Obstructive jaundice in a child with pancreatic hemangioma.

We report the case of a 2-year-old boy who presented with obstructive jaundice by pancreatic hemangioma. In this case, a minimal operation for obstructive jaundice without resection of the tumor was performed. Three years after the operation, the pancreatic hemangioma almost disappeared. We discuss treatment of the pancreatic hemangioma in children.

Endosonographic study of anal sphincters in patients after surgery for Hirschsprung's disease.

PURPOSE: This study was performed to evaluate the relationship between endosonographic findings of anal sphincters and anorectal function in patients after surgery for Hirschsprung's disease. In addition, whether internal sphincterotomy or sphincterectomy was accomplished was examined in each procedure by anal endosonography. METHODS: Fifteen patients, aged 11 to 20 years, were examined. Nine patients underwent modified Duhamel's operation, three underwent Rehbein's operation with anorectal myectomy, and three underwent modified Martin's operation. All 15 patients were examined by anal endosonography using a sonographic scanner (Aloka SSD 2000) with a 7.5-MHz radial rotating endoprobe, clinical bowel assessment, and manometric study. RESULTS: After the modified Duhamel operation, anal endosonography showed an interruption of the external anal sphincter (EAS) in eight of the nine patients, as a high, mixed, or low echoic lesion in the hyperechoic band correlated to the EAS. The locations of the interruption were wide in patients with mild constipation. An interruption of the internal anal sphincter (IAS) was observed in all nine patients, as a hyperechoic lesion in the hypoechoic band correlated to IAS, which indicated internal sphincterotomy. After Rehbein's operation with anorectal myectomy, an interruption of EAS was observed in all three patients as a high or low echoic lesion in the hyperechoic band. An interruption of IAS was observed in all three patients. After the modified Martin's operation, an interruption of EAS was observed in two of the three patients as a high or low echoic lesion in the hyperechoic band. An interruption of IAS was observed in all three patients. CONCLUSION: Anal endosonography showed detailed distributions of EAS and IAS in patients after surgery for Hirschsprung's disease and complete internal sphincterotomy or sphincterectomy after these operations.

A comparison of anal endosonography with electromyography and manometry in high and intermediate anorectal anomalies.

Anal endosonography, electromyography (EMG) of the external anal sphincter (EAS), and manometry of the internal anal sphincter (IAS) were performed in 15 patients with anorectal anomalies (10 with high and five with intermediate anomalies), ranging in age from 8 to 18 years. The anal endosonographic findings were compared with those for the EMG of the EAS and manometry of the IAS. An image including the hyperechoic band that corresponds to the EAS was obtained in all 15 patients. However, the distribution of EAS image was inadequate in high anomalies. In four patients who showed in Kelly score of 5 or 6, good visualization of the EAS was obtained in both anal endosonography and EMG. An Image including the hypoechoic band that corresponds to the IAS was obtained in five patients with high anomalies and in one with intermediate anomalies. Therefore, even in patients with anomalies, at these levels the IAS could be ultrasonically detected. However, only one of these six patients exhibited an anorectal reflex. These results indicate that, for the EAS, the findings of anal endosonography correspond well with those of EMG, but that for the IAS, they do not correspond with those of manometry. At the time of surgery for anorectal anomalies care should taken to preserve the IAS, which can be detected by anal endosonography even in patients with high or intermediate anomalies.

New biofeedback therapy in children with encopresis.

Biofeedback therapy was performed in 13 patients with encopresis using newly devised computerized equipment. The patients were children, aged 6 to 11 years, who had not responded to trials of conventional therapy with a mean follow-up period of three years and two months. The biofeedback therapy was effective in 12 of the 13 patients after one course of therapy. This positive results was attributed to the computerized equipment. The patients could more easily recognize how to squeeze their anal sphincters after seeing a colored ellipse representing sphincter pressure on a monitor. The results of anorectal manometry and electromyography (EMG) showed that biofeedback therapy improved the voluntary sphincter function and rectal sensation. Therefore, biofeedback therapy might be effective in patients with encopresis whose sphincter functions are intact.