Simultaneous correction of biliary atresia and small bowel atresia in the neonate.

The coexistence of biliary atresia and small bowel atresia has been described. However, attempts to correct the biliary atresia at the same time as small bowel atresia repair have not been detailed. In 1986, a 2,170-g female was delivered at 36 weeks' gestation. Postpartum, duodenal obstruction was suspected after oral feedings were not tolerated. At 37 hours after birth, laparotomy showed unsuspected biliary atresia in addition to intestinal malrotation, duodenal web, and type IIIb jejunal atresia with an apple-peel configuration of the upper jejunum and mesentery supplied by the superior mesenteric artery with normal small bowel length and normal ileal mesentery. A modified Roux-en-Y hepatic portoenterostomy was performed using the blind end of the apple-peel configuration of jejunum, with a side-to-side duodenojejunostomy 25 cm from the portoenterostomy. Microscopic examination of the fibrous extrahepatic biliary tissue showed a disarray of small bile ductules. The maximal ductal size at the portoenterostomy site was 600 microns. A liver biopsy specimen showed normal architecture with eosinophils infiltrating the portal triads and periductal areas. Postoperatively, she has maintained normal growth and development with no episodes of cholangitis. Liver biopsies at 1 year and 3 years were normal. At 4 years, total and conjugated bilirubin, serum proteins, liver enzymes, coagulation factors, and trace elements were normal. We conclude that simultaneous correction of biliary atresia and small bowel atresia can be accomplished in the neonate with excellent early results.

Placental teratoma.

Teratomas of the placenta are rare tumors. A case arising in a term placenta is reported, past cases are reviewed, and possible mechanisms of pathogenesis are reviewed.

Traumatic bilateral renal artery thrombosis.

Although unilateral traumatic renal artery thrombosis may be more common than was once thought, bilateral traumatic renal artery thrombosis is rare, with only thirteen previously reported cases. Time is of the essence in diagnosing this condition, so that in the proper clinical setting one may be able to proceed quickly to arteriography. However, the prognosis at present still remains poor.

Clindamycin-associated colitis.

Four cases of clindamycin-associated colitis have recently been observed at Kansas University Medical Center. There have been a few reports in the literature of colitis associated with this antibiotic, and our 4 cases are similar to those noted previously. All had the onset of diarrhea 7-14 days following the initiation of clindamycin therapy; the diarrhea persisted for weeks after the drug was discontinued. Mucosal changes ranged from focal ulceration to pseudomembrane formation. Diarrhea in a patient on clindamycin should alert the physician to the possibility of antibiotic induced colitis, a condition with significant morbidity and occasional mortality.