Intussusception in children presenting beyond the infancy

The authors review their experience with 23 children over one year of age who presented with intussusception. Idiopathic ileo-colic intussusception was the most frequent variety in children between 1-2 years of age [n=10], but in older children, there was a high incidence of ileo-ileal intussusception resulting from a pathological lead point. Intussusception was secondary to Henoch-Schonlein purpura in 5 patients, Meckel's diverticulum in 2 patients and cystic fibrosis, Peutz-Jeghers syndrome, duplication cyst and lymphoma in one patient each. Two patients developed post-operative intussusception after abdominal surgery. Ultrasound scan was the most helpful diagnostic investigation for initial screening. While hydrostatic reduction was generally successful in those with idiopathic ileocolic variety, a majority of children with intussusception secondary to a lead point required operative intervention and bowel resection. The likelihood of an underlying pathological lesion must always be considered in older children with intussusception. As the clinical presentation may be atypical, a high index of suspicion, prompt diagnosis and appropriate management are crucial to avoid the high mortality and morbidity associated with unrecognised bowel obstruction

Familial hydrocephalus

Congenital hydrocephalus without spina bifida is a major malformation with heterogeneous aetiology. It may result both from genetic and non-genetic factors. Familial congenital hydrocephalus may be inherited by sporadic, x-linked recessive or autosomal recessive fashion. Because of a high recurrence risk and deleterious long-term effects, proper genetic counselling should be offered to the parents of an affected child. Prenatal ultrasonography may help early detection of foetal hydrocephalus and associated anomalies indicative of a poor prognosis. Recent discovery of the locus for x-linked variety on chromosomal band xq28 may allow both prenatal and carrier detection. A family with four affected siblings is reported here alone with a literature review

Surgical implications of the haemolytic-uraemic syndrome in children

The Haemolytic-Uraemic Syndrome [HUS] in children is a heterogeneous condition consisting of microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure. Complications requiring surgical intervention are rare but potentially lethal and usually involve the colon. The surgeon may face diagnostic and therapeutic dilemmas. The decision to perform a laparotomy must be individualized. Furthermore, the problem of renal involvement, if not recognised, may lead to serious fluid and electrolyte imbalance. Two patients with HUS developed surgical complications. One had total colonic gangrene with perforation and the other had segmented ischaemic colitis

Surgical manifestations of Henoch-Schonlein purpura in children

Eleven patients of Henoch-Schonlein purpura presented with surgical conditions between 1988-1994. Of these, three patients, two presenting with gastrointestinal haemorrhage and one with an acute scrotum, were managed conservatively whereas eight patients required laparotomy. The latter group included 5 intussusceptions and one intestinal perforation. The remaining 2 patients had haemorrhagic, but viable, bowel. Continuous evaluation by a surgeon is invaluable in prompt management of these uncommon but potentially lethal complications