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Spigelian hernia in children: Two cases of unusual etiology
INTERNATIONALABSTRACTS
did not significantly affect the outcome. The authors suggest that in patients with small abscesses in whom the organism has been identified, a course of antibiotic therapy followed by CT scan is appropriate. Patients with large abscesses may best be treated by surgery (drainage, splenectomy, or partial splenectomy). The role of percutaneous drainage of solitary abscesses has yet to be defined.-Jefiey L. Z&man Anterior Abdominal Wall Defects. P.M. Lafirty. A. J. Emmerson, P.J. Fleming. et al. Arch Dis Child 64:1029-1031, (July), 1989.
The authors report 48 infants with abdominal wall defects over a L-year period; 27 had gastroschisis and 21 had exomphalos. Thirtytwo patients had antenatal ultrasound scanning, but the defect was only detected in 14 of these. Four infants with gastroschisis were terminated at parental request, one gastroschisis baby was stillborn, and one infant with exomphalos and trisomy 13 died soon after birth. In the remaining 42 live births, the 1 year survival with gastroschisis was 95%, and with exomphalos 81%.-D.M. Burge Comparison of Marlex and Gore-tex to Repair Abdominal Wall Defects in the Rat.
J.L. Murphy, J.B. Freeman. P.G. Dionne. Can J Surg 32:244-247, (July), 1989. The comparison was made with respect to strength and adhesion formation. Gore-tex resulted in wound strength equal to Marlex, but had fewer adhesions. (In a recent pig paper Gore-tex was superior to dura in a similar situation.)Sigmund H. Ein
fistulae formation with difficulty to achieve closure from other techniques led him to return to the Cecil-Culp operation. The difficulty of achieving a terminal meatus in this technique is noted. The author describes raising a flap of scrotal skin from the median raphe, which is relatively hairless, and leaving it attached to the penile shaft when the penis is mobilized from its buried position in the scrotum. Incisions are carried from the meatus forwards on either side of the glans, and the previously described skin flap is turned forward to be sutured to the medial edges of the glans incisions. The flap is subsequently buried by the glans tissue from either side, similar to the technique described by Mathieu-A. McKinnon Orohiopexy of the High Undescended Testis by Division of the Spermatic Vessels: A Critical Review of Thirty-Eight Selected Transections.
S.J. Kogan. B.Z. Houman. E.F. Reda, et al. J Urol 141:1416-1419, (June), 1989.
The technique used to perform 38 orchiopexies of high undescended testes by spermatic vessel transection in 26 patients is reviewed. Testicular vessel transection was performed only after determination that a conventional high dissection would not result in successful descent, and only if a Fowler-Stephens test (clamping of the spermatic pedicle with demonstration of an intact collateral testicular blood supply) was obtained. Careful attention to detail and selection using the Fowler-Stephens test allowed for an 89% success rate, confirming the efficacy of this procedure in cases selected in this manner.--&. W. Holcomb, Jr
Spigelian Hernia in Children: Two Cases of Unusual Etiology.
J.A. Bar-Maor and Y. Sweed. Pediatr Surg Int 4357-359, (August), 1989.
A 5-year-old girl with blunt trauma to the abdomen and a 3-month-old boy after abdominal surgery were found to have spigelian hernias. The pathogenesis of these rare hernias is discussed. The authors’ first case is the third recorded traumatic spigelian hernia occurring in a child, and the second is the first postoperative case described after abdominal repair of a Bochdalek hernia.-Prem Puri GENITOURINARY
TRACT
Diphallus and Associated Anomalies. AS.
Najmaldin, I.J. Goliow, N. Stoodley, et al. Pediatr Surg Int 4:360-362, (August), 1989. A rare case of diphallus associated with multiple urethras, double bladders, rectourethral fistula, and rectocutaneous fistula is reported. The surgical management is detailed.-Prem Puri Diphallia Associated With Malformation of Hindgut Derivatives.
M.C.S.P. Cernach. H. Hayashi. and D. Soares. Urology 33:209-210, (March), 1989. The authors report an 11-month-old child with diphallia. and describe their radiographic evaluation to assess other organ systems. A cystogram showed duplication of the bladder and urethra, a barium enema displayed a duplication of the colon, and the intravenous pylogram revealed normal kidneys. Management of the duplicated colon is described, and the child is awaiting genital correction. The authors emphasize that urologic abnormalities are found in 42% of cases of duplication of the colon, 25% of cases of double anus, and 90% of cases of some type of duplication of the genitalia.-George W. Holcomb HI A Manoeuvre to Locate the Distal Urethral Opening at the Tip of the Glans in the Final Stage of Cecil-Culp Urethroplasty.
R.L.
Thatte. Br J Plast Surg 42:70-73, (January), 1989. The author admits that a three-stage technique has largely been abandoned in most units, but in his experience the high incidence of
Infant Testicular Prostheses. J.S. Elder. M.A. Keating, and J.W. Duckeft. JUrol 141:1413-1415, (June), 1989.
Traditionally, the parents of young boys with an absent testis are advised to let the child decide whether he wants a testicular prosthesis after he enters puberty. Unfortunately, the decision by an adolescent to undergo prosthesis insertion often is made only after experiencing ridicule and embarrassment about the genital appearance. Accordingly, the authors have offered to implant an infant size prosthesis in patients with cryptorchidism when inguinal and abdominal exploration demonstrates that the testis is absent. A total of 41 boys, less than 5 years old, with an absent testis underwent simultaneous insertion of a testicular prosthesis. The only complication was a superficial wound infection that did not necessitate removal of the prosthesis. Two boys reported mild scrotal discomfort. In long-term follow-up, 91% of the families rated the cosmetic appearance as “good,” and 94% were content with the decision regarding placement of a prosthesis. Although many assume that these boys will desire a larger prosthesis after puberty, this consideration seems to be irrelevant. Longer follow-up will be necessary to ascertain whether this approach alters the psychosexual development of these patients. The authors believe that young boys with an absent testis should be considered for simultaneous testicular prosthesis insertion at inguinal exploration or orchiectomy.-G. W. Holcomb, Jr Laparoscopy: lts Selected Use in Patients With Unilateral Nonpalpeble Testis After Human Chorionic Gonadotropin Stimulation.
M.J. Naslund, J.P. Gearhart, and R.D. Jeffs. J Urol 142:108-110, (July), 1989. Laparoscopy has been used to help evaluate patients with a unilateral nonpalpable testis. This procedure can be performed quickly, just before exploration, with the patient under the same anesthetic. With laparoscopy it has been possible to localize either a testis or the course of the spermatic vessels in 100% of 21 patients. Preoperative knowledge of testis location is helpful in planning the location of the incision, as well as the type of repair. The incidence of vanishing testis in the authors’ series is much higher than that
did not significantly affect the outcome. The authors suggest that in patients with small abscesses in whom the organism has been identified, a course of antibiotic therapy followed by CT scan is appropriate. Patients with large abscesses may best be treated by surgery (drainage, splenectomy, or partial splenectomy). The role of percutaneous drainage of solitary abscesses has yet to be defined.-Jefiey L. Z&man Anterior Abdominal Wall Defects. P.M. Lafirty. A. J. Emmerson, P.J. Fleming. et al. Arch Dis Child 64:1029-1031, (July), 1989.
The authors report 48 infants with abdominal wall defects over a L-year period; 27 had gastroschisis and 21 had exomphalos. Thirtytwo patients had antenatal ultrasound scanning, but the defect was only detected in 14 of these. Four infants with gastroschisis were terminated at parental request, one gastroschisis baby was stillborn, and one infant with exomphalos and trisomy 13 died soon after birth. In the remaining 42 live births, the 1 year survival with gastroschisis was 95%, and with exomphalos 81%.-D.M. Burge Comparison of Marlex and Gore-tex to Repair Abdominal Wall Defects in the Rat.
J.L. Murphy, J.B. Freeman. P.G. Dionne. Can J Surg 32:244-247, (July), 1989. The comparison was made with respect to strength and adhesion formation. Gore-tex resulted in wound strength equal to Marlex, but had fewer adhesions. (In a recent pig paper Gore-tex was superior to dura in a similar situation.)Sigmund H. Ein
fistulae formation with difficulty to achieve closure from other techniques led him to return to the Cecil-Culp operation. The difficulty of achieving a terminal meatus in this technique is noted. The author describes raising a flap of scrotal skin from the median raphe, which is relatively hairless, and leaving it attached to the penile shaft when the penis is mobilized from its buried position in the scrotum. Incisions are carried from the meatus forwards on either side of the glans, and the previously described skin flap is turned forward to be sutured to the medial edges of the glans incisions. The flap is subsequently buried by the glans tissue from either side, similar to the technique described by Mathieu-A. McKinnon Orohiopexy of the High Undescended Testis by Division of the Spermatic Vessels: A Critical Review of Thirty-Eight Selected Transections.
S.J. Kogan. B.Z. Houman. E.F. Reda, et al. J Urol 141:1416-1419, (June), 1989.
The technique used to perform 38 orchiopexies of high undescended testes by spermatic vessel transection in 26 patients is reviewed. Testicular vessel transection was performed only after determination that a conventional high dissection would not result in successful descent, and only if a Fowler-Stephens test (clamping of the spermatic pedicle with demonstration of an intact collateral testicular blood supply) was obtained. Careful attention to detail and selection using the Fowler-Stephens test allowed for an 89% success rate, confirming the efficacy of this procedure in cases selected in this manner.--&. W. Holcomb, Jr
Spigelian Hernia in Children: Two Cases of Unusual Etiology.
J.A. Bar-Maor and Y. Sweed. Pediatr Surg Int 4357-359, (August), 1989.
A 5-year-old girl with blunt trauma to the abdomen and a 3-month-old boy after abdominal surgery were found to have spigelian hernias. The pathogenesis of these rare hernias is discussed. The authors’ first case is the third recorded traumatic spigelian hernia occurring in a child, and the second is the first postoperative case described after abdominal repair of a Bochdalek hernia.-Prem Puri GENITOURINARY
TRACT
Diphallus and Associated Anomalies. AS.
Najmaldin, I.J. Goliow, N. Stoodley, et al. Pediatr Surg Int 4:360-362, (August), 1989. A rare case of diphallus associated with multiple urethras, double bladders, rectourethral fistula, and rectocutaneous fistula is reported. The surgical management is detailed.-Prem Puri Diphallia Associated With Malformation of Hindgut Derivatives.
M.C.S.P. Cernach. H. Hayashi. and D. Soares. Urology 33:209-210, (March), 1989. The authors report an 11-month-old child with diphallia. and describe their radiographic evaluation to assess other organ systems. A cystogram showed duplication of the bladder and urethra, a barium enema displayed a duplication of the colon, and the intravenous pylogram revealed normal kidneys. Management of the duplicated colon is described, and the child is awaiting genital correction. The authors emphasize that urologic abnormalities are found in 42% of cases of duplication of the colon, 25% of cases of double anus, and 90% of cases of some type of duplication of the genitalia.-George W. Holcomb HI A Manoeuvre to Locate the Distal Urethral Opening at the Tip of the Glans in the Final Stage of Cecil-Culp Urethroplasty.
R.L.
Thatte. Br J Plast Surg 42:70-73, (January), 1989. The author admits that a three-stage technique has largely been abandoned in most units, but in his experience the high incidence of
Infant Testicular Prostheses. J.S. Elder. M.A. Keating, and J.W. Duckeft. JUrol 141:1413-1415, (June), 1989.
Traditionally, the parents of young boys with an absent testis are advised to let the child decide whether he wants a testicular prosthesis after he enters puberty. Unfortunately, the decision by an adolescent to undergo prosthesis insertion often is made only after experiencing ridicule and embarrassment about the genital appearance. Accordingly, the authors have offered to implant an infant size prosthesis in patients with cryptorchidism when inguinal and abdominal exploration demonstrates that the testis is absent. A total of 41 boys, less than 5 years old, with an absent testis underwent simultaneous insertion of a testicular prosthesis. The only complication was a superficial wound infection that did not necessitate removal of the prosthesis. Two boys reported mild scrotal discomfort. In long-term follow-up, 91% of the families rated the cosmetic appearance as “good,” and 94% were content with the decision regarding placement of a prosthesis. Although many assume that these boys will desire a larger prosthesis after puberty, this consideration seems to be irrelevant. Longer follow-up will be necessary to ascertain whether this approach alters the psychosexual development of these patients. The authors believe that young boys with an absent testis should be considered for simultaneous testicular prosthesis insertion at inguinal exploration or orchiectomy.-G. W. Holcomb, Jr Laparoscopy: lts Selected Use in Patients With Unilateral Nonpalpeble Testis After Human Chorionic Gonadotropin Stimulation.
M.J. Naslund, J.P. Gearhart, and R.D. Jeffs. J Urol 142:108-110, (July), 1989. Laparoscopy has been used to help evaluate patients with a unilateral nonpalpable testis. This procedure can be performed quickly, just before exploration, with the patient under the same anesthetic. With laparoscopy it has been possible to localize either a testis or the course of the spermatic vessels in 100% of 21 patients. Preoperative knowledge of testis location is helpful in planning the location of the incision, as well as the type of repair. The incidence of vanishing testis in the authors’ series is much higher than that