Intussusception in infancy and childhood.

Intussusception is the commonest cause of intestinal obstruction in childhood in Trinidad. A review of 94 consecutive cases seen at the General Hospital, Port-of-Spain, over a 12-year period (1974-1985) indicates that there had been a very rapid increase in incidence of intussusception in the last 4 years. The majority were under 1 year of age (87%) and there was a predominance in the Negro child (62%). Male to female ratio was 1.2:1. A high misdiagnosis rate (55%) lead to inappropriate treatment and delay in surgical intervention. This resulted in a high case fatality (6.4%) and complication rate. In order to minimize morbidity and mortality from intussusception steps must be taken to ensure earlier diagnosis and treatment.

Intussusception in infancy and childhood

Intussusception is the commonest cause of intestinal obstruction in childhood in Trinidad. A review of 94 consecutive cases seen at the General Hospital, Port-of Spain, over a 12 year period (1974-1985) indicates that there had been a very rapid increase in incidence of intussusception in the last 4 years. The majority were under 1 year of age (87 percent) and there was a predominance in the Negro child (62 percent). Male to female ratio was 1.2:1 . A high misdiagnosis rate (55 percent) lead to inappropriate treatment and delay in surgical intervention. This resulted in a high case fatality (6.4 percent) and complication rate. In order to minimize morbidity and mortality from intussusception steps must be taken to ensure earlier diagnosis and treatment. (AU)

Splenic salvage

Three cases of conservation of the ruptured spleen are reported. These show that the traumatised spleen may be salvaged by operative splenectomy in some patients with an injured spleen. (AU)

Segmental infarction of the omentum: diagnosis by ultrasound.

Pre-operative diagnosis of segmental infarction of the omentum is difficult because of its rarity and non-specific clinical features. We present a case of omental infarction and suggest that ultrasound scan may be helpful in the diagnosis of this entity.

Segmental infarction of the omentum: diagnosis by ultrasound - case report

Pre-operative diagnosis of segmental infarction of the omentum is difficult because of its rarity and non-specific clinical features. We present a case of omental infarction and suggest that ultrasound scan may be helpful in the diagnosis of this entity (Summary)

Ruptured appendicitis in childhood - abstract

Because we observed a very high perforation rate in children with acute appendicitis, we decided to review our experience with this condition. The records of 226 children who had had appendicectomy at the Port-of-Spain General Hospital between 1977 and 1981 were reviewed. There were 139 boys and 87 girls with an age range of 2 months to 10 years. The perforation rate (65.3 percent) was very high compared to studies from Jamaica (43 percent) and Los Angeles (37 percent). There was a positive correlation between perforation rate and increasing length of the history. Over one-third of patients with late diagnosis had already been seen by a doctor, treated medically, and not referred to surgery. Perforation was associated with a much higher incidence of wound infection (22.4 percent) and other complications such as intra-abdominal abscesses, pneumonia, faecal fistulae, wound dehiscence and a pelvic mass. In 83 patients, a positive culture of pus from the peritoneal cavity was obtained. The commonest organisms found were E. coli (71 percent), pseudomonas (21.7 percent) and Enterobacter (18 percent). In most cases the organisms were sensitive to either gentamicin ofcarbenicillin. Attempts to decrease the incidence of and morbidity from perforated appendicitis should include education of medical practitioner and the general public as well as the appropriate use of perioperative antibiotics (AU)

Carcinoma of the colon in an adolescent

A case of carcinoma of the colon in childhood is reported, There was remarkable absence of gastro-intestinal symptoms. Reasons for the poor prognosis in this condition are discussed as well as the possibilities for improving survival (AU)