Hirschsprung's disease with a long narrow segment

Hirschsprung's disease with a long narrow segment

126 INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY the atresia site with primary ileocolic anastomosis was carried out. In the remaining 8 infants, Mi...

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126

INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY

the atresia site with primary ileocolic anastomosis was carried out. In the remaining 8 infants, Mikulicz colostomy with subsequent closure of the enterotomy was performed. There were 3 deaths, 2 of which were related to malnutrition and sepsis and one from probable aspiration of gastric contents on the first postoperative day. There was one fecal fistula which was successfully treated. Colon atresia produces typical clinical manifestations of intestinal obstruction, but unfortunately is usually diagnosed late in a baby with more severe fluid and electrolyte imbalance. Barium enema is a useful diagnostic procedure. Resection and primary anastomosis is recommended for lesions proximal to the splenic flexure, and diverting transverse colostomy with subsequent resection and anastomosis is recommended for the distal lesions.-“. T. Cloud. HIRSCHSPRUNG’SDISEASE WITH A LONG NARROW SEGMENT. F. Rehbein, H. Halsband and S. Hofmann. Dtsch. Med. Wschr. 94:708-716,

1969. A long aganglionic segment was found in 27 of 265 children (10.3 per cent) with Hirschsprung’s disease, who were treated in the Children’s Surgical Clinic, Bremen, from 195 l-1967. In 16 cases long segments of the colon and in 11 cases the entire colon and various parts of the small intestine were aganglionic. Three of the 11 children suffering from total aganglionosis of the colon survived (27 per cent). One child died 4% years later due to cerebral causes. In the literature the mortality rate in cases with total aganglionosis of the colon is approximately 80 per cent. Altogether the authors found reports of about 100 cases with total aganglionosis of the colon. Because of diagnostic, therapeutic and prognostic differences, it is recommended that the long segment cases be divided into the above mentioned two groups: (1) aganglionosis of the entire colon and parts of the small bowel and (2) aganglionosis of part of the colon. Enterostomy above the aganglionic segment is always necessary. The postoperative treatment is more difficult and the prognosis worse the higher the enterostomy. However, once children have gotten past the critical period after an ileostomy has been made, no further difficulties are to be expected in the definite operation. The follow-up results of the surviving children are very good.H. Halsband. TREATMENT OF ANASTOMOTIC STRICTURE AFTER

SWENSON’S OPERATION FOR HIRSCHSPRUNG’S DISEASE. M. Jaubert de Beaujeu, P. Mallard and A. Campo-Paysaa. Ann. Chir. Inf. 10:

159-165, 1969. Anastomotic stricture is a very rare complication of Swenson’s procedure. The authors observed two cases in a series of 34 operations. As treatment they propose a submucosal resection of the stricture under cover of a temporary colostomy. Their 2 operations were successful.-M. Betten. MANAGEMENT OF THE NEWBORN WITH IMPERFORATE ANUS. R. Y Touloukian Pickett. Clin. Pediat. 8:389, 1969.

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Results of surgical care of 62 newborns with imperforate anus are summarized. This represents a 20-year study from Yale-New Haven Hospital. The nomenclature and embryology are discussed with specific differentiation between high and low anomalies. Forty-two patients had associated anomalies. The overall mortality rate was 30 per cent, with most of the deaths occurring either in untreated newborns or in infants with multiple other congenital defects. Patients without an external opening usually have a high type of imperforate anus, and defunctionalized colostomy is advised followed by a combined abdominoperineal pullthrough later on. In the newborn with low imperforate anus, anoplasty and cutback procedures proved successful, while dilations of perineal and vaginal fistulae did not give satisfactory results. . . The value of the upside-down lateral films of the pelvis in determining initial treatment is deemphasized, while x-rays of the chest, abdomen, spine and genitourinary tract are emphasized to detect associated anomalies. The functional results depend upon the “high or low” type of anomaly. Seven of 10 infants who had a perineal anoplasty for low anomaly showed good results. Poor functional results followed perineal anoplasty for high imperforate anus in 6 patients out of 12 (fair results in 4, good results in only 2). Better bowel function followed a combined abdominoperineal operation for high lesions. In 12 patients, 5 had good results, 6 had fair results and one had poor results. Close supervision of the postoperative patient is necessary to prevent and treat chronic fecal impaction--M. Gilbert. ABDOMEN THE USE OF CUTTING DIATHERMY IN LAPAROTOMY: TRANSECTION OF RECTUS ABDOMINIS.