Sutureless "button and hole" splenopexy.

A new technique for fixation of a mobile spleen is described. It offers the advantages of a minimally risky procedure that very effectively keeps a mobile spleen in its bed without foreign materials and is feasible even when the gastrosplenic ligament is absent and the splenic vessels are uncovered. Our "button and hole" sutureless splenopexy was performed in six patients from 1979 to 1995. Three had a gastric volvulus (GV) and an extremely mobile spleen; one of these also had a diaphragmatic eventration. Another three had torsion of the spleen; in one it occurred 9 months after repair of a diaphragmatic hernia. We achieved good results with splenopexy as the sole operation in two cases where a wandering spleen produced a GV.

Repair of gastroschisis using umbilical cord as a patch.

In some cases when complete primary closure is not possible, we have developed a new method of repair of gastroschisis using the umbilical cord as a patch. This method is simple, safe, and the patch is gratis.

Total gastrectomy in an infant with corrosive gastritis.

An 18-month-old infant with necrosis of the entire stomach and subsequent stricture is presented. Two months after the ingestion of corrosive solution, the infant was admitted in poor condition. Total gastrectomy and oesophago-duodenal anastomosis were performed. Two years after the operation the child is in good condition.

Adrenal cysts in the newborn.

We report on 2 newborns with adrenal cysts who were treated successfully with an operation. One patient had been well after birth with no adrenal insufficiency. However, 2 large and 2 small cysts were found, all of which were attached to the adrenal gland without a clear vascular stalk. The other patient had adrenal cortical insufficiency. His mother had had gestational diabetes and hypertension during pregnancy. The adrenal cyst was partially resected. Both patients were in good condition 5 years postoperatively.

Traumatic rupture of the testis and epididymis.

Traumatic rupture of the testis and epididymis is an uncommon condition in the pediatric surgical literature. Two children are presented, first with a rupture of the testis and second with laceration of the epididymis. Early surgical exploration was performed in both cases and good results were obtained.

Duodenal and jejunal atresia with agenesis of the dorsal mesentery: "apple peel" small bowel.

Two newborn infants with duodenal and jejunal atresia and agenesis of the dorsal mesentery represent our surgical experience with "apple peel" small bowel or "christmas tree" demormity. The first patient had the typical appearance of this condition. The postoperative course was complicated by hyperbilirubinemia, septicemia, and disseminated intravascular coagulation. The infant is in satisfactory condition 1.5 years after operation. The second patient had agenesis of the dorsal mesentery without spiraling of the bowel around its vascular stalk. The child died after 1 month, with complete absence of extrahepatic bile ducts as seen at a second laparotomy. Neither child had been subjected to gastrostomy.

Variations in the bladder exstrophy complex associated with large omphalocele.

Two newborns with a large omphalocele associated with the bladder exstrophy complex are presented. In 1 case the omphalocele was combined with a musculoskeletal defect and imperforate anus with an anovulvar fistula. The other patient had a musculoskeletal deformity and a duplicated bladder with exstrophy. Surgical treatment was successful in both cases.