Children. B. V. Palmer. Ann R
Cull Surg 60:121-124 (March), 1978 Over a period of 3.5 yr 110 children under the age of 4 yr were admitted with inguinal hernia, of whom 61 presented as emergencies with incarcerated hernia and were treated conservatively at first. Fourteen were reduced with taxis, 23 with Gallow's traction. The remaining 20 required emergency operation. None of the operated patients required resection of the bowel. In 2 patients ischemic testes were found at operation. Postoperative assessment of the patients showed that if the testicle had been mobilized during the operation there was a tendency for it to become fixed high in the scrotum.--Dushyant Mohla
771
T. TodanL g. Tabuchi, Y. Watanabe, A. Nabeyama, T. Emote, and Y. Munetomo. Z Kinderchir 23:280-286 (March), 1978 Perforated Choledochal Cyst in Children.
Twenty-five children were treated for choledochal cyst; all patients were under the age of 19 yr. Two children presented with perforation of cyst and biliary peritonitis. Including these 2 patients, 17 patients with perforated choledochal cyst have been reported in the literature. In the majority of these patients rupture develops spontaneously. This may occur due to regurgitation of pancreatic juice into the cyst, with resultant erosion of the wall, or it may be due to previous trauma, Two types of clinical course occur: the acute form, with vomiting, abdominal pain, and abdominal distension; the chronic form, with additional jaundice and acholic stools. Only 2 patients of all those with perforated cysts can be classified as type IV according to Longmire. The site of the perforation varied in each patient. External drainage through the site of perforation is recommended. A few months later conversion to internal drainage or preferably excision of the cyst should be performed, preventing ascending cholangitis or carcinoma. Accurate diagnosis of perforated choledochal cyst is usually made only intraoperatively or on the postoperative cholangiogram using a T-tube drain. Diagnosis seems to be difficult, even at the first operation, when the cyst is collapsed after perforation.--Karl-Ludwig Waag Averted
Management of Inferior Vena Caval Injury In Liver Trauma. P.
McMaster. Ann R Coil Surg 59:502-506 (November), 1977
Sudden
Neonatal
Death
Due t o
Pancreatic
A. Aynsley-Green, J. M. Polak, J. Keeling, M. H. Gough, and J. D. Baum. Lancet 1:550-551 (March), 1978
Nesidloblastoais.
A male infant (weight 3.7 kg) born without complication after a normal pregnancy was found 6 hr after birth to be apneic and cyanotic, with peripheral circulatory failure. Prompt resuscitation was successful. Investigation revealed a blood glucose of 0.5 mmoles/liter, and plasma insulin was inappropriately high (greater than 15 pU/ml for a blood glucose of less than 1.0 mmole/liter). He required dextrose infusion greater than 20 mg/kg/min to maintain blood glucose above 1.5 mmoles/liter. He remained hypoglycemic despite the use of hydrocortisone and diazoxide. At 11 days of age an 80% pancreatectomy was performed, but despite this he remained hypoglycemic, and at 18 days of age he underwent total pancreatectomy. Immunoeytochemical and aldehyde-fuchsin preparations of the pancreas revealed an a p p e a r a n c e c o n s i s t e n t with p a n c r e a t i c beta-cell nesidioblastosis. The authors conclude that this infant had hyperinsulinism due to a structural endocrine abnormality on the pancreas. Cholelithlasls and Wilson's Disease. N. Rosenfield, R. J. He was severely hypoglycemic when found collapsed on his Grand, J. B. Watkins, T. V. Ballentine, and R. H. Levey. J cot, and without prompt resuscitation he would have died. Pediatr 92:210-213 (February), 1978 The authors also cite 2 other cases of nesidioblastosis and Three children with Wilson's disease developed symptoms have found a total of 3 cases among 9300 births over 26 me; suggestive of cholecystitis. Each was found to have they suggest that nesidioblastosis is not an uncommon cause of hypoglycemia and may also be a n o t uncommon cause of cholelithiasis proven at the time of laparotomy. These stones proved to have a higher content of cholesterol than gallstones unexpected early neonatal death. They suggest that from children of similar ages with hemolytic disease. insulin-specific staining methods should be used to examine Cholelithiasis should be considered in the differential the pancreas in all cases of sudden unexpected infant death, diagnosis Of young children with Wilson's disease who.......... particularly those- in the early neonatal period.--J. G. develop abdominal pain.--George Holcomb Harvey Damage to the inferior vena cava in the region of the hepatic vein associated with major blunt hepatic injuries is more common than had previously been reported. A new technique of vascular isolation of the liver is described that avoids the use of internal vena caval shunts to permit repair of damaged inferior vena cava. The preoperative resuscitation, operative management, and vascular isolation of the liver are described. Over a period of 5 yr, 22 patients had sustained major blunt hepatic injuries in traffic accidents; 6: of these patients had associated damage to t h e inferior vena cava. Repair of the inferior vena eava was attempted in all 6, but 2 died during operation as a result of uncontrollable hemorrhage while attempts were being made to isolate the liver. Four patients had successful repair of the vena tara; however, 2 died from their other extensive injuries.--Dushyant Mohla
48 had incisional hernia at 3 yr follow-up. Their results compare favorably with those of other reported series in adults.-- Dushyant Mohla Fetus In Fetu. M. Yamamoto, 1t. Kondo, 1). Fukuda, et al. J
Jpn Soc Pediatr Surg 14:433-441 (April), 1978 A fetus in fetu, appearing as a retroperitoneal mass in a 3-me-old boy, was surgically removed. The authors collected 12 cases of fetus in fetu from the Japanese literature. Ten were found in males and two in females. Eleven of 12 cases originated in the retroperitoneal cavity, but one was found in the scrotum.--H. Suzuki Incarcerated Inguinal Hernia in Children. B. V. Palmer. Ann R
Cull Surg 60:121-124 (March), 1978 Over a period of 3.5 yr 110 children under the age of 4 yr were admitted with inguinal hernia, of whom 61 presented as emergencies with incarcerated hernia and were treated conservatively at first. Fourteen were reduced with taxis, 23 with Gallow's traction. The remaining 20 required emergency operation. None of the operated patients required resection of the bowel. In 2 patients ischemic testes were found at operation. Postoperative assessment of the patients showed that if the testicle had been mobilized during the operation there was a tendency for it to become fixed high in the scrotum.--Dushyant Mohla
771
T. TodanL g. Tabuchi, Y. Watanabe, A. Nabeyama, T. Emote, and Y. Munetomo. Z Kinderchir 23:280-286 (March), 1978 Perforated Choledochal Cyst in Children.
Twenty-five children were treated for choledochal cyst; all patients were under the age of 19 yr. Two children presented with perforation of cyst and biliary peritonitis. Including these 2 patients, 17 patients with perforated choledochal cyst have been reported in the literature. In the majority of these patients rupture develops spontaneously. This may occur due to regurgitation of pancreatic juice into the cyst, with resultant erosion of the wall, or it may be due to previous trauma, Two types of clinical course occur: the acute form, with vomiting, abdominal pain, and abdominal distension; the chronic form, with additional jaundice and acholic stools. Only 2 patients of all those with perforated cysts can be classified as type IV according to Longmire. The site of the perforation varied in each patient. External drainage through the site of perforation is recommended. A few months later conversion to internal drainage or preferably excision of the cyst should be performed, preventing ascending cholangitis or carcinoma. Accurate diagnosis of perforated choledochal cyst is usually made only intraoperatively or on the postoperative cholangiogram using a T-tube drain. Diagnosis seems to be difficult, even at the first operation, when the cyst is collapsed after perforation.--Karl-Ludwig Waag Averted
Management of Inferior Vena Caval Injury In Liver Trauma. P.
McMaster. Ann R Coil Surg 59:502-506 (November), 1977
Sudden
Neonatal
Death
Due t o
Pancreatic
A. Aynsley-Green, J. M. Polak, J. Keeling, M. H. Gough, and J. D. Baum. Lancet 1:550-551 (March), 1978
Nesidloblastoais.
A male infant (weight 3.7 kg) born without complication after a normal pregnancy was found 6 hr after birth to be apneic and cyanotic, with peripheral circulatory failure. Prompt resuscitation was successful. Investigation revealed a blood glucose of 0.5 mmoles/liter, and plasma insulin was inappropriately high (greater than 15 pU/ml for a blood glucose of less than 1.0 mmole/liter). He required dextrose infusion greater than 20 mg/kg/min to maintain blood glucose above 1.5 mmoles/liter. He remained hypoglycemic despite the use of hydrocortisone and diazoxide. At 11 days of age an 80% pancreatectomy was performed, but despite this he remained hypoglycemic, and at 18 days of age he underwent total pancreatectomy. Immunoeytochemical and aldehyde-fuchsin preparations of the pancreas revealed an a p p e a r a n c e c o n s i s t e n t with p a n c r e a t i c beta-cell nesidioblastosis. The authors conclude that this infant had hyperinsulinism due to a structural endocrine abnormality on the pancreas. Cholelithlasls and Wilson's Disease. N. Rosenfield, R. J. He was severely hypoglycemic when found collapsed on his Grand, J. B. Watkins, T. V. Ballentine, and R. H. Levey. J cot, and without prompt resuscitation he would have died. Pediatr 92:210-213 (February), 1978 The authors also cite 2 other cases of nesidioblastosis and Three children with Wilson's disease developed symptoms have found a total of 3 cases among 9300 births over 26 me; suggestive of cholecystitis. Each was found to have they suggest that nesidioblastosis is not an uncommon cause of hypoglycemia and may also be a n o t uncommon cause of cholelithiasis proven at the time of laparotomy. These stones proved to have a higher content of cholesterol than gallstones unexpected early neonatal death. They suggest that from children of similar ages with hemolytic disease. insulin-specific staining methods should be used to examine Cholelithiasis should be considered in the differential the pancreas in all cases of sudden unexpected infant death, diagnosis Of young children with Wilson's disease who.......... particularly those- in the early neonatal period.--J. G. develop abdominal pain.--George Holcomb Harvey Damage to the inferior vena cava in the region of the hepatic vein associated with major blunt hepatic injuries is more common than had previously been reported. A new technique of vascular isolation of the liver is described that avoids the use of internal vena caval shunts to permit repair of damaged inferior vena cava. The preoperative resuscitation, operative management, and vascular isolation of the liver are described. Over a period of 5 yr, 22 patients had sustained major blunt hepatic injuries in traffic accidents; 6: of these patients had associated damage to t h e inferior vena cava. Repair of the inferior vena eava was attempted in all 6, but 2 died during operation as a result of uncontrollable hemorrhage while attempts were being made to isolate the liver. Four patients had successful repair of the vena tara; however, 2 died from their other extensive injuries.--Dushyant Mohla