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Objective To investigate the imaging manifestations of congenital intestinal malrotation. Methods The clinical data of 92 infants with congenital intestinal malrotation admitted from January 1993 to December 2012 were studied retrospectively. All the 92 cases enrolled in this study were diagnosed based on imaging examinations and confirmed surgically. The imaging features of four examinations including plain abdominal radiography, upper gastrointestinal radiography, lower gastrointestinal angiography and ultrasound examination were analyzed. Results The percentage of the infants who presented with the initial clinical symptoms of vomit, blood stool and abdominal dilatation was 87.0%(80/92), 3.3%(3/92) and 1.1%(1/92), respectively, and eight cases [8.7%(8/92)] received prenatal ultrasound, which showed intestinal malrotation. Clinical examination showed no abdominal abnormalities in 68 (73.9%) cases. Seventy-seven cases underwent plain abdominal radiography, revealing intestinal obstruction in 31 cases. Thirty-six cases underwent upper gastrointestinal radiography, which revealed malrotation in 14 cases, and duodenal complete/incomplete obstruction or stenosis in 19 cases. Twenty-two cases underwent lower gastrointestinal angiography, and all of them were diagnosed as malrotation. Seventy-nine cases were examined with abdominal ultrasonography, and 58 cases were diagnosed as malrotation. Conclusions Rational selection of imaging examinations can improve the preoperative diagnosis. When congenital intestinal malrotation is suspected, abdominal ultrasound should be done as the first optional examination. At the same time, plain abdominal radiography should be selected accordingly. When intestinal malrotation with or without midgut volvulus is suggested, surgery should be performed as early as possible. When the diagnosis is not clear, upper or lower gastrointestinal radiography should be done.
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Objective To investigate the efficacy of standardized protocol,including prenatal diagnosis,perinatal management and treatment,on babies with meconium peritonitis.Methods A standardized protocol with prenatal diagnosis,perinatal management,treatment and follow-up on congenital anomaly was founded by Capital Institute of Pediatrics and several other obstetric hospitals.Thirty neonates diagnosed as meconium peritonitis prenatally from March 15,2006 to August 27,2012 were intervened according to this protoccl.The data of diagnosis,treatment after birth and prognosis were analyzed.Results (1) Prenatal diagnosis:Abnormal meconium peritonitis relative signs were found by ultrasound in all of these 30 cases.Among them,23 cases presented with intestine dilation,15 with polyhydromnios,nine with ascites,four with abdominal cystic mass and four calcification.(2)Diagnosis after birth (n=27):The most common imaging findings in abdominal X-ray were distention (27 cases),dilated intestine with air-fluid levels (22 cases) and calcification (11 cases).The most common imaging findings in ultrasound were obvious intestinal dilation (19 cases),cystic mass (7 cases) and calcification (7 cases).(3) Operation:Except for three cases without symptoms,the other 27 infants received operation at averagely 42 hours after birth (12 h-5 d).Besides the basic treatment as removal of the fuci and dissection of adhesion,peritoneal drainage was performed in one infant,two-stoma enterostomy in seven infants,inverted T-shape enterostomy in eight infants and primary intestinal anastomosis in 11 infants.Among these 27 cases,24 cases were cured,2 cases refused following treatment after surgery and one case was lost to follow up.Conclusions Standardized protocol with prenatal diagnosis,perinatal management and earlier intervention might improve the prognosis of meconium peritonitis.
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Objective To investigate the prenatal diagnosis, perinatal management and standardized treatment protocol for neonates with duodenal obstruction. Methods A network in prenatal diagnosis, perinatal management and monitoring of congenital malformation was founded between Beijing Obstetrics and Gynecology Hospital and the Capital Institute of Pediatrics. Forty-four fetuses were prenatally diagnosed as duodenal obstructions by this network from July,2001 to September, 2010. The data of prenatal diagnosis, treatment after birth and prognosis were analyzed. Results Among 44 patients diagnosed as fetal duodenal obstruction by prenatal ultrasonography, three cases underwent induced abortion, three were in pregnancy, 14 were lost during follow-up and 24 were confirmed by surgical treatments after birth. Within 24 neonates underwent surgery, 21 showed double-bubble sign and 20 combined with polyhydroamnios in prenatal ultrasonography. Twenty-four neonates underwent upright abdominal plain film examination,22 showed double-bubble sign, 1 showed single-bubble sign and 1 showed triple-bubble sign,respectively. Nineteen neonates underwent upper gastroenterography which showed distention of stomach and duodenum, increased stomach peristalsis and an obstacle of duodenum emptying. Within 23 neonates underwent ultrasonographic studies, 10 showed distention and increased peristalsis of duodenum. Following surgical procedures were performed: diamond shape anastomosis was completed in 19 cases with annular pancreas; duodenal vertical resection, across suture and excision of the membrane was done in four cases with duodenum membranate stenosis; end-to-back anastomosis was taken in one case with duodenal separate atresia; Ladd's procedure was applied in 11 cases associated with malrotation. All patients were cured. Conclusions Standardized perinatal management and earlier intervention should be offered to newborns with duodenal obstruction to achieve better effects.
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Objective To compare curative effects between laparoscopic and open surgery in the treatment of pediatric indirect inguinal hernia.Methods A group of 410 children with indirect inguinal hernia underwent micro-laparoscopic operation(Laparoscopic Group) from April 2001 to January 2006.This group was compared with another group of 408 children with indirect inguinal hernia,treated with open high ligation of the hernial sac(Open Group) from September 2004 to January 2006.In the Laparoscopic Group,a 5-mm trocar was inserted at the umbilicus for the exploration of bilateral internal rings.Another 5-mm trocar was inserted at the site slightly superior to the McBurney's point for introducing a needle holder.At the level of the neck of the hernial sac,the orifice of the vaginal process was circumferentially sutured and ligated.In the Open Group,high ligation of the hernial sac was conducted through a transversal incision at the external ring.Results The operations in the Laparoscopic Group were smoothly completed.The operative time for one side of hernia was significantly shorter in the Laparoscopic Group(33.4?9.6 min) than in the Open Group(38.0?7.6 min)(t=-7.596,P=0.000).In the Laparoscopic Group,no edema of the scrotum,subcutaneous hydrops,or infection occurred.The patients were followed for 1~55 months(mean,23.2 months).Short-term recurrence was observed in 3 children,who required a re-operation of laparoscopic repair.No testicular atrophy,iatrogenic retained testis,intestinal adhesion,or other long-term complications happened.In the Open Group,follow-up observations for 1~18 months(mean,10 months) revealed recurrence in 18 children,8 of whom were then cured with laparoscopic surgery and 10 of whom with open surgery.Iatrogenic retained testis happened in 9 children and a re-operation of open surgery was carried out.Conclusions Two-port laparoscopic high ligation of hernial sac for pediatric indirect inguinal hernia is minimally invasive,safe,and effective,but not suitable for children with cardiac insufficiency or newborn incarcerated hernia.