Exstrophy of the cloaca.
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Intraabdominal calcifications are an unusual radiographic finding in the newborn and can easily be misinterpreted as meconium peritonitis. The authors refer to a patient with anorectal malformation (ARM), intraluminal calcifications and other anomalies. Careful differentiation of the type of intraabdominal calcifications can suggest the possibility of other initially unsuspected anomalies.
Experiences gained in 150 newborns and infants receiving a complete parenteral nutrition are summarized. An infusion pattern for the complete parenteral nutrition of newborns is presented. Technical questions of parenteral nutrition are discussed. Finally the treatment of 2 newborns with inborn errors of the gastrointestinal tract is reported.
Three cases of "apple peel" syndrome are reported. The radiological features of this abnormality are discussed, and the possibility of pre-operative diagnosis stressed.
A distal gastrectomy reconstruction using the Billroth II procedure was performed for epigastralgia and liver dysfunction caused by a duodenal anomaly in an adult. Hypotonic duodenography revealed the duodenum to be obliterated at the junction of the second and third portion, while the third portion was joined to the first portion. Endoscopic retrograde cholangiopancreaticography (ERCP) and ultrasonography showed a normal construction of the common bile and pancreatic ducts, as well as gallstones. To prevent ingested food from the stomach from entering the obliterated second portion, a distal gastrectomy (Billroth II) was thus performed. The patient has remained asymptomatic for 4 years since surgery. A distal gastrectomy reconstructed by a gastrojejunostomy is thus considered to be an effective method for improving the symptoms caused by food stasis in the obliterated second portion of the duodenum.
A study of 23 neonates with congenital duodenal obstruction is reported. Their mean gestational age was 38 weeks and mean weight was 2.2 kg. Main clinical features observed were vomiting (100%), which was bilious in 74%, and epigastric fullness with visible peristalsis (74%). Plain X-ray abdomen confirmed the diagnosis in 78%. Associated congenital malformations were seen in 39% of cases. Eleven babies had an intrinsic defect, 11 had extrinsic defect and one baby had combination of intrinsic and extrinsic defect. Malrotations along with band was seen in 39% of cases. Reported mortality was 39%.
We present three cases with abnormal fetal heart rate patterns and cordocentesis umbilical venous blood gas analyses. Conflicting heart rate patterns and cordocentesis and postnatal blood gas analyses prompt questions with regard to abnormal fetal heart rate pattern interpretation and suggest that cordocentesis blood gas analysis aids perinatal management only as a reflection of fetal status at sampling time.
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Loss of duodenal tissue around the pancreatic and common bile ducts presents a challenge to abdominal surgeons. Available methods to correct the problem include duodenojejunostomy, diamond duodenoplasty, serosal patching, mucosal pedicle patching from the ileum or jejunum, and gastric island patching. The choice of procedure must be tailored to the nature of the defect, the amount of tissue lost and the amount of peritoneal contamination. We believe that jejunal mucosal pedicle patching is a reasonable choice in most instances.
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