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Peritoneal lavage in children and adolescents with blunt abdominal trauma
INTERNATIONAL ABSTRACTS
in these 10 children. Each of the patients had essentially no output before curettage. Seven of them are now long-term jaundice-free survivors; two did not respond to curettage and died. One responded initially, but subsequently output ceased and he also died.--George Hotcornb, Jr. Hemobilia Due to Ruptured Intrahepatic Aneurysm in a Child. G. H. Welch, W. Cochran, A. A. Azmy, et al. Z
209
easily reduced and the congenital defect closed. The postoperative course was uneventful. The patient also had a congenital hip dislocation on the same side. Whereas intestinal hernias due to developmental and rotational anomalies are not uncommon, herniation due to a congenital defect of the peritoneum is extremely rare. The authors could find only one case in the literature described by Parson in 1899.--Thomas A. Angerpointner
Kinderchir 36:66-68, 1982. Massive hemobilia with life-threatening hemorrhage in a 10-yr-old girl is described. This was due to rupture of an intrahepatic aneurysm of the right hepatic artery secondary to a road traffic accident. The girt was cured by ligation of the right hepatic artery. Increased serum bilirubin levels returned to normal and there was no deterioration of liver function. Hemobilia causes a classic triad of symptoms consisting of gastrointestinal bleeding, jaundice, and biliary colic. The diagnostic procedure of choice is selective angiography. Hemobilia is a rare clinical entity. Reviewing the literature the authors found that trauma was the causative factor in the majority of the cases. In the case presented, however, the accident m a y have been responsible for causing rupture of a preexisting aneurysm rather than for its formation.-- Thomas A. Angerpointner Role of Unusually Long Common Pancreatico-Biliary Channel as a Cause of Relapsing Pancreatitis in Children. S.
Matsusue, S. Kashihara, Y. Nakamura, et al. Z Kinderchir 36:69-72, 1982. The authors report on two children who had recurrent episodes of abdominal pain and vomiting accompanied by hyperamylasemia. In both cases operative cholangiograms revealed unusually long common pancreatico-biliary channels without signs of cystic dilatation of the common bile duct. Surgical procedures consisted of dissection of the common bile duct, cholecystectomy and hepatico-enterostomy with the Roux-en-Y-technique. Both children recovered from surgery uneventfully with return of serum amylase levels and liver functions to normal. The authors assume that a high intraductal pressure in the common bile duct due to an unusually long pancreatico-biliary channel may cause reflux of activated bile and pancreatic enzymes into the pancreatic duct leading to recurrent episodes of acute pancreatitis. Therefore, surgical separation of the biliary system from the pancreatic duct in the way described above is the treatment of choice. Exploratory laparotomy should be considered for children having recurrent abdominal pain with hyperamylasemia.--Thomas A. Angerpointner
Peritoneal Lavage in Children and Adolescents with Blunt Abdominal Trauma. R. IV. DuPriest, A. Rodriguez, and
C. H. Shatney. A m Surg 48:460-462, 1982. During a 3-yr-period 135 blunt trauma victims under 16 yr of age underwent open diagnostic peritoneal lavage. The overall accuracy of this method in the detection of intraabdominal injury was 95.5%. The absence of intraabdominal injury was correctly determined in 89 patients. Of 40 patients with intraabdominal injuries, five did not require surgical correction. For detection of serious intraabdominal injury following blunt trauma this diagnostic method is advocated as the single best test.--George A. Rowe GENITOURINARY TRACT Reflux Nephropathy: A Personal Historical Review. C. J.
Hodson. 1981.
A m J Roentgenol
137:451-462, (September),
The author chronicles the clinical and experimental work documenting the effect of reflux, both sterile and infected, on the kidney. Utilizing the pig model, direct evidence for renal scarring secondary to reflux was established in 1968. The scarring resulting from reflux of infected urine is more extensive than sterile reflux, but scarring does occur with the latter. In 1974 a rise of anti-Tamm-Horsfall protein antibody in the serum of pigs following unilateral ureteral obstruction associated with deposits of the protein in the renal interstitium led the author to postulate an autoimmune reaction that leads to scarring when the urine is sterile. The author's present hypotheses include high pressure pyelotubular reflux causing a pressure cone within the kidney that allows urine to leak into the renal interstitium. This gives rise to fibrosis, which is more intense when the urine is infected. Other factors contribute to damage in this pressure cone. Further knowledge will require evaluation of younger patients and animal models in order to study the effects of reflux on the growing kidney.--Randall W. Powell The Management of Vesicoureteral Reflux in Children with Myelodysplasia. S. B. Bauer, A. H. Colodny, and A. B.
Retik. J U r o | 128:102-105, (July), 1982. Intraabdominal Incarceration Through the W i n d o w of the Dorsal P e r i t o n e u m . S. Popovic, S. M. Zivcovic, and M.
Stefoski et al. Z Kinderchir 36:110-111, 1982. A l~/2-yr-old boy is described who had a 3 day history of nausea, bilious vomiting, copremesis, abdominal distention, and constipation. Plain abdominal x-ray showed signs of intestinal obstruction. On laparotomy an ileal segment was found to be herniated through a defect in the dorsal peritoneum on the left side of the mesosigmo]d. The ileal loop was
Thirty-six children with myelodysplasia and vesicoureteral reflux were treated systematically in an attempt to control infection, eliminate reflux, and preserve renal function without diversion. The reflux resolved in nine of 21 children on intermittent catheterization and remained stable without recurrent infection in an additional seven. Cutaneous vesicotomy in six infants temporarily eliminated reflux in three. Ureteral reimplantation was performed in 11 children (17 ureters) and was successful in all. Transureteroureterostomy
in these 10 children. Each of the patients had essentially no output before curettage. Seven of them are now long-term jaundice-free survivors; two did not respond to curettage and died. One responded initially, but subsequently output ceased and he also died.--George Hotcornb, Jr. Hemobilia Due to Ruptured Intrahepatic Aneurysm in a Child. G. H. Welch, W. Cochran, A. A. Azmy, et al. Z
209
easily reduced and the congenital defect closed. The postoperative course was uneventful. The patient also had a congenital hip dislocation on the same side. Whereas intestinal hernias due to developmental and rotational anomalies are not uncommon, herniation due to a congenital defect of the peritoneum is extremely rare. The authors could find only one case in the literature described by Parson in 1899.--Thomas A. Angerpointner
Kinderchir 36:66-68, 1982. Massive hemobilia with life-threatening hemorrhage in a 10-yr-old girl is described. This was due to rupture of an intrahepatic aneurysm of the right hepatic artery secondary to a road traffic accident. The girt was cured by ligation of the right hepatic artery. Increased serum bilirubin levels returned to normal and there was no deterioration of liver function. Hemobilia causes a classic triad of symptoms consisting of gastrointestinal bleeding, jaundice, and biliary colic. The diagnostic procedure of choice is selective angiography. Hemobilia is a rare clinical entity. Reviewing the literature the authors found that trauma was the causative factor in the majority of the cases. In the case presented, however, the accident m a y have been responsible for causing rupture of a preexisting aneurysm rather than for its formation.-- Thomas A. Angerpointner Role of Unusually Long Common Pancreatico-Biliary Channel as a Cause of Relapsing Pancreatitis in Children. S.
Matsusue, S. Kashihara, Y. Nakamura, et al. Z Kinderchir 36:69-72, 1982. The authors report on two children who had recurrent episodes of abdominal pain and vomiting accompanied by hyperamylasemia. In both cases operative cholangiograms revealed unusually long common pancreatico-biliary channels without signs of cystic dilatation of the common bile duct. Surgical procedures consisted of dissection of the common bile duct, cholecystectomy and hepatico-enterostomy with the Roux-en-Y-technique. Both children recovered from surgery uneventfully with return of serum amylase levels and liver functions to normal. The authors assume that a high intraductal pressure in the common bile duct due to an unusually long pancreatico-biliary channel may cause reflux of activated bile and pancreatic enzymes into the pancreatic duct leading to recurrent episodes of acute pancreatitis. Therefore, surgical separation of the biliary system from the pancreatic duct in the way described above is the treatment of choice. Exploratory laparotomy should be considered for children having recurrent abdominal pain with hyperamylasemia.--Thomas A. Angerpointner
Peritoneal Lavage in Children and Adolescents with Blunt Abdominal Trauma. R. IV. DuPriest, A. Rodriguez, and
C. H. Shatney. A m Surg 48:460-462, 1982. During a 3-yr-period 135 blunt trauma victims under 16 yr of age underwent open diagnostic peritoneal lavage. The overall accuracy of this method in the detection of intraabdominal injury was 95.5%. The absence of intraabdominal injury was correctly determined in 89 patients. Of 40 patients with intraabdominal injuries, five did not require surgical correction. For detection of serious intraabdominal injury following blunt trauma this diagnostic method is advocated as the single best test.--George A. Rowe GENITOURINARY TRACT Reflux Nephropathy: A Personal Historical Review. C. J.
Hodson. 1981.
A m J Roentgenol
137:451-462, (September),
The author chronicles the clinical and experimental work documenting the effect of reflux, both sterile and infected, on the kidney. Utilizing the pig model, direct evidence for renal scarring secondary to reflux was established in 1968. The scarring resulting from reflux of infected urine is more extensive than sterile reflux, but scarring does occur with the latter. In 1974 a rise of anti-Tamm-Horsfall protein antibody in the serum of pigs following unilateral ureteral obstruction associated with deposits of the protein in the renal interstitium led the author to postulate an autoimmune reaction that leads to scarring when the urine is sterile. The author's present hypotheses include high pressure pyelotubular reflux causing a pressure cone within the kidney that allows urine to leak into the renal interstitium. This gives rise to fibrosis, which is more intense when the urine is infected. Other factors contribute to damage in this pressure cone. Further knowledge will require evaluation of younger patients and animal models in order to study the effects of reflux on the growing kidney.--Randall W. Powell The Management of Vesicoureteral Reflux in Children with Myelodysplasia. S. B. Bauer, A. H. Colodny, and A. B.
Retik. J U r o | 128:102-105, (July), 1982. Intraabdominal Incarceration Through the W i n d o w of the Dorsal P e r i t o n e u m . S. Popovic, S. M. Zivcovic, and M.
Stefoski et al. Z Kinderchir 36:110-111, 1982. A l~/2-yr-old boy is described who had a 3 day history of nausea, bilious vomiting, copremesis, abdominal distention, and constipation. Plain abdominal x-ray showed signs of intestinal obstruction. On laparotomy an ileal segment was found to be herniated through a defect in the dorsal peritoneum on the left side of the mesosigmo]d. The ileal loop was
Thirty-six children with myelodysplasia and vesicoureteral reflux were treated systematically in an attempt to control infection, eliminate reflux, and preserve renal function without diversion. The reflux resolved in nine of 21 children on intermittent catheterization and remained stable without recurrent infection in an additional seven. Cutaneous vesicotomy in six infants temporarily eliminated reflux in three. Ureteral reimplantation was performed in 11 children (17 ureters) and was successful in all. Transureteroureterostomy