Congenital duodenal stenosis. A case treated in adulthood]

The authors report their experience the diagnosis and management of congenital duodenal malformation in adults. They emphasize problems and difficulties in this disease of pediatric age and the physiopathological adaptation in these years. They point out that surgery can modify important metabolic functions and sub-clinical pathological conditions that the malformation made up.     

Ultrasound diagnosis of pyloric stenosis in young children]

The results of observation of 12 children ranging in age from 1 to 4 mos with tentative diagnosis of pyloric stenosis are presented. The study was performed by special method, using "Aloka" SSD-280 (Japan) ultrasound apparatus. The characteristic symptoms of the disease were revealed in 9 children, diagnosis of pyloric stenosis was confirmed by means of endoscopy, palpation, and intraoperatively. The use of US is practically harmless, and can completely substitute for a roentgenologic method in detecting the given congenital pathology.     

Congenital urethrocele in children. A case report]

Congenital urethrocele is a fairly rare disease in children. The authors report the case of a 9-year-old child presenting with a penoscrotal mass. Pressure on the mass produced urine. The diagnosis of urethrocele was established by ultrasonography and cystourethrography. Urethroplasty was successfully performed.     

Caustic stenosis of the esophagus in Libreville. Results of the surgical treatment]

41 cases of caustic stenosis of the oesophagus were treated surgically by the thoracic and visceral surgical teams of La Fodation Jeanne Ebori and L'Hopital Pédiatrique d'Owendo in Libreville. The lesions were due to bleach ingestion in 38 cases, caustic soda in 2 cases and sulfuric acid in 1 case. Ingestion was an accident in 29 cases and voluntary in 12. There were 32 men and 9 women. Among them, there were 32 infants and 9 adults. The mean age was 4.5 years for the infants and 25 years for the adults. The surgical procedures were gastrostomy, followed by dilatations of the stenosis in 19 cases, esophagoplasty using the stomach, with pyloroplasty and jejunostomy in 4 cases, and gastrostomy associated with esophagoplasty using the colon in 18 cases. Mortality rate was 2.4%. It was about 1 patient, from general causes. Cervical or thoracic fistulae occurred in 4 patients, all of them successfully treated by medical means, and 3 patients had regressive pulmonary infections. The mean follow-up was 4 years, with good results. The authors suggest a surgical attitude in the management of caustic stenosis, every time the medical management is unsuccessfull.     

60 cases of stenosis of the thoracic esophagus. Surgical technic]

Thoracic esophageal stenosis most frequently is seen in reflux disease as sequelae of endobrachyesophagus. In 10% of these cases later on an adenocarcinoma will be proven. Of special therapeutic interest in this field is the relationship with the Zollinger-Ellison syndrome, with scleroderma and with juvenile acid burns of the esophagus. As operative therapy in the benign state of reflux disease we advise conservative, organ-preserving, functional surgery with peroperative dilatation, abdominal fundoplication and, if necessary, vagotomy. Long-term follow-up results are demonstrated.     

Conservative treatment of cicatricial stenosis of the esophagus]

One hundred and eight five patients with an esophageal burn were treated clinically, 53 of them showed already developed strictures. In 31 cases the narrowing could be passed by a bougie 12-14. In 28 of them the esophagus was dilated by means of a routine dilation; in 3 there was perforation of the esophagus necessitating jugular mediastinotomy in the first, transdiaphragmatic mediastinotomy in the second, and resection of the thoracic esophagus in the third, the results being favourable in all of them. In 5 cases dilation was accomplished via an esophagoscope, but in 9 gastrostomized patients a successful retrograde dilation was performed. Eight subjects having nonviable strictures were amenable to surgical therapy.     

Lymphangioma of the mesentery. A rare cause of acute abdominal pain syndrome in adults]

We report about one case of cystic lymphangioma of the jejunum in a 27-year-old woman admitted to hospital for abdominal pain. The study of this case and the review of the literature enabled us to bring out the main characteristics of the lesion: rarity in adults, benignancy, mode of occurrence--most often painful--, radiological--and particularly CT--features, diagnosis based on histological findings only, and lastly, treatment with surgical exeresis that must be complete to prevent recurrence.     

Congenital colonic atresia and stenosis.

Five more cases are added to the 88 reported cases of successfully treated newborns with congenital colonic atresia and stenosis. Because colonic atresia and stenosis are lethal conditions when untreated, early diagnosis and operative treatment are major requisites for survival. A two-stage procedure consisting of an emergency colostomy for decompression as the first stage and an elective resection with anastomosis a few months later is recommended. The need for thorough exploration of the abdomen is emphasized because atresias may be multiple or may be associated with additional gastrointestinal anomalies.     

Bouginage in chemical burns of the esophagus in children]

851 children suspected to have chemical burn of the esophagus were treated from 1996 to 2000. Use of esophageal bouginage along the guiding string has changed medical policy for esophageal burns. We completely rejected early bouginage. Late bouginage was necessary for 22% patients with II-III degree of chemical burns (3.8% of all hospitalized children). Results of the new policy depended on chemical agent. The best results were achieved after acetic acid burns. It is difficult to treat alkali burns leading to prolonged esophageal stenosis, and manganese crystal burns leading to pharynx injuries.