Abdominal posterior rectopexy with an omental pedicle for intractable rectal prolapse: a modified technique.

INTRODUCTION: Rectal prolapse is a relatively common paediatric surgical condition. It has a number of benign aetiologies. Management is usually centred on regulating bowel habits. Surgery is considered after the failure of medical treatment. Numerous surgical techniques have been described with a spectrum of results. MATERIALS AND METHODS: We adopted a limited abdominal approach to achieve a posterior rectopexy using an omental pedicle in intractable cases. This technique has not been performed in children previously. RESULTS: From 2005 to 2008 we have applied this technique on five patients with recurrent rectal prolapse which had failed to respond to medical treatment, injection sclerotherapy or perianal cercalage. One patient had solitary rectal ulcer syndrome, and was initially treated with a defunctioning colostomy, had a concomitant sigmoidectomy performed at the time of rectopexy. None of the patients had cystic fibrosis. There were three females and two males, with a mean age of 9.6 years (4.7-14.0). No operative complications were encountered. The mean hospital stay was 5.4 days (3-8). None of the patients experienced recurrence at a mean of 2.1 years (0.2-2.8) follow up. The cosmetic result was regarded as satisfactory by all patients. CONCLUSION: This early experience with abdominal posterior rectopexy using an omental pedicle graft is encouraging. This technique does not involve the use of synthetic material and hence the risk of infection is low.

Solitary rectal ulcer syndrome in children. A report of three cases.

Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. It is well recognised in the adult literature. We report our experience with 3 patients; two boys presented at a very young age (18 and 24 months, respectively) with a clinical picture simulating inflammatory bowel diseases. The other patient was a fifteen-year-old girl presenting with severe rectal stricture as a result of the syndrome, which is the first to be reported in the paediatric literature.

Multiple magnet ingestion and gastrointestinal morbidity.

Foreign body ingestion is common but multiple magnet ingestion is rare. When more than one magnet is ingested, gastrointestinal complications may occur. The magnets are attracted to each other across the bowel wall and this may lead to pressure necrosis, perforation, fistula formation, or intestinal obstruction. We report a case of perforation following the ingestion of 12 small magnets. Clinicians who care for children should be aware of this hazard.

Ovarian cysts and tumours in infancy and childhood.

Cysts and tumours of the ovary are not uncommon in childhood. In 33 years between 1950 and 1982 106 patients were operated on at Alder Hey Children's Hospital and the Royal Liverpool Children's Hospital. Of these 71 were pre-menarchal. The mode of presentation, pathology and diagnostic difficulties of the pre-menarchal lesions are reviewed. The value of ultrasound scanning has become apparent in recent years. Most cysts and tumours are benign, but dysgerminomas are the most common malignant tumours encountered. Even when there is evidence of spread of the tumour the prognosis in these remains reasonably good.

Gastric trichobezoar associated with transient pancreatitis.

A Pakistani girl presented with acute abdominal pain and raised serum amylase and alkaline phosphatase concentrations. She was found to have a gastric trichobezoar with a tail extending to the mid-ileum. The altered biochemical parameters returned to normal after surgical removal of the bezoar. Irritation of ampulla of Vater by the bezoar tail is believed to have caused transient pancreatitis.

Functional intestinal obstruction associated with malrotation and short small-bowel.

Two siblings are presented in whom a recognized syndrome of functional small-bowel obstruction with malrotation and short small-bowel was diagnosed. The previously described association with pyloric stenosis was not present in our cases. They do, however, support the view that this syndrome has an autosomal recessive model of inheritance. A deficiency of argyrophil neurones in the myenteric plexus has been noted in this syndrome but more precise neurohistochemical studies are required to define the exact deficit involved.