Neonatal ascites due to congenital jejunal obstruction

Small bowel atresia may present with congenital ascites. A neonate with ascites was found to have jejunal atresia complicated by volvulus and perforation.     

Neonatal urinary ascites due to unilateral vesicoureteric junction obstruction

A case of unilateral vesicoureteric junction obstruction presenting with ascites in a neonate managed successfully with serial ultrasonography and delayed primary reconstruction is described.Presented at the International Congress of Paediatric Surgery and Paediatric Radiology, Melbourne, Australia, 26-30 March 1995     

Neonatal intestinal perforation due to congenital defects in the intestinal muscularis

Congenital defect of the muscular layer of the small intestine is a rare cause of spontaneous bowel perforation in premature infants. During the last 12 years we have observed four similar cases. We describe the most recent one, a premature infant who developed two abdominal events. On her 2nd day of life, spontaneous perforation of the distal ileum due to focal absence of the muscular layer occurred. Several weeks later she developed the typical clinical and histological picture of necrotizing enterocolitis. The clinical and histological characteristics of the two different conditions are compared, and the 24 cases reported in the literature are discussed. We conclude that focal absence of intestinal musculature may be not such a rare entity as is commonly believed.     

Neonatal ascites and hyponatraemia following umbilical venous catheterization

The complications associated with umbilical venous catheterization in neonates range from pericardial effusion, portal hypertension, and peritoneal perforation with ascites, to Wharton's jelly embolism. The case of a term neonate who developed ascites and severe hyponatraemia (serum sodium 119 mmol/L) most probably following peritoneal perforation by an umbilical venous catheter is reported. The presenting feature was convulsions associated with dilutional hyponatraemia, probably following absorption of a large quantity of ascitic fluid across the peritoneum. Conservative management was associated with gradual recovery over 24 h. The case highlights that, irrespective of the route, excessive administration of salt-free fluids can lead to dilutional hyponatraemia with adverse consequences. The present case illustrates the importance of confirming intravascular positioning of umbilical catheters by ensuring free flow of blood on aspiration, to prevent/detect inadvertent peritoneal perforation. Ideally, echocardiographic confirmation of optimal intravascular placement of such catheters is preferred as radiographic confirmation is reported to be unreliable.     

Neonatal bowel obstruction due to meconium adhesions

Two cases of neonatal obstruction due to meconium adhesions are described that represent rare forms of meconium peritonitis. In such cases it is essential to remove the adhesions for histological investigation. Offprint requests to: G. de Miscault     

Neonatal urinary ascites in renal candidal infection

A preterm neonate developed anuria and abdominal distension. Peritoneal fluid contained high levels of potassium, urea and creatinine with a low level of bicarbonate compared with plasma. Renal ultrasound showed dilatation of the left collecting system with echogenic material in the calyces bilaterally, which together with positive cultures of candida from blood, urine and peritoneal fluid suggested renal candidiasis with obstruction. Computed tomography (CT) showed extravasation around the right kidney on delayed post contrast films, confirming that the peritoneal fluid was urine. The patient improved rapidly after insertion of the peritoneal drain and made a full recovery with antifungal agents and a left nephrostomy. Causes of urinary ascites are discussed and characteristic biochemical features described. Ultrasound and contrast CT may be diagnostic and help to monitor progress.     

Intestinal obstruction due to roundworms

Roundworms are the most common intestinal helminths responsible for small-bowel obstruction; 74 cases of intestinal obstruction due to ascariasis over 5 years are reviewed. Surgical intervention was necessary in 26 cases for relief of obstruction and included massaging of worms into the colon, enterotomy, resection and anastomosis, and bowel exteriorization. It is suggested that routine deworming of all patients attending pediatric surgical outpatient clinics should be done to prevent worm infestation and its complications. Surgery should be performed using nonabsorbable sutures for closure of enterotomies and for bowel anastomosis after resection.     

Ascites due to spontaneous rupture of the renal pelvis in an 11-month-old infant with uretero-pelvic junction obstruction

The authors describe an infant with ureteropelvic junction obstruction who developed ascites. The case is unusual because the ascites was due to spontaneous rupture of the renal pelvis as described before in adults and because the infant was older than previously reported (11 months).     

Operative and postoperative management of congenital duodenal obstruction: a 10-year experience

Forty-five patients with congenital duodenal obstruction aged from 1 day to 11 months were operated upon during the last decade. Group A included 25 neonates with duodenal obstruction due to atresia type I or a complete diaphragm in 10 cases, atresia type II in 3, atresia type III in 1, stenosis or incomplete diaphragm in 4, annular pancreas in 6, and aberrant vessels in 1. Seven duodenoduodenostomies (D-D) were performed, 14 duodenoplasties (D-P) with occasional excision of the diaphragm, and 4 duodenojejunostomies (D-J). Tapering, plication of the proximal duodenum, or gastrostomy was not performed in any child and no transanastomotic tube was placed. Group B included 20 infants with duodenal obstruction due to peritoneal bands and associated malrotation. They all underwent Ladd's procedure. All children in group B and 15 in group A had an uneventful recovery and tolerated oral feedings within the first 10 days postoperatively without any complication. Six children in group A had prolonged postoperative ileus and were treated with total parenteral nutrition (TPN), gastric decompression, and radiologic evaluation of anastomotic patency. These 6 children eventually tolerated oral feeding between the 18th and 45th postoperative days. In 1 child a technical error was found that caused a prolonged ileus. Three children died within the 1st postoperative week. It is concluded that simple establishment of continuity of the gastrointestinal tract by performing the appropriate surgical procedure in combination with TPN and gastric decompression gives satisfactory results in the management of duodenal obstruction.Presented at the 15th Annual International Meeting arranged by the Greek Association of Pediatric Surgeons.     

Excision duodenoplasty: a new technique for congenital duodenal obstruction

Slow anastomotic function is a common problem in the management of congenital duodenal obstruction. We describe a simple technique of excision duodenoplasty (ED) that results in a fixed open anastomosis, which facilitates early commencement of feeds and discharge from hospital. A retrospective case-note review (1981–2000) was undertaken to compare the results of ED with side-to-side duodenoplasty (SSD) and diamond-shaped anastomosis (DD). The outcome measures were days to commencement of feeds, duration of total parenteral nutrition (TPN), and length of hospital stay. In ED a 1.0 to 1.5-cm elleptical segment of dilated duodenum is excised. A longitudinal incision is made in the smaller distal duodenum. A side-to-side one-layer anastomosis is performed. The wall of the proximal duodenal stump is thick, and excision of the ellipse keeps the anastomosis open by preventing apposition of the opposing walls. This facilitates good drainage across the anastomosis. The time to onset of feeding was longer after SSD (median 7 days) compared to ED (5 days) and DD (5 days). The total duration of TPN was also longer for SSD (9 days) in comparison to ED (7 days) and DD (7 days). Although the duration of hospital stay was more for SSD (18 days) than ED (13 days) and DD (16 days), this difference was not statistically significant. The ED technique thus gives an equally good result as DD and a better result than SSD. It is simple to perform and to teach. Accepted: 26 February 2001     

Intractable congenital chylous ascites

A male newborn presented with congenital chylous ascites, the treatment of which is difficult and complicated due to persistent loss of chyle. The primary therapeutic goal is to reduce the lymph flow and to allow the leakage to heal naturally. Usually, conservative management--enteric rest with total parental feeding or an enteral diet with medium-chain triglycerides--can achieve this. A new treatment option is the use of octeotride, a somatostatin analogue. Both therapies failed in our patient, and surgical ligation of the leaking lymphatic duct was successful. Conclusion: The success of the surgical treatment depends on localizing the leaking lymphatic duct. Lymphatic imaging with lymphoscintigraphy and pre-operative administration of lipophilic dye can assist the surgeon.     

Neonatal spontaneous colonic perforation due to cystic fibrosis

We report two cases of spontaneous colonic perforation associated with cystic fibrosis (CF) in the neonatal period. Both presented with an acute abdomen soon after birth and required laparotomy and stoma formation. Colonic perforation as an initial presentation of CF is reviewed and management options are discussed.     

Intestinal obstruction due to phytobezoar in childhood

Phytobezoar is a gastric or small-intestinal foreign body of vegetable origin. Morphologic, diagnostic, and surgical aspects of this condition in adults have been sufficiently described in the recent literature; however, it is almost unknown in childhood. We present our experience with five children operated upon for intestinal obstruction due to a phytobezoar. Pathophysiology, diagnosis, and treatment are discussed on the basis of our cases and those in the literature. One of our patients had previously undergone a vagotomy with pyloroplasty for hemorrhagic gastritis. The incidence of phytobezoar may increase in the future because of the tendency to add a pyloroplasty to the surgical treatment of gastroesophageal reflux in children.Presented at the 16th European Federation Congress of the International College of Surgeons, November 12–17, 1989, Jerusalem, Israel Offprint requests to: Francis Serour     

Neonatal chylous ascites - report of three cases and review of the literature

Three cases of neonatal chylous ascites (CCA) were managed in the neonatal unit, University Hospital, Kuala Lumpur, over the past 9 years. Fetal ascites and polyhydramnios were the sole abnormalities detected in all three babies by antenatal ultrasonography. They were born at 36 weeks' gestation and their birth weights ranged from 3.0 kg to 3.8 kg. All three infants had abdominal distension at birth. Milky ascitic fluid was obtained after starting enteral feedings. Analysis of the ascitic fluid revealed a raised white blood cell count (predominantly lymphocytic) and triglycerides (1.4–3.8 mmol/1), cholesterol (1.6–2.8 mmol/1), and protein levels (25–41 g/1). Conservative management with skimmed milk and medium-chain triglycerides in one infant and Pregestimil in another was instituted. these two infants with CCA were clinically normal when reviewed at 19 months and 3.5 years of age. The third infant had a gut malrotation and associated pyloric septum; he died from complications of a laparotomy. The literature on this rare condition is reviewed.     

婴幼儿先天性乳糜性腹水病因及治疗的探讨

目的 探讨婴儿顽固性乳糜性腹水的病因及治疗方法.方法 回顾性分析2001至2014年我科收治的10例乳糜性腹水患儿临床资料,所有患儿均经过腹穿、实验室检查明确乳糜性腹水诊断,均先采用禁食水、联合静脉营养的保守治疗,症状缓解不明显,再采用腹腔镜探查,然后根据术中所见情况采取腹腔镜下或开放途径相应治疗.10例患儿中采用腹腔镜下Ladd手术6例,扩大脐窝切口将小肠提出腹壁外,开放手术Ladd手术3例,1例因肠系膜根部淋巴结破溃乳糜漏行腹腔镜下淋巴结切除.结果 所有患儿均行钡灌肠检查,其中回盲部位于右上腹者7例,回盲部在正常的右下腹位置3例.腹腔镜探查下10例患儿均有肠旋转不良改变,其中9例有明显的Ladd韧带压迫,6例实施腹腔镜下Ladd手术,3例实施开放Ladd手术,另外1例因肠系膜根部淋巴结破溃乳糜漏行腹腔镜下淋巴结切除,8例患儿治疗后乳糜性腹水明显缓解,2例术后轻度腹胀,经低脂进食保守治疗3个月后腹胀消失,所有患儿定期随访未见明显复发需要再手术者.结论 肠旋转不良系膜根受压是婴幼儿乳糜性腹水形成的重要因素之一,Ladd手术是其治疗的有效方法.     

Successful treatment of congenital chylous ascites with a somatostatin analogue

Congenital chylous ascites (CCA) results from maldevelopment of the intra-abdominal lymphatic system. Newborns present with respiratory distress and abdominal distention. Medical treatment of CCA is often prolonged. A newborn with CCA was treated with octreotide, a somatostatin analogue, resulting in rapid and complete resolution of the ascites.     

Neonatal perforated appendicitis associated with duodenal obstruction

The case of a premature infant with a simultaneous occurrence of appendiceal perforation and incomplete fixation of the colon producing early obstruction of the duodenum is reported. The clinical examination and laboratory and radiological investigations were all negative for the diagnosis of appendicitis, which was found incidentally at laparotomy for duodenal obstruction. Offprint requests to: P. Puri     

Congenital duodenal obstruction due to a preduodenal portal vein

Only about 80 cases of pre-duodenal protal vein (PDPV), a rare congenital anomaly of portal vein development that was first described by Knight in 1921, have been reported till date. We report a neonate with duodenal obstruction caused by PDPV and briefly review the available literature.     

Neonatal Meckel diverticulum: Obstruction due to a short mesodiverticular band

This is the first report of symptomatic Meckel diverticulum in a newborn, in which direct compression by a short mesodiverticular band (MDB) caused intestinal obstruction. A short MDB can cause intestinal obstruction due to direct compression. There are two mechanisms by which Meckel diverticulum with MDB can cause intestinal obstruction: internal hernia and direct compression. Onset of intestinal obstruction due to direct compression by a short MDB might be earlier than that for internal hernia with long MDB.     

Prenatally detected gastroschisis presenting as jejunal atresia due to vanishing bowel

A case of gastroschisis complicated by vanishing bowel and presenting as jejunal atresia is reported that is uniquely different from previously reported cases. Following delivery, complete closure of the abdominal wall with a small fascial defect was observed. Complete healing of this fascial defect was observed at 1 month of age. Accepted: 5 January 1999