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Sliding appendiceal inguinal hernia
ABSTRACTS Acute Appendicitis: Efficacy of Prophylactic Preoperative Antibiotics in the Reduction of Septic Morbidity, Marjorie
Fine and Ronald W. Busutti. Am J Surg 135:210 212 (February), 1978. A retrospective hospital chart analysis of 200 consecutive patients undergoing appendectomy is reported. Acute appendicitis was encountered in 144 patients, perforated appendicitis in 40 patients and a normal appendix in 16 patients. The overall infection rate was 13%. Three of 57 patients (5.3%) with acute nonperforated appendicitis receiving preoperative Gentamycin and Clindamycin developed postoperative infection. Five of 49 patients (10.2%) with nonperforated appendicitis receiving no preoperative antibiotics developed infection. Although this is a retrospective, nonrandomized analysis, it is suggested that preoperative systemic antibiotics may be of value in decreasing the incidence of postoperative infection. Gentamycin and Clindamycin are suggested for coverage of the pathogens most frequently encountered in the appendix. Riehard J. Andrassy Exsanguinating Uncontrollable Lower Gastrointestinal Hemorrhage Due to Juvenile Polyposis: Report of a Case.
P. Middleton and W. Ferguson. Dis Colon Rectum 20:690 694 (November December), 1977 The authors report a 12-yr-old girl who underwent sigmoidoscopy and polypectomy for complaints of rectal bleeding from multiple polyps. Three hours postoperatively the patient had severe rectal bleeding resulting in shock. Exploration revealed multiple bleeding polyps requiring total colectomy proctectomy and ileostomy. Pathology showed juvenile polyposis involving the entire colon and rectum except for an area of transverse colon. The patient recovered. In discussion the usual benign nature of juvenile polyps is reviewed. However, a kindred of patients with one family member requiring total proctocolectomy for florid juvenile polyp6sis is cited. The report suggests that patients requiring resection for florid polyposis should be carefully followed and the family examined. The reported patient and her family are disease free 6 mo postoperatively.--Bernard T. Ferrari Functional and Prognostic Evaluation of Anorectal Malformations. D. Berger, L. C. Schneider, M. Landry, and
N. Genton. Z Kinderchir 22:286 312 (November), 1977. Forty children, suffering from anorectal malformations, were examined in order to evaluate postoperative function and prognosis. Clinical assessment, electromyography, and radiologic data allowed the exact definition of rectal function and location of the pathogenesis of anorectal insufficiency. In this series, 13 anorectal malformations were at a high level, 8 at an intermediate, and 19 at a low level. Clinical investigation showed 26 good, 10 satisfactory, and 4 bad results. Electromyography showed that 24 patients had good, 12 satisfactory, and 4 bad function. Radiologically, 22 children had good, 14 satisfactory, and 4 bad scores. All malformations at an intermediate or low level showed markedly better function than those at a high level. Clinical data of the case history and examination are essential when investigating the function of sphincteric muscle postoperatively. Electromyography enables the 1o-
549
calization of muscular deficiency pre- and postoperatively. Radiologic studies allow the qualitative and quantitative analysis of anorectal dynamics, continence, and defecation. Postoperatively, all the combined data facilitate the choice of treatment.--Karl-Ludwig Waag ABDOMEN Sliding Appendiceal Inguinal Hernia. E, Rose and 72 V, San-
tulli. Surg Gynecol Obstet 146:626-627 (April), 1978. Rarely, the mesoappendix forms the sliding component of an inguinal hernia. Appendectomy, in such instances, permits effective repair of the hernia. This was accomplished in 16 patients (13 children) without wound complications or recurrence of the hernia. This series confirms the safety of combined appendectomy and inguinal herniorrhaphy without prophylactic antibiotics.--George Holcomb Conservative Surgery for Splenic Injuries. N. J. Sherman and M. J. Asch. Pediatrics 61:267-271 (February), 1978.
Because of the definite risk of postsplenectomy sepsis, the authors report six children with splenic injuries in whom, by utilizing different surgical maneuvers, they were able to preserve all or part of the spleen. The methods of preservation included mattress suturing of lacerations, topical hemostasis with "Avitene", splenic artery ligation, and partial resections. All patients survived without complications. Even with ligation of the main splenic artery, scans performed 1 wk and 6 wk postoperatively showed normal uptake and distribution.--Colin C. Ferguson Hepatic Hydatids in Childhood. E. Martini and C. VittorinL Rass Ital Chir Ped 18:39-43 (October-December), 1976.
Of 373 patients with pulmonary hydatids, 80 (22%) were aged between 33 mo and 15 yr. The involved sites were: liver (28), lung (48), both liver and lung (2), and peritoneum (2). Multiple cysts were found in 9 of 80 patients for a total of 105 cysts. Complications occurred in l0 patients. Symptoms were dyspepsia, malaise, anorexia, headache, and slight temperature. A mass in the hypochondrium was noted by the parents in all but two patients, who were operated upon for acute appendicitis and blunt abdominal trauma. Allergic symptoms were absent. After formolin injection, excision of the cyst was performed. The residual cavity was closed with plain catgut mattress suture without drainage. A penrose drain was left close to the suface of the liver. C . A . Montagnani Rupture of the Common Hepatic Duct After Blunt Abdominal Trauma in Childhood. G. DeJclnt and F. Pisoni. Rass
Ital Chir Ped 18:56 65 (October-December), 1976. Case histories, pathogenesis, pathology, symptoms, diagnosis, and treatment are thoroughly reviewed from the literature and one personal case is described. A boy, aged 4 yr, was seen because of an acute abdomen and shock. Two hours previously he was hit by an iron pole on his upper abdomen. Because of a definite improvement under conservative measures, rupture of a hollow viscus and acute hemorrhage were ruled out. Supportive therapy was continued, but after the seventh and up to the 13th day progressive deterioration of the general condition occurred
Fine and Ronald W. Busutti. Am J Surg 135:210 212 (February), 1978. A retrospective hospital chart analysis of 200 consecutive patients undergoing appendectomy is reported. Acute appendicitis was encountered in 144 patients, perforated appendicitis in 40 patients and a normal appendix in 16 patients. The overall infection rate was 13%. Three of 57 patients (5.3%) with acute nonperforated appendicitis receiving preoperative Gentamycin and Clindamycin developed postoperative infection. Five of 49 patients (10.2%) with nonperforated appendicitis receiving no preoperative antibiotics developed infection. Although this is a retrospective, nonrandomized analysis, it is suggested that preoperative systemic antibiotics may be of value in decreasing the incidence of postoperative infection. Gentamycin and Clindamycin are suggested for coverage of the pathogens most frequently encountered in the appendix. Riehard J. Andrassy Exsanguinating Uncontrollable Lower Gastrointestinal Hemorrhage Due to Juvenile Polyposis: Report of a Case.
P. Middleton and W. Ferguson. Dis Colon Rectum 20:690 694 (November December), 1977 The authors report a 12-yr-old girl who underwent sigmoidoscopy and polypectomy for complaints of rectal bleeding from multiple polyps. Three hours postoperatively the patient had severe rectal bleeding resulting in shock. Exploration revealed multiple bleeding polyps requiring total colectomy proctectomy and ileostomy. Pathology showed juvenile polyposis involving the entire colon and rectum except for an area of transverse colon. The patient recovered. In discussion the usual benign nature of juvenile polyps is reviewed. However, a kindred of patients with one family member requiring total proctocolectomy for florid juvenile polyp6sis is cited. The report suggests that patients requiring resection for florid polyposis should be carefully followed and the family examined. The reported patient and her family are disease free 6 mo postoperatively.--Bernard T. Ferrari Functional and Prognostic Evaluation of Anorectal Malformations. D. Berger, L. C. Schneider, M. Landry, and
N. Genton. Z Kinderchir 22:286 312 (November), 1977. Forty children, suffering from anorectal malformations, were examined in order to evaluate postoperative function and prognosis. Clinical assessment, electromyography, and radiologic data allowed the exact definition of rectal function and location of the pathogenesis of anorectal insufficiency. In this series, 13 anorectal malformations were at a high level, 8 at an intermediate, and 19 at a low level. Clinical investigation showed 26 good, 10 satisfactory, and 4 bad results. Electromyography showed that 24 patients had good, 12 satisfactory, and 4 bad function. Radiologically, 22 children had good, 14 satisfactory, and 4 bad scores. All malformations at an intermediate or low level showed markedly better function than those at a high level. Clinical data of the case history and examination are essential when investigating the function of sphincteric muscle postoperatively. Electromyography enables the 1o-
549
calization of muscular deficiency pre- and postoperatively. Radiologic studies allow the qualitative and quantitative analysis of anorectal dynamics, continence, and defecation. Postoperatively, all the combined data facilitate the choice of treatment.--Karl-Ludwig Waag ABDOMEN Sliding Appendiceal Inguinal Hernia. E, Rose and 72 V, San-
tulli. Surg Gynecol Obstet 146:626-627 (April), 1978. Rarely, the mesoappendix forms the sliding component of an inguinal hernia. Appendectomy, in such instances, permits effective repair of the hernia. This was accomplished in 16 patients (13 children) without wound complications or recurrence of the hernia. This series confirms the safety of combined appendectomy and inguinal herniorrhaphy without prophylactic antibiotics.--George Holcomb Conservative Surgery for Splenic Injuries. N. J. Sherman and M. J. Asch. Pediatrics 61:267-271 (February), 1978.
Because of the definite risk of postsplenectomy sepsis, the authors report six children with splenic injuries in whom, by utilizing different surgical maneuvers, they were able to preserve all or part of the spleen. The methods of preservation included mattress suturing of lacerations, topical hemostasis with "Avitene", splenic artery ligation, and partial resections. All patients survived without complications. Even with ligation of the main splenic artery, scans performed 1 wk and 6 wk postoperatively showed normal uptake and distribution.--Colin C. Ferguson Hepatic Hydatids in Childhood. E. Martini and C. VittorinL Rass Ital Chir Ped 18:39-43 (October-December), 1976.
Of 373 patients with pulmonary hydatids, 80 (22%) were aged between 33 mo and 15 yr. The involved sites were: liver (28), lung (48), both liver and lung (2), and peritoneum (2). Multiple cysts were found in 9 of 80 patients for a total of 105 cysts. Complications occurred in l0 patients. Symptoms were dyspepsia, malaise, anorexia, headache, and slight temperature. A mass in the hypochondrium was noted by the parents in all but two patients, who were operated upon for acute appendicitis and blunt abdominal trauma. Allergic symptoms were absent. After formolin injection, excision of the cyst was performed. The residual cavity was closed with plain catgut mattress suture without drainage. A penrose drain was left close to the suface of the liver. C . A . Montagnani Rupture of the Common Hepatic Duct After Blunt Abdominal Trauma in Childhood. G. DeJclnt and F. Pisoni. Rass
Ital Chir Ped 18:56 65 (October-December), 1976. Case histories, pathogenesis, pathology, symptoms, diagnosis, and treatment are thoroughly reviewed from the literature and one personal case is described. A boy, aged 4 yr, was seen because of an acute abdomen and shock. Two hours previously he was hit by an iron pole on his upper abdomen. Because of a definite improvement under conservative measures, rupture of a hollow viscus and acute hemorrhage were ruled out. Supportive therapy was continued, but after the seventh and up to the 13th day progressive deterioration of the general condition occurred