Robert P. Belin

Lymphoid hyperplasia of the bowel and its surgical significance in children

Twelve children with abdominal complaints had lymphoid hyperplasia of the bowel presenting in an acute or chronic form. The etiology is obscure. An infectious process is thought to precipitate the acute form of the disease. Parasites were identified in two patients with the chronic disease. The acute form, with involvement of the appendix or terminal ileum, presents commonly as acute appendicitis. Because of its self-limiting nature, appendectomy with perservation of the terminal ileum is appropriate. When intussusception is present, resection of the ileum is advisable. The chronic form, which is also common in the terminal ileum, produces disabling symptoms, recurrent intussusception, chronic anemia, and weight loss and is, therefore, amenable to surgical resection.

Diagnosis and management of scrofula in children

Abstract Atypical myobacterial infection in humans appears to be of low virulence and is acquired from the environment with no evidence of transmission ever from human contact. The majority of infected patients are never symptomatic and the disease is self-limited. When symptomatic disease does occur, it is usually in children. Treatment should be confined to patients with symptomatic cervical adenitis; surgical excision of the subcutaneous abscess and of the offending caseous lymph node is sufficient. Adjacent hyperplastic nodes should not be excised, and chemotherapy is not indicated.

Intramural tracheoesophageal fistula (TEF) associated with esophageal web

This is a report of the fourth known case of intramural TEF with diaphragmatic esophageal atresia. These patients present clinically as a typical esophageal atresia with tracheoesophageal fistula, but in effect have the following unusual features: 1) high TEF entering the trachea in the neck; 2) diaphragmatic-type atresia of the esophagus with uninterrupted muscular coat; 3) the location of this diaphragm is at the level of the carina producing in effect a long intramural fistulous tract. It is believed that faulty recannulization of a segment of the esophagus in association with H-type TEF may explain this uncommon anomaly.

Diagnosis of tracheoesophageal fistula by radioscanning

Abstract Current techniques for the detection of “H-type” tracheoesophageal fistula are cumbersome and inaccurate, and most require anesthesia. We have devised a rapid, noninvasive diagnostic method that detects the diffusion of an inert, radiolabeled gas across the fistula. 133 Xe is introduced and retained in the esophagus by means of a Foley catheter. During insufflation, the neck and chest are imaged by a scintillation camera and the radioactivity is recorded and displayed in counts per second. In control dogs, the gas remained in the esophagus and the level of activity decreased at an average rate of 7.5 counts/sec due to tissue absorption. In dogs with surgically created fistulas there was a rapid loss of activity as the gas diffused across the fistula into the trachea and was exhaled. The loss was directly proportional to the area of the fistula. After subtracting the component due to tissue absorption, a 2-mm fistula gave a loss at a rate of 8.2 counts/sec, a 5-mm fistula at 47 counts/sec, and an 8-mm fistula at 125 counts/sec. Although these results are only preliminary, the technique appears to be useful in the diagnosis of congenital tracheoesophageal fistula as well as acquired fistulas resulting from endoctracheal tubes, neoplasms, and trauma.

The meconium ileus equivalent following appendectomy.

A child with cystic fibrosis developed the meconium ileus equivalent in the postappendectomy period. This problem has not been emphasized in patients with cystic fibrosis. Operative evacuation only partially relieved the obstruction. Transient upper gastrointestinal bleeding fortuitously produced beneficial effect, which completely resolved the persisting ileus.

Radiological localization of the ampulla of Vater in an infant with duodenal atresia.

The authors describe an infant with a duodenal diaphragm in whom preoperative radiographs localized the ampulla of Vater within the medial wall of the diaphragm. This frequent close association must be kept in mind in order to avert surgical injury to this vital structure.