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Pyogenic hepatic abscess in infancy and childhood
ABSTRACTS
398
distended gut is more subject to ischemia during shock-like episodes than a nondistended gut would be. The feeding regime for low birth weight infants and others who are ill or who have had serious problems during labor and delivery consists of no feeding at all to begin with and intravenous fluids only. Total parenteral nutrition is provided in cases in which intravenous feeding is needed for several days. The feeding schedule, when it is begun, is given by nasogastric tube at 3-hr intervals and is presented in a tabular form. For example, for a baby weighing less than 1250 g, the first feeding is 2 ml of water progressing to 3 ml and after 3 water feedings, 8.43 cal/ml formula is started beginning with a dose of 3 ml. Immediately prior to each feeding the stomach contents are aspirated through the nasogastric tube. If an episode of abdominal distension occurs in association with one or more other bad signs such as pallor, cyanosis, apnea, etc., feedings are immediately stopped, the baby treated vigorously for shock, and no feedings reinstituted for 2 wk.--David L. Collins Appendicitis in Premature Infants. E. Kontor and T. Malik.
Gyermekgyogyaszat 29:224-226, 1978. This is a report on 11 premature neonates operated on for appendicitis during a 5-yr period. The average of birthweight and age at surgery were 1580 g and 9.9 days, respectively. Four infants had ruptured membranes and six an infected umbilicus. In 4 of these 6 neonates exchange transfusion was called for. The symptomatology of appendicitis in this age group is very poor: feeding troubles, slightly distended abdomen, vomiting with or without bile. There is no localized tenderness, only a mild difference between the two sides. Leukocytosis, a tendency to thrombocytopenia, fluid levels on roentgenogram might be characteristic. A few days before surgery, antimicrobial therapy was instituted in all the patients. The appendix was perforated in 6 cases, there was gangrenous destruction in 4 neonates, ulcero-phlegmonous changes in 1. All but one patient recovered. One neonate with very low birthweight (1150 g) died. Only early diagnosis and surgery can save the patients.--Andrew Pintkr Annotation: Faecal Soiling and Anal Acbalasia. J. F. R.
Bentley. Arch Dis Child 53:185-186, (March), 1978. This annotation describes the features of anal achalasia and the association with ultra-short segment Hirschsprung's disease. Diagnosis and treatment by anorectal manometry and myectomy or suction biopsy and anal dilatation are discussed. The author outlines his approach to the longer term management of chronic constipation by examination under anesthesia, digital evacuation where necessary and a regime of enemas and laxatives.--Peter A. M. Raine ABDOMEN Pyogenic Hepatic Abscess in Infancy and Childhood. M. J.
Chusid. Pediatrics 62:554-559, (October), 1978. Five patients with childhood hepatic abscesses at Milwaukee Children's Hospital and 61 cases reported in the literature are reviewed. Most hepatic abscesses occurred in infants with sepsis or umbilical infection. In older children the abscesses were usually associated with underlying host defense defects, particularly chronic granulomatous disease
and leukemia. Common clinical findings were fever, abdominal pain, and hepatomegaly. Radionuclide scan was useful in establishing the diagnosis when the lesions were larger than 2 cm. Small or microscopic lesions were not usually suspected until autopsy. Staphylococcus aureus was the most common etiologic agent. The mortality rate in all evaluable case reports was 27% in patients with chronic granulomatous disease and was 42% in the others. Open drainage with appropriate antibiotic therapy is indicated when f e a s i b l e . Colin C. Ferguson Calculous Cholecystitis Without Underlying Disease in Adolescents: A Survey of 21 such Cases. R. C. Spahr. Clin
Pediatr 17:908-909, (December), 1978. Of 1407 cases of calculous cholecystitis seen over a 5-yr period, 21 patients experienced symptoms before age 21. Eighteen were female; three were male; and eleven were obese. Presenting symptoms included right upper quadrant pain (14), epigastric pain (3), fatty food intolerance (5), "dyspepsia" (4), jaundice (3), and flatulence (2). Seven of the 18 females (33%) were postpartum and four experienced onset of symptoms in the third trimester or early postpartum period. Pathological diagnoses included 18 patients with chronic calculous cholecystitis, two with choledocholithiasis and chronic cholecystitis, and one with acute gangrenous calculous cholecystitis. No patients had an underlying disease other than obesity or pregnancy.--Randall 14I. Powell Abdominal Lymphangioma in Infancy. G. Romagnoli,
E. Perrotti, F. Faranda, B. Barbieri, C. Romano, and B. Possenti. Rass Ital Chir Ped 19:146, 1977. A 3-too-old male was admitted because the parents had noted progressive abdominal distension. Physical and x-ray examination revealed the presence of an abdominal mass with absence of intestinal loops in the left abdomen. I.V.P. showed partial obstruction of both ureters and pressure on the top of the bladder. At operation, a bilobed retroperitoneal lymphangioma was found dislocating and partially obstructing the first jejunal loop. The invaded mesentery and the corresponding small bowel loop were resected and an endto-end anastomosis performed. The cystic mass was filled with partially clotted milky fluid. The diagnosis of retroperitoneal chylous cyst was made, and x-ray 1 yr later showed complete recovery. A girl, aged 3, was admitted after 5 mo of weakness, pallor, anorexia, and frequent mucous bowel discharge followed by intermittent fever, abdominal pain, constipation and abdominal distension. A tense and mobile abdominal mass was palpable at the umbilical region extending to the left flank. X-ray examination of the G.I. tract showed that the duodenum and the small bowel were displaced to the right abdomen, the cecum apparently was dislocated anteriorly. At laparotomy a large cystic mass was found involving the left mesocolon, the spleno-colic ligament and the gastric part of the greater omentum. Excision of the mass was followed by uneventful recovery. Histological diagnosis was cystic lymphangioma. A newborn baby boy was admitted because of a large palpable mass practically occupying the whole abdomen.
398
distended gut is more subject to ischemia during shock-like episodes than a nondistended gut would be. The feeding regime for low birth weight infants and others who are ill or who have had serious problems during labor and delivery consists of no feeding at all to begin with and intravenous fluids only. Total parenteral nutrition is provided in cases in which intravenous feeding is needed for several days. The feeding schedule, when it is begun, is given by nasogastric tube at 3-hr intervals and is presented in a tabular form. For example, for a baby weighing less than 1250 g, the first feeding is 2 ml of water progressing to 3 ml and after 3 water feedings, 8.43 cal/ml formula is started beginning with a dose of 3 ml. Immediately prior to each feeding the stomach contents are aspirated through the nasogastric tube. If an episode of abdominal distension occurs in association with one or more other bad signs such as pallor, cyanosis, apnea, etc., feedings are immediately stopped, the baby treated vigorously for shock, and no feedings reinstituted for 2 wk.--David L. Collins Appendicitis in Premature Infants. E. Kontor and T. Malik.
Gyermekgyogyaszat 29:224-226, 1978. This is a report on 11 premature neonates operated on for appendicitis during a 5-yr period. The average of birthweight and age at surgery were 1580 g and 9.9 days, respectively. Four infants had ruptured membranes and six an infected umbilicus. In 4 of these 6 neonates exchange transfusion was called for. The symptomatology of appendicitis in this age group is very poor: feeding troubles, slightly distended abdomen, vomiting with or without bile. There is no localized tenderness, only a mild difference between the two sides. Leukocytosis, a tendency to thrombocytopenia, fluid levels on roentgenogram might be characteristic. A few days before surgery, antimicrobial therapy was instituted in all the patients. The appendix was perforated in 6 cases, there was gangrenous destruction in 4 neonates, ulcero-phlegmonous changes in 1. All but one patient recovered. One neonate with very low birthweight (1150 g) died. Only early diagnosis and surgery can save the patients.--Andrew Pintkr Annotation: Faecal Soiling and Anal Acbalasia. J. F. R.
Bentley. Arch Dis Child 53:185-186, (March), 1978. This annotation describes the features of anal achalasia and the association with ultra-short segment Hirschsprung's disease. Diagnosis and treatment by anorectal manometry and myectomy or suction biopsy and anal dilatation are discussed. The author outlines his approach to the longer term management of chronic constipation by examination under anesthesia, digital evacuation where necessary and a regime of enemas and laxatives.--Peter A. M. Raine ABDOMEN Pyogenic Hepatic Abscess in Infancy and Childhood. M. J.
Chusid. Pediatrics 62:554-559, (October), 1978. Five patients with childhood hepatic abscesses at Milwaukee Children's Hospital and 61 cases reported in the literature are reviewed. Most hepatic abscesses occurred in infants with sepsis or umbilical infection. In older children the abscesses were usually associated with underlying host defense defects, particularly chronic granulomatous disease
and leukemia. Common clinical findings were fever, abdominal pain, and hepatomegaly. Radionuclide scan was useful in establishing the diagnosis when the lesions were larger than 2 cm. Small or microscopic lesions were not usually suspected until autopsy. Staphylococcus aureus was the most common etiologic agent. The mortality rate in all evaluable case reports was 27% in patients with chronic granulomatous disease and was 42% in the others. Open drainage with appropriate antibiotic therapy is indicated when f e a s i b l e . Colin C. Ferguson Calculous Cholecystitis Without Underlying Disease in Adolescents: A Survey of 21 such Cases. R. C. Spahr. Clin
Pediatr 17:908-909, (December), 1978. Of 1407 cases of calculous cholecystitis seen over a 5-yr period, 21 patients experienced symptoms before age 21. Eighteen were female; three were male; and eleven were obese. Presenting symptoms included right upper quadrant pain (14), epigastric pain (3), fatty food intolerance (5), "dyspepsia" (4), jaundice (3), and flatulence (2). Seven of the 18 females (33%) were postpartum and four experienced onset of symptoms in the third trimester or early postpartum period. Pathological diagnoses included 18 patients with chronic calculous cholecystitis, two with choledocholithiasis and chronic cholecystitis, and one with acute gangrenous calculous cholecystitis. No patients had an underlying disease other than obesity or pregnancy.--Randall 14I. Powell Abdominal Lymphangioma in Infancy. G. Romagnoli,
E. Perrotti, F. Faranda, B. Barbieri, C. Romano, and B. Possenti. Rass Ital Chir Ped 19:146, 1977. A 3-too-old male was admitted because the parents had noted progressive abdominal distension. Physical and x-ray examination revealed the presence of an abdominal mass with absence of intestinal loops in the left abdomen. I.V.P. showed partial obstruction of both ureters and pressure on the top of the bladder. At operation, a bilobed retroperitoneal lymphangioma was found dislocating and partially obstructing the first jejunal loop. The invaded mesentery and the corresponding small bowel loop were resected and an endto-end anastomosis performed. The cystic mass was filled with partially clotted milky fluid. The diagnosis of retroperitoneal chylous cyst was made, and x-ray 1 yr later showed complete recovery. A girl, aged 3, was admitted after 5 mo of weakness, pallor, anorexia, and frequent mucous bowel discharge followed by intermittent fever, abdominal pain, constipation and abdominal distension. A tense and mobile abdominal mass was palpable at the umbilical region extending to the left flank. X-ray examination of the G.I. tract showed that the duodenum and the small bowel were displaced to the right abdomen, the cecum apparently was dislocated anteriorly. At laparotomy a large cystic mass was found involving the left mesocolon, the spleno-colic ligament and the gastric part of the greater omentum. Excision of the mass was followed by uneventful recovery. Histological diagnosis was cystic lymphangioma. A newborn baby boy was admitted because of a large palpable mass practically occupying the whole abdomen.