Omphalocele—an appraisal of therapeutic approaches

Omphalocele—an appraisal of therapeutic approaches

400 not accompanied by a rectal polyp. Twelve (21%) of these patients had colotomies for excision of the polyps. In 48 (88%) the polyp was removed thr...

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400 not accompanied by a rectal polyp. Twelve (21%) of these patients had colotomies for excision of the polyps. In 48 (88%) the polyp was removed through the anus. The morbidity, complications, and mortality (1%) associated with colotomy are discussed. The authors conclude that juvenile polyps of the rectum and colon are benign lesions, thus far never associated with malignant polyps of malignancy. They shouid, therefore, be treated conservatively. When located at a level where intralumenal removal can be easily accomplished (rectum and rectosigmoid) this should be done. Colonic juvenile polyps should not be removed by colotomy in a patient with a documented juvenile polyp of the rectum. In the absence of a rectal polyp for biopsy laparotomy for removal of proximal colonic polyps is not recommended in the first decade of Iife. In the, second decade, multiple polyps and a familial history of multiple polyposis are indications for colotomy.-W. K. Sieber.

ABSTRACTS of ganglia causes absence of normal peristalsis, and the deficient myenteric innervation of the proximal bowel, results in a weak propulsive force.-l. E. S. Scott. RECTAL MYECTOMY FOR SHORT SEGMENT AGANGLIONIC MEGACOLON. K. D. Back-

witlkel, D. W. Oakley, and G. A. Tuffle. Surg. Gynec. Obstet. 109-113 (January) 1971.

The authors report on seven patients with short aganglionosis who were seen during the past 3 years. This included five males and two females who ranged in age from 2 to 7 years. Although only one child had constipation in the neonatal period, two had an onset of symptoms before 2 years of age and the remainder after that. A biopsy demonstrated the absence of ganglion cells in all patients. The operative procedure was accomplished according to the technique of Lynn except that no strip of muscle longer than 5 cm was excised. The strip was usually about 6.5 cm in width. There were no postoperative complications. HIST~CHEMISTRYAND ELECTION MICROSCOPY OF RECTUM AND COLON IN H~RSCI-ISPRUNG’S Not only was there dramatic improvement immediately after the operation, but all DISEASE. E. R. Howard and J. R. Garrett. patients with the exception of one have Proc. Roy. Sot. Med. 63: 1264-1266 (December) 1970. maintained regular daily evacuations. None have developed fecal soiling and one patient In an attempt to explain the different who had preoperative encopresis has been presenting manifestations of Hirschsprung’s completely relieved of this difficulty. Only disease, the uncoordinated contractions that two patients failed to show to reversal in occur in aganglionic bowel and the fact that the roentgenographic appearance of their disease of definite clinical improvement. in acquired aganglionosis, the bowel dilates, G. Holcomb, Jr. a detailed investigation of the distribution and character of autonomic nerves in bowel from 19 cases of Hirschsprung’s disease was ABDOMEN undertaken. OMPHALOCELE-AN APPRAISAL OF TXBIMAdrenergic nerves were examined by the PEUTIC APPROACHES.H. V. Firar. Surgery catecholamine fluorescence technique and 69:208-214 (February) 1971. cholinergic nerves by staining for cholineThis paper reviews the course of 54 sterase. Specimens were also examined by patients with gastroschisis and omphalocele electron microscopy. treated at the Red Cross War Memorial As compared with normal controls, it was Hospital, Cape Town, South Africa, since found that there were many more cholinergic 1957, analyzes the therapy and result obnerves than normal in the distal segments of tained, and presents the therapeutic approach aganglionic bowel and that the adrenergic now followed. nerves were distributed throughout the There were seven patients with gastromuscle layers. The authors suggest that the schisis; the remaining had omphaloceles of increased number of cholinergic nerves provarying sizes. Three of those with gastroduces strong uncoordinated contractions, and schisis survived (43%). Of those with omthe absence of the normal periganglionic arphaloceles, seven were not treated (these rangement of sympathetic- nerves- prevents effective relaxation. In addition, the absence died of other anomalies), I5 were treated

401

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nonoperatively with I4 survivors (93%), and 25 were treated by a primary surgical procedure (either skin coverage or complete one stage repair) with 16 survivors ( 64%). Seven of the nine deaths in operatively treated patients were due to excessive intraabdominal pressure. The author recommends that: cases with a small fascial defect ( 2 cm or less) may be treated surgically or nonoperatively. Surgical repair in such cases is one of “convenience.” Prematurity, associated illnesses, or other congenital abnormalities are indications for nonoperative treatment. Ruptured omphaloceles are treated by operative skin coverage or by Schuster’s method using prosthetic material. All cases with an intact sac and a fascial defect larger than 2 cm or with any portion of a solid viscus in the sac are treated nonoperatively. Intra-abdominal complications are an indication for surgical treatment at any time. All babies admitted to the hospital with an omphalocele should have a blood sugar determination. HyPoglycemia and macroglossia with omphalocele is a treatable syndrome.-W. K. Sieber.

findings include the demonstration of contrast within the peritoneal cavity, including the recesses of the cavity, contrast outlining visceral margins or between loops of bowel. Wounds near the hemidiaphragms may enter both major body cavities. Contrast injected may enter both, or just one, and the investigator must be aware of this possibility. Wounds of the flank may also be investigated by this method. The average expectancy of negative findings in series where all stab wound patients undergo laparotomy range from 10-61X; ( average 37%) . At John Hopkins Hospital approximately 250 patients were investigated, using the contrast technique, since 1967. Approximately 60% avoided surgery because they were easily and readily categorized as “superficial wound patients” thus demonstrating the advantages of the technique.-W. L. Schey.

CONTRAST EXAMINATION OF ABWMINAL STAB WOUNDS. J. W. Bowermun and W.

The author discusses the applicability of supersonic tomography in abdominal affections in childhood (34 children, 1 to 13 years of age). By means of the twodimensional procedure (B scan) one may delineate in a two-dimensional manner whole cross sections of the body by registration of all bccurring echo signals of the region ex&mined. Normal and pathological smooth tissue structures of different density can separately be delineated with regard to reflexion characters, site, and extension. The recognition of specific pathological reflexion characters may effectively be completed by the one-dimensional registration technique (A scope), especially for differentiation of cystic structures and compact turnours. The author was able to demonstrate the efficiency of the method in the diagnosis of oncologic and traumatic abdominal affections in childhood.-A. Zimmermann and M. Better.

Smithwick, (December)

I& Radiology 1970.

97:619-624

A radiologic method for evaluating stab wounds of the abdomen was described in 196!j by Cornell, Ebert, and Zuidema. A number of these cases were investigated at the John Hopkins Hospital. These and a number of cases from the literature are reviewed in order to evaluate the value of the procedure. The method is applied to all patients with abdominal stab wounds excluding those with frank signs of peritoneal injury (shock, evisceration, hemorrhage). A 60-80 mm holes of sodium diatrizoate or methylglucamine is normally injected through a No. 14-18 French rubber catheter which is fixed to the abdominal wall by a purse-string suture. Films are obtained in anteroposterior, cross-table lateral, and upright positions 3 to 5 min after injection. Film interpretation falls into “negative” Or “positive” categories. “Negative” infers no contrast can be noted in the peritoneal cavity and the absence of contrast is simple to evaluate, “Positive”

SUPERSONICTOM~CRAPHY

OF

IN CHILDHOOD. R. Hiinig.

Acta, suppl. XXIV: 3-22,

THE ABDOMEN

Helv. Paediat. 1970.

ASC~TES IN CHILDREN. R. Ed. Sanchez, G. H. Mahour, L. P. Brennan, and M. M. Woolley. Surgery 69:183-188 (February) 1971.

CWIDUS

This report,

based

on seven

cases seen