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The management of pyocystitis following ilealconduit urinary diversion in children
ABSTRACTS
Pathohistological Study of the Extrahepatic Bile Duct of Uncorrectable Biliary Atresia, With Special Reference to its Etiology. T. Miyotoka, K. Suruga, H. Tsuchiya, and K. Suda. Jap J Pediatr Surg Med 8:198-202 (February), 1976.
Precise histologic studies was carried out on the papilla of Vater and the distal choledochus of 20 autopsied cases a n d extrahepatic bile duct remnants surgically removed from 28 patients with biliary atresia. A bile duct was found beside the pancreatic duct at the papilla of Vater in 13 of 20 cases examined. Histologic findings of the extrahepatic duct were variable from case to case and according to the portion of the extrahepatic bile duct in each case. Some showed a well-developed or hypoplastic bile duct and negligible inflammation, or a n u m b e r of tiny ductular structures and blood capillaries with marked cellular infiltration in the stoma, and others fibrosis without bile duct and cellular infiltration. It was speculated that the primary cause of biliary atresia m a y be congenital hypoplasia of extrahepatic bile duct which is followed by cholestasis a n d nonspecific inflammation resulting in complete o b s t r u c t i o n . - - M . Kasai
Combined Portal and Vena Caval Hypertension in Gaucher Disease: The Value of Preoperative Venography. K. E. Fellows, R. J. Grand, A. H. Colodny, E. N. Orsini, and A. C. Crocker. J Pediatr 87:739-743 (November), 1975.
Portal hypertension in G a u c h e r disease is unusual; the seventh known patient with this complication is reported. Prior to portacaval shunting in this child, a localized obstruction of the inferior vena cava at the subdiaphragmarie level was demonstrated by caval m a n o merry and inferior vena cavography. At autopsy, centrilobular hepatic fibrosis seemed to be responsible for the portal hypertension. N o d u l a r enlargement of the right and caudate lobes of the liver was the cause of the caval obstruction; elevated caval resistance m a y have contributed to the portal hypertension and possibly was responsible for failure of a portacaval anastomosis. The value of preoperative inferior vena cavography in addition to arterial portography in children with portal hypertension is stressed. The authors suggest that when caval hypertension greater than 10 cm of saline is found at any level, inferior vena cavography should be performed to identify the site of the obstruction.--George Holcomb
601
Neonatal Ascites From Spontaneous Rupture of the Bladder. J. McDonald and A. V. Murphy. Arch Dis Child 50:956-958 (December), 1975.
Two neonates who developed ascitis are presented. Radiologic investigation in each case demonstrated that the infants had rupture of the bladder. In one the abdominal cavity was drained and urinary tract drained by suprapubic catheterisation, while the second infant was drained perurethram and had abdominal paracentesis on two occasions. Both made uneventful recoveries. Neither p a t i e n t - - o n e male, one f e m a l e - - h a d any other definable urinary tract pathology.--D. G. Young GENITOURINARY
TRACT
A Case Report of Hygroma Kidney. G. Gopal. Ind. Pediatr 13:57-58 (January), 1976.
The patient was an 18-mo-otd boy with an abdominal mass which was shown to be a multilocular cystic mass of the left kidney. The author believes that h y g r o m a of the kidney, multilocular cystic kidney, hydrocele renalis, perirenal hydronephrosis, and peri or para renal cyst are synonymous.-- Vasant Talwalker
The Management of Pyocystitis Following Ileal Conduit Urinary Diversion in Children. Peter S. Stevens and Herbert B. Eckstein. Br J Urol 47:631633 (December), 1975.
The authors report 27 cases of pyocystis following ileal conduit urinary diversion in 113 patients between 1961 and 1973. There were 26 females and 1 male; all had myelomeningocele with neuropathic bladder and had had diversion for upper tract deterioration (14), incontinence (11), or uncontrolled urinary infection (1). Age at the time of diversion ranged from 6 mo to 11 yr and signs of pyocystis were evident within 3mo. All patients were initially treated by bladder irrigation with antiseptic or antibiotic solution once or twice weekly for 1 mo. Eleven patients responded to medical m a n a g e m e n t . O f those who did not respond despite frequent irrigations, 11 underwent cystectomy with negligible morbidity. Since 1973, five patients have undergone creation of a vaginal vesicostomy. There have been no complications using a modified Spence-Allen procedure and all have had a good response. Pyocystis and its m a n a g e m e n t is discussed and the authors r e c o m m e n d vaginovesicostomy as an alternative to cystectomy.--L. W. Mix
Pathohistological Study of the Extrahepatic Bile Duct of Uncorrectable Biliary Atresia, With Special Reference to its Etiology. T. Miyotoka, K. Suruga, H. Tsuchiya, and K. Suda. Jap J Pediatr Surg Med 8:198-202 (February), 1976.
Precise histologic studies was carried out on the papilla of Vater and the distal choledochus of 20 autopsied cases a n d extrahepatic bile duct remnants surgically removed from 28 patients with biliary atresia. A bile duct was found beside the pancreatic duct at the papilla of Vater in 13 of 20 cases examined. Histologic findings of the extrahepatic duct were variable from case to case and according to the portion of the extrahepatic bile duct in each case. Some showed a well-developed or hypoplastic bile duct and negligible inflammation, or a n u m b e r of tiny ductular structures and blood capillaries with marked cellular infiltration in the stoma, and others fibrosis without bile duct and cellular infiltration. It was speculated that the primary cause of biliary atresia m a y be congenital hypoplasia of extrahepatic bile duct which is followed by cholestasis a n d nonspecific inflammation resulting in complete o b s t r u c t i o n . - - M . Kasai
Combined Portal and Vena Caval Hypertension in Gaucher Disease: The Value of Preoperative Venography. K. E. Fellows, R. J. Grand, A. H. Colodny, E. N. Orsini, and A. C. Crocker. J Pediatr 87:739-743 (November), 1975.
Portal hypertension in G a u c h e r disease is unusual; the seventh known patient with this complication is reported. Prior to portacaval shunting in this child, a localized obstruction of the inferior vena cava at the subdiaphragmarie level was demonstrated by caval m a n o merry and inferior vena cavography. At autopsy, centrilobular hepatic fibrosis seemed to be responsible for the portal hypertension. N o d u l a r enlargement of the right and caudate lobes of the liver was the cause of the caval obstruction; elevated caval resistance m a y have contributed to the portal hypertension and possibly was responsible for failure of a portacaval anastomosis. The value of preoperative inferior vena cavography in addition to arterial portography in children with portal hypertension is stressed. The authors suggest that when caval hypertension greater than 10 cm of saline is found at any level, inferior vena cavography should be performed to identify the site of the obstruction.--George Holcomb
601
Neonatal Ascites From Spontaneous Rupture of the Bladder. J. McDonald and A. V. Murphy. Arch Dis Child 50:956-958 (December), 1975.
Two neonates who developed ascitis are presented. Radiologic investigation in each case demonstrated that the infants had rupture of the bladder. In one the abdominal cavity was drained and urinary tract drained by suprapubic catheterisation, while the second infant was drained perurethram and had abdominal paracentesis on two occasions. Both made uneventful recoveries. Neither p a t i e n t - - o n e male, one f e m a l e - - h a d any other definable urinary tract pathology.--D. G. Young GENITOURINARY
TRACT
A Case Report of Hygroma Kidney. G. Gopal. Ind. Pediatr 13:57-58 (January), 1976.
The patient was an 18-mo-otd boy with an abdominal mass which was shown to be a multilocular cystic mass of the left kidney. The author believes that h y g r o m a of the kidney, multilocular cystic kidney, hydrocele renalis, perirenal hydronephrosis, and peri or para renal cyst are synonymous.-- Vasant Talwalker
The Management of Pyocystitis Following Ileal Conduit Urinary Diversion in Children. Peter S. Stevens and Herbert B. Eckstein. Br J Urol 47:631633 (December), 1975.
The authors report 27 cases of pyocystis following ileal conduit urinary diversion in 113 patients between 1961 and 1973. There were 26 females and 1 male; all had myelomeningocele with neuropathic bladder and had had diversion for upper tract deterioration (14), incontinence (11), or uncontrolled urinary infection (1). Age at the time of diversion ranged from 6 mo to 11 yr and signs of pyocystis were evident within 3mo. All patients were initially treated by bladder irrigation with antiseptic or antibiotic solution once or twice weekly for 1 mo. Eleven patients responded to medical m a n a g e m e n t . O f those who did not respond despite frequent irrigations, 11 underwent cystectomy with negligible morbidity. Since 1973, five patients have undergone creation of a vaginal vesicostomy. There have been no complications using a modified Spence-Allen procedure and all have had a good response. Pyocystis and its m a n a g e m e n t is discussed and the authors r e c o m m e n d vaginovesicostomy as an alternative to cystectomy.--L. W. Mix