Martine Dassonville

Decrease of vasoactive intestinal peptide, methionine-enkephalin, substance P and increase of neuropeptide Y immunoreactive nerve fibres in aganglionic colon of Hirschsprung's disease.

Ganglionic and aganglionic full-thickness samples, at 4 levels of the colon of 26 infants with Hirschsprungs disease, were studied by immunohistochemistry. In the distal part of the aganglionic bowel, we observe a decrease of substance P and vasoactive intestinal peptide, an absence of methionine-enkephalin and an increase in neuropeptide Y nerve fibres. When detected, substance P and vasointestinal peptide are mainly present in abnormal bundle nerve fibres. In the middle part of the aganglionic bowel, a slight increase in the number of normal nerve fibres containing substance P, methionine-enkephalin and vasoactive intestinal peptide is observed. Some vasoactive intestinal peptide abnormal bundle nerve fibres are detected. They are less numerous than in the distal part. In the proximal ganglionic bowel, the number of vasoactive intestinal peptide, substance P and methionine-enkephalin normal nerve fibres is increased compared to the middle aganglionic segment but is slightly lower than in the normal colon. Again vasoactive intestinal peptide abnormal bundle nerve fibres are present at that level and are also detected in more proximal ganglionic bowel up to the hepatic flexure of the colon. Thus, abnormal distribution of neuropeptides is also found in more proximal ganglionic bowel and not only in the aganglionic segment of bowel usually specific of Hirschsprungs disease.

Falciform ligament: A cause of extrinsic antral obstruction in the neonatla period

We are describing two cases of neonatal antral obstruction due to the presence of an abnormal falciform ligament. Abdominal palpation revealed a cord in the right hypochondrium. In one case, a barium swallow revealed a very short extrinsic compression of the antrum. Division of the abnormally wide fibrous falciform ligament cured the babies.

Proenkephalin A associated peptides in the autonomic nervous system of the human infant gastrointestinal tract.

The digestive tract of neonates and infants were examined by immunohistochemistry using specific antisera raised against proenkephalin A related peptides. Proenkephalin A, methionine-enkephalin and leucine-enkephalin are observed in nerve fibres in the smooth muscles in the myenteric and submucosal plexuses or in neuronal cell bodies of the myenteric plexus. In these structures synenkephalin has general distribution as methionine-enkephalin but not the same as leucine-enkephalin. Co-localization of synenkephalin and methionine-enkephalin is found in several neurones. These results suggest that proenkephalin A is the precursor-protein in some enkephalinergic neurones of the human gut. A gradient in the density of immunoreactivity is observed and is maximal in the distal small bowel. This gradient contrasts with observations made in rodents where major enkephalin immunoreactivity is observed in the proximal digestive tract. These findings give evidence that proenkephalin A-derived peptides could have effects in the motility of the human gut.

Long-Term Outcomes and Quality of Life in Patients after Soave Pull-Through Operation for Hirschsprung's Disease: An Observational Retrospective Study

Introduction Patients after pull‐through operation for Hirschsprungs disease (HD) are at high risk of defecation disorders. This study aimed at investigating their long‐term outcomes and quality of life (QoL) in comparison with controls. Patients and Methods Patients older than 5 years operated on for HD were interviewed to complete detailed questionnaires on bowel function. Patients without neurologic impairment were enrolled in a QoL survey to compare with controls matched for sex and age and selected randomly from the general population using sampling set in a ratio of four controls to one case of HD. Results In total, 53 operated patients were enrolled. Mean age of the patients was 16 ± 8 years, with 68% boys. Rectosigmoid aganglionosis was the most seen form of HD in 38 (72%) cases. Open Soave was performed in 40 (75.5%) cases, and minimally invasive surgery Soave (MIS Soave) in 13 (24.5%) cases. At investigation, prevalence of fecal incontinence and constipation were 22.6 and 13.2%, respectively. Regarding QoL survey, 45 patients and 180 controls were enrolled, excluding 8 patients with neurologic impairment. Thirty‐seven (82.2%) patients were classified as having a good QoL (score ≥ 9 points); whereas six had a fair QoL (5‐8 points) and two had a poor QoL (< 5 points). QoL score in the cases and the controls were 10.2 ± 2.5 and 11.9 ± 0.4 points, respectively. Long aganglionosis form of HD was significantly associated with a low QoL (score < 8 points), adjusted odds ratio = 9, 95% confidence interval [1.3; 64.1] (p < 0.05). In subscales analyses, the prevalence of each dimension including fecal continence, school absenteeism, unhappiness or anxiety, food restriction, and peer rejection was significantly higher in operated patients than in controls (p <0.001). Conclusion Although the QoL of patients operated on for HD in general was with good outcomes, fecal incontinence and constipation still are problematic issues and challenges in a high percentage of patients. Therefore, a long‐term and multidisciplinary follow‐up is essentially required for these patients.

Laparoscopic Repair for Perforated Peptic Ulcer in Children.

Introduction A perforated peptic ulcer (PPU) is a rare but major complication of gastroduodenal peptic ulcer disease. Literature is scarce on this subject in the pediatric population and most articles describe a surgical treatment by laparotomy. We aim to review all our cases of pediatric PPU treated over the past 16 years and compare these to literature to deduce potential benefits and disadvantages regarding laparoscopic treatment of PPU in children. Materials and Methods A retrospective study of all cases of PPU treated at the Lenval Hospital in Nice (France) and the Queen Fabiola University Hospital for Children in Brussels (Belgium) between 1998 and 2015 was performed. Results A total of five children were treated for PPU (2 females). The average age was 11 years (range, 3‐17). All of them were surgically treated with laparoscopic simple suture of the perforation and placement of an omental patch. There were no mortalities, no conversions, and no extra‐abdominal complications or wound dehiscences. Mean operating time was 78.6 minutes (range, 70‐115 minutes). Mean duration of intravenous treatment was 6 days (range, 4‐12 days). One reintervention was performed for abdominal infection. In one patient, an abdominal drain was left in place for 2 days. The mean time before refeeding was 3.4 days (range, 3‐4 days) and mean length of stay was 12 days (range, 7‐30 days). Conclusion Laparoscopic repair is safe and feasible for PPU and should be the gold standard for treatment of PPU in children.

Right Lower Quadrant Pathology Including the Right Pelvis in the Pubertal Female

Pain in the right lower quadrant (RLQ) is common in children and represents a daily challenge for the clinician. This is even more difficult in the adolescent girl as the pain may have a gynecologic origin; furthermore, in girls, the psychological aspects are as important as the disease itself since their gynecologic future might be compromised.

Unusual Association of Upper Gastro-Intestinal Anomalies in a Newborn

We are describing one case of persistent nonbilious post-prandial vomiting in a newborn due to hypertrophic pyloric stenosis, intestinal malrotation and gastric antral diaphragm. Those three anomalies were successively diagnosed as causes of persistent upper gastrointestinal subobstruction.