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Treatment of acquired esophageal strictures in infants and children
391
ABSTRACTS
tier&s with acquired fistulae were operated upon by various techniques including quadruple ligation in six and arterial reconstruction in thirteen. Twenty-one of these patients are cured. Two patients were operated upon too recently for evaluation and two have been lost to followup. The authors emphasize the problems in managing congenital fistulae stressing difficulty in obtaining a cure when the fistula is not well localized and isolated. Proximal dilatation of the involved artery in congenital as well as acquired fistulae may indicate a permanently damaged arterial wall and a source of later aneurysm formation. The use of the Fogarty catheter to identify and control the fistula during operation is recommended by several of the discussers of this paper. Selected case reports emphasize problems in managing such cases. Despite the discouraging results of surgical treatment of congenital fistulae, discussers of this paper appear to favor aggressive and, if needed, repetitive surgery.-Willam K. Sieher ALIMENTARY
TRACT
TREATMENT OF ACQUIRED ESOPHAGEAL STRICTURES IN INFANTS AND CHILDREN. J. G. Kundert and R. Morger. Schweiz.
Med. Wschr.
100:273-280,
1970.
The authors describe the treatment of aquired strictures of the esophagus in infants and children by means of a guiding bougie inserted through a gastrostomy and pulled through the esophagus with a string swallowed from above. Dilating bougies with a screw attachment to the guiding bougie are then passed through the stricture (according to Rehbein). The string passing through nose and gastrostomy is left in place between dilatation sessions. The authors seem to be very satisfied with this method, but I was unable to find in the paper any figures on the number of cases treated that way. Four cases are fully discussed.-M. Bettex THE COMPLICATED PEPTIC ULCER IN INFANCY AND CHILDHOOD. H. Hartl. Wein.
klin. Wschr. 1969.
8 1: 945-948
In most cases the diagnosis
(December), is made only
when complications, such as bleeding, perforation or stenosis, occur. These complications necessitate surgery whereas in uncomplicated cases conservative treatment is indicated. Primary closure of a duodenal perforation might cause obstruction, so that a gastroenterostomy becomes necessary, as in one case described. In large ulcers of the posterior duodenal wall a small gastric resection might be indicated, as it was in two of the author’s cases. Hemorrhage occurs in 40 per cent of the cases but surgery should be employed only exceptionally and should consist of the smallest possible operation. Peptic ulcers and their complications are more common in Meckel’s diverticula and duplications of the alimentary tract. The author’s nine appropriate cases comprise five children with Meckel’s diverticula complicated by hemorrhage in four instances and perforation in one. In four cases gastric duplications were found, two of them with hemorrhage, one with perforation, and the fourth, an intrathoracic one, complicated by perforation and chronic bleeding. Surgery should be curative by resection of the duplication.-G. Brandesky LONG-TERM PROGNOSIS AFTER MAJOR RESECTION OF SMALL BOWEL IN EARLY INFANCY. W. F. Young, V. A. J. Swain and
E. M. Pringle. Arch. Dis. Child 44~46% 470, 1969. The progress of four children, each of whom had less than 100 cm. of small bowel remaining after resection for neonatal obstruction, is recorded. The children have reached three, four. nine and 10 years. Feeds during the early months of life were modified by reducing the fat, protein curd, and disaccharide content and replacing the caloric equivalent by predigested protein and monosaccharides. Minerals and vitamins were added. After the first few months on this modified diet the children were maintained on an easily assimilable high calorie and protein diet with restricted fats and multiple vitamin supplements high in folic acid. Their physical growth and development reached the normal range in all four cases but one child who had a long phase of undernutrition and growth retardation during infancy appears to be somewhat mentally retarded at nine years. Although the bowel function has apparently recov-
ABSTRACTS
tier&s with acquired fistulae were operated upon by various techniques including quadruple ligation in six and arterial reconstruction in thirteen. Twenty-one of these patients are cured. Two patients were operated upon too recently for evaluation and two have been lost to followup. The authors emphasize the problems in managing congenital fistulae stressing difficulty in obtaining a cure when the fistula is not well localized and isolated. Proximal dilatation of the involved artery in congenital as well as acquired fistulae may indicate a permanently damaged arterial wall and a source of later aneurysm formation. The use of the Fogarty catheter to identify and control the fistula during operation is recommended by several of the discussers of this paper. Selected case reports emphasize problems in managing such cases. Despite the discouraging results of surgical treatment of congenital fistulae, discussers of this paper appear to favor aggressive and, if needed, repetitive surgery.-Willam K. Sieher ALIMENTARY
TRACT
TREATMENT OF ACQUIRED ESOPHAGEAL STRICTURES IN INFANTS AND CHILDREN. J. G. Kundert and R. Morger. Schweiz.
Med. Wschr.
100:273-280,
1970.
The authors describe the treatment of aquired strictures of the esophagus in infants and children by means of a guiding bougie inserted through a gastrostomy and pulled through the esophagus with a string swallowed from above. Dilating bougies with a screw attachment to the guiding bougie are then passed through the stricture (according to Rehbein). The string passing through nose and gastrostomy is left in place between dilatation sessions. The authors seem to be very satisfied with this method, but I was unable to find in the paper any figures on the number of cases treated that way. Four cases are fully discussed.-M. Bettex THE COMPLICATED PEPTIC ULCER IN INFANCY AND CHILDHOOD. H. Hartl. Wein.
klin. Wschr. 1969.
8 1: 945-948
In most cases the diagnosis
(December), is made only
when complications, such as bleeding, perforation or stenosis, occur. These complications necessitate surgery whereas in uncomplicated cases conservative treatment is indicated. Primary closure of a duodenal perforation might cause obstruction, so that a gastroenterostomy becomes necessary, as in one case described. In large ulcers of the posterior duodenal wall a small gastric resection might be indicated, as it was in two of the author’s cases. Hemorrhage occurs in 40 per cent of the cases but surgery should be employed only exceptionally and should consist of the smallest possible operation. Peptic ulcers and their complications are more common in Meckel’s diverticula and duplications of the alimentary tract. The author’s nine appropriate cases comprise five children with Meckel’s diverticula complicated by hemorrhage in four instances and perforation in one. In four cases gastric duplications were found, two of them with hemorrhage, one with perforation, and the fourth, an intrathoracic one, complicated by perforation and chronic bleeding. Surgery should be curative by resection of the duplication.-G. Brandesky LONG-TERM PROGNOSIS AFTER MAJOR RESECTION OF SMALL BOWEL IN EARLY INFANCY. W. F. Young, V. A. J. Swain and
E. M. Pringle. Arch. Dis. Child 44~46% 470, 1969. The progress of four children, each of whom had less than 100 cm. of small bowel remaining after resection for neonatal obstruction, is recorded. The children have reached three, four. nine and 10 years. Feeds during the early months of life were modified by reducing the fat, protein curd, and disaccharide content and replacing the caloric equivalent by predigested protein and monosaccharides. Minerals and vitamins were added. After the first few months on this modified diet the children were maintained on an easily assimilable high calorie and protein diet with restricted fats and multiple vitamin supplements high in folic acid. Their physical growth and development reached the normal range in all four cases but one child who had a long phase of undernutrition and growth retardation during infancy appears to be somewhat mentally retarded at nine years. Although the bowel function has apparently recov-