uncommon in the pediatric population. Multiple localization and/or

extrathoracic recurrence of thymomas in children also appears to be rare,

with no recorded cases in the English literature. The authors report a case of

a 16-year-old girl where a mediastinal, benign thymoma was successfully

removed and recurrence appeared in the right fossa poplitea 3 years later.

Postoperative course was unventful.—Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2006.05.028

Alimentary tract

A technique to improve vascularity in colon replacement ofthe esophagusHadidi AT. Eur J Pediatr Surg 2006 (February);16/1:39 -44

The author presents a simple method to improve the results of colon

replacement of the esophagus in children with postcorrosive esophageal

stricture or long gap esophageal atresia. Technique: at gastrostomy operation,

the abdomen and colon are explored, and the segment of colon to be used

for replacement is chosen. The trunk of the middle colonic artery supplying

the transverse colon is ligated and divided proximally to the marginal artery,

or if another segment of the colon is chosen, the corresponding vessel is

ligated. Eleven children (6 boys and 5 girls) had their middle colonic

vessels ligated during gastrostomy operation. Five neonates had long gap

esophageal atresia with or without fistula. The other 6 children had long

segment esophageal stricture owing to swallowing caustic potash. The

interval between vascular ligation and replacement ranged from 1 to

3 months. One patient developed an anastomotic stenosis 2 months after

replacement, which had to be excised six months after colonic interposition.

There were no other complications. It is concluded that ligation of the

middle colonic vessels increases the blood supply to the transverse colon

through the left upper colonic and marginal vessels. This technique has

increased the success rate and minimized morbidity in colonic interposition.

Although the principle is commonly used in plastic surgery, it has never

been applied in intestinal surgery before.—Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2006.05.029

Prenatal diagnosis of gastric triplicationQueizan A, Hernandez F, Rivas S, et al. Eur J Pediatr Surg 2006

(February);16/1:52 -4

Duplications of the intestinal tract are rare malformations, and triplications

are even less common. Only 2 cases are found in the literature. The authors

describe a case of prenatal diagnosis of a gastric triplication and the surgical

treatment.—Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2006.05.030

Abdomen

Congenital dilatation of extrahepatic bile ducts in children.Experience in the Central Hospital of Hue, VietnamLe L, Pham A-V, Dessanti A. Eur J Pediatr Surg 2006 (February);

16/1:24 -7

The authors present a series of children with congenital dilatation of the

extrahepatic bile ducts. Thirty-eight children, aged 50 days to 15 years,

were treated surgically with a minimum follow-up of 1 year at the

Central Hospital in Hue, Vietnam. Diagnosis was based on ultrasound

only, which was accurate in 100% of the cases. According to Miyano’s

classification, 26 cases presented as cystic dilatation of the main bile

duct, associated with dilatation of the intrahepatic bile ducts, whereas in

the other 12 cases, the fusiform type was found. Surgical treatment

consisted of extensive excision of the dilatated extrahepatic bile ducts and

biliary drainage according to the Roux-en-Y method in 36 children. The

other 2 patients underwent surgery for internal biliary drainage without

removal of the cysts. On follow-up, 1 patient developed pancreatitis

secondary to excision of dilatated extrahepatic bile ducts, whereas the

2 patients with internal biliary drainage suffered from numerous attacks

of cholangitis. It is concluded that the reflux of bile in the dilatated

biliary tree plays an important role in the etiopathogenesis of congenital

dilatation of the extrahepatic bile ducts. Excision of the extrahepatic bile

ducts and biliary drainage by means of Roux-en-Y provides satisfactory

results.—Thomas A. Angerpointner

doi:10.1016/j.jpedsurg.2006.05.031

Current management of blunt splenic trauma in childrenThompson SR, Holland AJA. ANZ J Surg 2006 (January/February);

76:48-52

The authors have reviewed an Australian pediatric trauma center’s

experience in management of blunt splenic trauma. Demographic,

hemodynamic, imaging data pre and post discharge, and follow-up data

of 39 patients managed over an 8-year period were analyzed.

Most were boys. Falls and motor vehicle injuries accounted for 90% of

the injuries. Although computed tomography or ultrasound diagnosed the

injury in 35, in the remaining 4, it was diagnosed at laparotomy. Thirty-

three were managed nonoperatively. Six patients with splenic injury were

managed operatively—3 splenectomies for grade V injuries, 2 splenor-

rhaphies, and 1 incidental grade II splenic laceration noted during a

laparotomy for hollow viscus perforation. The authors noted a wide

variability among the surgeons in their institute with regard to intensive care

unit admission, length of stay, follow-up imaging, and advice regarding

restriction of activity.

This article again demonstrates the high efficacy achieved in pediatric

trauma centers for nonoperative management of blunt splenic trauma, not

only for isolated splenic injury but also in the multiply injured child. The

authors did not explain why 2 children had splenorrhaphies and also if any

of their patients were managed initially in an adult trauma centers. It is well

documented that the nonrepaired spleen regains wound healing strength in

6 weeks, although radiological resolution may take up to 90 days. Risk of

delayed rupture of spleen is very low (b2%). Surgery for splenic injuries

should be based on physiologic parameters rather than radiologic

appearance. As the authors have rightly noted, American Pediatric Surgery

Association guidelines have been validated in several studies, and

application of similar guidelines will confer uniformity in management

based on severity of injury and better use of resources. Although the authors

have not mentioned in their discussion, increasing experience in emboli-

zation of splenic injuries will further improve salvage of the severely

injured spleen.—Soundappan V.S. Soundappan

doi:10.1016/j.jpedsurg.2006.05.032

Incarcerated umbilical hernia in childrenChirdan LB, Uba AF, Kidmas AT. Eur J Pediatr Surg 2006 (February);16/

1:45 -8

Complications resulting from umbilical hernia are thought to be rare. The

authors report on 52 children, of whom 23 (44.2%) had incarceration.

Seventeen (32.7%) had acute incarceration, while 6 (11.5%) had

intermittent incarceration. Ages of children with acute incarceration ranged

from 3 to 15 years (median, 4 years), whereas the ages of those with

intermittent incarceration ranged from 3 to 15 years (median, 8.5 years).

There were 16 girls and 7 boys. Incarceration occurred in hernias of more

International Abstracts of Pediatric Surgery1630