Scrotoschisis as a mechanism for extracorporeal testicular ectopia.

Only one case of a rare anomaly, a congenital defect in the integrity of the scrotal wall permitting egress of the testis to an ectopic extracorporeal location, has been previously reported. A second occurrence of this rare anomally is herein described with a proposed mechanism of occurrence. The condition is termed scrotoschisis.

Management of gastroschisis.

Twenty consecutive cases of gastroschisis are presented. One patient died before surgery and 19 were managed with no surgical mortality. Both delayed closure with Silastic material and primary closure were used. The relationship of increased intra-abdominal pressure to the ease of abdominal wall closure is discussed and related to the prolonged gut dysfunction noted in this condition. The technique for both primary closure and silastic staging is presented. The technique selected for each case should be based on intragastric pressure measurements. Results suggest that either technique can be used with low mortality and that some of the morbidity and mortality reported for silastic closure is related to adaptation of a technique developed for closure of omphalocele to gastroschisis closure, without making allowances for the different pathophysiology of the two entities. Abdominal wall cellulitis seen following primary closure is discussed. The series studied suggests that the cellulitis is traumatic in origin and related to manual stretching of the abdominal wall.

Biliary ascariasis.

We have described a case of biliary ascariasis with the uncommon complication of pancreatitis. Ideally, the diagnosis is made preoperatively by cholangiography. If conservative therapy fails, surgery is recommended. Proper therapy includes complete clearance of worms from the hepatobiliary tract and the intestine. Results are good with early diagnosis and treatment.

Thyrohyoid separation due to penetrating trauma.

We present two cases of neck lacerations resulting from automobile accidents where the victim was thrown through the windshield and suffered thyrohyoid separation. In this lesion, the laryngeal mechanism is intact but detached from the hypopharynx. The prognosis is excellent with early recognition and repair.

Acute necrotizing enterocolitis in infancy: a review of 64 cases.

Sixty-four cases of necrotizing enterocolitis are reviewed. The diagnosis was based on tissue examination in 57 and on the clinical syndrome, including pneumatosis, in 7. Three factors are important in the development of the disease: injury to the intestinal mucosa, bacteria, and feedings. The indications for surgical intervention are pneumoperitoneum, signs of peritonitis, and intestinal obstruction. The importance of stress in the etiology of the disease is confirmed by the high incidence of perinatal complications, particularly hypoxia. The mortality was high, but results are improving with the institution of early aggressive treatment.