Early operation in children with pancreas transection.

BACKGROUND/PURPOSE: The preferred treatment for children with major pancreatic ductal injury remains controversial. This report compares our results using early operation with previously reported series using both operative and nonoperative management. METHODS: This is a retrospective analysis of all children with pancreatic transection identified at Children's Medical Center of Dallas, Texas, from 1995 through 1999. RESULTS: There were 11 children with pancreatic transection. There was a delay of 2.3 days before presentation to a hospital in 6. Transection was diagnosed within 12 hours of presentation in 5 children. In the other 6 there was a mean delay of 36 hours. Nine children underwent operation within 72 hours of injury. Two late presenters initially were treated nonoperatively, and both developed a pseudocyst. The length of hospital stay in patients undergoing early operation averaged 11 days. Early postoperative morbidity occurred in 4 children and late morbidity in 1. CONCLUSIONS: Major pancreatic injuries are uncommon in children, and the diagnosis often is delayed. A high index of suspicion and repeated computed tomography scans should lead to earlier diagnosis. When compared with nonoperative management, early pancreatic resection more expeditiously returns the child to good health and lessens the inconvenience and emotional stress associated with prolonged hospitalization.

Intussusception in children: international perspective.

Fifty consecutive cases of children with intussusception treated at a hospital in a developing country were compared with 50 consecutive cases treated at an American inner city children's hospital and 50 consecutive cases treated at an American referral children's hospital. The plan was to recommend ways of improving the treatment of children with intussusception in the developing world. Nonoperative reduction was attempted in the two American hospitals but was not available in the developing world hospital where all children were treated operatively. Children in the developing world hospital had a significantly longer duration of symptoms, an increased incidence of nonviable bowel, and a mortality of 18%. There were no deaths in either American hospital. The poorer outcome for developing world children was related to delay in treatment, the higher incidence of nonviable bowel, and the lack of adequate nursing care for acutely ill children. The use of nonoperative reduction would not have significantly improved the mortality rate among the developing world children. The mortality can best be reduced by: (1) earlier recognition and treatment of the intussusception; and (2) improvement in the postanesthetic care with better monitoring leading to prompt recognition and treatment of postoperative complications.

Surgical management of gastroesophageal reflux in severely mentally retarded children.

Thirty-three severely mentally retarded children with profound malnutrition and aspiration pneumonitis were treated by gastrostomy and Nissen fundoplication. Early and late complications were 27.3% and 16.6% respectively. Mortality was 9.4%. All surviving patients gained weight. Time required for feeding was greatly reduced. This study supports earlier operative intervention for the mentally retarded child with gastroesophageal reflux, malnutrition and aspiration pneumonitis.

Cardiovascular effects of intravenously given ATP-MgCl2 in canine hemorrhagic shock.

Mean arterial blood pressure, cardiac output, stroke volume and rate of left ventricular pressure rise were significantly higher in dogs given lactated Ringer's solution alone compared with dogs given lactated Ringer's solution plus intravenous ATP-MgCl2 complex. The reduced cardiac performance after intravenous ATP-MgCl2 occurred despite adequate coronary blood flow and adequate myocardial oxygen delivery. A decreased myocardial oxygen extraction and a negative myocardial lactate balance after intravenous ATP-MgCl2 indicate a cellular metabolic defect.

Prenatal diagnosis of gastrointestinal tract obstruction.

The diagnosis of possible duodenal atresia was made in a near-term fetus. The mother had developed polyhydramnios, and the fetus was found on sonography to have two communicating upper abdominal masses. It also failed to ingest contrast media after injection of radiopaque material into the amniotic sac. An esophageal atresia was found after delivery, in addition to the prenatally diagnosed duodenal atresia. The infant had a surgical repair 16 hours after delivery and survived.