Appendicectomy--becoming a rare event.
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Appendectomy↗
Biomedical subjects
A L Sparnon
Publications and source records attributed to A L Sparnon.
Active observation of children with possible appendicitis does not increase morbidity.
BACKGROUND: Attempts to maximise diagnostic accuracy and reduce unnecessary surgery have led to the hospital observation of children with suspected appendicitis but unconvincing physical signs. However, morbidity associated with perforation necessitates the prompt management of acute appendicitis and increases anxiety concerning prolonged preoperative observation. METHODS: To assess the preoperative delay and subsequent complications associated with active observation of appendicitis, we reviewed the records of 378 children who had an appendicectomy performed at the Women's and Children's Hospital during a 4-year period. RESULTS: Active observation was associated with an overall diagnostic accuracy of 93%. The mean preoperative hospital time was 12 h. The incidence of gangrene or perforation was 32%, with a mean preoperative hospital time in this group of 7 h. In view of the short preoperative waiting time in this group, we do not believe perforation in hospital to have been a frequent occurrence. The overall incidence of postoperative infective complications was 4%, with an incidence of 12% following perforation. CONCLUSIONS: Children with advanced disease often have convincing signs on presentation and are not usually subjected to a significant delay. Active observation is not associated with high postoperative morbidity.
Adolescent↗
Unusual donor site reactions to calcium alginate dressings.
Calcium alginate dressings have been used as the standard dressing for split skin donor sites at the Women's and Children's Hospital burn unit for the last 12 yr. This method has proven satisfactory with good haemostasis, reliable healing, low infection rate and is well accepted by the children and nursing staff. We have recently had 5 cases with the unusual and unexplained phenomenon of dermal calcification in the donor site following the use of two new varieties of calcium alginate dressing.
Alginates↗
Traumatic pancreatitis: long-term review of initial non-operative management in children.
OBJECTIVE: To assess the safety and long-term efficacy of an initial non-operative approach to the management of pancreatic trauma in children. METHODOLOGY: Retrospective case-note review of children admitted to our institution with the diagnosis of pancreatic trauma over a 10-year period from 1985 to 1994 inclusive. RESULTS: Fourteen children were identified with a diagnosis of traumatic pancreatitis. Eleven of the injuries were secondary to motor vehicle accidents or trauma from a bicycle handlebar. In seven patients there were associated intra-abdominal injuries and in eight patients the traumatic pancreatitis was complicated by development of a pseudocyst. Three pseudocysts settled without intervention, two resolved with percutaneous external drainage and the remaining three required open surgery. The mean in-patient stay was 21.2 days. The average length of follow-up was 7.7 years with no observed long-term complications. CONCLUSIONS: Non-operative management of traumatic pancreatitis in the absence of complete duct transection is safe in children and does not appear to be associated with adverse sequelae.
Accidents, Traffic↗
Two unusual cases of megacolons.
A 13-year-old boy with features of intestinal obstruction was found at laparotomy to have a sigmoid volvulus. A 7-year-old girl with a similar presentation had a tight stricture at the rectosigmoid junction causing obstruction. In both cases the proximal colon was grossly loaded with faeces. In the first child, a colostomy after resecting the sigmoid colon was considered the safer option, whereas in the second, an innovative method to decompress the proximal loaded colon using a sterilised colostomy bag was employed, enabling a primary anastomosis to be performed.
Adolescent↗
Thyroglossal duct cyst or ectopic thyroid gland?
We report a 16-year-old boy with an anterior midline neck mass clinically diagnosed as a thyroglossal duct cyst. An ultrasound scan performed prior to surgery suggested a normally located thyroid gland. Following surgical excision of the presumed thyroglossal duct cyst the patient became hypothyroid. A radioisotope scan confirmed no active thyroid tissue. A pitfall in the ultrasonographic identification of the thyroid gland is discussed.
Adolescent↗
Embryogenesis of enterocystomas-enteric duplication cysts of the tongue.
Enteric duplication cysts of the tongue are unusual lesions that may be confused with dermoid cysts, hemangiomas, lingual thyroid remnants, ranulas, and cystic hygromas. Two cases of lingual enteric duplications are reported in a 5-year-old boy and a 4-month-old boy. In the first case the cyst was lined by gastric-type epithelium, and in the second by colonic-type epithelium. Theories of pathogenesis of enteric duplications include development from small epithelial inclusions trapped during fusion of primordial tissues, from incomplete coalescence of lacunas that form between epithelial cells of the solid core of the developing gut, from persistence of epithelial buds within the wall of the bowel, or from nests of trapped entodermal cells. However, each of these theories presents problems with respect to lingual enteric cysts, as possible trapping of epithelium by fusing primordia does not explain the presence of heterotopic mucosa, and the tongue does not develop in the same manner as the hollow viscera. It becomes apparent therefore that enteric duplication cysts are a heterogeneous group of lesions that share some morphologic features, but perhaps not the same pathogenesis.
Child, Preschool↗
Double intussusception of ileum through a patent vitello-intestinal duct: report of a case and literature review.
The following is a case report of double intussusception of ileum through a patent vitello-intestinal duct in a 5 week old infant. This is the first case to be reported in Australia. The incidence, clinical features, diagnosis, treatment and prognosis of this condition are discussed.
Emergency Medical Services↗
Pharmacological manipulation of postoperative intestinal adhesions.
Paralytic ileus and intestinal adhesions are common events following intra-abdominal surgery. The theoretical hypothesis 'that stimulation of the postoperative bowel will reduce intestinal adhesions' was studied in a rat model for intestinal adhesions in which postoperative bowel motility was pharmacologically manipulated. Immediate postoperative stimulation of gastrointestinal motility by the prokinetic agent, Cisapride, resulted in a significant reduction in both the number and extent of adhesions. Inhibition of postoperative intestinal motility with the anticholinergic agent, atropine, resulted in a greater number of more dense adhesions involving an increased length of bowel.
Animals↗
Complete epispadiac urethral duplication.
A case of complete epispadiac urethral duplication is reported. The epispadiac opening was at the base of the penis. This case is unusual because the anatomy was otherwise normal and the incontinence was intermittent.
Child↗
Neonatal intestinal obstruction.
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Anus, Imperforate↗
Incarcerated inguinal hernia in infants.
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Colonic Diseases↗
Bicycle handlebar injuries in children.
A series of 30 apparently trivial accidents involving bicycle handlebars is reviewed. A mean delay of 23 hours existed between the accident and hospital presentation, and a mean hospital stay of 22 days resulted from a variety of serious intra-abdominal injuries. Handlebar injuries must be considered potentially serious, no matter how trivial the accident appears.
Athletic Injuries↗
Surgery of pelviureteric obstruction in 101 children over one year of age.
One hundred and one children over 1 year of age have had surgery for pelviureteric obstruction over an 11 year period. The common clinical features were abdominal pain, urinary infection or haematuria, but a number presented as an incidental finding. Less commonly, the patients presented with an abdominal mass or with hypertension. The diagnosis was usually made on intravenous pyelography (IVP) but in the latter part of the series, renal nuclide scan (RNS) and ultrasonography (US) were preferred. Ninety-three patients had a unilateral pyeloplasty, three had bilateral pyeloplasty and five had nephrectomy or heminephrectomy. Whereas initially nephrostomy drainage was used in the majority of patients after pyeloplasty, a trend away from nephrostomy evolved in the latter part of the series. With experience, the incidence of postoperative complications was also reduced and there was a reduction in the period of hospitalization. Clinical results were consistently satisfactory. Postoperative assessment after pyeloplasty was made by IVP and/or RNS and also US. A review of these investigations showed that RNS provided more factual information of the result when compared with the IVP.
Female↗
Intussusception in childhood: a review of 139 cases.
A retrospective survey of 128 patients, representing 139 instances of proven intussusception is reviewed. An initial hydrostatic enema reduction attempt was performed in 75% of cases, with 50% of these being successful. A high recurrence rate of 18.4% followed the hydrostatically reduced cases, compared with 2.7% for the surgically treated. Hydrostatic reduction was particularly unsuccessful in infants less than six months of age, when the duration of symptoms exceeded 12 hours and when the presentation is painless. Earlier surgery is recommended for these children.
Adolescent↗
Urological anomalies in the caudal regression syndrome.
Two cases of unusual urological anomalies seen in association with the caudal regression syndrome are reported. One patient had bilateral single ectopic ureters with unilateral renal agenesis and the other a megalo-ureter secondary to a ureteric valve.
Abnormalities, Multiple↗