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Perforation of normal colon by barium enema in an infant with gangrenous ileocolonic intussusception
ISTEHN:~TIOSAL
Symptoms
:GEGTRACTS
started
on
the
OF
PEDIATRIC
seventh
day
SUR(:EHY
after
birth \vith abdominal distention and loss of \\,eight. Radiological examination showed calcification iu the umbilical region, vvhich at operation \\.a\ sho\vn to correspond to the base of a hleckel’s tlivcrticulum. The intestine was sutured. There UYI\ an abscess in the left upper quadrant of the abdomen which MYIS aspirated but not drained. l’ostopc,r;lti\-elm. ;I fccnl fistula formed which finally c1o\e,1. ‘Then, i\ a re\ie\\r of the etiology, pathology aucl treatment of neonatal peritonitis.-./. R. de Oli!~cir,i.
In ;I rcvic,\v of I23 patients treated at the lIemy Ford Hospital during the periocl 1928 to 1964 1, ith the diagnosis of intussusception. 79 patient,\ were found to be nndcr 4 years of age, arid 44 patients were older children and adults. The, grcsatrst number of intussusccptions OCt,iirrc(l in patients under the age of 2 years: the uext peak incidence occurred during the fourth and fifth drcatles. In rcvicwing symptomatology, findings of physic:~l rsamination, roentgenographic findings. types of intiissusception and etiology of intussusception tlltz g!rc;itc-st differences between the younger and tlrt, oltkr group was that of chronicity of aymptams and the presence of a rcscctable lt+ion found iii the older group. ‘l’ht, author feels there is definite merit in atttmptiug reduction by barium errcma ill infant> a\ 16 of 79 infants so treated vverc successfully re~luced. Iu IO additional infants, partial rrcluction u a\ accomplished, with reduction being compl(tcd at surgery. The treatment of intussusccptlc,n irl 41 of 44 older children and adults was \Irrgic:tl. Surgical resection of the in\-olv~ed intc,\tinc, 11as indicated in 32 of 44 older patients. pi\- deaths occurred prior to 1945; sirIce 1945, 2. _ infants (lied of intussusception and its stquelae, .~rltl IIO immediate postoperative deaths in adults 11cn ~~llconntered.-F. J. Ha&erg.
-7;9
gaseous distention with multiple air fluid let-ei>. The next day a barium enema was administr~rr.d. which showed a markedly distended barium-filll 11 descending colon, ileocrcnl int~issusccptior~ $1itfi obstruction at the midportion of the trans\.t,rr+ colon and free harium in the peritoneal (‘:I\ it\. The patient vvtnt into shock and v\as taker1 to the operating room and esplorcd. After wasllin: the barium out and administering Solu-cortct tl 1 improv-e the general condition of the infant. t’\ploration revealed ii gangrenous intussuscc,ptir)ll. The point of interest in this case is that the barium was lcaking from it perforation in the dcscei~ing colon where according to the operator t1lc. colonic wall was otherwise normal. A resectlorr of the intussusception was performed and long-standing obstruction and perhaps mom importantly suqgests th:rt the site of perf~m~tic2i~ must be looked fur with great cart‘, ‘ts it ma! not he at thca point ot intussusception or apparcr It gangrcnc.---S. K. Connolly.
Sisty-one adolescents ( agrs 10-19) vr.ith rcgimr;rl cntrritis \~erc sccu ;rt the Clrvelaud Clinic 19.56 1966. In 42 cast’\ the diagnosis \vas coufirm(,d with \urgcry. Ordinarily~ pain and diarrhe;r an the prescntirig complaints, the pnirl bciug iutcrmittriit and colicky in uaturc. The course of th,x tliseaac i\ v2riabltt and nnpredict;ll,l~,. ,\Icdical treatment requires adequate rest and strenuoiis activity is forhidtleu. Dietary management ,‘\iclndes foods which a given patient seems ilot t ) tolerate. If obstructive symptoms arc promiir~~iit then ravv fruits autl \.egctables. nuts ant1 l)r,11r ~lioultl be a\,oidctl. Supplemental fcetling SINIIII~.I be offered using milkshakes, eggnogs, protc,itr supplements and hard candy. Large (loams clt vitamins are given. Inasmuch as the ahsorptioil of H,, may he inter-ferret1 with as this v.itamill :I, absurbctl from the terminal ileum. B, L’ iuj(,,~ti~~Il\ arc giv-cn montlrl! S;llic~lazosulfap~ritli~~c~ cAzrllfidinc j is given iu the dose of 1 gram ct.i.tl. ;triti prngrc+ses to 2 :gr,uns q.i.tl. The ohjcct is to (I\,( the largest dose toleratrd. The use of stcroitl\ i. of lrrrcertain value and ia restricted to toxic, ,lll~l unrc~sponsive cases. In addition to stcrr)itls Iiitro~t.l, niu\tartl 11~ beclr irsctl. Of 1:3 p:ctic7rts trc,.ltt,f! with this agent 9 1, trc tllouSht to h:i\.c, lK1<1 ,’ rrq>c”l\c’. Tlrc majorit). IIt t’.lticllt* batist:lctcq.
Symptoms
:GEGTRACTS
started
on
the
OF
PEDIATRIC
seventh
day
SUR(:EHY
after
birth \vith abdominal distention and loss of \\,eight. Radiological examination showed calcification iu the umbilical region, vvhich at operation \\.a\ sho\vn to correspond to the base of a hleckel’s tlivcrticulum. The intestine was sutured. There UYI\ an abscess in the left upper quadrant of the abdomen which MYIS aspirated but not drained. l’ostopc,r;lti\-elm. ;I fccnl fistula formed which finally c1o\e,1. ‘Then, i\ a re\ie\\r of the etiology, pathology aucl treatment of neonatal peritonitis.-./. R. de Oli!~cir,i.
In ;I rcvic,\v of I23 patients treated at the lIemy Ford Hospital during the periocl 1928 to 1964 1, ith the diagnosis of intussusception. 79 patient,\ were found to be nndcr 4 years of age, arid 44 patients were older children and adults. The, grcsatrst number of intussusccptions OCt,iirrc(l in patients under the age of 2 years: the uext peak incidence occurred during the fourth and fifth drcatles. In rcvicwing symptomatology, findings of physic:~l rsamination, roentgenographic findings. types of intiissusception and etiology of intussusception tlltz g!rc;itc-st differences between the younger and tlrt, oltkr group was that of chronicity of aymptams and the presence of a rcscctable lt+ion found iii the older group. ‘l’ht, author feels there is definite merit in atttmptiug reduction by barium errcma ill infant> a\ 16 of 79 infants so treated vverc successfully re~luced. Iu IO additional infants, partial rrcluction u a\ accomplished, with reduction being compl(tcd at surgery. The treatment of intussusccptlc,n irl 41 of 44 older children and adults was \Irrgic:tl. Surgical resection of the in\-olv~ed intc,\tinc, 11as indicated in 32 of 44 older patients. pi\- deaths occurred prior to 1945; sirIce 1945, 2. _ infants (lied of intussusception and its stquelae, .~rltl IIO immediate postoperative deaths in adults 11cn ~~llconntered.-F. J. Ha&erg.
-7;9
gaseous distention with multiple air fluid let-ei>. The next day a barium enema was administr~rr.d. which showed a markedly distended barium-filll 11 descending colon, ileocrcnl int~issusccptior~ $1itfi obstruction at the midportion of the trans\.t,rr+ colon and free harium in the peritoneal (‘:I\ it\. The patient vvtnt into shock and v\as taker1 to the operating room and esplorcd. After wasllin: the barium out and administering Solu-cortct tl 1 improv-e the general condition of the infant. t’\ploration revealed ii gangrenous intussuscc,ptir)ll. The point of interest in this case is that the barium was lcaking from it perforation in the dcscei~ing colon where according to the operator t1lc. colonic wall was otherwise normal. A resectlorr of the intussusception was performed and long-standing obstruction and perhaps mom importantly suqgests th:rt the site of perf~m~tic2i~ must be looked fur with great cart‘, ‘ts it ma! not he at thca point ot intussusception or apparcr It gangrcnc.---S. K. Connolly.
Sisty-one adolescents ( agrs 10-19) vr.ith rcgimr;rl cntrritis \~erc sccu ;rt the Clrvelaud Clinic 19.56 1966. In 42 cast’\ the diagnosis \vas coufirm(,d with \urgcry. Ordinarily~ pain and diarrhe;r an the prescntirig complaints, the pnirl bciug iutcrmittriit and colicky in uaturc. The course of th,x tliseaac i\ v2riabltt and nnpredict;ll,l~,. ,\Icdical treatment requires adequate rest and strenuoiis activity is forhidtleu. Dietary management ,‘\iclndes foods which a given patient seems ilot t ) tolerate. If obstructive symptoms arc promiir~~iit then ravv fruits autl \.egctables. nuts ant1 l)r,11r ~lioultl be a\,oidctl. Supplemental fcetling SINIIII~.I be offered using milkshakes, eggnogs, protc,itr supplements and hard candy. Large (loams clt vitamins are given. Inasmuch as the ahsorptioil of H,, may he inter-ferret1 with as this v.itamill :I, absurbctl from the terminal ileum. B, L’ iuj(,,~ti~~Il\ arc giv-cn montlrl! S;llic~lazosulfap~ritli~~c~ cAzrllfidinc j is given iu the dose of 1 gram ct.i.tl. ;triti prngrc+ses to 2 :gr,uns q.i.tl. The ohjcct is to (I\,( the largest dose toleratrd. The use of stcroitl\ i. of lrrrcertain value and ia restricted to toxic, ,lll~l unrc~sponsive cases. In addition to stcrr)itls Iiitro~t.l, niu\tartl 11~ beclr irsctl. Of 1:3 p:ctic7rts trc,.ltt,f! with this agent 9 1, trc tllouSht to h:i\.c, lK1<1 ,’ rrq>c”l\c’. Tlrc majorit). IIt t’.lticllt* batist:lctcq.