Michael J. Silberstein

Duodenal hematoma and acute pancreatitis after upper gastrointestinal endoscopy

Laparoscopy is still a widely practiced surgical procedure despite the risk for life-threatening intestinal lesions, which occur in approximately 0.14% to 0.2% of cases.1-4 Sonographic study of the pneumoperitoneum to choose the site of direct trocar insertion can minimize this incidence. We believe that ultrasonography is indicated for patients with previous abdominal surgery or peritoneal pathology but that it is not automatically indicated for all patients, as the finding of dense adhesions in patients without previous laparotomy or known peritoneal disease is rare. As we previously reported,5 ultrasonography may also identify significant portal collaterals in the anterior abdominal wall of patients with cirrhosis and portal hypertension. Trocar injuries in this setting can result in major, sometimes fatal, hemorrhage. Ultrasonography is ideally suited to select an appropriate site for trocar insertion in these patients.

Duodenogastric intussusception causing gastric outlet obstruction

Acquired gastric outlet obstruction occurred in an infant following surgery to correct congenital ileal atresia. Despite adequate decompression the gastric outlet obstruction persisted and required a second operation. A retrograde duodenogastric intussusception with an overlying pyloric stenosis proved to be the cause.

Jejunal intussusception in children

Jejunal intussusception in children is an uncommon form of intussusception often presenting with chronic intermittent abdominal pain and weight loss. Two cases of jejunal intussusception caused by enteric duplication are presented. It is concluded that in the absence of generalized small bowel disease, enteric duplication is the most likely cause of jejunal intussusception in children.

Multicystic hepatic mesenchymal hamartoma of childhood: Computerized tomography and ultrasound characteristics

A case of massive mesenchymal hamartoma of the liver is described in a 13-month-old infant. A complex multicystic mass was demonstrated by ultrasound and computed tomography (CT). The appearances suggested the preoperative diagnosis.

Congenital peritoneal mesothelioma

Only three primary peritoneal mesotheliomas in children have been previously reported. We describe a 6-wk-old girl with a papillary peritoneal mesothelioma of low grade malignancy. This is probably a congenital mesothelioma and is the youngest patient reported to date.

Bronchogenic cysts in children

Radiographic, surgical and pathological features of 33 paediatric patients with bronchogenic cysts are reviewed. These congenital lesions usually presented as spheroid mediastinal masses, near the carina or right paratracheal area, 2-3 cm in diameter with sharply delineated borders. Occasionally, the masses were lobulated or triangular in shape. Some cysts produced considerable airway distortion. All intrapulmonary cysts had connections, sometimes patent, with the trachea or main-stem bronchi. Thin-walled, completely aerated cysts became thick-walled with infection. A few air-filled and solid cysts grew rapidly. Cystic lung disease distal to central bronchogenic cysts was observed.

Sonography of the Zellweger syndrome.

Case 1 A 6-day-old white infant girl was transferred to Cardinal Glennon Childrens Hospital for evaluation of dysmorphism. She was born to a G2, P2, AbO, mother by spontaneous vaginal delivery. The parents were not consanguineous and another sibling was normal and healthy. Her birth weight of 2050 g placed her below the 5th percentile. Her estimated gestational age was 36 weeks by Dubowitz, but 39 weeks by date. Head circumference was 325 em (50th percentile) with a wide and full anterior fontanelle (4 X 4 em) and separated sutures. She had narrow palpebral fissures and demonstrated hypertelorism. Her ears were low set and her skin was icteric, coarse, and wrinkled. There was no organomegaly. She had large labia minora, a prominent clitoris, and an imperforate anus with an anterior perineal-vagino-rectal fistula. Her extremities dem~ onstrated a left simian crease, bilateral clinodactyly and bilatA era] club feet. Neurological examination revealed hypotonia, absent Moro and gTasp reflexes, and a poor sucking reflex. A skeletal survey demonstrated irregular calcifications in and around both patellae, a small focus of calcification in both greater trochanters, in the left triradiate cartilage and in the left

Bone Changes in a Neonate with Congenital Leukemia

A rare case of congenital leukemia is described showing prominent bone changes in a neonate.