Mason Brown lecture, May 1988. Surgery of inflammatory bowel disease in children, with reference to Crohn's disease.
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Biomedical subjects
Publications and source records attributed to C M Doig.
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We present a case of jejunal duplication with a localized perforation of the adjacent normal intestine into the substance of the liver in a 3-month-old baby. This was successfully treated by resection of the duplication and a short segment of the normal jejunum. The diagnosis was made preoperatively by pertechnetate technetium 99m isotope scanning and a barium meal examination, and we discuss the use of these investigations in children presenting with melena.
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Ultrasonography has been used as an investigation in children with abdominal signs after blunt injury. Sixteen children were examined, of whom nine had abnormal findings. Free intraperitoneal fluid was demonstrated in four cases. The injuries found are detailed and subsequent management of the patients is described. The children with normal scans settled with no sequelae. It is suggested that ultrasonography offers a valuable, non-invasive method of investigating blunt abdominal injury.
A Pakistani girl presented with acute abdominal pain and raised serum amylase and alkaline phosphatase concentrations. She was found to have a gastric trichobezoar with a tail extending to the mid-ileum. The altered biochemical parameters returned to normal after surgical removal of the bezoar. Irritation of ampulla of Vater by the bezoar tail is believed to have caused transient pancreatitis.
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The reverse latissimus dorsi muscle flap was successfully used for the repair of recurrent congenital diaphragmatic hernia in three neonates. This muscle flap can be rapidly raised on a reliable blood supply, and provides sufficient vascularized tissue to replace the whole hemidiaphragm without tension. It should be considered at the first reparative operation when insufficient tissue is available for safe repair by direct suture.
A total of 133 children, aged 16 months to 15 years (mean 6.7 years), with presumptive acute appendicitis, was included in a double-blind, placebo-controlled trial of the short-term (72 hour) use of metronidazole suppositories as prophylaxis against post-operative infection. There was no significant difference in the incidence or severity of wound infection or post-operative intra-abdominal sepsis between the metronidazole-treated and placebo groups. It is suggested that intra-rectal metronidazole, when used exclusively, is not sufficient for effective prophylaxis for appendicitis in childhood.
Four cases of fat embolism are described in infants receiving prolonged intravenous infusion of fat (Intralipid 20%). This therapeutic complication has been termed 'fat overloading syndrome' but bears a clinical similarity to post-traumatic fat embolism. These 4 cases are the first to be recorded in infancy, and with histopathological proof of fat embolism. These 4 cases are the first to be recorded in infancy, and with histopathological proof of fat embolism. Transient high rates of infusion of Intralipid appears to be a factor in the aetiology of the condition.
The operation wounds of 20 per cent of the children operated on in one surgical unit of a children's hospital became infected. Infection was commonest in the newly born operated on as emergencies, 50 per cent of whose wounds became infected. No connection was found between injection and nasal carriage of staphylococci. A possible source of infection in the young may be the umbilicus.
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The pathophysiology and aetiology of Hirschsprung's disease are still uncertain. The presentation varies with age. Various methods are used to make the diagnosis. Differing views of management are held both for emergency and definitive surgery, e.g. emergency colostomy or not, a covering colostomy or not for the definitive surgery, the type of operation used. The problems of diagnosis and treating diseases which mimic Hirschsprung's disease are highlighted.