Intestinal atresia and stenosis as seen and treated at Kenyatta National Hospital, Nairobi.

In this retrospective study carried out covering the period, 1978-1991, 62 neonates were seen, diagnosed and treated for intestinal atresia which included: duodenal atresia and stenosis, small bowel atresia and atresia of large bowel. Locations of obstruction were duodenal in 17 patients, jejunal in 25 patients, jejuno-ileal in 5 and colon in two. Duodenal atresia was noted in 9 infants and duodenal stenosis due to annular pancreas, Ladd's bands with malrotation of bowel in 8. Associated anomalies which were observed were anorectal malformations in 2 and malrotation in 2 infants. Birth weights ranged from 1450 gm to 3000 gm. Prematurity was recorded in 11 infants. Diagnosis of intestinal atresia in our patients was made clinically and radiologically. Intestinal atresia in neonates was differentiated from other causes of obstruction such as Meconium Ileus, Hirschsprung's disease, neonatal volvulus, rectal atresia in anorectal malformations. Treatment of infants with intestinal atresia was surgical. Surgical techniques used depended on pathological findings. In 36 patients, complications such as functional obstructions with vomiting and failure to thrive, malabsorption, aspiration, bronchopneumonia, sepsis were observed. Overall mortality rate in our cases was 25 (41.9%) out of 62 patients.

Splenectomy in kala-azar.

At the beginning of the century, splenectomy was used in the treatment of kala-azar, but now is rarely needed, the major indication being for drug resistant kala-azar. Inadvertent splenectomy prior to the diagnosis of kala-azar continues to occur, probably because of a reluctance to perform splenic aspiration in the investigation of splenomegaly. Five Kenyan children underwent splenectomy for drug resistant kala-azar. All were immediately improved, but one died of overwhelming post splenectomy infection (OPSI) two months later and another of a malignant lymphoma seven months after surgery. The other three patients appear to be cured. Splenectomy was considered in a sixth child with kala-azar because of a Salmonella abscess in the spleen, but the abscess ruptured catastrophically before surgery could be arranged.

Positive ventriculography using water-soluble contrast media in infants with myelomeningocele and hydrocephalus.

Ventriculography with meglumine iocarmate (Dimer X) or Metrizamide (Amipaque was carried out in 15 infants with myelomeningocele and progressive hydrocephalus. In all cases, an Anold-Chiari-Malformation type II was diagnosed with compression of the structures of the posterior cranial cavity and their displacement within or below the level of the foramen magnum. The aqueduct was always patent but laterally compressed. In the region of the third ventricle there was often encountered an enlargement of the massa intermedia with indentation of the lamina terminalis and enlargement of the recessus suprapinealis. Aspects of pathogenesis of the malformation and possible causes of hydrocephalus originating from these findings are discussed. Methods and advantages of positive ventriculography using water-soluble media are presented.