- Email: [email protected]
Tubular duplication of the bowel: Use of technetium 99m pertechnetate in diagnosis
ABSTRACTS
103
followed by vomiting_ Physical findings include right upper quadrant tenderness with or without a mass. Associated injuries such as perforation of the duodenum or jejunum should be suspected if peritonitis is evident. Laboratory values show an elevated white blood cell count and a falling hematocrit. Contrast studies show the classic coiled spring appearance. In contrast to the report of operation on 5 of 7 patients with duodenal hematoma reported in 1969, treatment rendered in 5 of the 8 patients without perforation included only nasogastric suction and intravenous fluid administration for 3 10 days. All 8 patients survived and only 1 experienced a complication, a wound infection and a ventral hernia. The authors make a plea for a high index of suspicion of child abuse in patients presenting with duodenal hematoma. They also recommend nonoperative management of those patients without obvious perforated viscus in anticipation of resolution of the duodenal hematoma.--Carey P. Page
Malrotation of the Duodenum. Frequency in Radiographic Control Group. E. Gravgaard, S. Holm Mbller and D.
Andersen. Scand J Gastroenterol 12:585-588, 1977. In a prospective r a d i o g r a p h i c study, a b n o r m a l configurations with kinking and torsion (malrotation) of the duodenum were found in 41% of 150 non-dyspeptic subjects. Malrotation of the duodenum (MD) was more frequent before the age of 30, and in the entire series the frequency decreased significantly with age from approximately 60% at 20 yr to approximately 25% in individuals aged 35 yr or more. It should be considered whether the same radiographic configurations as in MD up to the age of 30 35 yr is merely due to incompleted disposition and fixation of the duodenum, so that the diagnosis of MD cannot be definitely established until after that age. In the presence of MD the luminal diameter of the duodenum was larger than normal, and there was a greater tendency to gastric retention at 4 hr after the barium meal. Peter Volsted Pedersen
Malrotation
of the Duodenum and Duodenal Ulcer.
E.
Gravgaard, S. Holm MOiler and D. Andersen. Scand J Gastroenterol 12:589-592, 1977. In 173 patients with surgically confirmed duodenal ulcer, malrotation of the duodenum (MD) was found in the preoperative radiographs in a total of 54%, without significant differences in the age and sex distribution. As compared with a control group, the frequency of MD was significantly increased in men and in patients over 50 yr. Gastric retention at 6 hr after the barium meal was more frequent in ulcer patients with MD than in those with normal duodenal configuration and in both groups more frequent than in the control group. At a follow-up examination at least 12 mo after the operation for duodenal ulcer, a significant tendency to a poorer result was revealed in patients with MD. This was manifested by persistent or postoperatively developed postcibal pain, fullness, nausea and vomiting, except in patients who had undergone parietal cell vagotomy without pyloroplasty. The latter observation suggests that in the presence of MD, preserved pyloric function is of significance in the frequency of subsequent manifest symptoms of this anomaly. Peter Volsted Pedersen
Celiac Disease Diagnosed by Means of Duodenoscol~y and Endoscopic Duodenal Biopsy. R. Gillberg and C. J4hren.
Scand J Gastroenterol 12:911-916, 1977. Nineteen patients with suspected celiac disease were examined by duodenoscopy and biopsy. In all patients, histopathology c o n s i s t e n t with celiac disease was demonstrated in endoscopic biopsies of the duodenal mucosa. Close-up views through the duodenoscope shows villous atrophy of the duodenal mucosa disappearing after a gluten-free diet. The authors find duodenoscopy combined with biopsy a reliable assessment of the mucosal changes in celiac disease.--Peter Volsted Pedersen Tubular Duplication of the Bowel: Use of Technetium 99 m Pertechnetate in Diagnosis. D. C. Hitch, B. Shandling, and
D. L. Gilday. Arch Dis Child 53:178 179 (February), 1978. A 4-yr-old male presented with colicky abdominal pain and melena. A technetium scan revealed increased activity in the area of the terminal ileum that increased with gastric activity, although it was not characteristic of a Meckel's diverticulum or cystic duplication of the bowel. At exploration, a 52-cm tubular duplication of the small bowel was resected.--Randall W. Powell Growth, Health, and Development After Neonatal Gut Surgery: A Long-Term Follow-Up. A. Tejani, B. Dobias, B. Nangia.
and R. Mahadeven. Pediatrics 61:685-693 (May), I978. Growth and development data on 19 children who survived gut surgery in the immediate newborn period are presented. Six were low birth weight infants. Twelve had varying degrees of intestinal resection. The follow-up period ranged from 7 mo to 7~/2yr. Growth delay, intellectual impairment, developmental disorders, and perceptuomotor difficulties were noted in infants who underwent gut resection. These deficiencies did not necessarily occur in the same patients. There was an inconsistent relationship between the total amount and anatomic location of bowel resected and these findings. Six patients had postsurgical hyperalimentation (three with gut resections). Although hyperalimentation improved their inhospital weight gain, children with short guts still developed either intellectual or growth impairment. Developmental and growth parameters should be followed serially on children undergoing gut resection in the neonatal period.--Daniel Thomas Experimental Studies on Fluid Pathophysiology in Small Intestinal Obstruction in the Rat. I. Effects of Intraluminal Hyperosmolality. II. Effects of Intraluminal Hyperosmolality and Simultaneous Intravenous Infusions. III. Effects of Intraluminal Iso-osmolality and Simultaneous Intravenous Infusions. IV. Effects of Intraluminal Hyperosmolality and Simultaneous Intravenous Infusions on Mucosal Micromorphology. L. Johnson, P. G. Lundquist, H. NordstrOm and G.
Nylander. Scand J Gastronenterol 13:49, 113, 235, 373, 1978. The rapid collection of intraluminal fluids in obstructional ileus could be a consequence of increasing osmolality of the intestinal contents caused by enzymatic breakdown. In male Sprague-Dawley rats a 50-cm loop of distal ileum was extraperitonealized and tubulated with polythene
103
followed by vomiting_ Physical findings include right upper quadrant tenderness with or without a mass. Associated injuries such as perforation of the duodenum or jejunum should be suspected if peritonitis is evident. Laboratory values show an elevated white blood cell count and a falling hematocrit. Contrast studies show the classic coiled spring appearance. In contrast to the report of operation on 5 of 7 patients with duodenal hematoma reported in 1969, treatment rendered in 5 of the 8 patients without perforation included only nasogastric suction and intravenous fluid administration for 3 10 days. All 8 patients survived and only 1 experienced a complication, a wound infection and a ventral hernia. The authors make a plea for a high index of suspicion of child abuse in patients presenting with duodenal hematoma. They also recommend nonoperative management of those patients without obvious perforated viscus in anticipation of resolution of the duodenal hematoma.--Carey P. Page
Malrotation of the Duodenum. Frequency in Radiographic Control Group. E. Gravgaard, S. Holm Mbller and D.
Andersen. Scand J Gastroenterol 12:585-588, 1977. In a prospective r a d i o g r a p h i c study, a b n o r m a l configurations with kinking and torsion (malrotation) of the duodenum were found in 41% of 150 non-dyspeptic subjects. Malrotation of the duodenum (MD) was more frequent before the age of 30, and in the entire series the frequency decreased significantly with age from approximately 60% at 20 yr to approximately 25% in individuals aged 35 yr or more. It should be considered whether the same radiographic configurations as in MD up to the age of 30 35 yr is merely due to incompleted disposition and fixation of the duodenum, so that the diagnosis of MD cannot be definitely established until after that age. In the presence of MD the luminal diameter of the duodenum was larger than normal, and there was a greater tendency to gastric retention at 4 hr after the barium meal. Peter Volsted Pedersen
Malrotation
of the Duodenum and Duodenal Ulcer.
E.
Gravgaard, S. Holm MOiler and D. Andersen. Scand J Gastroenterol 12:589-592, 1977. In 173 patients with surgically confirmed duodenal ulcer, malrotation of the duodenum (MD) was found in the preoperative radiographs in a total of 54%, without significant differences in the age and sex distribution. As compared with a control group, the frequency of MD was significantly increased in men and in patients over 50 yr. Gastric retention at 6 hr after the barium meal was more frequent in ulcer patients with MD than in those with normal duodenal configuration and in both groups more frequent than in the control group. At a follow-up examination at least 12 mo after the operation for duodenal ulcer, a significant tendency to a poorer result was revealed in patients with MD. This was manifested by persistent or postoperatively developed postcibal pain, fullness, nausea and vomiting, except in patients who had undergone parietal cell vagotomy without pyloroplasty. The latter observation suggests that in the presence of MD, preserved pyloric function is of significance in the frequency of subsequent manifest symptoms of this anomaly. Peter Volsted Pedersen
Celiac Disease Diagnosed by Means of Duodenoscol~y and Endoscopic Duodenal Biopsy. R. Gillberg and C. J4hren.
Scand J Gastroenterol 12:911-916, 1977. Nineteen patients with suspected celiac disease were examined by duodenoscopy and biopsy. In all patients, histopathology c o n s i s t e n t with celiac disease was demonstrated in endoscopic biopsies of the duodenal mucosa. Close-up views through the duodenoscope shows villous atrophy of the duodenal mucosa disappearing after a gluten-free diet. The authors find duodenoscopy combined with biopsy a reliable assessment of the mucosal changes in celiac disease.--Peter Volsted Pedersen Tubular Duplication of the Bowel: Use of Technetium 99 m Pertechnetate in Diagnosis. D. C. Hitch, B. Shandling, and
D. L. Gilday. Arch Dis Child 53:178 179 (February), 1978. A 4-yr-old male presented with colicky abdominal pain and melena. A technetium scan revealed increased activity in the area of the terminal ileum that increased with gastric activity, although it was not characteristic of a Meckel's diverticulum or cystic duplication of the bowel. At exploration, a 52-cm tubular duplication of the small bowel was resected.--Randall W. Powell Growth, Health, and Development After Neonatal Gut Surgery: A Long-Term Follow-Up. A. Tejani, B. Dobias, B. Nangia.
and R. Mahadeven. Pediatrics 61:685-693 (May), I978. Growth and development data on 19 children who survived gut surgery in the immediate newborn period are presented. Six were low birth weight infants. Twelve had varying degrees of intestinal resection. The follow-up period ranged from 7 mo to 7~/2yr. Growth delay, intellectual impairment, developmental disorders, and perceptuomotor difficulties were noted in infants who underwent gut resection. These deficiencies did not necessarily occur in the same patients. There was an inconsistent relationship between the total amount and anatomic location of bowel resected and these findings. Six patients had postsurgical hyperalimentation (three with gut resections). Although hyperalimentation improved their inhospital weight gain, children with short guts still developed either intellectual or growth impairment. Developmental and growth parameters should be followed serially on children undergoing gut resection in the neonatal period.--Daniel Thomas Experimental Studies on Fluid Pathophysiology in Small Intestinal Obstruction in the Rat. I. Effects of Intraluminal Hyperosmolality. II. Effects of Intraluminal Hyperosmolality and Simultaneous Intravenous Infusions. III. Effects of Intraluminal Iso-osmolality and Simultaneous Intravenous Infusions. IV. Effects of Intraluminal Hyperosmolality and Simultaneous Intravenous Infusions on Mucosal Micromorphology. L. Johnson, P. G. Lundquist, H. NordstrOm and G.
Nylander. Scand J Gastronenterol 13:49, 113, 235, 373, 1978. The rapid collection of intraluminal fluids in obstructional ileus could be a consequence of increasing osmolality of the intestinal contents caused by enzymatic breakdown. In male Sprague-Dawley rats a 50-cm loop of distal ileum was extraperitonealized and tubulated with polythene