[Oral cholangiography and duodenal atresia]. / Colangiografía oral y la atresia duodenal.

A newborn male patient with trisomy-21 presented with bilious hemesis. The patient was icteric with slight hepatomegaly. Simple abdominal X-ray and upper gastrointestinal series with barium showed a dilated duodenal loop and inflammatory changes involving the duodenal mucosa. This image known as "double bubble" is characteristic of congenital duodenal obstruction. Simultaneously the gallbladder and choledochus were visualized. The former X-ray finding is very unusual. An uneventful Kimura procedure was performed.

Colangiografía oral y la atresia duodenal / Oral cholangiography and duodenal atresia

Se presenta el caso de un recién nacido masculino con síndrome de Down, que presentó al nacimiento vómito biliar y al examen físico ictericia y hepatomegalia leve. Los estudios radiológicos simple de abdomen y la serie gastrointestinal mostraron al duodeno dilatado y cambios inflamatorios de la mucosa. Esta imagen es conocida como la imagen en “doble burbuja” y es común en la obstrucción duodenal congénita. Simultáneamente fueron visualizados la vesícula biliar y el colédoco, siendo este hallazgo poco usual. Se le efectuó corrección del defecto mediante el procedimiento de Kimura.

A newborn male patient with trisomy-21 presented with bilious hemesis. The patient was icteric with slight hepatomegaly. Simple abdominal X-ray and upper gastrointestinal series with barium showed a dilated duodenal loop and inflammatory changes involving the duodenal mucosa. This image known as [quot ]double bubble[quot ] is characteristic of congenital duodenal obstruction. Simultaneously the gallbladder and choledochus were visualized. The former X-ray finding is very unusual. An uneventful Kimura procedure was performed.

[A pancreatobiliary malformation causing spontaneous perforation of the extrahepatic bile duct]. / Malformación del sistema pancreático-biliar como causa de perforación espontánea de la vía biliar extrahepática.

Biliaryascitis usually results from a spontaneous or traumatic perforation of the common bile duct, usually at the junction with the cystic duct. Distal duct obstruction, pancreatic fluid reflux up the common bile duct, congenital weakness or a localized mural malformation of the wall of the common duct have been proposed as possible causes. We present an 11-months-old infant girl who developed a biliary ascitis as a consequence of biliary rupture. Perforation was due to malformation of the pancreatico-biliary junction. An uneventful external derivation by tube was performed.

Malformación del sistema pancreático-biliar como causa de perforación espontánea de la vía biliar extrahepática / A pancreatobiliary malformation causing spontaneous perforation of the extrahepatic bile duct

La ascitis biliar usualmente resulta de la perforación espontánea o traumática del conducto biliar principal, usualmente en la unión con el conducto cístico. La obstrucción ductal distal, el reflujo hacia la vía biliar común, la debilidad o una muy localizada malformación mural de la pared del conducto común han sido propuestas como causas probables. Presentamos el caso de una niña de 11 meses de edad quien sufrió ascitis biliar como consecuencia de la ruptura del colédoco. La perforación probablemente se debió a una malformación de la unión pancreático-biliar. Se le derivó la bilis hacia el exterior mediante una sonda.

Biliaryascitis usually results from a spontaneous or traumatic perforation of the common bile duct, usually at the junction with the cystic duct. Distal duct obstruction, pancreatic fluid reflux up the common bile duct, congenital weakness or a localized mural malformation of the wall of the common duct have been proposed as possible causes. We present an 11-months-old infant girl who developed a biliary ascitis as a consequence of biliary rupture. Perforation was due to malformation of the pancreatico-biliary junction. An uneventful external derivation by tube was performed.

[Pulmonary contusion and hemothorax due to explosion]. / Contusión pulmonar y hemotórax por explosión.

Folklore and "uses and customs" in countries such as Mexico, under certain circumstances, have direct influences on risks for traumatic injuries. Such is the case of gunpowder explosive objects used during celebration holidays. We present a 14-year-old male who suffered a pulmonary contusion as a consequence of an explosion of "huevo de codorniz." A pleurostomy tube was required to resolve symptomatic hemothorax. The patient was discharged 5 days after admission.

[Esophageal atresia: a second-level hospital experience]. / Atresia esofágica: experiencia de un hospital de segundo nivel de atención.

INTRODUCTION: In recent years, surgical correction of esophageal atresia with distal tracheoesophageal fistula has become increasingly successful. However, there is still a group of high-risk patients with specific factors in whom the mortality remains appreciable. These associated factors include weight, gestational age, associated malformations and respiratory distress. MATERIAL AND METHODS: This report analyzes the mortality in 80 newborn infants with variants of esophageal atresia with or without tracheoesophageal fistula who were treated from 1999 to 2003. Data were collected restrospectively from hospital and office records. RESULTS: We observed 42 male patients, 69 patients were C variety, all had more than 12 h of postnatal life, 34 were preterm newborn, 41 were classified A or B according to Waterston, and 41 died. A logistic regression analysis and chi2 of the influence of each risk factor on mortality was performed. Relevant statistical significance was found in the studied variables. CONCLUSIONS: Morbidity and mortality of esophageal atresia was higher due to identified risk factors.

[Traumatic perforation of the anorectal canal]. / Perforación traumática del conducto anorrectal.

INTRODUCTION: Traumatic perforation of the anorectal canal in children is relatively uncommon. There may be difficulties in recognizing or properly treating such injuries because their severity may not be reflected accurately by the external appearance of the perineum. MATERIAL AND METHODS: This was a retrospective survey of 19 children with anorectal rupture injuries secondary to blunt trauma and perforating mechanisms. RESULT: Sixteen (89.4%) were male and 15 (77.0%)suffered perforation after al fall on a sharp tool. All were admitted more than 12 hours after accident. Twelve (63.0%) had transanal extra-peritoneal injuries and 13 (68.4%) patients underwent colostomy. CONCLUSIONS: The majority of these perforations are caused by falls at play. The current standard principles in the treatment of anorectal injuries in children and wound drainage, broad-spectrum antibiotics and frequently fecal diversion.

[Cost analysis: metronidazole-amikacin vs. preoperative monodose of ceftriaxone in appendicitis. Preliminary report]. / Análisis de costos: metronidazol-amikacina versus monodosis preoperatoria de ceftriaxona en apendicitis. Reporte preliminar.

INTRODUCTION: Postoperative management of acute appendicitis in our country has been supported by results from studies overseas. Ampicillin, clindamycin and gentamicin is the classic association of antimicrobial drugs. However, it is expensive, unnecessary and risky. We believe that a single dose can be useful. MATERIAL AND METHODS: We studied two groups comprised of 82 patients each in whom an appendectomy was performed. In group A an intravenous (i.v.) dose of ceftriaxone was given 30-240 minutes before skin incision. Group B or control group was comprised by the same number of patients previously operated and managed under traditional method (amikacin-metronidazole). RESULTS: In group A, three wound infections and an intraperitoneal abscess were identified, while in group B only one wound infection was seen. Average cost for patients in group A was 2,108.91 pesos (approx. 200 US dollars). In group B, the average cost was 9,407.48 pesos (approx. 900 US dollars). CONCLUSIONS: One dose of preoperative ceftriaxone proved to be most financially economical.

[Congenital transmesenteric hernia]. / Hernia transmesentérica congénita.

INTRODUCTION: Acute intestinal obstruction due to congenital defects in the mesentery of the small bowel are quite uncommon. The most frequent location of the defect is the mesentery of the terminal ileum. MATERIAL AND METHODS: Five cases of small bowel obstruction caused by congenital transmesenteric hernia was reviewed. RESULTS: Four were male and all patients had an intestinal obstructive disease, small bowel gangrene and peritonitis. Two patients died. DISCUSSION AND CONCLUSIONS: Diagnosis is difficult and most cases recorded until today are incidental findings on laparotomy and surgical treatment is mandatory.

[Intrauterine necrosis in closed gastroschisis]. / Necrosis intestinal in utero por gastrosquisis.

INTRODUCTION: Strangulation of the intestine as the result of compression of its blood supply in a tightly closed gastroschisis defect is a very rare occurrence. CLINICAL CASES: We present the cases of two newborn patients who had extra-abdominal infarcted bowel and intra-abdominal jejunal atresia due to vascular compression for gastroschisis defect. One was associated with colonic, probably acquired aganglionosis. Both had similar clinical courses. CONCLUSIONS: This association is very uncommon. Prognosis of this complex is very poor.

[Inguinal symptoms of acute abdomen]. / Manifestaciones inguinales del abdomen agudo.

INTRODUCTION: We describe a syndrome in which empty hernial sac, in its role of peritoneal recess, becomes distended with pus during or after general peritonitis, usually caused by acute appendicitis. Until 1998, only 14 pediatric cases were described in the literature. MATERIALS, METHODS, AND RESULTS: We presented here eight cases of patients who experienced inguinal symptoms. In four, appendectomy was performed; in four, this was secondary to necrotizing enterocolitis. Inguinal complaints, pain, and flogosis were present in first group, while pneumoperitoneum and visible duct vaginalis were present in second group. CONCLUSIONS: These cases demonstrated that persistent patent processus vaginalis may predispose to inguinal pathology secondary to intraabdominal sepsis and represent a unique complication.

[Hirschsprung in children over 6 years of age]. / Hirschsprung en niños mayores de seis años.

INTRODUCTION: Hirschsprung's disease or colonic agangliosis is a rare condition in schoolchildren and adolescents. It is common in infants and chronic constipation is the usual symptom. MATERIALS, METHODS, AND RESULTS: In a period of 5 years, 11-years-old patients were diagnosed and treated for Hirschsprung's disease. We studied six male patients; mean age was 8.6 years. All patients had classic disease and nine, severe chronic constipation, and two were admitted with encopresis. One had 10 kg of feces in 40 cm of colon. Diagnosis was established with barium enema and tissue biopsy. All patients had colostomy. In eight patients, Duhamel procedure was performed with good results. CONCLUSIONS: This disease is a rare condition in older patients and Duhamel procedure is a good surgical option.