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PubMed1990

[The efficacy of the Childs-Phillips mesenteric plication in intestinal obstruction].

From 1975 to 1988 we studied and valued fourteen pediatric patients, treated in the Department of Pediatric Surgery at Children's Hospital La Paz, with the Childs-Phillips procedure by postoperative recurrent bowel obstruction. Ten newborn infants had the following diagnoses: intestinal atresia, 4; Bochdaleck hernia, 3; Hirschsprung disease, 2; intestinal rotation anomalies, 1. Four patients out of neonatal period had: hiatal hernia, 1; intussusception, 1; appendicitis, 2. Six patients had more than one episode of bowel obstruction. The follow-up was 6.5 years (range four months to 13 years), and no recurrent bowel obstruction occurred.

Child↗
PubMed1997

[Congenital atresia and stenosis of the intestine].

During the period between 1946 and 1996, 59 patients of intrinsic duodenal obstruction and 67 of intrinsic jejunoileal obstruction were treated in our institute. Analysis of data obtained from the patients revealed that the duodenal obstruction was the most successfully treated by diamond-shaped duodenoduodenostomy, jejunal obstruction by resection of the dilated oral blind end, tapering jejunoplasty and ileal obstruction by resection of the dilated blind end and anastomosis or ileostomy in case with peritonitis. Associated anomalies in duodenal obstruction, anastomotic malfunction and postoperative short bowel syndrome in jejunal obstruction and complicated peritonitis in ileal obstruction were the most effective as prognostic factors.

Duodenal Obstruction↗
PubMed1986

Ileal atresia and absence of appendix.

A case of ileal atresia with absence of vermiform appendix in a female newborn is reported. At the region about 105 cm from the Treitz's arch, intestinal atresia was observed with an associated V-shaped deformity of the mesentery. Polyp-like protuberance was observed in the area a few centimeters from the blind end of the distal intestine. Histologically, keratinizing squamous cells, bile pigments, lanugo hair, and alcian-blue stained materials and cells were observed in the serosal layer of the tip of the proximal blind segment and mesenterium connecting to this portion. Thrombi were not observed in the mesenterium connecting to the proximal blind segment, gap segment, and distal blind segment. Squamous cells and lanugo hair were found in the green meconium taken from the large intestine. Polyp-like protuberance was surfaced by normal intestinal mucosa, and in its inside there were two layers consisting of folded muscular tissue. In this report, we describe the detailed pathology of ileal atresia and discuss its possible cause.

Abnormalities, Multiple↗
PubMed1994

[Identical twins with different types of jejunal atresia].

This is a report of identical twins who were associated with different types of jejunal atresia, whose mother had no problems during her gestation. One was associated with a membranous atresia, and the another multiple jejunal atresia. Identical twins, both of whom are associated with intestinal atresia are very rare. The anomalies of these infants might be resulted from congenital factor and secondary circulatory disturbance.

Adult↗
PubMed1984

[Total parenteral nutrition in surgical treatment of infants: recent progress and problems].

The frequency of TPN in surgical infants was 242/686 (37.8%) in neonates and 260/2693 (9.7%) in older infants for the past 15 years. The frequent indications of TPN were intestinal atresia, Hirschsprung's disease and esophageal atresia in the neonatal period, and Hirschsprung's disease, pyloric stenosis and biliary atresia in infancy. The effectiveness of TPN was impressively indicated by better survival rate in the infants with massive intestinal resection received TPN. An amino acid solution (N1-2) was newly devised, based on the analysis of plasma aminograms in 36 infants received TPN with a commercial amino acid solution (Proteamin), and theoretical considerations. It was more useful solution for TPN in 12 young infants. Urinary phosphorus was a considerable parameter for the administration of Vitamin D in TPN. The incidence of TPN-induced hepatic dysfunction was significantly referred to the amount of amino acid in TPN. Closed infusion system with a soft bag and triple bacterial filters in the line was effective for the prevention of sepsis caused by central venous catheter. The nutritional care was important in the treatment of infants with biliary atresia, because generally they had some nutritional defects such as essential fatty acid deficiency, insufficient amino acid metabolism and zinc deficiency. The nutritional care in infants with advanced neuroblastoma favorably altered the course of the disease.

Amino Acids↗
PubMed1987

Strategies for preserving intestinal length in the short-bowel syndrome.

Total parenteral nutrition now permits long-term survival in patients after massive intestinal resection. Surgical therapy for the short-bowel syndrome is still largely experimental and cannot be recommended routinely. Thus, prevention of intestinal resection and conservation of intestinal length, when resection is necessary, should be emphasized. Strategies are presented that can be employed to preserve intestinal length when surgery is required in patients with a shortened bowel. These include strictureplasty, minimal resection, serosal patching, and intestinal tapering. In suitable candidates strictureplasty can relieve obstruction from strictures while avoiding resection. Minimal resection of involved intestine can be performed safely in selected patients with radiation injury or Crohn's disease. Serosal patching is an alternative to resection for the treatment of perforation or strictures of the intestine. Intestinal tapering can improve the function of dilated intestinal segments and eliminate the need for resection in intestinal atresia. The judicious use of these procedures can preserve intestinal length and obviate the need for long-term parenteral nutrition in patients after massive intestinal resection.

Aged↗
PubMed2000

[Is the Bishop-Koop anastomosis in treatment of neonatal ileus still current?].

Fourty-three cases of ileus in newborns are presented. Twenty-seven newborns received a Bishop-Koop anastomosis. In 19 cases, the Bishop-Koop anastomosis was performed primarily and in 8 cases as a second intervention. We consider the Bishop-Koop anastomosis to be a safer procedure than primary end-to-end or end-to-side anastomosis. Only one anastomotic leak occurred in our patients. We prefer the Bishop-Koop anastomosis not only in cases of meconium ileus, but also in other types of intestinal atresia and stenosis, especially for the management of greatly different intestinal diameters. In our experience, this method is also suitable for re-anastomosing a double-barrel anastomosis. The Bishop-Koop procedure minimizes the risks of primary anastomosis without enterostoma, and later extraperitoneal closure of the stoma is easy and safe.

Anastomosis, Surgical↗
PubMed1989

Duodenal atresia.

The intestinal obstruction of duodenal atresia needs urgent differential diagnosis from malrotation with its risk of midgut volvulus and gangrene. There is an uncommon variant with a high incidence of familial recurrence, and a significant association with Down's syndrome, although the majority of the babies are otherwise normal. Oblique end-to-end anastomosis around the atresia is the preferred treatment and has a high success rate.

Anastomosis, Surgical↗
PubMed2006

The etiology of tracheal mucosal injury in proximal esophageal atresia plus distal tracheoesophageal fistula: an animal study.

Tracheal mucosal damage has been reported in autopsy specimens of cases with proximal esophageal atresia and distal tracheoesophageal fistula (EA-TEF) (Gross classification type C). Such changes have not been reported for isolated EA (Gross classification type A). Our hypothesis is that passage of amniotic fluid (AF) through fistula via larynx and trachea may damage tracheal mucosa. An experimental study was conducted to investigate this hypothesis in the Adriamycin-induced EA-TEF model. In the first stage of the study, we tested whether the fetuses with EA-TEF associated with pyloric atresia cannot swallow AF whereas the fetuses EA-TEF without intestinal atresia can swallow AF. Carbon solution was injected into the AF for this purpose. In the second stage of study, at the 21st day of their gestation, fetuses were extirpated and dissected under microscope. In both stages, fetuses were divided into four groups as control, fetuses without tracheoesophageal abnormalities, fetuses with EA-TEF only, fetuses with pyloric atresia associated with EA-TEF. Lungs and tracheas of the all fetuses were removed for histopathological examination. While carbon particles were present in the trachea, stomachs of the fetuses without tracheoesophageal anomalies, with EA-TEF only and control fetuses, carbon particles were absent in both trachea and stomachs of the fetuses with pyloric atresia associated with EA-TEF. Histopatological examination of the tracheal mucosa showed damage throughout the trachea in the fetuses with EA-TEF only group. Tracheal mucosa was found to be normal in other groups. Bronchial mucosa and lung tissues were found to be normal in all groups. Amniotic fluid swallowed through the TEF causes histopathological changes in the tracheal mucosa of the fetuses with EA-TEF only group. These findings may also contribute to the development of new fetal treatment modalities.

Amniotic Fluid↗
PubMedDate not supplied

Disaccharidase activities and intestinal absorption in infants with congenital intestinal obstruction.

The results of studies on disaccharidase activities and on intestinal absorption in cases of complete and incomplete congenital small bowel obstruction are presented. Assays of the activities of maltase, isomaltase, sucrase, trehalase, and lactase have been performed on biopsy specimens taken at the time of surgery. In specimens taken from above the site of obstruction, the activities are reduced for all disaccharidases, and are particularly low for trehalase and lactase. There was no difference between the cases with complete and incomplete obstruction. Distal to a complete obstruction, trehalase and lactase were reduced, whereas in cases of incomplete obstruction, the activities of all disaccharidases were within what is considered normal in the reference material. Two months after surgery, the disaccharidase activities were found to be normal. One month after surgery, the absorption of glucose and vitamin A was markedly impaired in cases with complete obstruction, whereas that of D-xylose was not significantly reduced from normal. In cases with incomplete obstruction, the results did not differ from those found in normal infants. The fact that failure to thrive is common during the first months after birth in patients with congenital intestinal atresia, even when surgery is successful, may be explained by deficient intestinal absorption, particularly in patients with complete obstruction.

Body Weight↗
PubMed2002

Pediatric surgery in India - a specialty come of age?

The quality of neonatal surgical care and scientific publications are reliable yardsticks that were used to assess the status of pediatric surgery in India. A specific questionnaire to assess neonatal care and surgical outcome was mailed to all institutes imparting pediatric surgery training. Data were obtained regarding the outcome of important neonatal surgical conditions for the year 1998 and a PubMed literature search was performed to identify scientific articles between 1995 and 2000. Though a literature search was done to compile a complete list of publications of all the consultants in all the institutes, of the 24 questionnaires mailed, only 11 (45.8%) institutes provided data. The mean (range) annual neonatal admissions in neonatal surgical units was 137 (42-263). The mean newborn admissions requiring surgical intervention per surgeon per year was 36 (17-80). The overall survival was 57.2% (30%-75%), 70.8% (40%-100%), 90.4% (75%-100%), 74.7% (30%-100%), and 59.1% (0%-100%) for esophageal atresia (EA) with or without tracheoesophageal fistula (TEF), congenital diaphragmatic hernia, anorectal malformations, intestinal atresia, and abdominal-wall defects, respectively. The center that had the lowest survival in EA/TEF and CDH had the highest workload per consultant. Between 1995 and 2000, the mean number of scientific articles published in indexed journals compiled from all the institutes (n = 24) was 10.7 (0-84). In conclusion, this is a preliminary study toward setting up national databases of neonatal surgery in different parts of the world to set goals for improvement.

General Surgery↗
PubMed2006

Rates for specific birth defects among offspring of Japanese mothers, Hawaii, 1986-2002.

The objective of this investigation was to identify the rates for specific birth defects among the offspring of Japanese mothers in Hawaii and compare them to rates among the offspring of white mothers. Cases were all infants and fetuses with any of 54 specific birth defects born to Japanese and white mothers identified by a population-based birth defects registry in Hawaii. The rates were calculated for both racial groups and comparisons made by calculating the rate ratio and 95% confidence interval. The rates among the offspring of Japanese mothers were substantially higher for four of the birth defects (pulmonary valve atresia and stenosis, anomalous pulmonary venous return, cleft lip with/without cleft palate, small intestinal atresia and stenosis) and substantially lower for five of the birth defects (pyloric stenosis, hypospadias and epispadias, renal agenesis and hypoplasia, obstructive genitourinary defect, syndactyly). After adjusting for maternal age, these significantly elevated or lower rates remained. Moreover, the rate was significantly higher among the offspring of Japanese mothers for anotia/microtia, tetralogy of Fallot, and persistent cloaca and significantly lower for transposition of great arteries. The rates for a number of specific birth defects differed between Japanese and white mothers in Hawaii.

Asian People↗
PubMed1999

Ultra-short-bowel syndrome is not an absolute indication to small-bowel transplantation in childhood.

Short-bowel syndrome (SBS) either in adults or in children is considered as an indication to small-bowel transplantation (SBTx), particularly in its most severe form with a residual bowel length below 20 cm. Among factors likely to worsen the prognosis, more recent reports also indicate the number of surgical interventions, early onset sepsis and early development of liver disease. We report six cases of ultra-short-bowel syndrome followed from birth to verify the importance of various prognostic factors. In our case series, the male sex is predominating (5:1). Intestinal resection was indicated in 3 patients for multiple intestinal atresias, in 2 for volvulus and in 1 for necrotizing enterocolitis. The length of intestine remaining was invariably less than 20 cm and 2 patients had a preserved ileocecal valve. In most cases, more than 50% of the colon remained. The number of abdominal operations ranged from 1 to 4. In almost all cases (5 of 6), sepsis and hepatopathy developed early. Our experience suggests that rather than depending on the length of intestine remaining or the presence of the ileocecal valve, the prognosis of patients with the extreme-short-bowel syndrome depends on recurrent neonatal onset sepsis and early onset liver impairment. In addition, our case review shows that the extreme-short-bowel syndrome is not necessarily an indication for bowel transplantation.

Child↗