Esophagogastric separation for failed fundoplication in neurologically impaired children.

Purpose: Recurrent gastroesophageal reflux (GER) after a fundoplication in severely neurologically impaired children is a frustrating problem without an effective solution: redo fundoplications carry a significant recurrence rate and gastrojejunostomy (GJ) tube feedings are associated with frequent tube dislodgment. The authors report a series of esophagogastric separation (EGS) procedures aimed at the management of failed fundoplication in neurologically impaired children.

Methods: Medical records of 10 patients who underwent EGS for recurrent GER were reviewed retrospectively.

Predictability of splenic salvage by computed tomography.

The recognition of overwhelming post-splenectomy infection (OPSI) has led to greater efforts to conserve splenic tissue in patients sustaining blunt torso trauma. Nonoperative management of splenic trauma has emerged as a means to enhance splenic salvage yet criteria to assure the safety of such an approach remain ill defined and controversial. Since severity of injury directly influences outcome, a need exists for identification of splenic injuries that require early operation and repair or removal.

Beneficial use of an evocative test in chronic relapsing pancreatitis in children.

The true incidence and cause of chronic recurrent pancreatitis in children remains enigmatic because little is known about its early natural history, it is considered only infrequently, and diagnosis is difficult. Chronic recurrent abdominal pain in children continues to be common. To help evaluate the possibility that such pain is related to chronic recurrent pancreatitis, this study used the morphine-prostigmine pancreatic evocative test with the recent addition of concomitant pancreatic ultrasonography to evaluate ductal activity.

Posterior sagittal anoplasty combined with ventricular peritoneal shunting: an unusual complication.

This report is intended to point out the potential difficulties in patients with the combined abnormalities of anorectal agenesis and central nervous system disorders requiring diversion of CSF. The potential accumulation of this diverted fluid in and around meticulously approximated pelvic musculature so important to continence was a real concern and prompted immediate reexploration and shunt conversion. It is recommended that future cases with these coexisting abnormalities should be carefully considered for shunt conversion prior to or at the time of posterior sagittal anorectoplasty, particularly if the peritoneum is inadvertantly entered.