Cryptogenic hepatic abscess in two uncompromised children.

A pre-mortem diagnosis of cryptogenic liver abscess in children is rare, but this diagnosis must be considered in the evaluation for pyrexia of unknown origin. Two previously healthy children were suspected of harboring liver abscesses. Radioisotopic, sonographic, and angiographic evidence supported the clinical diagnosis. Operative drainage was performed in each case. No source for either abscess was found and no cause established. Anaerobic bacteria, microaerophilic streptococcus and Fusobacterium necrophorum, each in pure culture, were retrieved on culture of the pus from each child's abscess. Experience gleaned from these two cases emphasizes the possibility of an hepatic abscess existing in the uncompromised child with fever of unknown origin. A cryptogenic hepatic abscess may occur in a child with only mild gastrointestinal complaints and in a child with sickle cell disease. Recovery is attributed to suspicion of diagnosis, prompt investigation, operative drainage, effective culture technique with isolation of organism and appropriate antibiotic coverage.

Chylous ascites: an etiology of peritonitis in infancy.

Fifty-six cases of chylous ascites in patients under the age of fifteen have been reported in the last three hundred years. A case of chylous ascites that presented with the signs and symptoms of peritonitis is reviewed. The normal anatomy and physiology of the intraabdominal lymphatic system, pathophysiology of the entity, as well as a mechanism for diagnosis, are addressed and a treatment algorithm is presented.

A case of neonatal intussusception.

A case of ileocotic intussusception in a 48-hr-old neonate due to saccular duplication of the terminal ileum is presented. The unique nature of intussusception due to a leading point is underscored and the case for early surgical intervention is emphasized. Barium enema examination is stressed as a prime diagnostic tool whenever intussusception is suspected.

Extraordinary hyperbilirubinemia in a neonate with idiopathic hypertrophic pyloric stenosis.

This case describes an extraordinarily elevated total bilirubin level that reverted to normal 9 1/2 wk after Fredet-Ramstedt pyloromyotomy. Although the etiology of jaundice occurring in patients with IHPS remains uncertain, theories implicating inhibition of the glucuronyl transferase system have been proposed. Infants with IHPS have a documented hypergastrinemia. An hypothesis is offered, illustrated by this case, to explain the inhibition of the glucuronyl transferase system with resultant hyperbilirubinemia by the hypergastrinemia of idiopathic hypertrophic pyloric stenosis.

Increased serum immunoreactive gastrin levels in idiopathic hypertrophic pyloric stenosis.

The serum immunoreactive gastrin (IRG) level in infants with confirmed idiopathic hypertrophic pyloric stenosis (IHPS) has been determined and compared to that found in vomiting infants without IHPS, in normal infants, and in normal adults. The mean serum IRG level of normal infants (103 +/- 9 pg/ml (mean +/- SEM) exceeded that of normal adults (28 +/- 5 pg/ml). The preoperative mean serum IRG level in IHPS infants (256 +/- 26 pg/ml) was significantly higher than that of both normal infants and vomiting infants without IHPS (93 +/- 9 pg/ml). Twenty-five per cent (5/20) of the IHPS infants had serum IRG levels within the upper range of normal infants. Fasting serum IRG levels in IHPS infants were not altered immediately by pyloromyotomy. The results from this study suggest a relationship between gastrin and idiopathic hypertrophic pyloric stenosis.