Dorsal herniation of the gut with posterior opening of the terminal colon: a rare manifestation of the split notochord syndrome

A newborn infant with a rare variety of combine anterior and posterior rachischisis in the lumbosacral spine is reported. The associated anomalies in this infant were meningomyelocele, communication of the colon with the spinal cleft, and anal atresia.

[Prenatal diagnosis of upper intestinal tract obstruction]

Case report of prenatal sonographic diagnosis of obstruction of the upper gastrointestinal tract (atresia of jejunum). The typical echographic findings and the significance of the hydramnion which is regularly concomitant with this rather rare condition, are discussed. Prenatal diagnosis of a small-bowel tract atresia allows optimal neonatal management improving the prognosis.

Congenital colonic atresia

Nineteen cases of congenital colon atresia are presented with two deaths resulting in a mortality rate of 10.5%. The authors conclude that operative management of atresias proximal to the splenic flexure should include resection of the dilated proximal colon with primary ileotransverse colostomy or ileosigmoidostomy. Atresias distal to the splenic flexure should be managed with a colostomy with later establishment of gastrointestinal continuity.

Congenital jejuno-ileal atresia and stenosis

Eighty-four patients with congenital jejuno-ileal atresias and stenoses admitted over a 20-year period (1959-1978) are reviewed. The overall survival rate of 88% is a reflection of the improvement in diagnosis and supportive care and refinements in technique. Our current ideas on this subject are expressed and a detailed account of the presentation, diagnosis and management is given.

[Apple Peel syndrome: an uncommon form of intestinal atresia (author's transl)]

A case of Apple Peel syndrome in a 1,800 g. premature female infant is reported. In a two stage approach, the dilated proximal segment of the jejunum was treated with jejunoplasty and termino-terminal anastomosis. After 55 days of total parenteral nutrition, oral feedings were instituted with good tolerance and satisfactory weight gain. Five months postoperatively, her weight is 5,500 g. and is on a standard diet for her age.

Calcified meconium in the newborn

Six neonates are described in whom plain films of the abdomen demonstrated scattered flecks of calcification. Three of the patients had rectal atresia with recto-urethral fistula, one rectal atresia without fistula, one jejunal atresia and one a severe stenosis of the distal small bowel associated with log segment aganglionosis. At operation the calcification was found to be in meconium within the bowel lumen and not as expected to represent serosal plaques following meconium peritonitis due to an intrauterine bowel perforation. Previous case reports are reviewed and possible mechanism discussed.

[Acute abdomen in pediatric roentgenology (author's transl)]

In vue of the successes of modern surgery, correct roentgenology in acute abdominal conditions of the infant and child is of utmost importance. History is very incomplete in children so that the most crucial question is when and how should X-ray investigation start? The answer is difficult to provide because of the necessity of early surgery which, in addition can be hindered by an unnecessary roentgenography. Often this cannot be repeated because of worsening in the patient's condition. Knowledge of specific pathology and of congenital malformations is necessary. One must be careful in using contrast medium in acute abdomens as it may worsen the situation. Hypertonic solutions can heavily modifie the fluid and electrolyte balance, especially in dehydrated children. Technical aspects deserve attention, for instance for treatment of invagination, or in congenital megacolon. The authors illustrate these problems with a few cases.

Intestinal atresia

Forty-five patients with intestinal atresia, including 20 with duodenal, 21 with jejunoileal, and 3 with colonic obstruction, were encountered at the Yale-New Haven Hospital between 1970 and 1976. The overall survival rate in the 43 operated cases was 93 per cent. The major reasons for the excellent operative survival with this malformation include: (1) the care received in a regional neonatal center; (2) the early recognition and appropriate case selection, denying operation unless mandated in babies with duodenal atresia and trisomy 21; (3) primary repair using modern surgical techniques which minimize anastomotic complications and the "blind-loop" and "short gut syndrome"; and (4) the use of uncomplicated long-term total parenteral nutrition in approximately one-half of operated cases.

Congenital atresia of the colon

Atresia of the colon is a rare congenital anomaly. In 1673, Binninger reported the first case of colonic atresia and Gaub reported the first survival of a patient with this anomaly in 1922. Since that time there have been 97 successfully managed patients described in the literature.

Duodenojejunal atresia with "apple-peel" small bowel. A distinct form of intestinal atresia

Prenatal occlusion of the superior mesenteric artery results in a distinct type of distal duodenal or proximal jejunal atresia in which the dorsal mesentery is absent and the distal small bowel assumes a spiral configuration around its vascular stalk, strongly resembling an apple peel. In some instances the condition is transmitted genetically as an autosomal recessive disorder. The mortality rate is much higher than in either simple duodenal or jejunal atresia because of deficient collateral circulation to the small intestine. The authors tell of 2 patients who died of necrotizing enterocolitis, a disease related to vascular insufficiency.

Radiological localization of the ampulla of Vater in an infant with duodenal atresia

The authors describe an infant with a duodenal diaphragm in whom preoperative radiographs localized the ampulla of Vater within the medial wall of the diaphragm. This frequent close association must be kept in mind in order to avert surgical injury to this vital structure.