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Radiologic management of fluid collections in children.

Percutaneous catheter drainage procedures have become widely accepted in the management of intraabdominal fluid collections in adults. We report our experience in 12 children with 15 fluid collections who underwent 22 procedures and emphasize the usefulness of this procedure in the pediatric population. Thirteen fluid collections were cured by the procedure. One collection improved with the procedure but needed definitive surgical correction to effect a cure. One other patient with an intestinal fistula did not respond. The complicated nature of many of our cases coupled with the high cure rate (87%) and low complication rate (4.5%) makes percutaneous drainage an excellent alternative to surgical drainage under general anesthesia.

Abscess↗

Psoas abscess resulting from perforating carcinoma of the sigmoid colon. Report of a case.

We report a case of a left psoas abscess resulting from a perforating carcinoma of the sigmoid colon. The chief complaints were edema of the left leg and pain in the left thigh. Single and double contrast barium-enema film demonstrated an extrinsic inflammatory mass distorting the sigmoid colon. A preoperative diagnosis of sigmoid carcinoma was not made on these examinations, nor on flexible colonoscopy. Carcinoma of the colon should be considered as a cause of an unexplained psoas abscess.

Abscess↗

Surgical aspects of radiation enteritis of the small bowel.

Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.

Adult↗

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.

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