Seven years' experience with idiopathic unremitting chronic constipation.

Two hundred sixty patients with severe chronic constipation were studied by rectal biopsy, barium enema, and anorectal manometry. None had any medical, neurologic, or anatomic cause for their complaint. All biopsies showed presence of ganglion cells and absence of hypertrophied nerves.

Deficient neurogenic innervation of the myenteric plexus with normal submucous plexus involving the entire small and large bowel.

A newborn presented with a picture of intestinal obstruction. Multiple biopsies of the small and large bowel showed an unusual neurogenic innervation. The myenteric plexus of Auerbach was severely depleted of ganglion cells and nerve fibers, while the submucous plexus of Meissner was normally innervated.

Postoperative functional and manometric evaluation of patients with Hirschsprung's disease.

Sixty-two patients with Hirschsprung's disease (operated on according to Duhamel, Swenson, or Soave) were evaluated for quality of defecation and studied manometrically. Follow-up was 30 years. Stools were normal in 30% to 50% of patients, while the rest had either constipation, loose, or increased frequency of stools per day.

Congenital liver cyst presenting as congenital diaphragmatic hernia.

A 5-day-old infant was found to have an unusual presentation of a congenital liver cyst. The cyst arose from the left lobe of the liver and herniated into the left thoracic cavity through a congenital defect at the central tendinous portion of the diaphragm. The association between a congenital liver cyst and the location of the diaphragmatic hernia suggests that the abnormality occurred during very early embryonic development when the liver rapidly expands and extends into the septum transversum at the base of the heart.

Congenital diaphragmatic hernia in monozygotic twins.

This is the third reported instance of identical twins, each with left-sided posterolateral congenital diaphragmatic hernia (CDH) (Bochdalek type), who have been operated upon successfully. The associated anomalies were mirror image undescended testicles. Comparative review of familial and sporadic cases of CDH revealed that males were more commonly affected in the former, while females were more commonly affected in the latter.

Chronic constipation. Manometric patterns and surgical considerations.

We studied 80 children who had severe chronic constipation that was refractory to dietary, medicinal, and psychiatric therapy by means of barium enemas, rectal biopsies, and manometry. Four patients had Hirschsprung's disease and three patients had segmental dilatation of the colon. The remaining 73 patients had radiologically dilated anorectums with inpaction.

Radioisotope spleen scan in patients with splenic injury.

The technetium Tc 99m sulfur colloid liver-spleen scan is a valuable aid in diagnosis and treatment of patients with splenic injury. After reviewing the charts of 47 patients who were ill as a result of splenic trauma, we came to the following conclusions: (1) the scan identified the injury, accurately mapped its extent, and indicated the presence or absence of associated liver injuries; (2) the scans were useful in following the extent and rate of healing of the splenic injury; (3) the scan is an indirect measurement of of return of splenic fuction; (4) the procedure can be performed in a reasonable time frame with no serious morbidity; and (5) the indications, contraindications, and timing of scans are now reasonably well established.

Littre's hernia in infancy presenting as undescended testicle.

Littre's hernia is defined as any hernial sac which contains a Meckel's diverticulum. It has been reported in association with inguinal, umbilical, femoral, sciatic, ventral, and lumbar hernias. This hernia is rare, particularly in children, in whom the umbilical variety is reported by some to be most common.

Congenital asplenia and anomalies of the gastrointestinal tract.

Congenital asplenia has been traditionally described in association with cardiopulmonary anomalies (Ivemark syndrome). A case of congenital asplenia with duplication of the hindgut and genitourinary tract, myelomeningocele, situs inversus abdominis, and imperforate anus generated interest in review of the gastrointestinal anomalies of 36 patients who died of the disease in Childrens Hospital of Los Angeles. A significant number were found to have situs inversus, malrotation of the bowel, esophageal varices, duplication and hypoplasia of the stomach, Hirschsprung's disease, imperforate anus, and duplication of the hindgut.

Congenital diaphragmatic hernias: eleven years' experience.

Fifty-five patients with congenital diaphragmatic hernias (1966 to 1976) were studied and compared to 65 similar patients reported previously (1953 to 1963). The mortality was found to be the same in the two groups despite the fact that in the current series, patients were diagnosed and operated on at a younger age. Initial uncorrected pH value was found to be of prognostic importance.

Preservation of the injured spleen.

Experience with suture repair of splenic lacerations in 14 children and 8 adults is reported. The youngest patient was 3 days old and the oldest 60 years. Adequate healing was confirmed by postoperative splenic scans with or without arteriography.

The role and safety of early postoperative feeding in the pediatric surgical patient.

The authors report their experience with early postoperative feedings in a variety of pediatric surgical patients utilizing a needle catheter jejunostomy. A small caliber catheter, similar to that used for antecubital central venous cannulation, is inserted in the antimesenteric border of the jejunum providing a subserosal tunnel. A purse-string suture is placed around the catheter and then it is secured to the abdominal wall, and the catheter is brought out through the abdominal wall via a needle puncture wound.

Neuronal colonic dysplasia: an unusual association of Hirschsprung's disease.

A case of neuronal colonic dysplasia in association with Hirschsprung's disease is described. It is suggested that this condition be borne in mind when investigating operated Hirschsprung's cases having residual symptoms.

Ten-year experience with childhood rhabdomyosarcoma.

The ten-year (1965-1975) experience of the Pediatric Tumor Clinic with 14 cases of proven CRM was reviewed. Seven cases seen prior to 1970 acted as control. They were treated by surgery and X--ray therapy alone (one received one chemotherapeutic agent).

Pyloro-duodenal atresia. A report of three families with several similarly affected children.

Seven patients born with pyloro-duodenal atresia are reported, one had an additional atresia of the small and large bowel, and another had a pneumoperitoneum probably secondary to rupture of the stomach. All patients had the same radiological findings and had no air distal to the pylorus. Consanguinity was elicited in four and a familial incidence of an identical malformation in siblings in six.