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