Pediatric lateral ventral (spigelian) hernias.

Lateral ventral (spigelian) hernias may not be recognized if the physician is unaware that they can occur in pediatric patients. Diagnosis depends on finding a protrusion in the spigelian fascia lateral to the rectus sheath at the junction of the arcuate and semilunar lines, below the umbilicus. We report nine such cases, to bring the total number of recorded pediatric cases to 18. Surgical repair involves a layered overlapping closure using interrupted nonabsorbable sutures. Since the rim of the defect is extremely difficult to outline once the child is asleep and relaxed, it must be outlined in indelible ink while the child is awake and straining.

A double ballooned inflatable and collapsible T tube for selective proximal or distal cholangiography.

A double ballooned T tube for common bile duct occlusion and optional collapse of the intra-balloon tube segments was used for improved roentgenologic delineation of the biliary tree intraoperatively and postoperatively. This silicone T tube is effective for intraoperative and completion cholangiograms, and avoids resuturing of the choledocotomy. Furthermore, with increased inflation, each balloon is capable of occluding the proximal or distal, or both, intraductal horizontal limbs. These features have been exploited for optimal imaging and therapeutic purposes. The tube with its deflated balloons is left in the common duct for drainage and further selective proximal or distal cholangiograms. Several extensions of its use can be envisaged.

Technique and trial of continent ileocystostomy.

To overcome the problem of incontinence which failed to respond to standard measures, an animal model was designed for continent diversion without cystectomy. A tapered terminal ileal segment was implanted in a submucosal tunnel on the anterior aspect of the bladder, and the proximal end of the segment was brought out to the abdominal wall as a stoma that is catheterized intermittently. Ileocystostomy provided continent diversion in 10 dogs at intravesical pressures as high as 45 cm H2O, and there were no changes in serum electrolytes, creatinine, or urea nitrogen concentration.

A new type of continent ileostomy. Results of an animal study.

Kock's continent ileostomy is a well-established technique, however, it is technically difficult to construct and has a high incidence of complications. This study evaluates a new type of mucosal valve constructed in continuity with an intestinal reservoir. The valve is created along the antimesenteric border of the efferent limb 0.5 cm distal to the reservoir. The seromuscular layer is "stripped" from the mucosal layer for 50 per cent of the bowel circumference and then excised. The remaining seromuscular borders are then sutured to the apex of the pouch and along the antimesenteric border of the afferent limb. In this way the valve is created and, upon distention of the afferent limb and apex of the pouch, the valve closes. In seven dogs such a continent ileostomy was constructed and all were clinically continent. The reservoirs were intubated through the ileostomy two to three times a day. The mean volume aspirated was 143 ml/day. After eight weeks, radiographic and volume-pressure studies were performed. Prior to sacrifice, increasing volumes of barium were instilled into each pouch via the afferent limb and radiographs were taken: these studies confirmed the continence in all seven ileostomies. Following this the reservoirs were intubated and the instilled barium was aspirated. Then Ringer's solution was instilled into each pouch with continuous intrapouch pressure measurements. The pressure remained at 0 cmH2O until a mean volume of 243 ml was exceeded. The mean volume at which incontinence occurred was 415 ml.

Abdominoscrotal hydrocele. Case presentation and review of the literature.

Abdominoscrotal hydrocele has been known for over a century although it rarely has been reported in children. A review of the world literature revealed 84 such cases, only three cases in the pediatric age group. Our patient, a 5-mo old male, presented with abdominal and scrotal masses of 4 to 6 wk duration. The abdominal mass measured 12 x 8 cm. The scrotal mass, which clinically seemed to be a hydrocele, measured 3 x 5 cm. Both masses appeared cystic and communicated. Diagnostic work-up clearly established the diagnosis. Complete surgical excision was accomplished through an inguinal crease incision.