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Swallowed button batteries: Is there a consensus on management?
INTERNATIONAL
627
ABSTRACTS
ing indicated a right paratracheal mass. At neck exploration a single large parathyroid gland that weighed 500 mg was removed. The patient’s discharge calcium level was 9.3 mg/dL. Pathology examination of the tissue showed parathyroid adenoma. Previous reports have documented the rare incidence of primary hyperparathyroidism in neonates and infants. In these patients, this is usually due to parathyroid hyperplasia, whereas adenomas predominate in childhood and adolescence. This report acknowledges that unilateral exploration and removal of the solitary parathyroid gland is not the customary treatment for hyperparathyroidism. However, contralateral exploration might have increased the chance for recurrent nerve damage and hypoparathyroidism, especially with the normal relationship of the thyroid and parathyroid glands absent in the case.-Thomas F. Tracy, Jr THORAX Surgical Treatment of Tracheomalacia and Bronchomalacia in Infants. C. Tsugawa, T. Muraji, E. Nishijima, et al. Jpn J Pediatr
Surg 22:87-92, (January), 1990. During the period 1980 to 1989, 20 patients with various symptoms of respiratory distress referred to as “dying spells” underwent surgical repair of tracheomalacia and/or bronchomalacia. Fourteen patients (aged 1 to 23 months) had aortopexy for tracheomalacia. Seven of these patients were associated with esophageal atresia and two with Campomelic syndrome. In 11 of the 14 patients, the results were satisfactory enough to allow removal of the endotracheal tubes. These patients have been free of respiratory symptoms. Six patients (aged 2 to 9 months) with bronchomalacia underwent external stenting of the bronchus and/or bronchial sleeve resection. which did not correct the collapse of the malacic bronchus. An alternative method of surgical treatment for bronchomalacia should be sought.-Tukeshi Miyuno Mediastinai Sequestration With Ectopic Pancreas. D. von Schweinitz, C. Wit&kind, and J. Freihorst. Z Kinderchir 45:249-250,
(August), 1990. A 5-year-old boy with chronic pneumonia of the upper left lobe of the lung is reported in whom a bronchoenteric sequestration with ectopic pancreas was found in the mediastinum. Reviewing the literature, different theories of this extremely rare anomaly are discussed.-Thomas A. Angerpointner ALIMENTARY
TRACT
Esophageal Atresia and Quality of Life. M. Lehner. Z Kinderchir
45:209-211, (August), 1990. Questionnaires on 122 children undergoing operation for esophageal atresia in several centers were studied in order to evaluate their quality of life. On the basis of this information, the author’s own cases, and study of the literature, it was observed that the early childhood of these children was burdened by operations, dilatation treatments, swallowing difficulties, and frequent bronchopulmonary infections. Usually, these problems improved during the first year of life. Later on, the quality of life can be regarded as good. Parental groups for self-help may play a central role, both for patients and parents.-ThomasA. Angerpointner
lowed button batteries so the results were not of the optimum treatment. Of the 312 cases suitable for analysis, over one third of doctors were not concerned about ingested button batteries despite the known dangers of heavy metal poisoning, which is more frequent than suspected. These doctors gave no treatment whereas a further 6% gave medical treatment, eg, antacids, emeretics, and, occasionally, laxatives if the battery was in small or large bowel. Nine percent did not know what to do. Almost 50% removed the batteries under certain circumstances. Of those who contemplated removal, 78% attempted removal if the battery was in the esophagus. Seventy-two percent removed the battery from the stomach and 48% from the duodenum, all within 24 hours of ingestion. The usual reason for removal was failure to progress. However, such progress is variable and the battery may pass through without problems. Removal was usually with a flexible endoscope and Dormier basket. When surgery was performed in one in whom endoscopic removal was not possible, the battery was found to be disintegrating.-Caroline Doig Esophageal Rupture Due to Air-Blast Injury in Children: Case Report and Review of the Literature. A.C. Basaklar. Z Kinder-
chir 45:2.57-259,(August), 1990. Perforation of the esophagus is a surgical emergency that is usually lethal if untreated and commonly fatal if treatment is delayed. The most common type of trauma causing esophageal perforation is a penetrating injury. Esophageal rupture due to external blunt trauma or air-blast injury is exceedingly rare. Such a case with esophageal rupture related to air-blast injury to the chest and upper abdomen in a 12-year-old boy is reported. Tube thoracostomy, gastrostomy, and feeding jejunostomy were established. Esophagogram taken on the 51st day showed complete closure of the esophageal leak. On follow-up, no stricture or swallowing problems were present.-ThomasA, Angerpointner Postoperative Assessment of Cardia Function in Newborns after Esophageal, Diaphragmatic and Abdominal Wall Defects. P. Schmittenbecher. Z Kinderchir 45:278-281, (October),
1990. Long-term pH-metry was used in 46 newborns after correction of esophageal atresia, diaphragmatic defects. and abdominal wall malformations to record postoperative cardia function. In 15 of 40 (37.5%) long-term pH-metries and 11 of 22 (50%) x-ray studies, pathological results were found. Consecutively, 8 children underwent operative correction and another 8 underwent conservative treatment. pH-metry is a valuable method for postoperative assessment of cardia function even in very small newborns. If pathological results are disclosed, radiological examination is supplementary to diagnosis and therapeutic planning.-Thomas A. Angerpointner Gastric Trichobezoars-Sonographic and Computed Tomographic Appearance. B. Newman and B.R. Girdany. Pediatr Ra-
diol20:526-527. (August), 1990. The authors report two young females with gastric trichobezoars in whom ultrasound, computed tomography, and upper gastrointestinal contrast studies were performed. The authors highlight the importance of recognizing the distinctive appearance of a trichobezoar on sonography and computed tomography.--Prem Pun’
Swallowed Button Batteries: Is There a Consensus on Management? J.G.N. Stud@, I.P. Linehan, A.L. Ogilvie, et al. Gut 31867-870, (August), 1990.
Asymmetrical Nature of the Muscular Anatomy of the Infantile Pylorus: A Possible Consideration in Pyloromyotomy. D.,.T. Cuss and G. Bond. Br J Surg 77:919-921, (August), 1990.
A survey of members of the British Society of Gastroenterology was undertaken to assess current attitudes to treatment of swal-
Postmortem studies of the normal infantile pylorus demonstrated an asymmetrical structure with the mucosa protruding
627
ABSTRACTS
ing indicated a right paratracheal mass. At neck exploration a single large parathyroid gland that weighed 500 mg was removed. The patient’s discharge calcium level was 9.3 mg/dL. Pathology examination of the tissue showed parathyroid adenoma. Previous reports have documented the rare incidence of primary hyperparathyroidism in neonates and infants. In these patients, this is usually due to parathyroid hyperplasia, whereas adenomas predominate in childhood and adolescence. This report acknowledges that unilateral exploration and removal of the solitary parathyroid gland is not the customary treatment for hyperparathyroidism. However, contralateral exploration might have increased the chance for recurrent nerve damage and hypoparathyroidism, especially with the normal relationship of the thyroid and parathyroid glands absent in the case.-Thomas F. Tracy, Jr THORAX Surgical Treatment of Tracheomalacia and Bronchomalacia in Infants. C. Tsugawa, T. Muraji, E. Nishijima, et al. Jpn J Pediatr
Surg 22:87-92, (January), 1990. During the period 1980 to 1989, 20 patients with various symptoms of respiratory distress referred to as “dying spells” underwent surgical repair of tracheomalacia and/or bronchomalacia. Fourteen patients (aged 1 to 23 months) had aortopexy for tracheomalacia. Seven of these patients were associated with esophageal atresia and two with Campomelic syndrome. In 11 of the 14 patients, the results were satisfactory enough to allow removal of the endotracheal tubes. These patients have been free of respiratory symptoms. Six patients (aged 2 to 9 months) with bronchomalacia underwent external stenting of the bronchus and/or bronchial sleeve resection. which did not correct the collapse of the malacic bronchus. An alternative method of surgical treatment for bronchomalacia should be sought.-Tukeshi Miyuno Mediastinai Sequestration With Ectopic Pancreas. D. von Schweinitz, C. Wit&kind, and J. Freihorst. Z Kinderchir 45:249-250,
(August), 1990. A 5-year-old boy with chronic pneumonia of the upper left lobe of the lung is reported in whom a bronchoenteric sequestration with ectopic pancreas was found in the mediastinum. Reviewing the literature, different theories of this extremely rare anomaly are discussed.-Thomas A. Angerpointner ALIMENTARY
TRACT
Esophageal Atresia and Quality of Life. M. Lehner. Z Kinderchir
45:209-211, (August), 1990. Questionnaires on 122 children undergoing operation for esophageal atresia in several centers were studied in order to evaluate their quality of life. On the basis of this information, the author’s own cases, and study of the literature, it was observed that the early childhood of these children was burdened by operations, dilatation treatments, swallowing difficulties, and frequent bronchopulmonary infections. Usually, these problems improved during the first year of life. Later on, the quality of life can be regarded as good. Parental groups for self-help may play a central role, both for patients and parents.-ThomasA. Angerpointner
lowed button batteries so the results were not of the optimum treatment. Of the 312 cases suitable for analysis, over one third of doctors were not concerned about ingested button batteries despite the known dangers of heavy metal poisoning, which is more frequent than suspected. These doctors gave no treatment whereas a further 6% gave medical treatment, eg, antacids, emeretics, and, occasionally, laxatives if the battery was in small or large bowel. Nine percent did not know what to do. Almost 50% removed the batteries under certain circumstances. Of those who contemplated removal, 78% attempted removal if the battery was in the esophagus. Seventy-two percent removed the battery from the stomach and 48% from the duodenum, all within 24 hours of ingestion. The usual reason for removal was failure to progress. However, such progress is variable and the battery may pass through without problems. Removal was usually with a flexible endoscope and Dormier basket. When surgery was performed in one in whom endoscopic removal was not possible, the battery was found to be disintegrating.-Caroline Doig Esophageal Rupture Due to Air-Blast Injury in Children: Case Report and Review of the Literature. A.C. Basaklar. Z Kinder-
chir 45:2.57-259,(August), 1990. Perforation of the esophagus is a surgical emergency that is usually lethal if untreated and commonly fatal if treatment is delayed. The most common type of trauma causing esophageal perforation is a penetrating injury. Esophageal rupture due to external blunt trauma or air-blast injury is exceedingly rare. Such a case with esophageal rupture related to air-blast injury to the chest and upper abdomen in a 12-year-old boy is reported. Tube thoracostomy, gastrostomy, and feeding jejunostomy were established. Esophagogram taken on the 51st day showed complete closure of the esophageal leak. On follow-up, no stricture or swallowing problems were present.-ThomasA, Angerpointner Postoperative Assessment of Cardia Function in Newborns after Esophageal, Diaphragmatic and Abdominal Wall Defects. P. Schmittenbecher. Z Kinderchir 45:278-281, (October),
1990. Long-term pH-metry was used in 46 newborns after correction of esophageal atresia, diaphragmatic defects. and abdominal wall malformations to record postoperative cardia function. In 15 of 40 (37.5%) long-term pH-metries and 11 of 22 (50%) x-ray studies, pathological results were found. Consecutively, 8 children underwent operative correction and another 8 underwent conservative treatment. pH-metry is a valuable method for postoperative assessment of cardia function even in very small newborns. If pathological results are disclosed, radiological examination is supplementary to diagnosis and therapeutic planning.-Thomas A. Angerpointner Gastric Trichobezoars-Sonographic and Computed Tomographic Appearance. B. Newman and B.R. Girdany. Pediatr Ra-
diol20:526-527. (August), 1990. The authors report two young females with gastric trichobezoars in whom ultrasound, computed tomography, and upper gastrointestinal contrast studies were performed. The authors highlight the importance of recognizing the distinctive appearance of a trichobezoar on sonography and computed tomography.--Prem Pun’
Swallowed Button Batteries: Is There a Consensus on Management? J.G.N. Stud@, I.P. Linehan, A.L. Ogilvie, et al. Gut 31867-870, (August), 1990.
Asymmetrical Nature of the Muscular Anatomy of the Infantile Pylorus: A Possible Consideration in Pyloromyotomy. D.,.T. Cuss and G. Bond. Br J Surg 77:919-921, (August), 1990.
A survey of members of the British Society of Gastroenterology was undertaken to assess current attitudes to treatment of swal-
Postmortem studies of the normal infantile pylorus demonstrated an asymmetrical structure with the mucosa protruding