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1672 International Abstract of Pediatric Surgery
Pyloric stenosis is a common cause of vomiting in infancy and is usually
treated with Ramstedt's pyloromyotomy. In this study, the authors reviewed
their experience with the circumumbilical incision with a particular
emphasis on the relation between postoperative emesis and postoperative
time to feeding.
The medical records of all patients undergoing pyloromyotomy for infantile
hypertrophic pyloric stenosis were reviewed retrospectively. The authors
were looking specifically at the postoperative time to initial feeds as a way to
minimize hospital stay. Five hundred thirteen patient records were available.
There were 44 males and 73 females (male-female ratio, 6:1). Median age at
operation was 40 days (range, 2-194 days). A positive family history was
obtained in 11.9%. Median duration of symptoms was 10 days (range, 1-60
days). There were 31 complications (6%) related to surgery. The average
postoperative emesis episodes was 1.9. The median postoperative hospital
stay was 2 days (range, 1-60 days). The average time to feeding was 20
hours (range, 1-69 hours).
Ramstedt's pyloromyotomy via circumumbilical approach has a low rate of
complications and is a safe and feasible method to treat pyloric stenosis. The
establishment of feeds soon after surgery minimizes the postoperative in-
hospital stay.—Thomas A. Angerpointner
doi:10.1016/j.jpedsurg.2011.04.072
Kikuchi-Fujimoto's disease mimicking acute appendicitisvan Rij S, Wright DM. Aust N Z J Surg 2010;80760-1
The authors' report a 10-year-old boy of Chinese origin who presented
with a clinical history and signs of acute appendicitis. At operation, the
appendix was normal, but an adjacent 2-cm necrotic mass was excised.
The patient made an uneventful recovery. Histopathologic examination
revealed Kikuchi-Fujimoto's disease or histiocytic necrotizing
lymphadenitis.
First reported in 1972, this typically benign, self-limiting condition generally
presents with tender cervical lymphadenopathy in association with a fever
and is more common in patients of Asian origin. It may be confused
histologically with lymphoma or systemic lupus erythematosus but very
rarely presents with abdominal signs and symptoms.—A.J.A. Holland
doi:10.1016/j.jpedsurg.2011.04.073
Skip segment Hirschsprung's disease: a systematic reviewO'Donnell AM, Puri P. Pediatr Surg Int 2010;26(11):1065-9
Hirschsprung's disease is characterized by the congenital absence of
ganglion cells beginning in the distal rectum and extending proximally
for varying distances. Zonal aganglionosis is a phenomenon involving a
zone of aganglionosis occurring within normally innervated intestine. “Skip
segment”Hirschsprung's disease (SSHD) involves a “skip area” of normally
ganglionated intestine, surrounded proximally and distally by aganglionosis.
Although Hirschsprung's disease is believed to be the result of incomplete
craniocaudal migration of neural crest-derived cells, the occurrence of
SSHD has no clear embryologic explanation. The aim of this study was to
perform a systematic review of SSHD, reported in the literature between
1954 and 2009, to determine the clinical characteristics of this rare entity and
its significance. The first reported case of SSHD was published in 1954. A
systematic review of SSHD cases in the literature, from 1954 to 2009, was
carried out using the electronic database “PubMed.” Detailed information
was recorded regarding the age, sex, presenting symptoms, and location of
the skip segment in each patient. Twenty-four cases of SSHD have been
reported in the literature to date. Eighteen (75%) of these cases were males,
and 6 (25%) of 24 were females. Of these, 22 (92%) of 24 were cases of total
colonic aganglionosis (TCA), and 2 (8%) of 24 were rectosigmoid
Hirschsprung's disease. Of the 22 TCA cases, 9 (41%) had a skip segment
in the transverse colon, 6 (27%) in the ascending colon, 2 (9%) in the cecum,
and 5 (23%) had multiple skip segments. In both rectosigmoid Hirsch-
sprung's disease cases, the skip segment was in the sigmoid colon. Overall,
the length of the skip segment was variable, with the entire transverse colon
ganglionated in some cases. Skip segment Hirschsprung's disease occurs
predominantly in patients with TCA. The existence of a skip area of
normally innervated colon in TCA may influence surgical management,
enabling surgeons to preserve and use the ganglionated skip area during
pull-through operations.—Federico G. Seifarth
doi:10.1016/j.jpedsurg.2011.04.074
Success of Malone's antegrade continence enema (MACE) from thepatients' perspectiveTiryaki S, Ergun O, Celik A, et al. Eur J Pediatr Surg 2010;20(6)
Fecal incontinence (FI) is s devastating problem for children. The failure of
optimal medical treatment may require further interventions such a
appendicocutaneostomy. The authors report on a patients' perspective of
the success of a Malone antegrade continence enema (ACE) procedure for FI.
The records of 32 patients who had undergone a MACE procedure were
reviewed. Patients and families were contacted, and telephone inquiries
were conducted to assess the overall success of the operation. The
questionnaire covered the concerns of patients/families about the stoma,
functional results, and changes in the patients' quality of life (QOL).
The indications for ACE stomas were meningomyelocele in 17 patients,
anorectal malformation in 8, Hirschsprung/NID in 3, spinal tumor in 3, and
traumatic spinal injury in 1.
Seven laparoscopic and 25 conventional operations were performed. The
vermiform appendix was used in 27 of the patients and a cecal flap was used
in 5. The most frequent complication was stenosis of the stoma orifice
observed in 14 patients. Eight patients responded to dilatations, whereas 6
patients required minor surgical revision. There were 2 perforations during
catheterization, and they required surgical repair of the conduit. Five
patients had mild leakage from the stoma, all of them had open ACE
procedures and required revision. Twenty-five patients could be reached by
telephone. Five of these children stopped using the stoma because of
previous perforation in 2 patients and stricture in 1. The remaining two
stopped using their stomas because “they did not like the idea of it.” Sixteen
patients are completely clean. Three patients have occasional soiling. Only
one patient was not satisfied with using the ACE stoma and stated that it did
not sufficiently improve her condition. Eight patients complained about the
duration of the enema (longer than 1 hour); however, 5 of them refuse to use
the stoma on a daily basis. All but one patients perceived a significant
improvement in their QOL. Mean QOL scores before and after the
procedure were 5.0 (2-0) and 11.5 (5-14), respectively. It is concluded that
ACE stomas provide a satisfactory improvement in patients' QOL. Stoma-
related complications are not uncommon.—Thomas A. Angerpointner
doi:10.1016/j.jpedsurg.2011.04.075