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[Abdomino-thoracic digestive duplications. General review apropos of 2 cases].

The authors present two personal observations of thoraco-abdominal duplications of the foregut and analyze 48 others cases collected in the literature since the first one related by Budde in 1912. Anatomic study, evolutivity of the malformation, fully expression of notochordodysraphia, allow an analysis of symptoms, which must actually lead to an acute diagnosis. Total excision in a single stage through a double thoracic and, after, abdominal approach is the logic treatment.

Abdomen↗

Enteric thoracoabdominal duplications in children.

The clinical and pathological findings of two children with thoracoabdominal enteric duplications are described in detail. In addition, 23 case reports are reviewed. The majority of duplications communicated with the gastrointestinal tract below the diaphragm, but in one case, reported here, the duplication communicated with the cervical esophagus. In infants these duplications most often present with respiratory symptoms, whereas older children more typically have pain and melena. If possible the entire duplication should be removed during one operation.

Adolescent↗

[Rare duplications of the alimentary tract (author's transl)].

Three rare cases of spherical duplication of the alimentary tract and a duplication with a pedicle associated with the ileum are reported. The treatment advocated for the duplication of the cervical oesophagus and of the ano-rectal region is the removal of the mucosa with suturing of the partially removed cyst edges. The rare intraluminous duplication of the pylorus can be removed by a duodenoantrostomy which can be performed easily in the new-born.

Anal Canal↗

[Duplication of the digestive tract in children. Apropos of 12 cases].

Duplications of the gastro intestinal tract are characterised (Ladd and Gross) by the following histological features two muscular layers with myenteric cells inside. Cystic or tubular, they are always situated on the mesenteric border of the gastro intestinal tract with a common blood supply. The pathogenesis of duplication affects early fetal development via various mechanisms. Located anywhere along the alimentary tract as in our review of 12 cases, clinical manifestations vary according to the site. Abdominal cystic mass, mediastinal compression or intestinal obstruction bleeding or perforation are possible symptoms, but the presentation is very variable. The age of presentation is usually within the first year of life. The diagnosis can be made preoperatively by several investigations but the malformation is frequently discovered during surgery. Surgery is the only treatment for these duplications, but smaller cystic lesions are easily treated. However surgery of extensive duplications remains difficult.

Adolescent↗

Alimentary tract duplications.

A total of 17 patients with alimentary tract duplications underwent surgery at National Taiwan University Hospital from 1978 to 1994. Fifteen patients (88%) had gastrointestinal duplication and two (12%) had esophageal duplication. Common presenting symptoms of gastrointestinal duplication were melena and abdominal pain. The ileum was the most common site of duplication. Multiple duplications were seen in three patients. All duplications were cystic, except for one single appendiceal duplication. Ectopic gastric mucosa was detected in nine of the 16 nongastric duplications. One patient with ileal duplication had ectopic pancreatic tissue. Twelve patients received resection of the duplication with a segment of bowel and primary anastomosis, three patients underwent simple excision and two patients had partial resection of the duplication and stripping of the residual mucosa. Two patients had other associated congenital anomalies: one had ventricular septal defect and the other, imperforate anus and malrotation of intestine. There was no operative mortality or morbidity in this series.

Abdominal Pain↗

Pattern of congenital alimentary tract malformation in Ibadan, Nigeria.

Nineteen children with congenital upper alimentary tract malformation were studied prospectively at the Department of Paediatrics, University College Hospital (UCH), Ibadan, over a period of 12 months. There were 20 cases, grouped into six types comprising congenital hypertrophic pyloric stenosis, seven; cleft lip and/or cleft palate, five; oesophagal atresia with or without tracheo-oesophageal fistula, four; jejunal atresia two and a case each of achalasia and annular pancreas. One patient had oesophageal atresia and congenital hypertrophic pyloric stenosis. The mortality rate was 31.51% (six out of nineteen). Low mortality was recorded in cases of cleft lip and/or palate, while mortalities of over 70% were recorded among cases of jejunal atresia, and oesophageal atresia with or without tracheo-oesophageal fistul. The common causes of death were milk feed aspiration (28.6%-two cases), purulent peritonitis (14.3%-one case), and probable septicaemia (14.3%-one case). The cause of death in two cases could not be determined.

Cause of Death↗

Surgical management of perineal masses in patients with anorectal malformations.

BACKGROUND: The aim of this study was to review the outcome of surgical management of various types of perineal masses encountered in patients with anorectal malformations (ARM). METHODS: Retrospective review from 2 large pediatric anorectal referral centers. RESULTS: Twenty-two patients with a perineal mass were identified in more than 2000 patients treated for an ARM over a 15-year period. The 22 patients (4 men) represented all levels of severity of ARMs. The lesions were of 3 types: lipomas (n = 10), vascular anomalies (n = 4), and hamartomas/choristomas (n = 8). The lipomas were carefully removed from between the muscle fibers during the posterior sagittal anorectoplasty. The vascular anomalies (3 of 4 were hemangiomas) underwent magnetic resonance imaging preoperatively, but none were found to invade deeply and all were excised at the time of the posterior sagittal anorectoplasty. The hamartomas/choristomas all occurred in women, and 50% arose as a pedunculated mass from the vulva. The lesions contained tissues such as glia, osteoid, nephrogenic rests, and endocervical-type mucosa. One was initially misinterpreted as a teratoma, prompting a wider excision. This and all subsequent patients have been correctly diagnosed pathologically as having either hamartomas or choristomas, which were not widely excised. Follow-up ranges from 5 months to 12 years. Six of the 10 lipoma patients are continent. One vascular anomaly was re-excised and there was minor wound separation in another. None of the hamartoma/choristoma lesions recurred. CONCLUSION: The presence of unusual perineal masses can add to the complexity of ARMs; however, most of these lesions can be carefully excised with preservation of the muscle complex and ultimate continence. Hamartomatous lesions can be mistaken for teratomas but do not require aggressive excision with clear margins.

Anal Canal↗

Malrotation of the intestine in children.

Intestinal malrotation may be complicated by volvulus and intestinal necrosis. One hundred two children (64 male, 38 female) undergoing surgical abdominal exploration from 1977 to 1987 had malrotation. Fifty-two patients were less than 7 days of age, 13 from 8 to 30 days, 26 from 31 to 365 days, and 11 were older than 1 year of age. Of infants, 39 of 65 had 40-week gestations, 18 of 65 had 36- to 39-week gestations, and 8 of 65 had less than 36-week gestations. Chief symptomatology included: bilious emesis (47), intestinal obstruction (19), abdominal pain (11), and bloody stools (7). Seventy patients had congenital anomalies (50 single, 20 multiple). Diagnostic evaluations included 56 upper gastrointestinal series and 27 barium enemas. Each patient underwent correction of malrotation and appendectomy, and correction of congenital anomalies (omphalocele-9, gastroschisis-6, diaphragmatic hernia-7). Complications included short gut (2), sepsis (5), feeding difficulties (2), pneumonia (3), small bowel obstruction (2), and other (15). Nine patients (8.8%) died (trisomy 18-1, trisomy 13-1, intestinal necrosis-3, hepatic failure-1, prematurity-1, other sepsis-2). Two hundred sixteen children with intestinal malrotation have been treated from 1937 to 1987. Mortality rate has improved from 23% to 2.9%.

Abnormalities, Multiple↗

[Abnormalities of the digestive system in autopsy material of children].

As a result of the autopsy reports of the Pathological Institute of M uhlhausen in a twenty-year-period from 1960 to 1979 there were 4.8 per cent (n = 219) malformations of the digestive tract among the 4,561 autopsies of stillborn children and live-born ones up to their 16th year of age. Lip, jaw and plate clefts, defects of diaphragm as well as oesophagus atresia and stenosis predominate among the various malformations. The malformations were classified and discussed according to nature, combinations, and sex differences as well as with respect to importance for mortality, territorial and time distribution.

Abnormalities, Multiple↗

Fetal gastrointestinal anomalies.

A review of fetal gastrointestinal anomalies is presented. Normal abdominal development and anatomy, including basic embryology and recommended ultrasound techniques, are first outlined. Next is a more detailed discussion of the abnormal examination, including abdominal wall defects and intra-abdominal abnormalities. The goal of this work is to present a practical approach to the abnormal fetal abdominal examination enabling the sonographer and sonologist to suggest precise differential diagnoses.

Abdominal Muscles↗