International Abstracts 1215

post-burn food ingestion leads to food impaction and colonisation

because of mucosal injury and failure of peristalsis, and increases the

inflammatory reaction and collagen production. Therefore, they gave

nothing by mouth in more severe burns for at least one week. The

stricture rate was 17% of all grade 2 and 3 burns, and no dilatation was

necessary for more than one year. Whether the authorsT main goal of

keeping the oesophagus as clean as possible really decreases the

inflammatory reaction is still unanswered, and further studies are needed

to prove this thesis.—Peter Schmittenbecher

Duplication cyst of the stomach presenting as hemoptysisMenon P, Rao KLN, Saxena AK. Eur J Pediatr Surg 2004 (December);

14:429-431.

The authors report a rare case of a 2-year-old boywith gastric duplication cyst

located in the stomach, presenting with vague abdominal pain, recurrent

cough, hemoptysis and a lesion in the left lung reported as lung sequestration.

The duplication cyst was attached to the diaphragm and lung by a narrow

canal. The cyst was excised. Subsequent scans showed regression of the lung

lesion. It is believed that this is the first case in the literature where

hemoptysis was cured and the lung lesion regressed completely after excision

of the duplication cyst of the stomach alone. Pulmonary resection was

avoided thereby.—Thomas A. Angerpointner

Appendico-gastrostomy: a new technique for long-term feedingMohta A. Aust N Z J Surg 2004 (September);74:799-800.

The author reports a new surgical technique for facilitating gastrostomy

feeding, using the appendix as a conduit in those children with malrotation

in which the appendix lay close to the stomach. The author performed the

surgery open via a left subcostal incision. The appendix was mobilised on

its vascular pedicle, a 6-8 Fr feeding tube passed through the appendix and

the distal end anastomosed to the anterior wall of the stomach. The body of

the appendix was then buried over a length of 2-3 cm in the seromuscular

layer of the stomach wall, which was closed with an absorbable suture, to

create a valve mechanism. The proximal end of the appendix was then

passed through the anterior abdominal wall through a separate incision,

completing the appendico-gastrostomy.

The author claims several advantages of this technique over other

methods of surgical gastrostomy, including no reduction in gastric capacity,

a continent stoma, reduced risk of gastro-oesophageal reflux and impaired

gastric motility, and the potential for reduced operating time.

Comment: Evidence for the advantages associated with the technique

was not provided, nor an evaluation of the surgeon’s own experience. The

number of patients in whom this procedure could be applied would be

small. All would need to have been identified beforehand with a contrast

study to confirm malrotation or be subject to extensive mobilisation of the

right colon to facilitate the procedure.—A.J.A. Holland

Diverticulectomy is inadequate treatment for short Meckel’sdiverticulum with heterotopic mucosaVarcoe RL, Wong SW, Taylor CF, et al. Aust N Z J Surg 2004 (October);

74:869-872.

The authors retrospectively reviewed adult and paediatric patients that

had resection of a Meckel’s diverticulum (MD) between January 1992

and May 2003 at an adult and paediatric teaching hospital. They sought

to determine whether the resection technique should depend upon the

external appearance of the MD. The authors measured the length of the

resected MD and compared this to the width to obtain a height to

diameter ration (HDR), with a ratio of z2 considered dlongT.Overall, 77 patients between 1 day of age to 92 years (median 8 years)

had a MD resected, with a nearly 3:1 male to female ratio. A minority of

patients (n = 33, 43%), more commonly male and in the first decade of life,

were symptomatic; usually with diverticulitis or haemorrhage. A Meckel’s

scan was positive in only 2 out of 8 patients: in 7 of these patients heterotopic

gastric mucosa was present. The majority (62%) of patients had a limited

small bowel resection, with the remainder a diverticulectomy. Heterotopic

gastric mucosa was commoner in males (4:1) and in symptomatic MD.

Of those MD with gastric mucosa, there were 5 MD with a HDR of z2: in

all of these ectopic mucosa involved the tip or body of the MD only and

would have been completely resected by a diverticulectomy. In those MD

with a HDR of b2, the ectopic mucosa was variously located but in 60%

involved the base and would not have been completely resected by

diverticulectomy alone. Clinical assessment of dthickeningT of the MD at

time of operation was positive for gastric mucosa in only 54% of cases.

The authors concluded that MD likely to become symptomatic usually

did so within the first decade of life. The sensitivity of a Meckel’s scan was

low, severely limiting the predictive value of a negative study. A dlongTMD

could be safely resected diverticulectomy, as any gastric mucosa present

will not be located at the base. Conversely, a dshortT diverticulum should be

formally resected with a portion of small bowel to ensure complete removal

of any ectopic gastric mucosa present.

Comment: Although interesting, the value of this study was li-

mited by its retrospective nature. Patients in whom an MD was

found but not resected were excluded; the assessment of bthickening Qof an MD was based on comments made in operation records and

measurements on pathology reports of fixed rather than fresh

specimens.—A.J.A. Holland

Updated results on intestinal neuronal dysplasia (IND B)Meier-Ruge WA, Ammann K, Bruder E, et al. Eur J Pediatr Surg 2004

(December);14:384-391.

Intestinal neuronal dysplasia (IND B) is still a subject of controversy. The

aim of this paper was to review the present state of knowledge on IND B.

A summary is given of the technical and diagnostic criteria which have

to be considered to achieve a reliable diagnosis. The available thera-

peutic procedures are additionally discussed. Between 1992 and 2001,

3984 colonic mucosal biopsies from 1328 children were investigated. Nerve

cell staining was performed on native tissue sections: 15 lm thick cryostat

sections which, after spreading and drying, have a final thickness of 4-5 lm,

with dehydrogenase reactions. The biopsies were taken 8-10 cm above the

dentate line with a sufficient amount of submucosa. The criteria for IND B is

15-20% submucosa) giant ganglia with more than 8 nerve cells on 30

sections of a single biopsy. The diagnosis of IND B is quantitative.

A diagnosis of IND B was made in 51 Hirschsprung resections, and in

92 children with chronic constipation (6% and 2.3% incidence, respective-

ly). Up to the 14th year of life, most children with isolated IND B can be

treated conservatively due to the delayed maturation of the enteric nervous

system which is characteristic for IND B. Only children with additional

hypo-plastic hypoganglionosis were treated surgically. Children with HD

and IND B proximal to the aganglionosis often exhibited post-operative

disturbances of intestinal motility when a disseminated IND B was present.

Ganglioneuromatosis (MEN2B) must be clearly differentiated from IND B.

The clinical course in IND B depends on the extent of impaired bowel

innervation, the severity of motility affection and the coexistence of HD.

Conservative management of isolated IND B is possible in most children. In

individual cases, however, a transient enterostomy or segmental resection is

unavoidable.—Thomas A. Angerpointner

Incisional local anaesthesia versus placebo for pain relief afterappendectomy in children—a double-blinded controlledrandomised trialJensen SI, Andersen M, Nielsen J, et al. Eur J Pediatr Surg 2004

(December);14:410-413.

Incisional local anesthesia is widely used for postoperaive pain relief after

surgery. The authors present the results of a double-blinded and