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38 cases of acute multilocular osteomyelitis out of a total of 165 osteomyelitis patients were treated between 1974 and 1986 at the Department of Paediatric Surgery and Paediatric Diseases at the University of Mainz. Osteomyelitis in infants was separated from juvenile osteomyelitis because of the different problems inherent to this disease depending upon the age; likewise, multilocular remote involvement was separated from regional multiple involvement. It was found that distant involvement is of special importance in infancy. 6 of the 8 cases in this group presented with symmetrical involvement. This interesting phenomenon is described in this article for the first time in acute multilocular osteomyelitis; so far, it was known to occur only in chronic recurrent multifocal osteomyelitis (CRMO). The infants in this group were predominantly newborn who were particularly severely handicapped by predisposing factors such as necessary intensive-care measures or surgical interventions. Our findings showed that in this age group most of the problems occurred, namely: 3 deaths and 2 healing defects in 8 children. For this reason it is imperative to effect particularly close monitoring of multilocular acute osteomyelitis in infancy. This must be considered as a paediatric and paediatric-surgical emergency requiring not only accurate diagnostic measures but also early internistic and surgical treatment to improve the prognosis of this specific disease pattern.

Hemangiomas of the gastrointestinal tract are very rare in both children and adults. The following case history describes a child with uncharacteristic abdominal pain and stenosis of the terminal ileum. Intraoperatively we found an enlarged hamartomatous alteration of the ileocecal region. The histological analysis showed a hamartomatous venous hemangioma. Problems concerning classification and diagnosis are discussed.

Spilled gallstones abandoned intraperitoneally may cause serious complications. The following case history describes a patient who had undergone a laparoscopic cholecystectomy elsewhere 2 years previously, and who had to have a laparotomy because of a pararenal abscess caused by spilled gallstones. fatal sepsis ensued and the patient died on the 6th postoperative day.