Hydrostatic reduction of acute intussusception: a prospective study

Data were collected prospectively on 57 Jamaican children presenting with 62 episodes of acute intussusception over a two year period, for whom operative and hydrostatic methods of reduction were employed. 31 (54 percent) of 57 episodes were reduced successfully using barium (42), saline (11) and air (4) hydrostatically. Among the 31 other episodes, 15 had ileo-colic intussusception, seven caeco-colic, six ileo-ileo-colic and one ileo-ileal. Two patients had spontaneous reduction discovered at surgery. There were two episodes of barium hydrostatic perforation of the colon leading to death in one patient. Hydrostatic reduction is recommended as the first therapeutic option for acute intussusception because it spares the patient a major operative procedure when successful(AU)

Childhood injuries in Jamaica - abstract

Childhood (age < 10 years) injuries were the reason for 225 emergency admissions to the Bustamante Hospital for Children and the University Hospital of the West Indies over a six week period ending June 30, 1996. Intentional injuries numbered 21 (9.3 percent) and unintentional injuries 204 (90.7 percent). Male/Female distribution was 143 (63.5 percent) and 82 (36.5percent). The average age of patients was 4.9 years. Falls, burns and motor vehicle accidents were the common causes of injuries resulting in 125 (55.5 percent), 19 (8.4 percent) and 17 (7.5 percent) admissions respectively. Bony, head and soft tissue injuries numbered 79 (35 percent), 63 (28 percent) and 35 ( 15.5 percent) respectively. Injury severity was graded according to the Tepas trauma score with severe injuries receiving grade 8 and lower. These totalled 22 affecting head (9), bone (8), and multiple sites (5). There were two deaths: a severe head injury (Tepas score 5) and a case of 35 percent flame burns. (AU)

Cholecystectomy in sickle-cell disease: the Jamaican experience

Fifty-eight patients with homozygous sickle-cell disease had cholecystectomy for symptomatic gallstones between January 1986 and September 1995 at the University Hospital of the West Indies and the Bustamante Hospital for Children, Jamaica. Top-up blood transfusion was administered to 7 patients with haemoglobin levels > lgm/dl below their steady state values. Complications related to the presence of biliary calculi were cholecystitis (58), common bile duct (CBD) dilatation (20), gallbladder empyema (2), and gallstone ileus (1). Nine developed the acute chest syndrome post-operatively leading to death in two patients. Three had retained CBD stones, which passed into the duodenum after a trial of saline irrigation via an in-situ t-tube. Because pre-operative ultrasonography is an unrelialbe modality for detecting CBD stones and also because of the high presence of CBD stones in sickle-cell disease, routine operative cholangiography is recommended at the time of surgery (AU)

Sixty-two episodes of acute intussusception: a Jamaican prospective study - abstract

Data were collected prospectively on 57 patients presenting with 62 episodes of acute intussusception between September, 1992 and August, 1994. Both operative and hydrostatic methods (barium, air, saline) of reduction were used. Fifty-seven episodes were subject to hydrostatic reduction, 31 of them being reduced successfully, a success rate of 54 percent. Barium, saline and air were employed in 42, 11 and 4 cases, respectively. There were 2 cases of barium colonic perforation leading to mortality in 1. Among 31 cases not having successful hydrostatic reduction, 15 had ileocolic intussusception, 7 had caecocolic, 6 had ileo-ileo-colic, 1 had ileoileal and 2 were found spontaneously reduced at surgery. We believe that hydrostatic methods should be a first treatment option for acute intussusception in third world institutions. Our study shows that satisfactory rates of reduction can be achieved outside of the first world with the main advantages relating to cost and patient morbidity (AU)

Gallstone-related morbidity in Jamaican children with homozygous sickle-cell disease: a six-year review

The clinical details of 17 patients aged 18 years and under with homozygous sickle-cell disease (SS) who presented with gallstone-related symptoms to the University Hospital of the West Indies, and the Bustamante Hospital for Children are analysed. All patients had right upper quadrant signs pre-operatively and all were confirmed to have acute or chronic cholecystitis based on gallbladder (GB) histology. Other gallstone-related complications were obstructive jaundice in 2, mucocoele of the GB in 1 and GB empyema in 1. While 16 of 17 had gallstones detected preoperatively ultrasound, only 2 of 6 patients later confirmed to have common bile duct (CBD) stones, were also detected. One patient had retained CBD stones post-operatively which were successfully dislodged by saline irrigation via t-tube. There was no mortality but 3 patients developed the acute chest syndrome, 4, unexplained pyrexia and 1, wound abscess. We believe that gallstone-related morbidity in children with SS disease may so far be underestimated. Even the youngest develop life-threatening complications. The risk of associated choledocholithiasis and obstructive complications may be just as high in paediatric SS disease patients with gallstones as in adults similarly affected (AU)

Common bile duct stones in sickle-cell disease - abstract

Common bile duct (CBD) stones were found intra-operatively in 12 patients (11 SS, 1 SC) among 36 patients with homozygous sickle-cell (ss) disease and 2 patients with sickle-cell haemoglobin C (SC) disease subjected to cholecystectomy between January, 1985 and December, 1992. Pre-operatively, ultrasonography had identified common bile duct stones in only 5 of these 12 patients. Operative cholangiography was diagnostic in 11 and equivocal in one. Following exploration of the common bile duct, immediate closure was performed in one, transduodenal sphincteroplasty in one, insertion of a T-tube in 4, and choledochoduodenostomy (CDD) in 6. Retained CBD stones were detected in 2 patients on routine T-tube cholangiography performed on the 10th postoperative day, and in both were successfully dislodged by saline irrigation. The high frequency of CBD stones in this symptomatic group of patients receiving cholecystectomy justifies routine diagnostic operative cholangiography. Saline irrigation intra-operatively may successfully remove stones, reducing the risk of iatrogenic damage by ductal instrumentation. Marked ductal dilatation with calculi can be treated successfully by CDD (AU)

Burn injuries at the Bustamante Hospital for Children

Gives an historical account of burn injuries at the Bustamante Hospital for Children

Congenital hypertrophic pyloric stenosis - abstract

This well-known disease entity is said to be less common among blacks, and in underdeveloped countries. Of the 105 patients with pyloric stenosis seen at the University Hospital of the West Indies 1953-1967, 16 were infants. However, the paediatric surgical ward at the UHWI only opened in 1962, and the Children's Hospital (now BHC) in 1963; and this figure may not have adequately reflected the frequency of the disease. With this in mind, a retrospective review of patients seen with congenital hypertrophic pyloric stenosis (CHPS) at the Bustamante Hospital for Children over the 5-year period 1975-1979 was undertaken. There were fifty (50) cases; an average of 10 per year. There were 43 males and 7 females, a ratio of 6:1. Their ages ranged between 8 days and 3 months. Of 29 patients in whom the family rank was shown, only 7 were first born; 6 of whom were males. One mother had pyloric stenosis as an infant. Forty nine of the 50 patients presented with vomiting, while one presented with apnoeic spells at age 8 days. In two patients the method of presentation is not known. The "pyloric olive" was felt in 31 of the 50 patients. Two others had their diagnoses confirmed by straight abdominal X-Rays, while 14 needed Barium meal studies. In one infant, projectile vomiting and visible perisalsis were used as the indications for operation, and in the remaining two patients the confirming signs are unknown. This disease appears to be less common among Jamaican patients than those in developed countries. Nonetheless, the average age, and clinical presentation of these patients is essentially the same as in developed countries. The smaller number of first-born infants seen in this series may reflect the fact that rarely was the infant first-born to both parents (AU)

Burn injuries at the Bustamante Hospital for Children

Gives an historical account of burn injuries at the Bustamante Hospital for Children