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Population-based study of surgery in juvenile onset ulcerative colitis
1352
included bacterial ileocecitis, mesenteric lymphadenitis, gynecological conditions, urological conditions, cecal diverticulitis, perforated peptic ulcer, Crohn’s disease, and other miscellaneous conditions. In 139 patients in whom no definitive diagnosis was made, ultrasound showed no abnormality in 138. There were four falsepositive ultrasound diagnoses of acute appendicitis. During the last 3 years of the study the negative appendicectomy rate was 7%, and delay beyond 6 hours after admission occurred in only 2% of patients with surgically proven appendicitis. The results of ultrasound examinations are strongly operator dependant. However, when used to complement the clinical diagnosis, diagnostic accuracy and patient management are improved.-Jo/m D. Orr Population-Based Study of Surgery in Juvenile Onset Crohn’s Disease. D.M. Sedgwick, J.R. Barton, D. W. Hamer-Hodges, et al. Br
J Surg 78:171-175, (February), 1991. The authors compare the surgical progress of a cohort of 68 children with Crohn’s disease derived by sampling the Scottish Hospital In-Patient Statistics with a group of adult patients with Crohn’s disease undergoing surgery from the. Lothians Surgical Audit. Fifty-four of the 68 were treated surgically with 50% of the group having a major operation within 5 years of onset of their symptoms. Fifty-nine percent of those had a second operation within 5 years. Eighteen percent of the group have a permanent stoma. There were five deaths in the series, three of which were postoperative. The types of major operation performed in the juvenile onset group differed significantly from those recorded in adults, this being due to the higher laparotomy rate in juveniles, a larger proportion of small bowel resections in the adults, and the absence of abdominal perineal resection in the juvenile group. The study allows an accurate prognosis to be given when the patient and relatives seek information concerning prognosis, morbidity, and mortality in this age group.-John D. Orr Population-Based Study of Surgery in Juvenile Onset Ulcerative Colitis. D.M. Sedgwick, J.R. Barton, D. W. Hamer-Hodges, et al. Br J Surg 78:176-178, (February), 1991.
Thirty-seven children with ulcerative colitis had their surgical histories examined and analyzed by actuarial methods so that the major operations performed could be compared with those carried out in adults with ulcerative colitis in the Lothian Surgical Audit. Sixteen percent of those children had major surgery within 5 years of the onset of symptoms. The types of operation were similar to those recorded in the adult group, with colectomy and ileostomy predominating. The operation rate was significantly lower than that of the parallel cohort of patients with Crohn’s disease. Almost 20% of the patients had a permanent stoma with a mean follow-up of 7.4 years. One death was recorded.-John D. Orr Experience With Primary Swenson Resection and PullThrough for Neonatal Hirschsprung’s Disease. L.K.R. Shanbhope and A. Bianchi. Pediatr Surg Int 5:446-448, (November),
1990. The authors report their experience with 25 cases of Swenson’s pull-through operation performed in the newborn period. There was no mortality. Three children developed major complications. One had a wound infection with wound dehiscence, one had an ileostomy site incisional hernia, and a third child developed a rectal fistula. With improvements in neonatal anesthesia, monitoring, and surgical care together with effective antibiotics it should be ljossible to undertake early corrective surgery for Hirschsprung’s disease with low morbidity.-&em fin’
INTERNATIONAL
ABSTRACTS
Hirschsprung’s Disease Presenting as Neonatal Gastrointestinal Perforation. MD. Qringer and D.P. Drake. Br J Surg 78:188-
189, (February), 1991. The authors report three cases of Hirschsprung’s disease presenting with intestinal perforation in the neonatal age group. A review of the reports published previously and the authors’ patients allow several important conclusions to be drawn. Ninety percent of perforations occur in the proximal colon, appendix, or terminal ileum. Whereas total colonic aganglionosis represents approximately 8% of patients with Hirschsprung’s disease, it occurs in half of those presenting with neonatal intestinal perforation and almost all the cases presenting with appendiceal or ileal perforations. If Hirschsprung’s disease is not recognized as a potential cause of neonatal intestinal perforation, inappropriate surgical therapy could be the consequence. Thus, acareful search for the transition zone should be made in suspected cases, and, ideally, intraoperative frozen section examination should be available. Otherwise, the proximal stoma should be sited in dilated bowel and urgent histology obtained from the distal bowel.-John D. Orr TotalGslectomy and Massive Small Bowel Resection in Rats. S. Goto and J.L. Grosfeld. Eur J Pediatr Surg 1:24-26, (February),
1991. Ileoendorectal or jejunoendorectal pull-through following total colectomy (TC) and massive small bowel resection (SBR) were performed in the rat to investigate the natural course of the condition. Animals were assigned to five experimental groups: TC only (n = 6); TC + 25% SBR (n = 6); TC + 50% SBR (n = 6); TC + 75% SBR (n = 6); and sham operation (SH) (n = 6). Survival at 28 days was 100% in groups TC and SH, while all rats receiving both TC and massive SBR eventually died within t4 days. Their numbers of survival days were 10.5 ? 0.76 in group TC + 25% SBR, 9.5 2 0.56 in group TC + 50% SBR, and 5.8 2 0.48 in group TC + 75% SBR (P < ,001 group TC + 25% SBR v group TC + 75% SBR). Changes of percentage of initial body weight revealed that the rats who received both TC and massive SBR showed a tremendous decrease of weight in the following postoperative days, and its degree was attributable to the extent of SBR. The data support the clinical trials designed to preserve the aganglionic terminal ileum for the surgical treatment of extensive aganglionosis.-Thomas A. Angepointner Familial Juvenile Polyposis Coli with Congenital Heart Disease. P. Mehmet, N. Yilmaz, A. Baki, et al. Pediatr Surg Int
5:429-432, November 1990. The authors describe the association of familial juvenile polyposis coli with congenital heart disease in five siblings. The cardiac lesions were mitral insufficiency (l), tetralogy of Fallot (l), and pulmonary stenosis (3).-Prem Pun’ The Empty Rectum on Plain X-Ray. Does It Have a Significance in the Neonate? M.J. Bradley and D. Pilling. Clin Radio1
43:265-267, (April), 1991. This is a review of 136 neonates who had plain abdominal x-rays. Eighty-three had multiple examinations, 52 of which showed variably gas in the rectum. Fifty-seven had significant bowel distension, 42 of which had no gas in rectum. Only one of these cases had Hirschsprung’s disease. Most of the infants had generalized sepsis or necrotizing enterocolitis. The authors conclude that absence of rectal gas is a variable and non-specific sign. Further investigation for Hirschsprung’s disease is only indicated when there is associated delayed passage of meconium and no evidence of sepsis or necrotizing enterocolitis.-
Amir Azmy
included bacterial ileocecitis, mesenteric lymphadenitis, gynecological conditions, urological conditions, cecal diverticulitis, perforated peptic ulcer, Crohn’s disease, and other miscellaneous conditions. In 139 patients in whom no definitive diagnosis was made, ultrasound showed no abnormality in 138. There were four falsepositive ultrasound diagnoses of acute appendicitis. During the last 3 years of the study the negative appendicectomy rate was 7%, and delay beyond 6 hours after admission occurred in only 2% of patients with surgically proven appendicitis. The results of ultrasound examinations are strongly operator dependant. However, when used to complement the clinical diagnosis, diagnostic accuracy and patient management are improved.-Jo/m D. Orr Population-Based Study of Surgery in Juvenile Onset Crohn’s Disease. D.M. Sedgwick, J.R. Barton, D. W. Hamer-Hodges, et al. Br
J Surg 78:171-175, (February), 1991. The authors compare the surgical progress of a cohort of 68 children with Crohn’s disease derived by sampling the Scottish Hospital In-Patient Statistics with a group of adult patients with Crohn’s disease undergoing surgery from the. Lothians Surgical Audit. Fifty-four of the 68 were treated surgically with 50% of the group having a major operation within 5 years of onset of their symptoms. Fifty-nine percent of those had a second operation within 5 years. Eighteen percent of the group have a permanent stoma. There were five deaths in the series, three of which were postoperative. The types of major operation performed in the juvenile onset group differed significantly from those recorded in adults, this being due to the higher laparotomy rate in juveniles, a larger proportion of small bowel resections in the adults, and the absence of abdominal perineal resection in the juvenile group. The study allows an accurate prognosis to be given when the patient and relatives seek information concerning prognosis, morbidity, and mortality in this age group.-John D. Orr Population-Based Study of Surgery in Juvenile Onset Ulcerative Colitis. D.M. Sedgwick, J.R. Barton, D. W. Hamer-Hodges, et al. Br J Surg 78:176-178, (February), 1991.
Thirty-seven children with ulcerative colitis had their surgical histories examined and analyzed by actuarial methods so that the major operations performed could be compared with those carried out in adults with ulcerative colitis in the Lothian Surgical Audit. Sixteen percent of those children had major surgery within 5 years of the onset of symptoms. The types of operation were similar to those recorded in the adult group, with colectomy and ileostomy predominating. The operation rate was significantly lower than that of the parallel cohort of patients with Crohn’s disease. Almost 20% of the patients had a permanent stoma with a mean follow-up of 7.4 years. One death was recorded.-John D. Orr Experience With Primary Swenson Resection and PullThrough for Neonatal Hirschsprung’s Disease. L.K.R. Shanbhope and A. Bianchi. Pediatr Surg Int 5:446-448, (November),
1990. The authors report their experience with 25 cases of Swenson’s pull-through operation performed in the newborn period. There was no mortality. Three children developed major complications. One had a wound infection with wound dehiscence, one had an ileostomy site incisional hernia, and a third child developed a rectal fistula. With improvements in neonatal anesthesia, monitoring, and surgical care together with effective antibiotics it should be ljossible to undertake early corrective surgery for Hirschsprung’s disease with low morbidity.-&em fin’
INTERNATIONAL
ABSTRACTS
Hirschsprung’s Disease Presenting as Neonatal Gastrointestinal Perforation. MD. Qringer and D.P. Drake. Br J Surg 78:188-
189, (February), 1991. The authors report three cases of Hirschsprung’s disease presenting with intestinal perforation in the neonatal age group. A review of the reports published previously and the authors’ patients allow several important conclusions to be drawn. Ninety percent of perforations occur in the proximal colon, appendix, or terminal ileum. Whereas total colonic aganglionosis represents approximately 8% of patients with Hirschsprung’s disease, it occurs in half of those presenting with neonatal intestinal perforation and almost all the cases presenting with appendiceal or ileal perforations. If Hirschsprung’s disease is not recognized as a potential cause of neonatal intestinal perforation, inappropriate surgical therapy could be the consequence. Thus, acareful search for the transition zone should be made in suspected cases, and, ideally, intraoperative frozen section examination should be available. Otherwise, the proximal stoma should be sited in dilated bowel and urgent histology obtained from the distal bowel.-John D. Orr TotalGslectomy and Massive Small Bowel Resection in Rats. S. Goto and J.L. Grosfeld. Eur J Pediatr Surg 1:24-26, (February),
1991. Ileoendorectal or jejunoendorectal pull-through following total colectomy (TC) and massive small bowel resection (SBR) were performed in the rat to investigate the natural course of the condition. Animals were assigned to five experimental groups: TC only (n = 6); TC + 25% SBR (n = 6); TC + 50% SBR (n = 6); TC + 75% SBR (n = 6); and sham operation (SH) (n = 6). Survival at 28 days was 100% in groups TC and SH, while all rats receiving both TC and massive SBR eventually died within t4 days. Their numbers of survival days were 10.5 ? 0.76 in group TC + 25% SBR, 9.5 2 0.56 in group TC + 50% SBR, and 5.8 2 0.48 in group TC + 75% SBR (P < ,001 group TC + 25% SBR v group TC + 75% SBR). Changes of percentage of initial body weight revealed that the rats who received both TC and massive SBR showed a tremendous decrease of weight in the following postoperative days, and its degree was attributable to the extent of SBR. The data support the clinical trials designed to preserve the aganglionic terminal ileum for the surgical treatment of extensive aganglionosis.-Thomas A. Angepointner Familial Juvenile Polyposis Coli with Congenital Heart Disease. P. Mehmet, N. Yilmaz, A. Baki, et al. Pediatr Surg Int
5:429-432, November 1990. The authors describe the association of familial juvenile polyposis coli with congenital heart disease in five siblings. The cardiac lesions were mitral insufficiency (l), tetralogy of Fallot (l), and pulmonary stenosis (3).-Prem Pun’ The Empty Rectum on Plain X-Ray. Does It Have a Significance in the Neonate? M.J. Bradley and D. Pilling. Clin Radio1
43:265-267, (April), 1991. This is a review of 136 neonates who had plain abdominal x-rays. Eighty-three had multiple examinations, 52 of which showed variably gas in the rectum. Fifty-seven had significant bowel distension, 42 of which had no gas in rectum. Only one of these cases had Hirschsprung’s disease. Most of the infants had generalized sepsis or necrotizing enterocolitis. The authors conclude that absence of rectal gas is a variable and non-specific sign. Further investigation for Hirschsprung’s disease is only indicated when there is associated delayed passage of meconium and no evidence of sepsis or necrotizing enterocolitis.-
Amir Azmy