A national analysis of operative treatment of adult patients with Hirschsprung's disease.

PURPOSE: Hirschsprung's disease is primarily a disease of infancy, but in rare cases, adults with this condition require surgery. The aim of this study is to identify the types of operations and postoperative outcomes in adults with Hirschsprung's disease on a national level. METHODS: The National Surgical Quality Improvement Program database was used to perform a retrospective review of all adult patients diagnosed with Hirschsprung's disease. Patients were divided into two groups depending on the type of operation: restoration of bowel continuity or diversion of fecal stream; clinicopathologic data and 30-day outcomes were compared between the two groups. RESULTS: A total of 32 patients were analyzed. Fourteen patients (43.8%) underwent diversion and 18 (56.2%) underwent restorative procedures. The median age was 49.5 years old for the diversion group and 23.5 years old for the reconstructive group (p = 0.001). The restorative surgery group was more likely to have an ASA 1-2 while the diversion group had a higher frequency of ASA 3-5 (p = 0.011). The median length of stay for the diversion surgery was 9.5 days and 5 days for the restoration group (p = 0.045). Complications occurred in 57% of patients in the diversion group and in 22% of patients in the restoration group (p = 0.049). There were otherwise no statistically significant differences in intraoperative data and postoperative complications. CONCLUSION: This is the first study using a national database to evaluate the surgical treatment of Hirschsprung's disease in adult patients. Complications are common and were more frequent in the older, sicker diversion group, with restoration of continuity being better tolerated in the younger, healthier patient population.

Experience with alternate sources of venous inflow in the meso-Rex bypass operation: the coronary and splenic veins.

The meso-Rex bypass procedure has been used to treat patients with portal hypertension from extrahepatic portal vein obstruction. This report describes modifications of this procedure in 5 patients. Either the splenic or coronary vein was used as the venous inflow point, and the bypass was performed either directly through transposition of the vein or with the use of a venous conduit.

Evolution of the CT imaging findings of accessory spleen infarction.

We report the case of a 12-year-old girl presenting with multiple episodes of left upper-quadrant pain caused by torsion of an accessory spleen.We present the CT findings of progression of accessory spleen infarction over the course of 7 days.

To drain or not to drain: a single institution experience with neonatal intestinal perforation.

AIMS: The optimal surgical treatment for extremely-low-birth-weight (ELBW) neonates with pneumoperitoneum is controversial. This study aimed to identify clinical factors associated with two known causes of pneumoperitoneum-necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP), and assesses the treatment outcome with primary peritoneal drainage (PPD) vs. laparotomy. METHODS: We reviewed and analyzed clinical characteristics and outcome from records of neonates with pneumoperitoneum treated at our institution from January 1999 to January 2003. RESULTS: Forty-six neonates (31 NEC, 15 SIP) were treated with either PPD (20 with NEC, 13 with SIP) or laparotomy (11 with NEC, 2 with SIP). In neonates who underwent PPD, those with NEC (vs. SIP) were less likely to have a patent ductus arteriosus, but were more likely to have been fed, have drains placed later in life, have a subsequent laparotomy, a longer total parental nutrition course, a higher 30-day mortality, and to take more days to begin enteral feeds. CONCLUSION: The etiology of pneumoperitoneum (NEC vs. SIP) in ELBW neonates can usually be determined preoperatively. Neonates with SIP should have a drain placed while those with NEC should undergo laparotomy.

Fetal therapy.

The advances in fetal therapy including endoscopic approaches and the advent of safer anesthetic techniques has led to the intrauterine management of potentially lethal diseases or diseases associated with high morbidity. This review will elicit certain newer techniques for fetal therapy including their application and complications.