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Vitelline duct anomalies
INTERNATIONAL ABSTRACTS
Vitelline Duct Anomalies. D.W. Vane, E.W. West, J.L. Grosfeld, et al. Arch Surg 122:542-547, (May), 1987. During a 16-year period 217 infants and children were observed to have vitelline duct anomalies, ranging in age from less than 1 month to 18 years. The male-to-female ratio was 2:1. Eighty-five children with symptomatic lesions underwent laparotomy. Forty-eight patients presented with rectal bleeding; 28 with intestinal obstruction; five with abdominal pain; four with bilious umbilical drainage. An asymptomatic Meckel's diverticulum was discovered incidentally at laparotomy in 132 children. Surgical management included bowel resection (24), diverticulectomy (189), and excision of a patent vitelline duct (4). Ectopic gastric mucosa was present in all 48 patients with bleeding, in four of five with inflammation, but in only two asymptomatic specimens. More than one third of the cases were symptomatic and presented in younger patients, which suggests that elective resection of asymptomatic remnants in early childhood is reasonable when discovered incidentally during laparotomy for other conditions.--George A. Rowe Prenatal Intussusception of a Vitello-lntestinal Duct With Association With Ileal Atresia. N. McMullin, S. W. Beasley, and J.H. Kelly.
Pediatr Surg Internat 2:122-123, (March), 1987. A complication of patent vitello-intestinal ducts is intussusception producing a double-horned prolapse of small bowel through the duct. The authors report a previously undescribed varient where prolapse occurred prenatally and resulted in complete atresia of the distal horn as far as the transverse colon.--Prem Purl Peutz-Jeghers Syndrome: A Clinical Study of a Large Family in Two Generations. N. G~trses and N. Gi~rses. Z Kinderchir 41:364-
368, (December), 1986. Peutz-Jeghers syndrome was detected in ten out of 15 family members in two generations. One family member had to undergo repeat small bowel surgery. Rectal bleeding dominated the clinical picture in two patients. Five family members had small bowel polyps; five siblings had polyps in the colon. A colonic polyp was also found in one patient with small bowel polyps. Four of the ten affected family members had mucocutaneous pigmentation. One patient died in the early postoperative period.--Thomas A. ,4ngerpointner The Treatment of Complicated Appendicitis in Children. S.R. Elmore, ,4. W. Dibbons, M. R. Curci, et al. Arch Surg 122:424-425, (April), 1987.
One hundred fourteen children with complicated appendicitis were managed over 9 years: 26 had gangrene, 78 had perforation, and ten had perforations with well-developed abscesses. Treatment of gangrenous and perforated appendicitis consisted of giving ampicillin sodium, gentamicin sulfate, and clindamycin phosphate. Appendectomy and saline irrigation were also performed. Skin and subcutaneous tissues were left open for delayed primary closure. Perforations with well-developed abscesses were treated with triple antibiotic therapy and interval appendectomy. There were no wound infections or deaths. There was one intra-abdominal abscess. The rate of infectious complications was 0.9% and overall morbidity was 4.4%.--George `4. Rowe
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control subjects (2%). Yersiniosis occurred in 31% of patients with acute appendicitis. Acute-phase serum samples only, obtained in a further 307 patients, yielded a falsely low frequency of yersiniosis (4%). Y pseudotuberculosis was five times more common than Y enterocolitica, and Y pseudotuberculosis type IV was the most common serotype, accounting for 43% of Yersinia infections. Yersinia may play a more important part in the etiology of acute abdominal pain, and particularly acute appendicitis, than has been appreciated previously. Antibody titers to both Yenterocolitis and Y pseudotuberculosis frequently rise late in infections causing abdominal pain. Consequently, analysis of acute-phase serum samples alone leads to underdiagnosis of yersiniosis.--Prem Purl Surgery for Necrotizing Enterocolitis. J.F.R. Robertson, ,4.F.
,4zmy, andD.G. Young. Br J Surg 74:387-389, (May), 1987. A 13-year experience of surgery for necrotizing enterocolitis (NEC) is reported. Of 102 patients with NEC, 32 were operated on. The majority of patients presented in the first week of life, 60.7% with perforation. There was no detectable pattern in the organisms isolated from numerous cultures. The most common operative procedure was percutaneous peritoneal catheter drainage performed in 13 very low birth infants with a 23% mortality. Six did not require further surgery. Six of eight patients undergoing intestinal diversion alone died, but only two of ten died following intestinal resection and diversion. All four survived following resection and primary anastomosis, which is only recommended for selective cases. Twelve patients (32%) developed intestinal strictures between 1 month and 1 year following acute onset. No problems were encountered with short bowel syndrome. N.P. Madden Enhanced Urinary Immunoreactive Thromboxane in Neonatal Necrotizing Enterocolitis. P.E. Hyman, C.E. Abrams, and R.D.
Zipser. Am J Dis Child 141:686-689, (June), 1987. Urinary thromboxane B2 (TxB2) levels were measured in 11 premature infants with diagnosed neonatal necrotizing enterocolitis (NNEC). Comparison to results obtained in 14 healthy term infants, 39 healthy preterm infants, 18 sick preterm infants, 11 infants with documented heme-positive stools from benign causes, and seven infants treated for patent ductus arteriosus with indomethicin, these values demonstrated a statistically significant elevation in the infants with NNEC (P < .01). Urinary TxB2 levels rose coincident with development of signs of NNEC and paralleled the course of the disease. Infants with serious illnesses other than NEC had increased urinary TxB 2 levels but with lower values than those of infants with NEC. Decreased platelet counts in infants with NEC correlated inversely with urinary thromboxane and directly with urinary fl-thromboglobulin. This suggests that platelet consumption due to ischemic thrombosis is the source of enhanced thromboxane excretion. Because of this proposed mechanism, urinary TxB2 level measurement may be contributory to the diagnosis of NNEC, but cannot provide a premorbid diagnosis of incipient NNEC. The authors note that/3-thromboglobulin, a product of platelet activation, was also increased in the urine of infants with NNEC.--J.J. Tepas Total Colonic Aganglionosis: 30 Years" Experience. D.T. Cass and
N. Myers. Pediatr Surg Internat 2:68-75, (March), 1987. Yersinia Infection and Acute Abdominal Pain. S.E.A. Attwood,
M.T. Cafferkey, A.B. West, et al. Lancet I:529-533, (March), 1987. In 194 patients presenting with acute abdominal pain from whom sequential serum samples were taken, the frequency of yersiniosis, established serologically, was significantly higher (23%) than in 320
Thirty-two patients with total colonic aganglionosis (TCA) were seen in 30 years, representing 10% of the total number with aganglionosis seen during that period (1954 to 1983). The mortality rate was 45%, but has shown a progressive decrease from 82% in the first decade to 9% in the last. The improvement is specifically related to earlier diagnosis, control of sepsis, and the use of parenteral
Vitelline Duct Anomalies. D.W. Vane, E.W. West, J.L. Grosfeld, et al. Arch Surg 122:542-547, (May), 1987. During a 16-year period 217 infants and children were observed to have vitelline duct anomalies, ranging in age from less than 1 month to 18 years. The male-to-female ratio was 2:1. Eighty-five children with symptomatic lesions underwent laparotomy. Forty-eight patients presented with rectal bleeding; 28 with intestinal obstruction; five with abdominal pain; four with bilious umbilical drainage. An asymptomatic Meckel's diverticulum was discovered incidentally at laparotomy in 132 children. Surgical management included bowel resection (24), diverticulectomy (189), and excision of a patent vitelline duct (4). Ectopic gastric mucosa was present in all 48 patients with bleeding, in four of five with inflammation, but in only two asymptomatic specimens. More than one third of the cases were symptomatic and presented in younger patients, which suggests that elective resection of asymptomatic remnants in early childhood is reasonable when discovered incidentally during laparotomy for other conditions.--George A. Rowe Prenatal Intussusception of a Vitello-lntestinal Duct With Association With Ileal Atresia. N. McMullin, S. W. Beasley, and J.H. Kelly.
Pediatr Surg Internat 2:122-123, (March), 1987. A complication of patent vitello-intestinal ducts is intussusception producing a double-horned prolapse of small bowel through the duct. The authors report a previously undescribed varient where prolapse occurred prenatally and resulted in complete atresia of the distal horn as far as the transverse colon.--Prem Purl Peutz-Jeghers Syndrome: A Clinical Study of a Large Family in Two Generations. N. G~trses and N. Gi~rses. Z Kinderchir 41:364-
368, (December), 1986. Peutz-Jeghers syndrome was detected in ten out of 15 family members in two generations. One family member had to undergo repeat small bowel surgery. Rectal bleeding dominated the clinical picture in two patients. Five family members had small bowel polyps; five siblings had polyps in the colon. A colonic polyp was also found in one patient with small bowel polyps. Four of the ten affected family members had mucocutaneous pigmentation. One patient died in the early postoperative period.--Thomas A. ,4ngerpointner The Treatment of Complicated Appendicitis in Children. S.R. Elmore, ,4. W. Dibbons, M. R. Curci, et al. Arch Surg 122:424-425, (April), 1987.
One hundred fourteen children with complicated appendicitis were managed over 9 years: 26 had gangrene, 78 had perforation, and ten had perforations with well-developed abscesses. Treatment of gangrenous and perforated appendicitis consisted of giving ampicillin sodium, gentamicin sulfate, and clindamycin phosphate. Appendectomy and saline irrigation were also performed. Skin and subcutaneous tissues were left open for delayed primary closure. Perforations with well-developed abscesses were treated with triple antibiotic therapy and interval appendectomy. There were no wound infections or deaths. There was one intra-abdominal abscess. The rate of infectious complications was 0.9% and overall morbidity was 4.4%.--George `4. Rowe
89
control subjects (2%). Yersiniosis occurred in 31% of patients with acute appendicitis. Acute-phase serum samples only, obtained in a further 307 patients, yielded a falsely low frequency of yersiniosis (4%). Y pseudotuberculosis was five times more common than Y enterocolitica, and Y pseudotuberculosis type IV was the most common serotype, accounting for 43% of Yersinia infections. Yersinia may play a more important part in the etiology of acute abdominal pain, and particularly acute appendicitis, than has been appreciated previously. Antibody titers to both Yenterocolitis and Y pseudotuberculosis frequently rise late in infections causing abdominal pain. Consequently, analysis of acute-phase serum samples alone leads to underdiagnosis of yersiniosis.--Prem Purl Surgery for Necrotizing Enterocolitis. J.F.R. Robertson, ,4.F.
,4zmy, andD.G. Young. Br J Surg 74:387-389, (May), 1987. A 13-year experience of surgery for necrotizing enterocolitis (NEC) is reported. Of 102 patients with NEC, 32 were operated on. The majority of patients presented in the first week of life, 60.7% with perforation. There was no detectable pattern in the organisms isolated from numerous cultures. The most common operative procedure was percutaneous peritoneal catheter drainage performed in 13 very low birth infants with a 23% mortality. Six did not require further surgery. Six of eight patients undergoing intestinal diversion alone died, but only two of ten died following intestinal resection and diversion. All four survived following resection and primary anastomosis, which is only recommended for selective cases. Twelve patients (32%) developed intestinal strictures between 1 month and 1 year following acute onset. No problems were encountered with short bowel syndrome. N.P. Madden Enhanced Urinary Immunoreactive Thromboxane in Neonatal Necrotizing Enterocolitis. P.E. Hyman, C.E. Abrams, and R.D.
Zipser. Am J Dis Child 141:686-689, (June), 1987. Urinary thromboxane B2 (TxB2) levels were measured in 11 premature infants with diagnosed neonatal necrotizing enterocolitis (NNEC). Comparison to results obtained in 14 healthy term infants, 39 healthy preterm infants, 18 sick preterm infants, 11 infants with documented heme-positive stools from benign causes, and seven infants treated for patent ductus arteriosus with indomethicin, these values demonstrated a statistically significant elevation in the infants with NNEC (P < .01). Urinary TxB2 levels rose coincident with development of signs of NNEC and paralleled the course of the disease. Infants with serious illnesses other than NEC had increased urinary TxB 2 levels but with lower values than those of infants with NEC. Decreased platelet counts in infants with NEC correlated inversely with urinary thromboxane and directly with urinary fl-thromboglobulin. This suggests that platelet consumption due to ischemic thrombosis is the source of enhanced thromboxane excretion. Because of this proposed mechanism, urinary TxB2 level measurement may be contributory to the diagnosis of NNEC, but cannot provide a premorbid diagnosis of incipient NNEC. The authors note that/3-thromboglobulin, a product of platelet activation, was also increased in the urine of infants with NNEC.--J.J. Tepas Total Colonic Aganglionosis: 30 Years" Experience. D.T. Cass and
N. Myers. Pediatr Surg Internat 2:68-75, (March), 1987. Yersinia Infection and Acute Abdominal Pain. S.E.A. Attwood,
M.T. Cafferkey, A.B. West, et al. Lancet I:529-533, (March), 1987. In 194 patients presenting with acute abdominal pain from whom sequential serum samples were taken, the frequency of yersiniosis, established serologically, was significantly higher (23%) than in 320
Thirty-two patients with total colonic aganglionosis (TCA) were seen in 30 years, representing 10% of the total number with aganglionosis seen during that period (1954 to 1983). The mortality rate was 45%, but has shown a progressive decrease from 82% in the first decade to 9% in the last. The improvement is specifically related to earlier diagnosis, control of sepsis, and the use of parenteral