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Two cases of pyloric atresia
862
INTERNATIONAL ABSTRACTS
Unusual Case of Benign Tracheo-oesophageal Fistula. K. Mc-
Gastric Emptying in Children: Unusual Patterns Detected by Scin-
Nicholas and J. Stark. Thorax 39:311-312, (April), 1984.
tigraphy. J.J. Siebert, W.J. Byrne, and A.R. Euler. Am J Roentge-
This case report concerns a previously healthy 3 year old boy who developed an acute chest infection that failed to respond to 5 days of antibiotic therapy. Radiographs demonstrated a disc shaped foreign body just below clavicular level, probably ingested 3 weeks earlier. This proved to be a battery containing sodium hydroxide which leaked during endoscopic removal. Dysphagia, drooling, and a tracheo-oesophageal fistula, subsequently developed. The fistula was closed at operation one month later. Thereafter oesophageal dilatation was required on two occasions because of slight narrowing.-J.F.R. Bentley Gastroesophageal Reflux in Children: Results of a Standardized Fluoroscopic Approach. R.H. Cleveland, D.C. Kushner, and A.N.
Schwartz. Am J Roentgenol 141:53-56, (July), 1983. A retrospective study of 470 children (age 3 d-18 yr) undergoing barium UGI examinations revealed 305 to have gastroesophageal reflux (GER) with 238 of these being in the birth to 6 mo age group. The incidence of GER and mean number of episodes/5 min decreased with increasing age. Each group revealed significant differences in episodes/5 min in patients with symptoms of GER compared to asymptomatic patients. Of the 263 symptomatic patients 211 (80.2%) experienced at least one episode of reflux to the level of the cervical esophagus. An esophgeal "beak" (inverted cone at area of gastroesophageal junction) was demonstrated in 72 patients with 68 having GE reflux. The beak probably represents a small hiatal hernia. The authors conclude that GER can be demonstrated in a large number of children, that the incidence of GER decreases with age, that reflux to the cervical esophagus may occur in asymptomatic patients (22 of 36), and that fluoroscopy is a reliable study for GER but may be associated with a high falsepositive rate.--Randall W. Powell Fundoplication Enhances Gastric Emptying. G.J. Maddern and
G.G. Jamieson. Ann Surg 201:296-299, (March), 1985. Fundoplication of the stomach for gastroesophageal reflux is a common operative procedure although the mechanism of action is unclear. In an attempt to study gastric emptying after fundoplication, 21 patients between 19 and 72 yrs underwent gastric emptying studies before and 6 months after fundoplication. Both solid and liquid emptying rates were studied. In all patients, solid emptying was slower than liquid emptying and was characterized by a lag period followed by linear emptying. There was a significant decrease in the percentage of solid remaining at 100 minutes in the postoperative group compared with the preoperative group. The authors conclude that gastric emptying of both solids and liquids tends to be increased following fundoplication. This observation suggests a further mechanism for the efficacy of this operation in the treatment of gastroesophageal reflux.--Richard J. Andrassy Two Cases of Pyloric Atresia. A. Weitzel, P. GObel, and D. Roesner.
nol 141:49-51, (July), 1983. Gastric emptying times were determined by technitium--99m sulfur colloid scintigram in 41 infants (mean age 5.7 mo) and 8 children (9.1 yr). Normal emptying time was defined as a percentage of radionuclide emptied at 1 hour. For the infants it was 48% _+ 16% and for the children 51% _+7%. Five patients exhibited delayed emptying. Two patients were found to have pylorospasm and one an antral membrane. In 2 patients the duodenum lay partially over the stomach and resulted in an abnormal emptying pattern. The authors recommend this technique for determining gastric emptying due to its simplicity and reproducibility.--Randall W. Powell Radiographic Evaluation of Gastrostomy Complications. A. Vade, S.Z.H. JafrL F.P. Agha, et al. Am J Roentgenol 141:325-330, (August), 1983.
A retrospective review of 230 patients yielded 70 patients requiring radiographic studies due to clinically suspected complications of their gastrostomy tubes. Patients were divided into three groups by age: group 1, age 1 mo or less, 18 patients with 7 complications; group 2, age 1 mo-16 yr, 28 patients with 15 complications; group 3, 16 yr and older (to 80 yr), 24 patients with 8 complications. Complications in the group 1 patients included gastric obstruction (4), gastric ulceration (1), gastric perforation (1), and intraperitoneal displacement of the gastrostomy tube (1). The gastric obstructions resulted from pyloric stenosis (1), severe pylorospasm (1), and antral webs (2). Group 2 complications included gastric obstructions (4), gastric ulcer with perforation (1), distal displacement of the tube without obstruction (3), displacement of the tube into the distal esophagus (2), retraction of the tube into the anterior abdominal wall (2), a broken tip (1), and a leaking gastrostomy (1). The obstruction resulted from distal displacement of the tube in 2 patients, pylorospasm in one, and gastric torsion in another. Group 3 complications included gastric obstruction (3-distal tube migration, pylorospasm, and gastric torsion), gastric ulcer (2), distal placement (2), and partial retraction of the tube into the anterior abdominal wall resulting in gastric pneumatosis (2). Gastric torsion and gastric pneumatosis had not previously been reported as complications of gastrostomy.--Randall W. Powell Gastrointestinal Complications in Children with Hemolytic Uremic
Syndrome. J. Karcz, M. Uszycka-Karcz, and R. Gross. Z Kinderchir 39:373-375, (December), 1984. Eight children out of 106 with hemolytic uremic syndrome presented with severe gastrointestinal complications. The complications were closely associated with multiple erosions of the mucosa and ulcerations of the intestinal wall due to thrombotic and necrotic processes. Two cases perforated and two others developed intestinal intussusception. These 4 children were the only ones who underwent operation and all died. Laparotomy in hemolytic uremic syndrome carries a poor prognosis.--Thomas A. Angerpointner
Z Kinderchir 39:396-397, (December), 1984. Pyloric atresia is a relatively rare congenital malformation. The authors report on two newborns with pyloric atresia, one of whom had a long and the other a short atretic segment. The first patient was operated upon in 1962 and underwent isoperistaltic gastroenterostomy. In the second patient pyloroplasty was performed. The surgical PrOcedure depends on the length of the atretic segment, and where the segment is long the authors today would suggest gastroduodenostomy (Billroth I) rather than gastroenterostomy.-Thomas A. Angerpointner
Transient Bacteriemia and Sepsis Following Rectal Suction Biopsy.
M. SchwObel, R. Seger, and P. H~ger. Z Kinderchir 39:386-388, (December), 1984. Histoehemical investigation of rectal suction biopsies is the method of choice in the diagnosis of Hirschsprung's disease. Reports on complications are rare and involve bleeding or perforation in most instances. The authors report on a newborn who developed E. coil sepsis following rectal suction biopsy. Thereafter, 9 children who had to undergo rectal suction biopsy were investigated prospectively for
INTERNATIONAL ABSTRACTS
Unusual Case of Benign Tracheo-oesophageal Fistula. K. Mc-
Gastric Emptying in Children: Unusual Patterns Detected by Scin-
Nicholas and J. Stark. Thorax 39:311-312, (April), 1984.
tigraphy. J.J. Siebert, W.J. Byrne, and A.R. Euler. Am J Roentge-
This case report concerns a previously healthy 3 year old boy who developed an acute chest infection that failed to respond to 5 days of antibiotic therapy. Radiographs demonstrated a disc shaped foreign body just below clavicular level, probably ingested 3 weeks earlier. This proved to be a battery containing sodium hydroxide which leaked during endoscopic removal. Dysphagia, drooling, and a tracheo-oesophageal fistula, subsequently developed. The fistula was closed at operation one month later. Thereafter oesophageal dilatation was required on two occasions because of slight narrowing.-J.F.R. Bentley Gastroesophageal Reflux in Children: Results of a Standardized Fluoroscopic Approach. R.H. Cleveland, D.C. Kushner, and A.N.
Schwartz. Am J Roentgenol 141:53-56, (July), 1983. A retrospective study of 470 children (age 3 d-18 yr) undergoing barium UGI examinations revealed 305 to have gastroesophageal reflux (GER) with 238 of these being in the birth to 6 mo age group. The incidence of GER and mean number of episodes/5 min decreased with increasing age. Each group revealed significant differences in episodes/5 min in patients with symptoms of GER compared to asymptomatic patients. Of the 263 symptomatic patients 211 (80.2%) experienced at least one episode of reflux to the level of the cervical esophagus. An esophgeal "beak" (inverted cone at area of gastroesophageal junction) was demonstrated in 72 patients with 68 having GE reflux. The beak probably represents a small hiatal hernia. The authors conclude that GER can be demonstrated in a large number of children, that the incidence of GER decreases with age, that reflux to the cervical esophagus may occur in asymptomatic patients (22 of 36), and that fluoroscopy is a reliable study for GER but may be associated with a high falsepositive rate.--Randall W. Powell Fundoplication Enhances Gastric Emptying. G.J. Maddern and
G.G. Jamieson. Ann Surg 201:296-299, (March), 1985. Fundoplication of the stomach for gastroesophageal reflux is a common operative procedure although the mechanism of action is unclear. In an attempt to study gastric emptying after fundoplication, 21 patients between 19 and 72 yrs underwent gastric emptying studies before and 6 months after fundoplication. Both solid and liquid emptying rates were studied. In all patients, solid emptying was slower than liquid emptying and was characterized by a lag period followed by linear emptying. There was a significant decrease in the percentage of solid remaining at 100 minutes in the postoperative group compared with the preoperative group. The authors conclude that gastric emptying of both solids and liquids tends to be increased following fundoplication. This observation suggests a further mechanism for the efficacy of this operation in the treatment of gastroesophageal reflux.--Richard J. Andrassy Two Cases of Pyloric Atresia. A. Weitzel, P. GObel, and D. Roesner.
nol 141:49-51, (July), 1983. Gastric emptying times were determined by technitium--99m sulfur colloid scintigram in 41 infants (mean age 5.7 mo) and 8 children (9.1 yr). Normal emptying time was defined as a percentage of radionuclide emptied at 1 hour. For the infants it was 48% _+ 16% and for the children 51% _+7%. Five patients exhibited delayed emptying. Two patients were found to have pylorospasm and one an antral membrane. In 2 patients the duodenum lay partially over the stomach and resulted in an abnormal emptying pattern. The authors recommend this technique for determining gastric emptying due to its simplicity and reproducibility.--Randall W. Powell Radiographic Evaluation of Gastrostomy Complications. A. Vade, S.Z.H. JafrL F.P. Agha, et al. Am J Roentgenol 141:325-330, (August), 1983.
A retrospective review of 230 patients yielded 70 patients requiring radiographic studies due to clinically suspected complications of their gastrostomy tubes. Patients were divided into three groups by age: group 1, age 1 mo or less, 18 patients with 7 complications; group 2, age 1 mo-16 yr, 28 patients with 15 complications; group 3, 16 yr and older (to 80 yr), 24 patients with 8 complications. Complications in the group 1 patients included gastric obstruction (4), gastric ulceration (1), gastric perforation (1), and intraperitoneal displacement of the gastrostomy tube (1). The gastric obstructions resulted from pyloric stenosis (1), severe pylorospasm (1), and antral webs (2). Group 2 complications included gastric obstructions (4), gastric ulcer with perforation (1), distal displacement of the tube without obstruction (3), displacement of the tube into the distal esophagus (2), retraction of the tube into the anterior abdominal wall (2), a broken tip (1), and a leaking gastrostomy (1). The obstruction resulted from distal displacement of the tube in 2 patients, pylorospasm in one, and gastric torsion in another. Group 3 complications included gastric obstruction (3-distal tube migration, pylorospasm, and gastric torsion), gastric ulcer (2), distal placement (2), and partial retraction of the tube into the anterior abdominal wall resulting in gastric pneumatosis (2). Gastric torsion and gastric pneumatosis had not previously been reported as complications of gastrostomy.--Randall W. Powell Gastrointestinal Complications in Children with Hemolytic Uremic
Syndrome. J. Karcz, M. Uszycka-Karcz, and R. Gross. Z Kinderchir 39:373-375, (December), 1984. Eight children out of 106 with hemolytic uremic syndrome presented with severe gastrointestinal complications. The complications were closely associated with multiple erosions of the mucosa and ulcerations of the intestinal wall due to thrombotic and necrotic processes. Two cases perforated and two others developed intestinal intussusception. These 4 children were the only ones who underwent operation and all died. Laparotomy in hemolytic uremic syndrome carries a poor prognosis.--Thomas A. Angerpointner
Z Kinderchir 39:396-397, (December), 1984. Pyloric atresia is a relatively rare congenital malformation. The authors report on two newborns with pyloric atresia, one of whom had a long and the other a short atretic segment. The first patient was operated upon in 1962 and underwent isoperistaltic gastroenterostomy. In the second patient pyloroplasty was performed. The surgical PrOcedure depends on the length of the atretic segment, and where the segment is long the authors today would suggest gastroduodenostomy (Billroth I) rather than gastroenterostomy.-Thomas A. Angerpointner
Transient Bacteriemia and Sepsis Following Rectal Suction Biopsy.
M. SchwObel, R. Seger, and P. H~ger. Z Kinderchir 39:386-388, (December), 1984. Histoehemical investigation of rectal suction biopsies is the method of choice in the diagnosis of Hirschsprung's disease. Reports on complications are rare and involve bleeding or perforation in most instances. The authors report on a newborn who developed E. coil sepsis following rectal suction biopsy. Thereafter, 9 children who had to undergo rectal suction biopsy were investigated prospectively for