Ultrasonographic diagnosis of intussusception in children

To asses the role of ultrasonography in the diagnosis of intussusception in children. Design: Retrospective review of medical records of the patients presenting with a tentative diagnosis of intussusception. Setting: Paediatric Surgical Units at Queen Mary's Hospital for Children, London and Chelsea and Westminster Hospital, London, UK. Subjects: Children admitted with a tentative clinical diagnosis of intussusception. Main Outcome Measures: The validity of ultrasound scan in confirming or refuting the diagnosis of intussusception. Ultrasound scan was employed in 57 children suspected to have an intussusception. It confirmed the diagnosis in 43 patients, in 39 of whom pneumatic reduction was attempted that successfully reduced intussusception in 34 [87%]. The diagnosis was refuted in 1 4 children, thus obviating the need for any further intervention. No false-positive or false-negative result was observed in this series. This study confirms that ultrasound is a safe, sensitive and specific investigation that may be used as on initial screening procedure, to confirm or refute the diagnosis, in patients in whom intussusception is suspected

Experience with pneumatic reduction of intussusception in children

Intussusception is a frequent cause of intestinal obstruction in infants. The majority of infants who are diagnosed at an early stage and referred to a paediatric surgical unit before the development of an advanced intestinal obstruction are amenable to non-operative reduction of intussusception. Pneumatic enema reduction was employed in 39 infants that successfully reduced intussusception in 34 [87%] of them. No complication resulted from the procedure. One patient developed recurrent intussusception after six months that was again successfully reduced by pneumatic enema. Pneumatic enema was found to be a safe clean, rapid and effective mode of non-operative reduction of intussusception

Post-operative feeding regimen after pyloromyotomy for infantile hypertrophic pyloric stenosis

Vomiting is the most common post-operative problem and main determinant of the length of hospital stay after pyloromyotomy for infantile hypertrophic pyloric stenosis. The optimal post-operative feeding regimen, to reduce the incidence and severity of vomiting and the length of post-operative hospital stay, has always been a subject of debate. We review, our experience with three types of delayed post-operative feeding regimens employed in 71 babies. These regimens included immediate resumption of normal feeding, an initial 5% dextrose food followed by normal feeding and gradual graded feeding. An immediate resumption of full-strength normal feeds, 12-24 hours post-operatively was found to be associated with shortest hospital stay without any significant increase in the incidence of vomiting

mitrofanoff procedure for uninary incontinence in children

A continent urinary diversion using the Mitrofanoff principle was constructed in 16 children who were incontinent because of severe bladder/urethra] dysfunction secondary to spins bifida [12 patients], exstophy/epispadias complex [3 patients] and limbo-sacral agencies [one patient]. The procedure was combined with bladder augmentation in all patients except for one in whom an autocystoplasty was carried out. The continent conduit was constructed by using the vermiform appendix in 12 patients and the distal ureter in 4 patients. Follow-up period ranged between six months to three years. The capacity of neobladder was good in all patients. All patients were able to catheterise the stoma themselves successfully. Full continence was achieved in 14 patients while the remaining 2 patients had some degree of urinary leakage per urethra. The renal functions remained stable in all patients. We believe that the Mitrofanoff procedure combined with bladder augmentation is the procedure of choice 10 treat refractory urinary incontinence in selected children with bladder/urethral failure

Congenital hydrocephalus

Hydrocephalus results from an imbalance between the production and absorption of cerebrospinal fluid It is a common major malformation with a multifactorial aetiology. Arnold-Chiari hindbrain deformity and aqueductal stenosis are frequent underlying problems leading to congenital hydrocephalus. It is associated with deleterious long-term effects and high recurrence risk. Prompt diagnosis, adequate treatment and proper genetic counselling remain the key to successful management of this problem in children

Midgut malrotation in children: experience with 33 cases

Midgut marlrotation [MM] typically presents with bilious vomiting with or without abdominal distension. However there is a wide spectrum of associated clinical features that may on occasion lead to a delayed or erroneous diagnosis. In this retrospective study medical records of 33 children with MM were reviewed. Seventeen patients [52%] presented in the neonatal period, seven [21%] in infancy and nine [27%] after the first year of life. Seventy percent of patients presented with bilious vomiting. Although more common in neonates, acute volvulus occurs in all age groups. In patients presenting beyond the neonatal period the features of chronic/intermittent volvulus were more evident. Upper gastrointestinal contrast studies and ultrasound scan were the most commonly used investigations and were almost equally reliable. Awareness of unusual presentations in infants and older children and a high index of suspicion is recommended to avoid delayed diagnosis and surgical referral

Use of subcuticular absorble sutres in paediatric cases of complicated appendicitis

Modern surgical practice and use of appropriate antimicrobial therapy have rendered earlier methods of wound care in complicated appendicitis unnecessary. We performed primary wound closure with absorbable subcuticular stitches in 51 children with complicated appendicitis. The wound healed nicely in all patients except three who developed infection that was easily managed by simple drainage and did not lead to any major complication. The use of subcuticular absorbable stitches obviates the necessity of traumatic daily dressing changes, leaves an excellent scar and decreases hospital stay and cost