Conservative management of major abdominal wound dehiscence in premature babies - a seven-year experience.

AIM: The aim of the study was to analyse our experience of managing complete abdominal wound dehiscence in preterm neonates non operatively, when primary closure was not possible. We used intrasite gel (a carboxymethyl cellulose polymer which helps in wound debridement and healing) and occlusive duoderme dressings. MATERIALS AND METHODS: There were seven neonates who developed abdominal dehiscence following laparotomy between January 2000 and December 2006. All had complete abdominal dehiscence with visible intestines. The defect was allowed to granulate and epithelialise by the application of intrasite gel and duoderme dressings. Dressings were changed every 3 days, or earlier, if necessary. RESULTS: All babies responded well, i.e. their wounds healed without the need for immediate surgery. One patient actually had a stoma in the middle of the wound which was managed with stoma bags during the same period. The period of total epithelialisation ranged from 21 to 108 days. Two patients developed adhesive intestinal obstruction requiring surgery, at 2 and 3 months after the start of treatment. On follow-up, 2/7 patients had developed an incisional hernia. CONCLUSION: Abdominal wound dehiscence can be successfully managed conservatively with intrasite gel and duoderme dressings, even if bowel is visible. This is potentially lifesaving in severely premature and septic babies in whom primary closure is not desirable. However, some patients do develop adhesive intestinal obstruction or a faecal fistula, either as a result of their primary illness or of this treatment. We believe that this series is the first of its kind to be reported in the world literature.

An evaluation of the role of suction rectal biopsy in the diagnosis of intestinal neuronal dysplasia.

BACKGROUND: German pathologists have developed a consensus for histological features of intestinal neuronal dysplasia. METHODS: A blind reevaluation of ganglionic suction rectal biopsies from infants and children who initially presented with symptoms of intestinal dysmotility was made. RESULTS: 84 of 411 specimens had sufficient depth of submucosa for adequate assessment. Questionnaires or clinical interviews were employed 3-5 years after biopsy in these 84 patients to assess the relationship between histological changes and persistent symptomology. Eighteen children were lost to follow-up, 4 others had Hirschsprung's disease the study biopsy specimen having been taken from the pulled-through bowel after surgical resection of the aganglionic segment. The remaining 62 patients were divided into three groups. There were six patients in group A (both obligatory criteria) and 28 in group B (nonessential, or just one of the obligatory criteria), and 28 in group C (normal appearances). On follow-up, two of the 28 (7%) in group B, and six of the 28 (21%) in group C had persistent dysmotility symptoms. CONCLUSIONS: Histological criteria of the consensus of German Pathologists for intestinal neuronal dysplasia was unhelpful in predicting the clinical outcome and therefore, should not influence clinical management. As one of the obligatory criteria, hyperplasia of the submucosal plexus was significantly more common in neonates (< 4 weeks), it is concluded that this is an age-related variation.

Association of ambiguous genitalia with VATER anomalies and its significance in management.

Tracheo-oesophageal fistula, oesophageal atresia, and imperforate anus are known to be associated with renal anomalies - the VATER complex. The occurrence of ambiguous genitalia with this collection of anomalies has not previously been highlighted. We report two cases occurring 15 years apart; both had renal agenesis and neither was salvagealble from a renal or pulmonary viewpoint. Preoperative ultrasound examination of the renal tract should be performed in all babies born with the VATER complex and ambiguous genitalia; this will prevent unnecessary surgery.

Surgical complications in acute leukemia in childhood: a 20 year experience.

A retrospective study of all patients presenting with acute leukemia to a single institution during the period 1968-1988 was undertaken to determine the type and incidence of surgical complications. One hundred twenty-eight of 296 patients were identified as requiring a surgical consultation for complications occurring during the course of the disease and many surgical disciplines were involved. Operative intervention was often required for these complications. Pediatric surgical specialists need to be aware of the range of surgical complications that can occur in children with acute leukemia and they must work in close co-operation with pediatric medical oncologists to ensure optimal treatment for all patients.