ABSTRACT
METHODS: In the past 18 years, the authors have treated 84 patients with Hirschsprung's disease. Of these, 43 patients were under 1 month of age and underwent endorectal pull-through without colostomy. Some have undergone follow-up for as long as 18 years. RESULTS: Thirty-four of these 43 (79%) newborn patients were available for follow-up. Twenty-two were totally continent. The remaining 12 have normal sphincter tone. Of the 41 patients above 1 month of age, 34 (83%) were available for follow-up. Some have undergone follow-up for as long as 18 years. CONCLUSION: Twenty-two of this latter group (79%) have normal bowel control.
Subject(s)
Digestive System Surgical Procedures/methods , Hirschsprung Disease/surgery , Rectum/surgery , Adolescent , Anastomosis, Surgical , Child , Child, Preschool , Colostomy , Evaluation Studies as Topic , Female , Follow-Up Studies , Hirschsprung Disease/diagnosis , Humans , Infant , Infant, Newborn , Male , PrognosisABSTRACT
Three infants presented with acute scrotal swelling, erythema, and a tender irreducible firm mass within the scrotum. All patients were operated upon with the preoperative diagnosis of testicular torsion. At operation, grossly purulent fluid was found in a hydrocele sac. In all the cases, the testes were normal and no source of the scrotal infection was identified. A variety of bacterial organisms were cultured and responded readily to antibiotics. Follow-up has documented survival of the testes without apparent atrophy. "Idiopathic" infant pyocele is rarely described and consequently, not included in the differential diagnosis of patients with acute surgical conditions of the inguinoscrotal region.
Subject(s)
Suppuration/diagnosis , Testicular Diseases/diagnosis , Diagnosis, Differential , Hernia/diagnosis , Humans , Infant , Male , Spermatic Cord Torsion/diagnosis , Testicular Diseases/surgery , Testicular Hydrocele/diagnosisABSTRACT
Gastric and esophageal dysfunction are components of familial dysautonomia. The limited success of various medical management programs, has led to two types of surgical intervention. Experience with nine patients who had gastrostomy alone and 12 patients who had gastroesophageal fundoplication is reviewed. Both surgical procedures decreased frequency of vomiting and pneumonias and had positive effects on weight gain. Although "dysautonomic crises" are not eliminated, sufficient modification in character occurs so that associated risks are lessened. It is suggested that if medical management cannot control recurrent pneumonia, postprandial vomiting, esophageal bleeding, and/or inadequate weight gain, then the patient should be evaluated for fundoplication and/or gastrostomy.
Subject(s)
Dysautonomia, Familial/surgery , Esophagogastric Junction/surgery , Gastrostomy , Stomach/surgery , Adolescent , Adult , Body Weight , Child , Child, Preschool , Dysautonomia, Familial/diagnosis , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/surgery , Humans , Infant , Infant, Newborn , Postoperative ComplicationsABSTRACT
Anomalies of the omphalomesenteric duct (OMD) present a variety of surgical problems. The most readily apparent of these lesions is the umbilical polyp. One-third of patients explored at our hospital and 56% of patients reviewed had an additional OMD anomaly when explored for an umbilical polyp. The preferred treatment for this lesion should be a mini-laparotomy after the presence of intestinal mucosa at the umbilicus is confirmed.
Subject(s)
Polyps/surgery , Umbilicus , Child, Preschool , Humans , Infant , Male , Polyps/pathology , Umbilicus/pathology , Umbilicus/surgeryABSTRACT
Villous tumors of the duodenum are rare, but treatment may be problematic because of their association with invasive adenocarcinoma. Two cases of villous tumor of the duodenum are described and 39 other reported cases are reviewed. Presenting symptoms were bleeding 27%; obstruction 24%; jaundice 22% and vague dyspepsia 20%. Diagnosis may be made by radiographic barium contrast evaluation of the duodenum, especially with the addition of air contrast hypotonic studies and by fibro-optic endoscopy. Twenty-seven per cent of villous tumors of the duodenum are associated with adenocarcinoma. Invasive tumor is more common in patients over 50 years old (35%), in tumors of the third and fourth portions of the duodenum (44%) and in tumors over 4 cm in diameter (30%). Local excision is the treatment of choice for benign lesions. Pancreatico-duodenectomy is recommended for tumors which include invasive carcinoma in patients without distal metastases.
