role of electro-diagnosis and therapy in management of fecal incontinence secondary to anorectal congenital anomalies

To assess the diagnostic and prognostic role of electromyography [EMG] of the external anal sphincter and pelvic floor muscles in children born with anorectal anomalies. Also, we tried to assess the role of electric stimulation to the sphincter muscles when applied pre and/or postoperatively in the control of fecal incontinence in those children. Eighty children with congenital anorectal anomalies and ten normal children who served as a control group were enrolled to the study. All were subjected to EMG assessment of the puborectalis [PR], external anal sphincter [EAS] and levator ani [LA]. Accordingly patients were divided into: Group I: Patients with normal EMG subjected to surgery, [posterior sagittal anorectoplasty] and EMG assessment after surgery. Group II: Patients with reduced electric activity of EMG. They were subjected to pre and postoperative electric stimulation and EMG before and after electric stimulation with postoperative EMG assessment. Group III: Patients with reduced EMG; they were operated with no electric stimulation with post-op. EMG assessment. Group IV: Patients with post operative fecal incontinence before being included in the study they were subjected to electric stimulation and post electric stimulation EMG assessment. EMG- showed a reduced value of the mean amplitude/turn [M] and number of turns/sec [T] value in the clinically weak muscles. M value was a more sensitive EMG parameter than T value in assessment of sphincter muscle activity. Electrophysiological stimulation showed significant clinical and EMG improvement in the studied groups in the PR, EAS and LA muscles. EMG can be a good diagnostic and prognostic measure in the assessment of EA, PR and LA muscles. Electric stimulation had a valuable role in strengthening the sphincteric muscles before and after correction, especially if combined, and in the conservative management of older incontinent children

Balloon dilatation of cradiac achalasia in children

Surgical treatment of cardiac achalasia in children is still the main line of treatment with a success rate of 70-80%. Balloon dilatation is less widely used due to inappropriate size of balloons. The authors report their experience in 11 children with cardiac achalasia over the last 3 years using balloon dilatation as the first line of treatment. There were 8 boys and 3 girls -with ages ranging from 1.5-14 years [average 7.5 years]. One family presented to us [brother and sister] but with no glucocorticoid deficiency or other anomalies, one patient had mental retardation otherwise the rest had no associated anomalies.All Patients presented with vomiting, 7 with dysphagia, 6 with loss of weight, 5 with recurrent chest infection and 2 with retrostenal pain. Radiological diagnosis was accurate in all patients, endoscopy with biopsy were done to confirm diagnosis and exclude other pathology, manometry was confirmative in 4 patients. Dilatation was done under fluoroscopic control, balloons were used over a guide wire [balloon size were 18-35 mm]. Seven patients had 2 sessions and 4 had 3 sessions with radiological follow up after the second dilatation. Follow up ranged from 6 months to 3 years: excellent results were achieved in 8 pateints [72.7%] with disappearance of symptoms and marked radiological improvment, 2 still have mild symptoms with over all success of [90.9%] one has mild gastroesphageal reflux controlled medically and one has mild dysphagia but better than before dilatation. One pateint had recurrent dysphagia necessitating cardiomyotomy [9.1%]. Results were not related to age and sex. the authors recommend balloon dilatation in children with achalasia as the first line if not the definitive line of treatment

Malrotation of the intestine: a major pediatric surgical emergency

Malrotation is one of the serious surgical conditions in the pediatric age group. The authors report their experience of 19 cases of malrotation with or without volvulus in the period of January 1989 till June 1992. Eleven patients [58%] presented below the age of one month among which 8 [42%] were below the tenth day of life. Gangrene was present in two cases [10.6%]. The commonest presentation was bilious vomiting which occurred in all patients, colics in four patients [21%], perforation and septicemia in three patients [16%], one with gastric perforation, one with gangrene of the colon and one with gangrene of the whole bowel. Volvulus was present in 16 patients [84%]. Associated malformations were noticed in four cases [21%]. Mortality occurred in two patients [one with gangrene of the whole bowel and the other with gastric perforation and septicemia]