Norio Hasuda

Perforation of Meckel's Diverticulum Manifesting as Aseptic Peritonitis in a Neonate: Report of a Case

We report a case of perforated Meckels diverticulum with aseptic peritonitis in a 17-day-old neonate. The baby had been brought to the hospital with fever and abdominal distention. Abdominal computed tomography showed a 5-cm abscess in the lower abdomen, and emergency laparotomy was performed for suspected perforated appendicitis. However, we found a perforated Meckels diverticulum. No bacteria were detected in the purulent ascites from the peritoneal cavity. We speculate that the narrow lumen between the small intestine and the diverticulum, accompanied by poor self-emptying had caused acute inflammation resulting in perforation of Meckels diverticulum. The anatomic limitations in “walling off” the perforated Meckels diverticulum by the surrounding loops of small intestine prevented the bowel contents from spreading within the peritoneal cavity.

Effects of Rikkunshi-to on infantile hypertrophic pyloric stenosis, refractory to atropine

© 2008 Japan Pediatric Society Recently, atropine therapy for infantile hypertrophic pyloric stenosis (IHPS) has been developed as an alternative to pyloromyotomy, and a high success rate for this therapy has been reported. 1,2 We report here a case of IHPS treated with i.v. atropine therapy. Although projectile vomiting ceased in a week, vomiting recurred after hospital discharge despite the patient being treated with oral atropine. An upper gastrointestinal series indicated gastric hypomotility and uncoordinated hyperactive gastric peristalsis. Oral administration of Rikkunshi-to (TJ-43) or Liu-Jun-Zi-Tang, a Kampo medicine or a traditional herbal medicine, was initiated in the expectation that it would improve gastric motility and restore normal gastric myoelectric activity. This was based on the fact that this herbal medicine functions as a potent stimulator of gastric myoelectric activity in pediatric gastroesophageal refl ux patients. 3 We noted cessation of vomiting 1 week after initiation of treatment and this improvement confi rms that Rikkunshi-to could be used as a prokinetic agent.

Use of an appendicitis medical information sheet in the pediatric primary care system.

Accurate and prompt diagnosis is required for the primary evaluation of pediatric appendicitis. Among pediatricians and surgeons working in Yamanashi Prefecture, the pediatric appendicitis medical information (PAMI) sheet was edited in April 2011 to reflect the diagnostic results of the pediatric primary and emergency medical service and used as a referral document for surgical consultation to secondary hospitals.

Performance of the appendicitis medical information sheet in pediatric primary care system

Accurate and prompt diagnosis is required for the primary evaluation of pediatric appendicitis. Among pediatricians and surgeons working in Yamanashi Prefecture, the pediatric appendicitis medical information (PAMI) sheet was edited in April 2011 to reflect the diagnostic results of the pediatric primary and emergency medical service and used as a referral document for surgical consultation to secondary hospitals.