Search

Dilatation (expansion) of parts of the small bowel (segmental dilatation) is a rare congenital condition that occurs without thickening of the muscles that surround the bowel. The condition occurs mainly in children and, although it is not associated with a specific set of symptoms, segmental dilatation may coexist with other serious abdominal disorders in the neonatal period (first six weeks after birth). Radiological examination, using barium as a radioactive contrast agent, demonstrated morbid (diseased) anatomy. Three cases of small bowel segmental dilation were studied: an infant girl who vomited after feedings and displayed an enlarged abdomen; a five-year-old boy with a history of recurrent mild abdominal pain; and a six year-old-boy who had severe recurrent abdominal pain with vomiting of bile. All of the patients underwent a laparotomy (surgical opening of the abdomen). Researchers noted three main categories of symptoms: (a) signs of bowel obstruction in the neonatal period (vomiting and absence of a bowel movement); (b) anemia (low red blood cell count), which can be severe and is usually caused by blood loss; (c) signs and symptoms of bowel obstruction in older infants, children, and adults. After reviewing 33 additional cases of small bowel segmental dilation, researchers conclude that failure to demonstrate a bowel lesion in older children with blood loss prolonged the period of illness symptoms and seriously increased the likelihood that invasive examinations would be performed. The report advocates an x-ray barium study of the small bowel in cases where endoscopy (a visual examination of the stomach and small intestine) can not find a cause for blood loss. However, it is not suggested that barium studies of the small bowel be performed in all children with intermittent abdominal pain. For most children with these symptoms, a standard x-ray image of the small bowel is sufficient.

Abstract Central venous catheters (CVC) have become an important adjunct to the overall management of paediatric patients, but their use is associated with frequent complications resulting in premature removal. This report evaluates the insertion techniques and complications of 295 consecutive surgically inserted CVC from 1987 to 1991 in a paediatric hospital. Fully implanted catheters had significantly less incidence of catheter-related problems necessitating removal (infection, dislodgment, leaking, blockage, or migration — 31%) compared to exteriorised catheters (58%). One-third of catheters were removed because of infection, one-third as they were no longer needed, and the remaining for multiple reasons. Infected (110±18 days), dislodged (18 ± 4 days), or migrated (44 ± 6 days) catheters were removed significantly earlier than those removed because they were no longer needed (195 ± 24 days). Catheters became dislodged more frequently in the younger patients. Catheters with the tip in the subclavian vein (29%) migrated more frequently than those in the right atrium. There was a significantly increased incidence of infection in catheters inserted into the saphenous vein (43%) compared to those in the internal jugular vein (11%). Some episodes of catheter infection were managed with antibiotics, with short-term resolution of symptoms and signs. However, all 71 infected catheters ultimately required removal for further sepsis. Fully implanted catheters had 1.1 episodes of catheter-related sepsis per 1,000 catheter days compared to 3.7 for exteriorised catheters. The position of the catheter tip, vein used for insertion, training of young surgeons, and location of the subcutaneous tunnel need particular attention in order to reduce catheter complications.

Persistent cloacal anomalies are usually recognised in newborn females. A 2-year-old presented with a cloacal lesion not previously documented. The precise diagnosis was delayed due to the fact that her external anatomy resembled a normal appearance. The urethro-vaginal and rectal canal opened through the anterior external anal sphincter complex. Chronic diarrhoea and genital excoriation ensued due to the mixing of the urine and faecal stream. The anatomy was defined by direct endoscopy, and radiological studies demonstrated a normal sacrum and bilateral renal tract anomalies. A preliminary diverting divided-limb sigmoid loop colostomy was followed by a posterior sagittal ano-rectoplasty with correction of the urethral, vaginal, and anorectal anomalies. The cosmetic appearance is very satisfactory. The urinary and faecal control in the child, whose unusual anomaly had been missed by many practitioners, both general and specialist, is very good. The renal anomalies now constitute the greatest threat to her longevity.

Objectives:To investigate the frequency and causes of bicycle related abdominal injuries in children and to examine the pattern of presentation. Design:The study was a prospective study of bicycle related injury in children less than 15 years of age presenting to two paediatric hospitals (15 April‐30 June 1992) and three general hospitals (1 August 1991‐30 June 1992). Results:In a series of 813 children, 41 sustained non‐penetrating abdominal trauma due to a bicycle incident. In 21 cases, handlebar trauma was responsible. Ten of these children suffered life‐threatening intra‐abdominal injury. Handlebars with no plastic or foam covering of the metal ends were involved in all ten cases. In several of these cases, presentation to hospital was delayed and in others confirmation of the extent of injury took up to 48 hours. The length of hospital stay for those with significant intra‐abdominal organ damage ranged from two to 156 days. Conclusions:Intra‐abdominal trauma must be considered when dealing with children who are victims of bicycle trauma. Impact with handlebars may have occurred and some form of padded protection of handlebar ends is recommended unless their design can be suitably modified.

This study involves a combined radiology/pathology approach. In each case x-rays of the cervical spine were made before autopsy. The cervical spine was then removed and x-rayed again before fixation. After fixation the specimens were cut in the mid sagittal plane and damage to the vertebrae, discs, ligaments and cord assessed. The mid sagittal width of the bony canal was also measured.