Chirurgie pediatrique最新文献

A rare case of Crohn's disease limited to the appendix is reported in an 18 years old adolescent, hospitalised as having acute appendicitis. Appendectomy was performed. There were no postoperative complication and no recurrence after 3 years follow-up. Surgical indications are discussed and literature reviewed.

We report seven cases of congenital colonic atresia over a 13 year period (1975-1988). The atresia was located in the ascending or transverse colon (4 cases), or in the descending or sigmoid colon (3 cases). According to Bland-Sutton classification, one patient was a type I, five were either a type II or III, and for the last patient the type was not precise. Three infants had associated malformations: jejunal atresia (case n. 6), intestinal malrotation (case n. 5), and gastroschisis and jejunal atresia. This last patient, in whom jejunal and colonic atresias were autopsy findings, died after a Schuster procedure for gastroschisis closure. The six other neonates survived. Five of them underwent emergency colostomy and delayed anastomosis when general conditions were stable (2 to 10 months after colostomy). The sixth neonate (case n. 2) was treated by colonic resection and primary ileocolic anastomosis. Two patients had postoperative complications, ie, anastomotic leak (case n. 4) or disfunction (case n. 2), which were successfully treated by another operation. The outcome, one year after the onset of the disease, was good for 5 out of the 6 survivors. All these five patients were normally passing stools, once or twice a day, with no abdominal distension. One patient (case n. 6) had a short bowel syndrome secondary to a jejunal atresia, with intermittent watery stools and abdominal distention. We reviewed the 161 cases of colonic atresia from English and French experience since 1960. The overall mortality rate is 25%. Associated malformations and infection are the main causes of death. The rate of anastomotic complications is high (15%).(ABSTRACT TRUNCATED AT 250 WORDS)

Examination of the hips had been performed in an algerian maternity ward on nearly 15,000 neonates. The results show an important number of babies lost from control, either after they have left the maternity or after one or two orthopedic weekly examinations. There were various causes to explain this important number of babies lost from control but the attempts to reduce this number were disappointing during the six years of the study. We suggest that, for a better control of the babies, the personal of public health administration must be concerned in the neonatal prevention of congenital dislocation of the hip in a developing country under the medical supervision of a pediatrician or an orthopedist. Moreover, a too high number of neonates had been submitted to the abduction treatment, because there was a difficulty in differentiating Ortolani's and Barlow's signs. The abduction treatment is proposed for all the babies that could not be under medical examination in the developing countries to reduce the number of late diagnosis of congenital dislocation of the hip.

We report a case of umbilical cord angioma in a female newborn. Ultrasonographic antenatal diagnosis had suspected either an omphalocele or a tumor of the umbilical cord. A caesarean had been decided at term. Surgery was necessary to ligate the umbilical vessels. The cord was 37 cm long and 7 cm large in several places. It weighed 495 g. The interest of this case resides in its rarity. First description of this kind of tumor was made by Gerdes in 1864 and since, only 20 cases have been reported. Antenatal diagnosis difficulties in umbilical cord tumors are reviewed. Vitelin cyst, angioma, and teratoma represent the most common diagnosis which are histologically and clinically discussed. Associated malformations and complications of umbilical cord angioma are reviewed in the literature.

Two cases of isosexual precocity in relation to granulosa cell tumor in 2 girls aged 6 and 9 months respectively are described. In the two cases clinical and biological signs of hyperoestrogenemia were found but in one, acute signs of tumoral rupture were the first symptom. Histologically, the two classical subtypes were found: macrofollicular ("adult" type) and "juvenile". These two children are alive without any sign of recurrence with a follow up of 12 and 18 months. The occurrence of granulosa cell tumors in such young girls seems extremely rare.

The follow up of a 4 1/2 years old boy ingesting a coin shows gastric stagnation of the foreign body. The coin does not pass through the pylorus and upper endoscopy is performed at 6 weeks. No foreign body is visualized but gastric retention is showed by X ray. The coin's extraction is performed after several "biopsy" because mucosal impaction. The patient is now no symptomatic. The anusual complication of coin's ingestion is reported to remember management of this problem.

Two cases of prenatal detection of congenital biliary cysts are reported. Prenatal and postnatal ultrasonography demonstrate a solitary sonolucent cystic lesion. The differential diagnosis in fetus and infant includes any abdominal cystic lesions: ovarian cyst, duplication cyst, cystic lymphangioma, choledochal cyst and other congenital cysts of the liver. In opposite to the difficulty of diagnosis, the choice for treatment is easy: surgery is the only way to allow histologic diagnosis and to avoid any relapse or complications.

Unlabelled: Continuous epidural analgesia is an common technique in neo-natal surgery. It will be possible with a fitting material. Principal indications are: omphalocele, gastroschisis, oesophagol atresia an diagphragmatic hernia.

Technique: our protocol has been approved by the Regional Ethical Committee and informed written consent has been obtained from parents. General anaesthesia was induced and children were placed in lateral position. After skin preparation, the interspace L 3-L 4 has been punctured to identify the epidural space by loss of resistance. An epidural catheter (19 to 27 G) has been placed. 0.5 ml.kg-1 of 0.25% bupivacaine have been immediately injected, followed by a continuous injection of 0.3 ml.kg-1h-1 of the same bupivacaine. Epidural has been kept for four to five days.

Advantages: very good analgesia; abdominal and vascular pressures decreased; to wean from respirator very quickly. No accident was founded.

Fourteen of Dunn's operations for slipped upper femoral epiphysis were analysed in their indications and their results in comparison with others series. The open operation of the femoral head is a good method for the chronic highest displacements. The notion of an acute displacement leads us to ask for a previous bone scintigraphy in order to make sure of the integrity of the vascularisation. Thus, there was no complication of necrosis in this surgery, but unfortunately, there were two chondrolysis and one mechanical accident.

A 10 year old girl developed a skin exanthema and an ileus after ingestion of a great number of elastic bands. The girl was never seriously ill before. She underwent at two different times a laparotomy each of one showing no mechanical obstructions. The bowel was distended and inflammatory processes were detected on the serosa. The proximal jejunal loops were adherent to each other and the whole bowel was adynamic. The histological findings showed a muscle necrosis of the tunica muscularis propria (longitudinal layer). Two months later the girl died on therapy resistant chronical intestinal pseudoobstruction. The autopsy showed the above mentioned muscle necrosis without vacuoles in the tunica muscularis beginning from the stomach till the anus. After consideration of the clinical, laboratory and patho-anatomical findings we think that this is a case of parainfectious visceral leiomyositis.