Absence of the appendix discovered during childhood.

Absence of the appendix is rare. Isolated cases are usually discovered in adult patients or cadavers. We report the case of a 14 year old boy who was found to have no appendix on laparotomy for assumed acute appendicitis and use this opportunity to highlight the growing surgical uses of this vestigial structure.

Penetrating anorectal injuries in Jamaican children.

PURPOSE: To discuss the presentation, management and outcomes of penetrating anorectal injuries at the Bustamante Hospital for Children. METHODS: A retrospective review over an 11-year period (January 2001-December 2011) was undertaken. The data analysed were extracted from patients' case notes which were pulled based on the hospital's admission database. RESULTS: Over the study period a total of 14 children presented with penetrating anorectal injuries. The medical records for one child were missing. The mean age at presentation was 6 years. Impalement by a metal spike was the mechanism of injury in 12 children, with one case of sexual assault. Three of the children had associated urogenital injuries. Ten rectal injuries were extraperitoneal. Five of the 13 cases (38 %) were managed with a colostomy-average time to closure was 6 months. There was one case of perineal wound infection and dehiscence. There was no mortality. CONCLUSION: Selective fecal diversion in the form of a sigmoid loop colostomy is a safe and acceptable management option for children with penetrating anorectal injuries. The perineal wound itself can be closed primarily except in cases of delayed presentation.

Use of pelvic ultrasound in the diagnosis of megarectum in children with constipation.

PURPOSE: It has not been possible so far to differentiate slow transit constipation from functional fecal retention because the existing medical literature lacks data on rectal dimensions for healthy children or children with chronic idiopathic constipation (CIC). We, for the first time, describe the use of pelvic ultrasound (US) to achieve this. METHODS: A pelvic US was carried out on 82 children with a full or partially full bladder and with no history of bowel problems and on 95 children with CIC. The rectal crescent seen behind the bladder was measured. All children also had documentation of their age, weight, and height. RESULTS: The median age, weight, and height for the healthy children were comparable with those of the children with CIC. The median rectal crescent size in children with constipation was 3.4 cm (range, 2.10-7.0; IQR, 1.0), as compared with 2.4 cm (range, 1.3-4.2; IQR, 0.72) in the healthy children, and this difference is statistically significant on multiple regressions of log for rectal diameter, adjusted for height, weight, and age (P value< .001). CONCLUSION: Pelvic US is a quick child-friendly investigation, which can be used to document the presence of megarectum. It should be the first line investigation for all the children with CIC.

Intraoperative colonic lavage in infants using a Replogle tube.

On-table colonic lavage for preparing obstructed bowel prior to anastomosis or stoma formation is now routine in adults, but it is seldom used in paediatric practice. We describe a simple technique for intraoperative colonic lavage using inexpensive medical devices that are also readily available and disposable, a Replogle tube, a fine-bore sucker, and a 20-ml syringe. We have used this technique in infants with intestinal obstruction due to anorectal malformations, intestinal atresias, and post-NEC strictures, to good effect.