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Ruptured spleen in a malarious area: With emphasis on conservative management in both adults and children
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attempt was made on the third postoperative day to change from IPPV to Continuous Positive Airway Pressure to (CPAP), the baby developed apneic episodes with deteriorated blood gases. Chest x-ray revealed elevation of the right hemidiaphragm suggestive of a right phrenic nerve palsy. IPPV was continued for 4 wk during which nerve paralysis recovered completely. Repeat screening of the diaphragm showed normal movements, and the baby was weaned off artificial ventilation. Phrenic nerve injury as complication of esophageal atresia repair has rarely been reported. When the nerve injury is considered reversible, management consists in maintaining ventilatory support for several weeks. If it is considered irreversible, paralysis must be treated by plication of the diaphragm.-- Thomas A. Angerpointner
Problems of Intramural Hematomas in Childhood: A Report of Five Cases. R. Daum, H. Roth, and M. Bolkenius. Z.
Kinderchir 36:53-57, 1982. Intramural hematomas of the intestine are of different origin, localization, and extent, but all lead to bowel obstruction. Abdominal blunt trauma, iatrogenic cause, such as endoscopy, surgery, and abdominal puncture, hemorrhagic diathese, such as hemophilia, Henoch-Sch~inlein's disease, pathologic changes of the bowel wall, and idiopathic causes may produce intramural hematomas of the intestine. The authors describe five cases. One child developed an obstructive duodenal hematoma following liver and spleen rupture; two children suffered from hemorrhagic diatheses; in another child, a bowel clamp caused intramural hematoma; in one case the origin remained unknown. The authors favor surgical treatment since they regard it safer than conservative treatment. Removal of the hematoma, bowel resection, gastroenterostomy, and colostomy are recommended as surgical procedures.--Thomas A. Angerpointner
Contrast Enemas in Cystic Fibrosis: Implications of Appen-
Nonfllling. B. D. Fletcher and C. R. Abramowsky. Am J Roentgenol 137:323-326, (August), 1981. diceal
A retrospective review of 34 contrast enemas in 29 patients with cystic fibrosis presenting with abdominal pain (five with palpable mass and four with gastrointestinal bleeding) revealed absence of filling of the appendix in 22 patients. Of these, seven underwent appendectomy with only four having appendicitis. The remaining 15 patients underwent no abdominal operations up to an average of 4 yr following the contrast study. Ten patients in the nonfilling group also had cecal defects. Of the seven patients with varying degrees of appendiceal filling, five underwent exploration, and none had appendicitis. On microscopic examination of the noninflamed appendices a large increase in the number and size of goblet cells with excess mucus in the lumen was noted. The authors feel that the mucus filling the lumen results in the inability to fill the noninflamed appendix. They feel that contrast enemas, contrary to the experience in normal children, are insensitive tests in children with cystic fibrosis and abdominal pain, and may lead to unnecessary operation in 80% of cases.--Randall 14I.Powell
INTERNATIONAL ABSTRACTS ABDOMEN Blunt Splenic Trauma in Children: A Retrospective Study of Nonoperative Management. R. C. Cohen. Aust Paediat J
18:211-215, 1982. This paper is a retrospective study of the management of 58 cases of blunt splenic injury in the pediatric age group. Fifty of these cases were managed at the Adelaide Children's Hospital during the period 1964-1980 and eight cases at the Flinders Medical Center during the period 1976-1980. A policy of nonoperative management of blunt splenic injury was introduced to the Adelaide Children's Hospital in 1964, a policy not fully adopted until 1975. By this time nuclear scanning techniques were readily available and enabled accurate diagnosis of splenic trauma. Followup scans provided more knowledge of the healing process. Between 1975 and 1980 a total of 42 proven cases of blunt splenic injury were treated nonoperatively, including one case of total avulsion of the spleen. Splenectomy was performed on 16 cases, all prior to June 1975. There was no case of postsplenectomy sepsis. Postoperative obstruction due to small bowel adhesions was encountered in 25% of the splenectomy cases. Comparison of results shows that nonoperative management is preferable in selected children when adequate monitoring facilities are available. If the clinical condition deteriorates, operative intervention is indicated; this occurred in two patients both of whom underwent splenectomy. Of the 42 patients treated nonoperatively, delayed hemorrhage occurred in only one. There was no evidence of a posttraumatic splenic cyst in any of the followup scans.--N. A. Myers Ruptured Spleen in a Malarious Area: With Emphasis on Conservative Management in Both Adults and Children.
D. R. Hamilton and D. Pikacha. Aust N Z J Surg 52, (June), 1982. Sixty-two consecutive cases of ruptured spleen occuring in a malarious area are reviewed. Nineteen died before treatment could be commenced. All patients who survived the initial hypotensive episode, and who were admitted to the authors' unit, recovered, whether managed operatively or nonoperatively. They conserved 26 spleens and removed 17. One splenectomized patient is known to have died subsequently from cerebral malaria. Although four cases of delayed rupture were seen, no conservatively treated patient had a delayed hemorrhage. Their policy is to avoid removal of the spleen in malarious areas in both adults and children. The authors suggest that if capsular tear occurs as part of the original injury and hemostasis occurs with or without the aid of the greater omentum, secondary hemorrhage is much less likely than if at the time of injury the splenic parenchyma is disrupted within an intact capsule.--N. A. Myers Reoperation for Failure of Portoenterostomy. E. S, Golla-
day. South Med J 75:927-932, (August), 1982. Over a 4-yr-period, 18 children with biliary atresia have required portoenterostomy. Either because of failure of initial biliary output (five patients) or failure to resume output after an episode of ascending choloangitis (five patients), reoperation on the portoenterostomy with curettage was performed
attempt was made on the third postoperative day to change from IPPV to Continuous Positive Airway Pressure to (CPAP), the baby developed apneic episodes with deteriorated blood gases. Chest x-ray revealed elevation of the right hemidiaphragm suggestive of a right phrenic nerve palsy. IPPV was continued for 4 wk during which nerve paralysis recovered completely. Repeat screening of the diaphragm showed normal movements, and the baby was weaned off artificial ventilation. Phrenic nerve injury as complication of esophageal atresia repair has rarely been reported. When the nerve injury is considered reversible, management consists in maintaining ventilatory support for several weeks. If it is considered irreversible, paralysis must be treated by plication of the diaphragm.-- Thomas A. Angerpointner
Problems of Intramural Hematomas in Childhood: A Report of Five Cases. R. Daum, H. Roth, and M. Bolkenius. Z.
Kinderchir 36:53-57, 1982. Intramural hematomas of the intestine are of different origin, localization, and extent, but all lead to bowel obstruction. Abdominal blunt trauma, iatrogenic cause, such as endoscopy, surgery, and abdominal puncture, hemorrhagic diathese, such as hemophilia, Henoch-Sch~inlein's disease, pathologic changes of the bowel wall, and idiopathic causes may produce intramural hematomas of the intestine. The authors describe five cases. One child developed an obstructive duodenal hematoma following liver and spleen rupture; two children suffered from hemorrhagic diatheses; in another child, a bowel clamp caused intramural hematoma; in one case the origin remained unknown. The authors favor surgical treatment since they regard it safer than conservative treatment. Removal of the hematoma, bowel resection, gastroenterostomy, and colostomy are recommended as surgical procedures.--Thomas A. Angerpointner
Contrast Enemas in Cystic Fibrosis: Implications of Appen-
Nonfllling. B. D. Fletcher and C. R. Abramowsky. Am J Roentgenol 137:323-326, (August), 1981. diceal
A retrospective review of 34 contrast enemas in 29 patients with cystic fibrosis presenting with abdominal pain (five with palpable mass and four with gastrointestinal bleeding) revealed absence of filling of the appendix in 22 patients. Of these, seven underwent appendectomy with only four having appendicitis. The remaining 15 patients underwent no abdominal operations up to an average of 4 yr following the contrast study. Ten patients in the nonfilling group also had cecal defects. Of the seven patients with varying degrees of appendiceal filling, five underwent exploration, and none had appendicitis. On microscopic examination of the noninflamed appendices a large increase in the number and size of goblet cells with excess mucus in the lumen was noted. The authors feel that the mucus filling the lumen results in the inability to fill the noninflamed appendix. They feel that contrast enemas, contrary to the experience in normal children, are insensitive tests in children with cystic fibrosis and abdominal pain, and may lead to unnecessary operation in 80% of cases.--Randall 14I.Powell
INTERNATIONAL ABSTRACTS ABDOMEN Blunt Splenic Trauma in Children: A Retrospective Study of Nonoperative Management. R. C. Cohen. Aust Paediat J
18:211-215, 1982. This paper is a retrospective study of the management of 58 cases of blunt splenic injury in the pediatric age group. Fifty of these cases were managed at the Adelaide Children's Hospital during the period 1964-1980 and eight cases at the Flinders Medical Center during the period 1976-1980. A policy of nonoperative management of blunt splenic injury was introduced to the Adelaide Children's Hospital in 1964, a policy not fully adopted until 1975. By this time nuclear scanning techniques were readily available and enabled accurate diagnosis of splenic trauma. Followup scans provided more knowledge of the healing process. Between 1975 and 1980 a total of 42 proven cases of blunt splenic injury were treated nonoperatively, including one case of total avulsion of the spleen. Splenectomy was performed on 16 cases, all prior to June 1975. There was no case of postsplenectomy sepsis. Postoperative obstruction due to small bowel adhesions was encountered in 25% of the splenectomy cases. Comparison of results shows that nonoperative management is preferable in selected children when adequate monitoring facilities are available. If the clinical condition deteriorates, operative intervention is indicated; this occurred in two patients both of whom underwent splenectomy. Of the 42 patients treated nonoperatively, delayed hemorrhage occurred in only one. There was no evidence of a posttraumatic splenic cyst in any of the followup scans.--N. A. Myers Ruptured Spleen in a Malarious Area: With Emphasis on Conservative Management in Both Adults and Children.
D. R. Hamilton and D. Pikacha. Aust N Z J Surg 52, (June), 1982. Sixty-two consecutive cases of ruptured spleen occuring in a malarious area are reviewed. Nineteen died before treatment could be commenced. All patients who survived the initial hypotensive episode, and who were admitted to the authors' unit, recovered, whether managed operatively or nonoperatively. They conserved 26 spleens and removed 17. One splenectomized patient is known to have died subsequently from cerebral malaria. Although four cases of delayed rupture were seen, no conservatively treated patient had a delayed hemorrhage. Their policy is to avoid removal of the spleen in malarious areas in both adults and children. The authors suggest that if capsular tear occurs as part of the original injury and hemostasis occurs with or without the aid of the greater omentum, secondary hemorrhage is much less likely than if at the time of injury the splenic parenchyma is disrupted within an intact capsule.--N. A. Myers Reoperation for Failure of Portoenterostomy. E. S, Golla-
day. South Med J 75:927-932, (August), 1982. Over a 4-yr-period, 18 children with biliary atresia have required portoenterostomy. Either because of failure of initial biliary output (five patients) or failure to resume output after an episode of ascending choloangitis (five patients), reoperation on the portoenterostomy with curettage was performed