- Email: [email protected]
Post-traumatic atresia of the common bile duct in a child
INTERNATIONAL ABSTRACTS
cirrhosis with portal hypertension, all 44 patients who are alive at least 5 years after surgery seem to lead almost normal lives. Prem Purl Treatment of Extrahepatic Bile Duct Atresia: Results and Longterm Prognosis after Hepatic Portoenterostomy. P. Schweizer.
Pediatr Surg lnt 1:30-36, (March), 1986. Since 1972, 64 infants suffering from extrahepatic bile duct atresia have been examined. Between 1985 and 1984, conventional or extended hepatic portoenterostomy was performed on 41 patients. These infants were classified into two groups on the basis of age at the time of surgery in relation to the duration of cholestasis. Of 12 patients operated upon 5 or more years ago, eight (66%) are still alive with favorable bile flow, and four (34%) have died from hepatic failure caused by biliary cirrhosis. Of 22 infants over 8 weeks of age who have been treated so far, seven (31%) are alive with good bile flow, and 15 (69%) have died within the past 3 years. In contrast, 12 (63%) of 19 infants operated upon before 8 weeks of age are healthy with good bile flow, and only seven (37%) have died from cirrhosis. The course of the disease was analyzed with regard to the following: (1) age at surgery with respect to the duration of cholestasis; (2) extent of liver fibrosis at surgery; (3) cross-section of ductular structures in the porta hepatis; (4) numerical and morphologic changes in the interlobular bile ducts; (5) extent of dissection of the porta hepatis; and (6) postoperative hepatoportitis. A favorable prognosis can be expected if the following conditions are fulfilled: no cholestasis for more than 6 weeks; low-grade fibrosis at the time of surgery; a mean diameter of the ductular structures in the porta hepatis of more than 450 #m; no numerical or morphologic alterations in the interlobular bile ducts; no postoperative "hepatoportitis."--Prem Purl Biliary Scintigraphy with DISIDA. A Simpler Way of Showing Bile Duct Patency in Suspected Biliary Atresia. M.C. Dick and A.P.
Mowat. Arch Dis Child 61:191 192, (February), 1986. 99mTC-diisopropyl iminodiacetic acid (DISIDA) scintigraphy after oral pbenobarbitone treatment accurately indicated bile duct patency or obstruction in 28 of 32 (87%) infants, aged less than 12 weeks, with suspected biliary atresia. This investigation is more rapid than, and as accurate as the t3~I Rose-Bengal fecal excretion test. Prem Purl Choledochal Cyst: A Report of Fifteen Cases. P. Upadhyaya and P.
1011
Post-Traumatic Atresia of the Common Bile Duct in a Child. M.S. Slim, I.B. Kreidieh, A. Jabi, et al. Ann Paediatr Surg 1:177 180, (July), 1984.
A case of complete common bile duct (CBD) obstruction due to fibrosis secondary to blunt abdominal trauma in a 10-year-old boy is reported. Jaundice was noted 1 month after the injury. Diagnosis of the ductal obstruction was confirmed preoperatively by ultrasonography and percutaneous transhepatic cholangiography. The obstruction was relieved by a choledochoduodenostomy 3.5 months after trauma. Postoperatively, the liver function returned to normal. Follow-up for 1 year did not reveal any episode of ascending cholangitis. The rarity of CBD obstruction after blunt trauma to the abdomen is noted on review of the English literature and is unique in the total experience of the authors' institution. The pathologic findings support the hypothesis of a severe localized vascular injury to the terminal end of the choledochus resulting in a progressive form of atresia of this segment. Exploratory laparotomy done immediately after the injury did not disclose any biliary leakage into the abdominal cavity.--Prem Purl Surgical Treatment of Nesidioblastosis. L. Spitz, R. G. Buick, D.B.
Grant, et al. Pediatr Surg lnt 1:26 29, (March), 1986. This report comprises ten children with hyperinsulinemic hypoglycemia who did not respond to medical management and required surgical treatment. Eight were infants under the age of 1 year while two were children aged 3.5 and 5 years, respectively. In each case the diagnosis of nesidioblastosis was confirmed at operation by frozen section histopathologic examination and a 95% pancreatectomy was performed. No patient developed recurrent hypoglycemia, although transient hyperglycemia, which temporarily required insulin therapy, appeared in five children. All ten patients are now normoglycemic without treatment. Prem Purl Femoral Hernia in Children. S. Schulze and P.F. Schmidt.
Z
Kinderchir 40:287-288, (October), 1985. A series of 26 children who underwent surgery for femoral hernia is presented. In five patients, inguinal hernias had been repaired previously. Correct diagnosis was made preoperatively in seven (27%) cases only. The operation narrowed the femoral canal. At follow-up 6 months to 19~/z years later no recurrence was found. The authors stress the importance of a careful preoperative and perioperative examination.-- Thomas A. Angerpointner
Upadhyaya. Ann Paediatr Surg 1:181 186, (July), 1984. Fifteen cases of choledochal cyst were seen in the period 1972 to 1984. There were eight females and seven males, ranging in age from 1 month to 12 years. The presenting features were jaundice in 11, a palpable mass in 8, and recurrent pain in 7 patients. One patient had associated biliary atresia. Two patients had multiple cysts (Caroli's disease), and three had giant intrahepatic cysts with a normal extrahepatic biliary tree. Ultrasonography and the hepatic iminodiacetic acid (HIDA) scan were the mainstays of preoperative diagnosis. An operative cholangiogram is, however, mandatory to demonstrate the cyst, define intrahepatic biliary channels, and demonstrate the junction of the common bile duct and the main pancreatic duct. Patients with giant intrahepatic cysts benefit from a short preliminary period of tube drainage, which effectively reduces cyst size and makes subsequent excision or internal drainage technically easier. In the latter case there is also a decreased likelihood of anastomotic stricture. Eleven patients in this series had total excision of the cyst; four had partial excision and internal drainage. Three patients in this series, all under 1 year of age, died. Eleven patients are alive and well, and one was lost to follow-up.--Prem Purl
Historical Overview of the Bilateral Approach to Pediatric Inguinal Hernias. F. Rathauser. Am J Surg 150:527-532, (November),
1985. A detailed and extensively referenced history of the issue of bilateral repair in pediatric hernias is presented dating from 1899 to the present. Because the author's experience in nearly 8,000 pediatric hernias over 25 years does not correspond to the experience in the literature, a questionnaire was developed and sent to 80 senior pediatric surgeons on three occasions (1964, 1974, and 1984). The clear majority consistently favored bilateral groin explorations (80%) with varying upper age limits. A prospective evaluation of 440 patients seen over 30 months was also undertaken. The criteria for a hernia was a processus length of at least 2 cm past the internal ring, unstretched, and with demonstrable patency. The male to female ratio was 4:1. Thirty-two percent had bilateral inguinal protrusions. Of the remaining 301 children, patency of a contralateral processus was seen in 78% (250). The author concludes that the bilateral approach to the pediatric hernia patient is to be preferred in the hands of appropriately trained surgeon.-- Thomas V. Whalen
cirrhosis with portal hypertension, all 44 patients who are alive at least 5 years after surgery seem to lead almost normal lives. Prem Purl Treatment of Extrahepatic Bile Duct Atresia: Results and Longterm Prognosis after Hepatic Portoenterostomy. P. Schweizer.
Pediatr Surg lnt 1:30-36, (March), 1986. Since 1972, 64 infants suffering from extrahepatic bile duct atresia have been examined. Between 1985 and 1984, conventional or extended hepatic portoenterostomy was performed on 41 patients. These infants were classified into two groups on the basis of age at the time of surgery in relation to the duration of cholestasis. Of 12 patients operated upon 5 or more years ago, eight (66%) are still alive with favorable bile flow, and four (34%) have died from hepatic failure caused by biliary cirrhosis. Of 22 infants over 8 weeks of age who have been treated so far, seven (31%) are alive with good bile flow, and 15 (69%) have died within the past 3 years. In contrast, 12 (63%) of 19 infants operated upon before 8 weeks of age are healthy with good bile flow, and only seven (37%) have died from cirrhosis. The course of the disease was analyzed with regard to the following: (1) age at surgery with respect to the duration of cholestasis; (2) extent of liver fibrosis at surgery; (3) cross-section of ductular structures in the porta hepatis; (4) numerical and morphologic changes in the interlobular bile ducts; (5) extent of dissection of the porta hepatis; and (6) postoperative hepatoportitis. A favorable prognosis can be expected if the following conditions are fulfilled: no cholestasis for more than 6 weeks; low-grade fibrosis at the time of surgery; a mean diameter of the ductular structures in the porta hepatis of more than 450 #m; no numerical or morphologic alterations in the interlobular bile ducts; no postoperative "hepatoportitis."--Prem Purl Biliary Scintigraphy with DISIDA. A Simpler Way of Showing Bile Duct Patency in Suspected Biliary Atresia. M.C. Dick and A.P.
Mowat. Arch Dis Child 61:191 192, (February), 1986. 99mTC-diisopropyl iminodiacetic acid (DISIDA) scintigraphy after oral pbenobarbitone treatment accurately indicated bile duct patency or obstruction in 28 of 32 (87%) infants, aged less than 12 weeks, with suspected biliary atresia. This investigation is more rapid than, and as accurate as the t3~I Rose-Bengal fecal excretion test. Prem Purl Choledochal Cyst: A Report of Fifteen Cases. P. Upadhyaya and P.
1011
Post-Traumatic Atresia of the Common Bile Duct in a Child. M.S. Slim, I.B. Kreidieh, A. Jabi, et al. Ann Paediatr Surg 1:177 180, (July), 1984.
A case of complete common bile duct (CBD) obstruction due to fibrosis secondary to blunt abdominal trauma in a 10-year-old boy is reported. Jaundice was noted 1 month after the injury. Diagnosis of the ductal obstruction was confirmed preoperatively by ultrasonography and percutaneous transhepatic cholangiography. The obstruction was relieved by a choledochoduodenostomy 3.5 months after trauma. Postoperatively, the liver function returned to normal. Follow-up for 1 year did not reveal any episode of ascending cholangitis. The rarity of CBD obstruction after blunt trauma to the abdomen is noted on review of the English literature and is unique in the total experience of the authors' institution. The pathologic findings support the hypothesis of a severe localized vascular injury to the terminal end of the choledochus resulting in a progressive form of atresia of this segment. Exploratory laparotomy done immediately after the injury did not disclose any biliary leakage into the abdominal cavity.--Prem Purl Surgical Treatment of Nesidioblastosis. L. Spitz, R. G. Buick, D.B.
Grant, et al. Pediatr Surg lnt 1:26 29, (March), 1986. This report comprises ten children with hyperinsulinemic hypoglycemia who did not respond to medical management and required surgical treatment. Eight were infants under the age of 1 year while two were children aged 3.5 and 5 years, respectively. In each case the diagnosis of nesidioblastosis was confirmed at operation by frozen section histopathologic examination and a 95% pancreatectomy was performed. No patient developed recurrent hypoglycemia, although transient hyperglycemia, which temporarily required insulin therapy, appeared in five children. All ten patients are now normoglycemic without treatment. Prem Purl Femoral Hernia in Children. S. Schulze and P.F. Schmidt.
Z
Kinderchir 40:287-288, (October), 1985. A series of 26 children who underwent surgery for femoral hernia is presented. In five patients, inguinal hernias had been repaired previously. Correct diagnosis was made preoperatively in seven (27%) cases only. The operation narrowed the femoral canal. At follow-up 6 months to 19~/z years later no recurrence was found. The authors stress the importance of a careful preoperative and perioperative examination.-- Thomas A. Angerpointner
Upadhyaya. Ann Paediatr Surg 1:181 186, (July), 1984. Fifteen cases of choledochal cyst were seen in the period 1972 to 1984. There were eight females and seven males, ranging in age from 1 month to 12 years. The presenting features were jaundice in 11, a palpable mass in 8, and recurrent pain in 7 patients. One patient had associated biliary atresia. Two patients had multiple cysts (Caroli's disease), and three had giant intrahepatic cysts with a normal extrahepatic biliary tree. Ultrasonography and the hepatic iminodiacetic acid (HIDA) scan were the mainstays of preoperative diagnosis. An operative cholangiogram is, however, mandatory to demonstrate the cyst, define intrahepatic biliary channels, and demonstrate the junction of the common bile duct and the main pancreatic duct. Patients with giant intrahepatic cysts benefit from a short preliminary period of tube drainage, which effectively reduces cyst size and makes subsequent excision or internal drainage technically easier. In the latter case there is also a decreased likelihood of anastomotic stricture. Eleven patients in this series had total excision of the cyst; four had partial excision and internal drainage. Three patients in this series, all under 1 year of age, died. Eleven patients are alive and well, and one was lost to follow-up.--Prem Purl
Historical Overview of the Bilateral Approach to Pediatric Inguinal Hernias. F. Rathauser. Am J Surg 150:527-532, (November),
1985. A detailed and extensively referenced history of the issue of bilateral repair in pediatric hernias is presented dating from 1899 to the present. Because the author's experience in nearly 8,000 pediatric hernias over 25 years does not correspond to the experience in the literature, a questionnaire was developed and sent to 80 senior pediatric surgeons on three occasions (1964, 1974, and 1984). The clear majority consistently favored bilateral groin explorations (80%) with varying upper age limits. A prospective evaluation of 440 patients seen over 30 months was also undertaken. The criteria for a hernia was a processus length of at least 2 cm past the internal ring, unstretched, and with demonstrable patency. The male to female ratio was 4:1. Thirty-two percent had bilateral inguinal protrusions. Of the remaining 301 children, patency of a contralateral processus was seen in 78% (250). The author concludes that the bilateral approach to the pediatric hernia patient is to be preferred in the hands of appropriately trained surgeon.-- Thomas V. Whalen