H. Ludot

Successful resuscitation after ropivacaine and lidocaine-induced ventricular arrhythmia following posterior lumbar plexus block in a child.

We report the case of a 13-yr-old girl scheduled for knee surgery under general anesthesia and posterior lumbar plexus block. A ventricular arrhythmia developed 15 min after local anesthetic injection. A 20% lipid emulsion was successful in converting the ventricular arrhythmia to a sinus rhythm. This is consistent with previous reports suggesting that lipid emulsion is an effective emergency treatment of local anesthetic toxicity. We recommend the immediate availability of lipid emulsion along with other emergency therapeutics in operating rooms where local anesthetics are used.

Nonoperative management of biliary tract fistulas after blunt abdominal trauma in a child

Nonoperative treatment was carried out in a 12-year-old girl who presented with biliary fistulas after blunt abdominal trauma with hepatic injury. A computed tomography-guided percutaneous puncture showed biliary peritonitis and permitted the positioning of an efficient intraperitoneal drainage. Endoscopic retrograde cholangiography was very helpful for visualization and accurate localization of biliary injuries. This permitted positioning a nasobiliary drain to reduce intrabiliary pressure and to bypass a lesion of the common hepatic duct. This nonoperative management allowed healing of fistulas within 20 days, without bile duct stricture (noted on the follow-up intravenous cholangiogram 18 months later).

Wandering spleen in children: multicenter retrospective study

Wandering spleen in children is a rare condition. The diagnosis is difficult, and any delay can cause splenic ischemia. An epidemiologic, semiological, and surgical diagnosis questionnaire on incidence of wandering spleen in children was sent to several French surgical teams. We report the results of this multicenter retrospective study. Fourteen cases (6 girls, 8 boys) were reported between 1984 and 2009; the age range varies between 1-day-old and 15 years; 86% were seen in the emergency department. Ninety-three percent had diffuse abdominal pain. For 57% of the cases, it was their first symptomatic episode of this type. No diagnosis was established based on the clinical results alone. All patients had presurgical imaging diagnosis. Open surgery was performed on 64% cases. Forty-three had splenectomy for splenic ischemia. Thirty-six percent had splenopexy, 14% had laparoscopic gastropexy, and 7% had spleen repositioning and regeneration. Complications were noted in 60% of the cases resulting in postsplenopexy splenic ischemia. Early diagnosis and surgery are the best guarantee for spleen preservation. Even if the choice of one technique, splenopexy or gastropexy, can be argued, gastropexy has the advantage of avoiding splenic manipulation and restoring proper physiologic anatomy. When there is no history of abdominal surgery, laparoscopy surgery seems the best procedure.

Laparoscopic Gastropexy for the Treatment of Wandering Spleen With or Without Gastric Volvulus

Wandering spleen is caused by failed fusion of the dorsal peritoneum, or absence or abnormal development of its suspensory ligaments that hold the spleen in its normal position in the left upper quadrant of the abdomen. The splenic ligaments are the gastrosplenic, splenorenal (splenopancreatic), splenophrenic, splenocolic ligaments. (Couinaud, 1963) Embryologically, the splenic ligaments develop in the coeliac artery territory, from the primitive dorsal mesentery (mesogastrium), which is responsible for the formation of peritoneum, the greater omentum and the several peritoneal folds. However, developmental anomalies or variations may take place. These variations in the embryologic development of the spleen’s primary supporting ligaments could explain the wandering spleen. These ligaments may be absent, may be too long or too short, too wide or too narrow, or abnormally fused.

CL073 - La rate oscillante chez l’enfant : étude multicentrique

Le diagnostic de rate oscillante est difficile et tout retard peut etre responsable, en cas de torsion, d’une ischemie splenique. Un questionnaire portant sur l’epidemiologique, la semiologique, le diagnostic, la chirurgie, a ete envoye par e-mail aux chirurgiens pediatriques Francais. 14 (6 F et 8 G) cas entre 1984/2009 (1 j-15 ans). 86 % ont consulte en urgence. Il s’agissait du premier episode dans 57 % des cas. 93 % presentaient des douleurs abdominales. 54 % des vomissements. Aucun diagnostic n’a ete pose sur la seule clinique. Tous les patients ont eu un diagnostic preoperatoire grâce a l’imagerie. Le traitement a consiste a une chirurgie a ciel ouvert dans 64 % des cas. 43 % ont eu une splenectomie pour ischemie. 36 % ont eu une splenopexie. 14 % ont eu une gastropexie par laparoscopie, et 7 % ont eu un repositionnement de la rate et avivement. Les complications a long terme : 60 % d’ischemies spleniques post splenopexie. La precocite du diagnostic et l’intervention garantissent au mieux la survie splenique. Meme si le choix entre splenopexie et gastropexie reste discutable, la gastropexie nous semble avoir l’avantage d’eviter la manipulation splenique, et de restaurer l’anatomie. En l’absence d’antecedent de chirurgie abdominale, la laparoscopie nous parait devoir etre preferee.

P207 - Maladie de Hirschsprung et abaissement trans-anal : évaluation précoce des résultats

But : Preciser l’interet de l’abaissement trans-anal pour le traitement de la maladie de Hirschsprung. Etude retrospective de 24 enfants ayant beneficie d’un abaissement trans-anal entre 2000 et 2009. Les resultats sont evalues notamment en les comparant a ceux d’une etude plus ancienne portant sur 48 patients (1975-1996) operes selon Soave par laparotomie. La continence est evaluee selon le score d’Holschneider pour les enfants en age de l’etre. Resultats 24 abaissements trans-anaux : âge moyen 76 jours (15 formes recto- sigmoidiennes, 7 rectales, 2 coliques gauche). 100 % d’abaissement en zone saine. Pas de complication immediate. Complications tardives: - 8 % de syndromes occlusifs resolutifs apres lavements - 4 % de fuites anales inconstantes a l’emission de gaz - 25 %de dilatations anales iteratives au cours de la premiere annee de suivi. Meme si l’heterogeneite des deux series est manifeste, et si la laparoscopie permet aujourd’hui de ne plus recourir a la laparotomie d’emblee, il nous a paru interessant de comparer nos resultats recents avec ceux plus anciens, l’evaluation ayant ete faite selon le meme protocole et portant sur une meme technique realisee par deux voies d’abord differentes.