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ABSTRACT: In the past 9 years, 3 children suffering rare pancreatic disorders have undergone cephalic pancreaticoduodenectomy (Whipple procedure) required after the failure of initial conservative treatments. Ductal anomalies such as pancreas divisum or predominant Santorini duct can be managed conservatively (especially by papillotomy of the minor papilla), unless the extent of the fibrotic lesions of the pancreas jeopardizes the final evolution of the pancreatic disease. Intrapancreatic gastric duplications remain extremely rare. Even to-day, diagnosis was made only on pathologic specimens after radical surgery. Better knowledge of this rare pathology, with emphasis on its radiological features, may help better assessment. Hemoductal pancreatitis is evocative of the coexistence of gastric duplication and pancreatic aberrant duct. However, when fibrotic and necrotic changes in the duodenopancreatic region are considerable, assessment of this anomaly becomes difficult. Radical though it is, pancreaticoduodenectomy may be necessary to treat cephalic pancreatic lesions in childhood after the failure of reasonable attempts of conservative treatment.
European Journal of Pediatric Surgery 11/1995; 5(5):305-9. · 0.81 Impact Factor
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ABSTRACT: The Currarino triad consists of an anorectal malformation, a presacral tumor and a sacrum defect. A new case is reported in a female neonate. The diagnosis was suspected because of delayed emission of meconium associated with an occlusion syndrome. It was confirmed by bone imaging, ultrasonography and magnetic resonance imaging. A colostomy was performed on day 7 then closed on day 43 after several rectal dilation were carried out. A presacral lipoma was operated on at 10 months. The 56 cases reported in the literature are reviewed.
Archives françaises de pédiatrie 12/1991; 48(9):631-4.
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ABSTRACT: We report seven cases of congenital colonic atresia over a 13 year period (1975-1988). The atresia was located in the ascending or transverse colon (4 cases), or in the descending or sigmoid colon (3 cases). According to Bland-Sutton classification, one patient was a type I, five were either a type II or III, and for the last patient the type was not precise. Three infants had associated malformations: jejunal atresia (case n. 6), intestinal malrotation (case n. 5), and gastroschisis and jejunal atresia. This last patient, in whom jejunal and colonic atresias were autopsy findings, died after a Schuster procedure for gastroschisis closure. The six other neonates survived. Five of them underwent emergency colostomy and delayed anastomosis when general conditions were stable (2 to 10 months after colostomy). The sixth neonate (case n. 2) was treated by colonic resection and primary ileocolic anastomosis. Two patients had postoperative complications, ie, anastomotic leak (case n. 4) or disfunction (case n. 2), which were successfully treated by another operation. The outcome, one year after the onset of the disease, was good for 5 out of the 6 survivors. All these five patients were normally passing stools, once or twice a day, with no abdominal distension. One patient (case n. 6) had a short bowel syndrome secondary to a jejunal atresia, with intermittent watery stools and abdominal distention. We reviewed the 161 cases of colonic atresia from English and French experience since 1960. The overall mortality rate is 25%. Associated malformations and infection are the main causes of death. The rate of anastomotic complications is high (15%).(ABSTRACT TRUNCATED AT 250 WORDS)
Chirurgie pédiatrique 02/1990; 31(6):289-94.
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ABSTRACT: Two large bladder diverticula that induced severe micturition disturbances were surgically removed in a 5-year-old boy with Ehlers-Danlos syndrome (EDS). One year after surgery, a new, asymptomatic diverticulum developed. This case is discussed in the light of nine similar cases that have already been published. It is concluded that EDS diverticula form a distinct group characterized by postoperative recurrence. They are not due to vesicourethral obstruction but probably result from an anomaly of the vesical wall. They are responsible for micturition difficulties and urinary tract infections. Their unavoidable recurrence means that surgery should be restricted only to symptomatic patients.
Journal of Pediatric Surgery 12/1989; 24(11):1184-6. · 1.45 Impact Factor
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ABSTRACT: Two children with the coexistence of long segment Hirschsprung's disease, ganglioneuroblastoma with Ondine's curse in one case and autonomic nervous system impairment in the other are presented. All lesions may be related to aberrations of neural crest cell growth, their migration, or differentiation. A genetic etiology, and the link between Hirschsprung's disease and multiple endocrine adenomatosis is discussed. The combination of Hirschsprung's disease and a neurocristopathy strongly suggests that exploration of the autonomic nervous system and APUD system be carried out.
Archives françaises de pédiatrie 11/1989; 46(8):595-7.
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ABSTRACT: We report two new cases of multiple gastrointestinal atresias as described by Guttman and al in 1973. The clinical presentation is characteristic: the newborn presents himself with a neonatal occlusion. Plain abdominal film shows gas in a distended stomach with intraluminal calcifications. At laparotomy in both cases a diaphragm was present at the pyloric region followed by innumerable diaphragms only a few centimeters apart until the rectum in the first case, and the right colon in the second one. Reconstruction of the intestinal lumen was impossible and the babies died due to sepsis. Pathologic finding in both cases were those of numerous intraluminal diaphragm associated in the first cases with types II atresias. There was no normal epithelium from the stomach to the rectum. This strongly supports the hypothesis of a malformation of the gastrointestinal tract occurring during early fetal life. The possibility of an autosomic recessive transmission of the process was outlined by Guttman.
Chirurgie pédiatrique 02/1989; 30(2):61-4.
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ABSTRACT: 13 high jejunal atresias, including 6 type IIIb apple peel small bowel deformities, have been treated by a one stage surgical procedure, including proximal jejunal resection, tapering duodenoplasty and end-to-end duodeno-jejunal or duodeno-ileal anastomosis. All 13 infants survived. There were no anastomotic leak or malfunction. 7 jejunal atresias with normal distal small bowel were fed a mean of 9 days post-operatively (range 4 to 12 days). Intra-venous fluids were discontinued at a mean of 18 days post-operatively (range 13 to 24 days). Patients, all premature babies, were discharged on the mean 30th post-operative day (range 24 to 40). 5 jejunal atresias with apple peel deformity were fed with an average post-operative delay of 21 days (range 12 to 24). All intra-venous fluids were discontinued at a mean of 48 days post-operatively (range 35 to 90). Average hospital stay was 78 days (45 to 120). In one case, an ileal diaphragm, unnoticed during the first operation was subsequently resected at age 45 days and an iterative tapering duodenoplasty was performed at the age of 8 months. Recovery was then uncomplicated and the child was discharged on a normal oral feeding at the age of 10 months. Functional obstruction of the intestine at the site of anastomosis often occurs in high jejunal atresias. 70% of mortality resulted from operative complications in atresias with apple peel deformity. Intestinal distension is the cause of anastomotic malfunction. After jejunal resection, the duodenum remains dilated and anastomosis cannot function properly.(ABSTRACT TRUNCATED AT 250 WORDS)
Chirurgie pédiatrique 02/1989; 30(5):191-5.
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ABSTRACT: A new case of calcified thrombus in the Inferior Vena Cava is described, and added to the 19 previously reported cases in literature. The etiology of these calcified thrombi is unknown, but a precise diagnostic an therapeutic approach is now well established. On plain X-ray of the abdomen, the right paravertebral bullet-shaped calcification is diagnostic. No further investigations are necessary, except in the neonatal period, when the thrombus is incompletely calcified, suggesting neuroblastoma or adrenal hemorrhage. Definitive diagnosis, in that case, can be made by abdominal ultrasonography. In the current state of our knowledge, the clinical tolerance of this anomaly is excellent. No specific treatment appears to be necessary.
Chirurgie pédiatrique 02/1988; 29(4):201-4.
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La Revue du praticien 12/1987; 37(45):2782-5.
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ABSTRACT: Prenatal ultrasonographic diagnosis of urethral valves is now common. Treatment of the urethral obstruction has sometimes to be done in low weight newborn babies. In these babies, the stripping of valves using a Fogarty catheter provides an helpful way of treatment, easier than endoscopy. The technique is presented here. The results of this procedure in 10 neonates with a follow up of 3 to 22 months are reported. The urethral obstruction is easily cured in most patients without using a previous diversion. This procedure is indicated in premature or hypotrophic newborns when the urethral size is too small to allow a safe endoscopic section of the valves. We did not observe secondary stricture. Follow up is too short to allow a correct investigation of the continence.
Chirurgie pédiatrique 02/1986; 27(4):196-200.
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ABSTRACT: Surgical approach to short bowel syndrome has been dealing with two major problems: lack in absorptive surface and dysfunction of the peristalsis of the widely distended loop above the anastomosis. In those children having a very short intestine, one is reluctant to either resect or reduce the diameter of this loop. Bianchi, followed by Boeckman and Traylor, described a procedure of loop lengthening by dividing it longitudinally. Their procedure has the advantage of restoring normal peristalsis without losing any absorptive surface. A modification of the original procedure of Bianchi is described. We report on its application in a child born with laparoschisis and intestinal atresia; she had in fact 25 centimetres of duodenum and proximal jejunum anastomosed with left colonic angle. This child was referred to us with functional occlusion related to distension above an intact and unobstructed anastomosis. She was operated on at six weeks of age. Postoperatively oral feeding could be started after one month. Broviak's catheter for parenteral nutrition was removed at six months. In conclusion we believe that this technique offers a chance of better and faster adaptation to children born with short bowel syndrome.
Zeitschrift für Kinderchirurgie: organ der Deutschen, der Schweizerischen und der Osterreichischen Gesellschaft für Kinderchirurgie = Surgery in infancy and childhood 09/1985; 40(4):233-6.
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ABSTRACT: Although rarely encountered in childhood, renal regenerated nodules present definite characteristics, individualizing this pseudorenal tumor. They appear on kidneys previously affected by infectious or degenerative process. On IVP they do not enlarge the kidney's size, but roll-up the calyces, without amputation. They are homogeneous on ultrasonic investigation, isofixing on radio-isotopic scan., normally vascularized on computerized angiography, if a doubt upon nephroblastoma imposes this investigation. The percutaneous puncture biopsy, aided by sonography, shows normal glomeruli and tubules two or three times wider than usual, without scars of the original disease. Some authors consider them as a peculiar pattern of hypertrophic compensation, starting from remaining healty renal parenchyma. Reasons of their i frequency, and functional value are still unknown.
Chirurgie pédiatrique 02/1985; 26(6):346-50.
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ABSTRACT: Replacement of the oesophagus with a colonic graft brought up to a retrosternal or intrathoracic position is usually performed in children with undilatable oesophageal stenosis resulting from caustic burns. However, incidents associated with the oesophagus remaining in situ regularly raise the problem of concomitant or delayed oesophagectomy and therefore thoracotomy. A one-stage surgical technique is described, which includes closed-thorax oesophagectomy and colonic oesophagoplasty in situ in the oesophageal bed. The 3 patients operated upon by this method made an uneventful recovery.
La Presse Médicale 01/1985; 13(46):2810-2. · 0.67 Impact Factor
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La Revue du praticien 10/1984; 34(41):2217-21.
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ABSTRACT: A simple treatment of valves obstructing the posterior urethra in male neonates consists of breaking them by pulling a balloon catheter. This technique is preferable to instrumental manoeuvres, always delicate in such small urethras. In the case reported here a 28-months follow-up showed satisfactory results with regard to both renal function and urinary continence.
La Presse Médicale 04/1983; 12(12):761-3. · 0.67 Impact Factor
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ABSTRACT: For the last 5 years, duodeno-duodenostomy with tapering of the dilated duodenal pouch has been the usual method of surgical treatment of complete neo-natal duodenal occlusions. The results of this technic in 25 operated newborns have been compared with those obtained in a previous group of 24 cases operated by technics preserving the duodenal pouch. By restoring the peristaltic efficiency of the upper part of the duodenum, this technic allows early oral feeding (average delay: 7 days), thus avoiding a classical inconvenience of the usual methods of duodeno-duodenostomy or duodeno-jejunostomy. The aetiology of a non-patent anastomosis after the 10th post-operative day is clarified, a persistent duodenal obstruction indicates an organic complication that must lead to re-operation.
Chirurgie pédiatrique 02/1982; 23(6):369-72.
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La Revue du praticien 04/1981; 31(17):1245-6, 1249-51.
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La Revue du praticien 04/1981; 31(13):937-40.
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Annales de pédiatrie 04/1980; 27(3):169-77.
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Chirurgie pédiatrique 02/1980; 21(2):107-16.
