Gastric outlet obstruction due to X-linked chronic granulomatous disease.

Children with chronic granulomatous disease (CGD) may develop a peculiar form of gastric outlet obstruction due to involvement of the stomach wall with granulomatous tissue. An illustrative case is presented (which occurred despite adequate control of infection with antibiotherapy), including details of surgical management, distinctive radiographic and pathologic findings, and a review of other reported cases.

Hepatic portoenterostomy (the Kasai operation) for biliary atresia.

Twenty-two infants and children with extrahepatic biliary atresia were treated by Kasai's hepatic portoenterostomy operation since 1972. Postoperative bile drainage occurred in 11 infants. Success never was obtained in patients older than 12 weeks nor in the absence of microscopic biliary ductules in the excised fibrotic remnant of the extrahepatic bile ducts.

Technical details in the surgical correction of extrahepatic biliary atresia.

As in any new operation, what appear to be minor variations in surgical methods may be crucial to the success or failure of the procedure. Extended biliary drainage has been achieved in infants with extrahepatic biliary atresia by adherence to the details of the surgical technique just described. To date, results appear to be better in those infants having the definitive operation at the time of the initial exploration.

Split portal flow in heterotopic hepatic transplantation.

Heterotopic hepatic transplantation was carried out in 31 pigs using three different methods of homograft revascularization. In one experimental group the host portal inflow was split between the homograft and native liver so that the graft was provided with intestinal-pancreatic effluent; the host liver with gastric-splenic venous blood. The liver grafts flourished in this environment.

Hereditary telangiectasia manifested as gastrointestinal bleeding without external visible telangiectasia.

Gastrointestinal bleeding is one of the most common problems confronting the physician. In most instances, the source of the bleeding is easily identified, e.g.

The management of foreign affairs of the GI tract.

The flexible fiberoptic endoscope has not been employed consistently in the removal of foreign bodies from the gastrointestinal tract due to size limitations of the forceps and biopsy channel. The following report describes a technique for extracting large irregular objects from the upper-gastrointestinal tract, employing the polypectomy snare. It is a safe and reproducible procedure for the careful extraction of impacted objects.

Five cases and five unusual indications for autogenic renal transplantation.

Five cases of renal autotransplantation representing five different indications for the procedure are presented and discussed.

The Japanese operation for biliary atresia: remedy or mischief?

A case illustration is given of an infant with biliary atresia who had the Kasai operation more than 1 1/2 years ago and is now, by all biochemical and histological criteria, cured. The early results with this operation in 14 patients are similar to those reported by the Japanese, that is, 25% have had sustained postoperative bile drainage. Success has never been achieved in infants older than 4 months.

Surgical treatment of gastroesophageal reflux in infants.

Thirty-one infants less than a year of age underwent surgery for correction of pernicious gastroesophageal reflux. Severe growth retardation from persistent vomiting was the single most important indication for surgery (25 patients). Recurrent aspiration penumonitis was another serious sequella of reflux and necessitated surgery in six patients.

Liver transplantation in biliary atresia with concomitant hepatoma.

Two cases are reported in which the very infrequently reported association was found of liver cell carcinoma and biliary cirrhosis secondary to congenital biliary atresia. A search of the literature revealed 4 previous reports of cases with similar pathology. Our 2 patients were both operated upon within the first few months of life, at which time congenital biliary atresia was documented, and in 1 instance temporarily corrected.