[Primary volvulus of the small intestine without malrotation. Apropos of 7 cases]. / Volvulus primitif du grêle sans malrotation. A propos de sept observations.

We report seven cases of complete volvulus of the small bowel without malrotation seen from 1973 through 1986. The clinical setting is always the same in this condition: the infant exhibits no clinical anomalies during the symptom-free interval between birth and the volvulus (4 h to 35 d, m = 7 d in our series). Onset is extremely sudden, with a complete, proximal obstruction, early and abundant passage of blood per rectum, and above all a severe shock that fails to respond to resuscitation. Roentgenograms contribute little to the diagnosis and surgery should never be delayed to perform complementary investigations of any kind. Indeed, the only effective treatment is unwinding the volvulus within the first six hours following onset, for beyond that time irreversible necrosis of the entire small bowel and occasionally colon occurs. Five infants died because they were seen too late and operated on 36 hours on average after the onset of symptoms. The two survivors had an early operation that prevented total necrosis of the small bowel. However, this pattern seems to vary according to the degree of cecum anchorage: a fixed cecum results in a very tight volvulus with complete, early ischemia and usually irreversible necrosis of the small bowel beyond the sixth hour (9/9 published cases); an even slightly mobile cecum results in a looser volvulus, with less severe ischemia, more delayed necrosis, and a possibility of complete recovery (5/6 published cases).(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary ulcero-necrotizing enterocolitis of the newborn. Advancements in management. Improvement in prognosis]. / L'entérocolite ulcéro-nécrosante primitive du nouveau-né. Progrès dans la prise en charge. Amélioration du pronostic.

We report our experience acquired over the last seven years with the management of necrotizing enterocolitis in neonates. This condition occurs mainly in small-for-dates, premature, critically ill infants. Diagnosis rests on the combination of clinical evidence of intestinal obstruction with non-specific signs of a decline in general health and suggestive roentgenographic findings. Mortality has fallen from 80% to 24% over the last eight years as a result of advances in the medical management of low-birth-weight infants, earlier treatment of bowel ischemia suspected on the basis of inconspicuous manifestations, and improvements in neonatal intensive care and surgical techniques.

[Antenatal diagnosis of lung malformations. Apropos of 9 case reports]. / Malformations pulmonaires de diagnostic anténatal. A propos de 9 observations.

The authors report 9 cases of prenatal diagnosis of lung malformations. The diagnoses was performed between 17 to 33 weeks amenorrhea (mean = 25.5 weeks). The clinical findings were: 7 cystic adenomatoid malformations of the lung, 1 intralobar sequestration and 1 bronchogenic cyst associated with extralobar sequestration and esophageal duplication. In two cases of cystic adenomatoid malformation of the lung with polyhydramnios and fetal hydrops death occurred at 27 and 32 weeks amenorrhea. In the seven other cases surgery was performed shortly after birth, before any serious complications occurred. No problems were encountered following the surgical intervention and the remaining lung inflated after a few days. All these children are currently alive and well, without pulmonary or thoracic disorder. The authors first explain the echographic findings in each malformation and later discuss the sonographic criteria of the diagnoses. The antenatal diagnosis permits early recognition and thus adequate management using a team of neonatologists, radiologists and pediatric surgeons. This type management involves: --normal vaginal delivery if there are no obstetrical problems; --if it is possible, artificial ventilation should be avoided as it may increase respiratory distress. If however, it is necessary, the healthy lung should be intubated; --the surgical procedure should be performed as soon as possible, before complications as respiratory distress or recurring pulmonary infections occur; --the major risk of this surgery is respiratory and heart failure when the child is placed in the operating position. A rapid thoracotomy permits the extraction of the compressed lung and the resuscitation of the patient.

[The association of a dysplastic kidney with a single vaginal ectopic ureter and a homolateral genital abnormality in a girl. Comments based on 3 case reports]. / Association, chez la fille, d'un rein dysplasique avec uretère simple à abouchement ectopique vaginal et d'une anomalie génitale homolatérale. Commentaires, à partir de trois observations.

We recently treated one female infant and two young girls with coincidence of three anomalies: --hypoplastic ectopic kidney; --single vaginal ectopic ureter; --ipsilateral genital abnormality. Clinical presentation was lifelong wetting, "multicystic" kidney, urinary tract infection, or abdominal pain. The diagnostic studies include ultrasonography, excretory urography, cystography and vaginoscopic examination with retrograde catheterization, rarely radionuclide scanning. This study failed in two cases, with non visualization of the hypoplastic and dysplastic kidney, and diagnosis was done at laparotomy. Genital anomalies were unilateral hydrocolpos with uterus didelphys in one case, dilated or cystic Gärtner's duct in the other two. The anomaly may be caused by a maldevelopment of the wolffian and müllerian ducts in early fetal life, between 5 and 6 weeks of gestation. A review of the literature revealed only 6 similar instances in childhood. The combination of lifelong wetting, pelvic mass or pain in girl with "solitary" kidney on excretory urography and ultrasonography should alert to this syndrome. Meticulous search for the hypoplastic kidney, the genital abnormality and the ectopic ureteral orifice are keys to early accurate diagnosis and treatment.

[Chronic volvulus of an ectopic spleen with subcapsular hematoma. CT x-ray aspect]. / Volvulus chronique d'une rate ectopique avec hématome sous-capsulaire. Aspect TDM.

The authors present a case of ectopic spleen complicated by chronic torsion and subcapsular haematoma in an asymptomatic patient. The value of ultrasonography and computed tomography in the diagnosis of these complications is discussed.