Antenatal finding of intestinal obstruction caused by isolated segmental jejunal dilatation: a case report.

The authors report a case of segmental jejunal dilatation that was discovered antenatally and manifested clinically as lower obstruction in a newborn boy. The antenatal ultrasound findings at 29, 30, and 31 weeks' gestation showed a constant hypoechogenic image (6 x 3 cm in diameter) localized to the right flank of the fetal abdomen, thought to be situated in the right colon. A prenatal diagnosis of incomplete right colonic stenosis was considered. In the immediate postnatal period, there were clinical manifestations of intestinal obstruction; however, results of a contrast enema and rectal biopsies were normal. An upper gastrointestinal contrast study showed a dilated jejunal loop situated approximately 15 cm from the ligament of Treitz. During surgery, a large dilated jejunal loop (7 cm in diameter, 15 cm in length) was found and resected. Histopathologic examination confirmed the diagnosis of segmental jejunal dilatation. This is the first antenatal illustration of this rare pathology, and it supports the hypothesis of a congenital origin for this anomaly.

[The urorectal syndrome caused by abdomen-levator incoordination in children]. / Le syndrome urorectal par incoordination abdomino-lévatorienne chez l'enfant.

We have studied thirty four children (mean age 6.6 years) with severe functional constipation, associated or not with encopresis. In twenty three cases the defecography showed a persistent anorectal angle due to failure of puborectalis sling relaxation during defecation straining. Voiding disorders, unknown to parents, but demonstrated by obstructive uroflowmetry, are also seen in nineteen of these children. Therefore is definite a true urorectal outlet obstruction syndrome by spastic pelvic floor mechanism. The exact etiologic factor of these functional abnormalities remains undefined. All children were managed by biofeedback training. A satisfactory result (with six months follow up), has obtained in fourteen cases.

Unusual approaches for insertion of the Greenfield vena cava filter: the value of its approach through the jugulosubclavian junction.

During the last four years, we have attempted 249 insertions of the Greenfield inferior vena cava filter using the right internal jugular vein. This approach was impossible in 31 patients (12.5%). Our first alternative was the insertion of the filter through the venous junction between the right internal jugular and right subclavian veins. If this latter technique was not possible we attempted the insertion of the Greenfield filter through the left internal jugular vein before using the retrograde femoral route which is associated with high morbidity. By these techniques we have been able to reduce the number of patients in whom it is impossible to achieve mechanical endocaval partial interruption to 2.4%.