ABSTRACT
BACKGROUND: Meckel's diverticulum is a well known disease in children. The main clinical presentations are rectal bleeding and intestinal occlusion. OBJECTIVE: To investigate the frequency, main clinical symptoms, signs, complications, localization, histology and diagnosis in a population of mexican children. METHOD: We studied 61 children who were seen at the Instituto Nacional de Pediatria, Mexico City, during a period of 10 years. The age, sex, symptoms, complications, hematocrit, 99mTc-Pertechnetate scanning, histology, and localization of Meckel's diverticulum were analyzed in all of them. RESULTS: 15 children were female and 46 male (1:3). In infants the main clinical finding was rectal bleeding. Intestinal occlusion was the most common clinical expression in older children. Gastric mucosa was a common finding in the diverticulum of children with rectal bleeding in contrast to ileal mucosa in children with intestinal occlusion. 99mTc-pertechnetate scanning with previous administration of H2 blocking agent was the best diagnostic procedure. CONCLUSIONS: Meckel's diverticulum must be considered an emergency in children. Meckel's diverticulum, has to be ruled cut as in infants with significant bleeding, as well as in children with intestinal occlusion. The best method for diagnosis is 99mTc-pertechnetate scanning.
Subject(s)
Diverticulum , Adolescent , Child , Child, Preschool , Diverticulum/complications , Diverticulum/diagnosis , Diverticulum/epidemiology , Female , Humans , Infant , Longitudinal Studies , Male , Retrospective StudiesABSTRACT
Angiodysplasia of the colon as a cause of lower intestinal bleeding is diagnosed frequently in the elderly, with defined clinical characteristics. In the pediatric population there is little experience; only six cases have been reported. The present study evaluates the clinical, radiological, and surgical aspects of nine children with angiodysplasia of the colon who were treated at the National Institute of Pediatrics in Mexico City between 1970 and 1993. The mean age of clinical onset was 2.3 years. In six patients, symptoms appeared before the first year of life. Lower intestinal bleeding and severe anemia were present in all cases. The diagnosis and localization of the lesions were established by selective visceral angiography. Six patients were treated by operative resection of the affected colonic segments. For four patients with lesions in the rectum and sigmoid, a Swenson pull-through was performed. In one patient the lesion was recurrent because of incomplete resection. Follow-up ranges from 8 months to 4 years; all patients have had normal hemoglobin levels and negative stool results. Unlike in the elderly and the cases reported in the literature, the left hemicolon was the most frequently involved area.
Subject(s)
Angiodysplasia/surgery , Colectomy , Colon/surgery , Colonic Diseases/surgery , Colostomy , Gastrointestinal Hemorrhage/surgery , Rectal Diseases/surgery , Rectum/surgery , Anastomosis, Surgical , Angiodysplasia/complications , Angiodysplasia/diagnosis , Barium Sulfate , Child , Child, Preschool , Colon/pathology , Colonic Diseases/complications , Colonic Diseases/diagnosis , Colonoscopy , Enema , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Humans , Infant , Infant, Newborn , Male , Rectal Diseases/complications , Rectal Diseases/diagnosis , Rectum/pathology , Recurrence , Time FactorsABSTRACT
We studied 26 children with congenital hepatic fibrosis during the period 1971-1993. About half of the children were about the 6 years old. Only two had brothers with same disease. The chief clinical manifestation was hematemesis associated or not with liver enlargement, predominantly of left lobe. Only one case showed fever and cholangitis. Liver function tests were usually normal. Twenty-two children had portal hypertension. Liver biopsy was of definitive for diagnosis. Seven children died.
Subject(s)
Liver Cirrhosis/congenital , Child , Child, Preschool , Female , Humans , Infant , Liver Cirrhosis/diagnosis , MaleABSTRACT
Se presentan 26 niños con fibrosis hepática congénita que asistieron al INSTITUTO NACIONAL DE PEDIATRIA durante el período de 1971-1993. Más de la mitad de los casos fueron preescolares y escolares. En 5 casos se documentó antecedente familiar de hepatopatía, pero sólo en 2 hermanos lo fue de fibrosis hepática congénita. La manifestación clínica predominante fue hematemesis con hepatomegalia de predominio de lóbulo izquierdo (34,6 por ciento) se encontró enfermedad renal poliquística asociada. Las pruebas de funcionamiento hepático fueron normales, en la mayoría de los niños. En 22 casos se detectó hipertensión portal demonstrándose várices esófago-gástricas en 20 casos. La biopsia hizo el diagnóstico definitivo en todos los casos. En 9 niños exitó asociación con patología renal. A la fecha, 7 niños han fallecido. En base a nuestras conclusiones es importante que el pediatra sospeche esta enfermedad y refiera al niño a un centro hospitalario especializado
Subject(s)
Infant , Child, Preschool , Child , Humans , Male , Female , Liver Cirrhosis/congenital , Liver/pathology , Hypertension, Portal/diagnosis , Biopsy , Liver Cirrhosis/diagnosis , Liver Cirrhosis/pathology , Hematemesis , Hepatomegaly , Hypertension, Portal/etiology , Kidney , Kidney/pathology , Liver Function Tests , Portography , Students , UltrasonographyABSTRACT
Se presentan 26 niños con fibrosis hepática congénita que asistieron al INSTITUTO NACIONAL DE PEDIATRIA durante el período de 1971-1993. Más de la mitad de los casos fueron preescolares y escolares. En 5 casos se documentó antecedente familiar de hepatopatía, pero sólo en 2 hermanos lo fue de fibrosis hepática congénita. La manifestación clínica predominante fue hematemesis con hepatomegalia de predominio de lóbulo izquierdo (34,6 por ciento) se encontró enfermedad renal poliquística asociada. Las pruebas de funcionamiento hepático fueron normales, en la mayoría de los niños. En 22 casos se detectó hipertensión portal demonstrándose várices esófago-gástricas en 20 casos. La biopsia hizo el diagnóstico definitivo en todos los casos. En 9 niños exitó asociación con patología renal. A la fecha, 7 niños han fallecido. En base a nuestras conclusiones es importante que el pediatra sospeche esta enfermedad y refiera al niño a un centro hospitalario especializado (AU)
Subject(s)
Infant , Child, Preschool , Child , Humans , Male , Female , Liver Cirrhosis/congenital , Liver/pathology , Hypertension, Portal/diagnosis , Liver Cirrhosis/diagnosis , Liver Cirrhosis/pathology , Hypertension, Portal/etiology , Kidney/pathology , Kidney/diagnostic imaging , Portography , Ultrasonography , Biopsy , Students , Hematemesis , Hepatomegaly , Liver Function TestsABSTRACT
We studied 26 children with congenital hepatic fibrosis during the period 1971-1993. About half of the children were about the 6 years old. Only two had brothers with same disease. The chief clinical manifestation was hematemesis associated or not with liver enlargement, predominantly of left lobe. Only one case showed fever and cholangitis. Liver function tests were usually normal. Twenty-two children had portal hypertension. Liver biopsy was of definitive for diagnosis. Seven children died.
