360 ABSTRACTS

jejunostomy in Roux-Y fashion were carried out. Postopera- tive bile excretion was not noted and the patient died 86 days after the operation.--H. Suzuk i

Congenital Biliary Atrssia in Two Siblings. H. Saito et al. Jpn J Pediatr Surg 11:1387-1391, (November), 1979.

Two cases of congenital biliary atresia in siblings (both female) are reported. Type of atresia was "noncorrectable" and hepatic portoenterostomy was carried out in vain in both of them. HBs antigen and antibody were negative in both patients and their mother, but positive in the fa ther . - -H. S u z u k i

Portal Hypertension Secondary to Choledochal Cyst. L. W. Martin and G. A. Rowe. Ann Surg 190:638 639, (Novem- ber), 1979.

Two children are added to the literature who presented with portal hypertension caused by a compressing chole- doehal cyst. One child died prior to operation, and the other made an uneventful recovery after internal drainage of the cyst with a Roux-en-Y choledochocystojejunostomy. This article reconfirms the need for cyst drainage only with subsequent resolution of the portal hypertension.--Robert W. Feldtman

Demonstration of Traumatic Bile Leakage With Cholescin- tigraphy and Ultrasonography. H. S. Weissman, K. J. Chun, M. Frank, et al. Am J Roentgenol 133:843-847, (Novem- ber), 1979.

A 5-yr-old male developed low grade fever, leukocytosis, and right upper quadrant pain after being struck by a truck. Initial liver-spleen scan and ultrasound were normal. A repeat liver scan at day 29 revealed a defect in the right lobe and an ultrasound exam revealed two cystic masses. An HIDA choleseintogram revealed one of the cystic lesions to communicate with the biliary tree. The larger cyst was drained and the other resolved on serial scans. 99mTe HIDA choleseintigraphy presents a rapid, safe and physiologic approach to the diagnosis of posttraumatic or postoperative bile leaks.--Randall IV. Powell

Hepatic Artery Ligation. E. T. Mays, S. Conti, H. Fallah- zadeh, et al. Surgery 86:536-543, (October), 1979.

Hepatic artery ligation may be safely and reliably employed in the control of a variety of causes of bleeding from the liver. The authors describe eight patients in which hepatic artery ligation (HAL) was used: 3 had ruptured hepatic tumors, 1 had post partum liver rupture, 1 had delayed bleeding following trauma, l had hematobilia, 1 had an hepatic artery aneurysm, and 1 had hemorrhage following percutaneous liver biopsy. The technique includes initial control of the hepatoduodenal ligament, subsequent precise vascular occlusion of the appropriate portion of the hepatic arterial tree with subsequent ligation if hemorrhage is controlled. When occlusion does not control hemorrhage, intraoperative arteriography is performed to identify the pattern of arterial inflow. The authors favor HAL because of its simplicity and avoidance of serious complications which

may follow mass suturing, packing or resection. Postopera- tive care includes gastrointestinal arrest for seven to ten days to maintain portal oxygenation, intravenous hyperalimenta- tion to maintain serum proteins and glucose, and pulmonary, cardiac, and vascular support .--Eugene S. Wiener

Control of Massive Hepatic Bleeding by Ligation of Right Hepatic Artery. Y. Shapira, I. Kransna, J. Jersky. Harefuah 95:19-21, (July), 1978.

A 7-yr-old child was presented with massive bleeding from multiple deep lacerations of the right lobe of the liver as a result of blunt trauma. At operation orthodox methods of control were unsuccessful and as an alternative to major hepatic resection the right hepatic artery was ligated, with immediate control of the bleeding. Apart from a small temporary biliary fistula, the postoperative course was unev- e n t f u l . ~ h e m u e l Nissan

Torsion of the Spleen in a 51/2-mo-old Infant. D. Fried, A. Gotlieb, A. Hanukoglu; et al. Israel J Med Sci 15:35-37, 1979.

In this report, torsion of the spleen in a 51/z-too-old infant, thus far the youngest reported patient in the literature, is discussed. Celiac angiography and tuftsin determination confirmed the clinical impression that the pathology was confined to the spleen. The infant underwent a splenectomy and made an uneventful recovery.--Shemuel Nissan

Correction of Hyparsplenism Following Distal Splenorenal Shunt, J. Ferrara, E. C. Ellison, E. W. Martin, Jr., et al. Surgery 86:57(~573, (October), 1979.

The effect of distal splenorenal shunt on hypersplenism in 47 patients was studied. Of 16 with leukopenia, 11 had normal white counts after operation. Of 16 patients with thrombocytopenia, platelet counts returned to normal in 15. Long term follow-up demonstrated sustained improvement in leukocyte count in 4 of 7 (57%) patients and in platelet count in 7 of 9 (78%), thus hypersplenism is not a contraindication to distal splenorenal shunt . - -Eugene S. Wiener

Splenorrhaphy: Changing Concepts for the Traumatized Spleen. W. L. Buntain and H. B. Lynn. Surgery 86:748-760, (November), 1979.

An excellent historical review and description of operative techniques that have been and are being used to preserve the traumatized spleen. Clear illustrations are used to depict all previously described techniques including those of Dretzka in 1930, Campos Christo in 1965 and Mishalany in 1974. Two previously unreported methods are described by the authors: In one, large through and through horizontal mattress sutures of Dexon are threaded through a #20 spinal needle which has been passed through the spleen perpendicular to the plane of injury. The second method employs a preformed suture "ladder" that is tied around the spleen in such a way as to approximate the laceration(s) and restore normal splenic contour without direct needle suture t e c h n i q u e . - Eugene S. Wiener