Colorectal carcinoma

Two rare cases of colorectal adenocarcinoma seen during the last 3 years in children under 10 years of age are reported. To improve survival, emphasis is given on its early diagnosis by a thorough examination and investigation of the child in every case of prolonged bleeding per rectum, diarrhoea and other non specific abdominal symptoms.     

Rectal burkitt lymphoma in childhood

Lymphomas are the third most common cancer in children and Burkitt lymphoma (BL) accounts for about 40% of them. The rectum is extremely seldom involved in BL: 91 children were treated at our institution for BL between 1987 and June 2006, but none of them had involved the rectum. We report here on a 9-year-old boy who presented with bowel bleeding and subocclusion, which proved due to a BL of the rectum. The role of surgery for this tumor is limited nowadays, except for surgical emergencies, biopsies, and second-look surgery in selected cases.     

Primary signet-ring-cell carcinoma of the rectum in a 12-year-old boy

A case of primary signet-ring-cell carcinoma of the rectum is presented. Colorectal carcinoma is uncommon in childhood; moreover, the signet-ring-cell type is very rare even in adults. The clinical, pathologic, and biologic characteristics of this carcinoma are different from ordinary colorectal carcinomas. Our patient was a 12-year-old boy, the youngest with a signet-ring-cell carcinoma of the rectum in the English literature, who had a Dukes' C lesion. Pathologically, the tumor is characterized by diffuse infiltration of the bowel wall by signet-ring-cells. The prognosis is extremely poor.     

Primary malignant lymphoma of the rectum

A rare case of a primary malignant lymphoma of the rectum in a 7 year old girl is presented. Although rectal polyps in children are usually benign juvenile polyps, a rare possibility of malignancy should be kept in mind. An adequate histological examination is essential.     

Rectal Involvement in Neutropenic Enterocolitis

Neutropenic enterocolitis is a common gastrointestinal complication in children undergoing chemotherapy for a variety of malignancies. It usually involves ileum and caecum, and involvement of rectum has rarely been reported. The authors report neutropenic enterocolitis in a child undergoing chemotherapy for acute lymphoblastic lymphoma which presented with ileus along with a mass like lesion in the rectum.     

Adrenocortical carcinoma in two female children

Adrenocortical carcinoma is a rare tumor in children. This tumor is more likely to be hormonally active in children than in adults and tends to cause a variety of symptoms, which may mimic other benign endocrinopathies. These tumors are usually diagnosed at advanced stages and portend a dismal prognosis. We describe two cases of adrenocortical carcinoma. One child presented with Cushingoid symptoms secondary to hypercortisolism, including amenorrhea, hirsutism and weight gain. The other child presented with precocious puberty. Both children underwent resection of the tumors. We describe their presenting symptoms, postoperative course, adjuvant therapy and clinical course. Pertinent literature regarding the anatomy of the adrenal gland, pathology of adrenocortical carcinoma, factors influencing outcome, diagnostic modalities and treatment, are discussed. Accepted: 5 August 1999     

肛管压力的对称性变化趋势对括约肌功能状态的定量评价

目的 探寻肛管压力的对称性变化趋势的存在与否,探讨它对括约肌功能状态的定量评价。方法 采用瑞典ＣＴＤ－ＳＹＮＥＣＴＩＣＳ公司提高的高分辨多通道胃肠功能测定仪对２７例正常儿童及１２例肛门失禁患儿进选手在约肌压力及其偏位的测定,观察压力及其偏位的变化趋势。结果 静息及收缩状态下,正常儿童肛管直肠之间不仅存在明显升高的压力梯度变化,而且存在明显降低的压力偏位梯度变化,并且在距离肛门缘１ｃｍ处形成压力及其     

Rectal bleeding in children

Summary Forty-two cases of bleeding per rectum in children seen during a three-year period are reviewed. Different causes of bleeding, their symptoms, methods of diagnosis and treatment are given. With proper methods, cases can be correctly diagnosed and adequately treated. From the G. T. Hospital, Bhatia General Hospital and Grant Medical College, Bombay.     

Trichuriasis

Summary Clinical signs and symptoms in 24 children with heavy infestation byTrichuris trichura are reported. Common clinical manifestations were diarrhoea, under-nutrition, anaemia, oedema and prolapsed rectum. It is stated that in cases of chronic diarrhoeaT. trichura infection should be kept in mind in Saurashtra. This infestation was common in children below 5 years of age. From the General Hospital, Junagadh.     

Rectal involvement in necrotizing enterocolitis

Although necrotizing enterocolitis (NEC) is a common cause of neonatal intestinal disease, rectal involvement has not previously been reported. We describe five children with NEC involving the rectum. In four infants pancolorectal disease occurred; in the fifth the ascending colon was spared. A Swenson-type abdomino-perineal resection was performed in four cases. No definitive cause for the extension of the disease into the distal rectum was noted. There were no immediate postoperative complications. Long-term follow-up showed normal anorectal function and a normal-appearing perineum. Possible rectal involvement should be considered in all neonates with colonic NEC. Contrast studies visualizing the rectum are advised prior to closing colostomies performed in newborns with NEC. Ileorectal anastomosis after resection produces a satisfactory result. Offprint requests to: S. Z. Rubin     

The posterior sagittal approach: further pediatric applications

The posterior sagittal transsphincteric approach is useful for surgical management of tumors, fistulae, and sequelae of failed pull-throughs for congenital anomalies, particularly when these conditions are located too high to be approached conveniently through the perineum or too low to be approached through the abdomen. Except for anorectal malformations, there have been no previous reports of use of this approach in children. Five cases are presented to demonstrate the advantages of this approach: two patients with severe sequelae of pelvic trauma; one with a large tumor invading the rectum and vagina; one case of adrenal hyperplasia, urogenital sinus, and a high implanted vagina; and one case of a failed pull-through for the treatment of Hirschsprung's disease. All patients are continent of stool and urine. The authors suggest using this approach with a protective colostomy.     

Solitary ulcer syndrome of the rectum in children

We present two children with solitary ulcer syndrome of the rectum (SUSR): a 7-year-old and an 11-year-old. Although well recognized in the adult literature, the pediatric experience with this condition is limited. We review the clinicopathologic features of SUSR with emphasis on the pediatric experience. Greater awareness of this syndrome by both the pediatrician and pathologist may lead to more diagnosed cases in children.     

Posterior sagittal approach with perirectal dissection for reconstructive surgery of severe urogenital anomalies

There are many approaches for surgery of complicated congenital and acquired urogenital anomalies in children with intact rectum. Pena advocates the mid-sagittal division of the sphincter mechanism posterior and anterior to the rectum, along with opening of the posterior and anterior rectal walls. The aim of this study is to determine whether the posterior sagittal approach with perirectal dissection (PSAPD) and elevation of the mobilized rectum would impair fecal continence when used for correction of complicated urogenital anomalies in children with normal rectum. Between 1988 and 1994 the authors performed PSAPD in eight infants and children with an intact anorectum. Indications for PSAPD were high vaginal atresia, Mullerian duct remnants, prostatic rhabdomyosarcoma, and traumatic vesicovaginal fistula. After a mean 10-year follow-up the bowel habits were assessed. Anorectal and uromanometric studies and a detailed questionnaire (modified Holschneider’s scoring) sent to children or parents were evaluated. Three patients who preoperatively were clinically fecal continent had soiling only at the time of diarrhea. Early postoperative low anorectal pressure profile normalized during the follow-up. Seven patients had a fecal continence score above 23, two of them with maximum points of 26. Only one girl had a low score of 15. The authors conclude the PSAPD which offers a few advantages over the sagittal division of the rectum provides an alternative approach for selected lesions of the genitourinary tract in children with a normal rectum. Our results suggest that fecal continence is either preserved or partially affected.     

The value of sodium pertechnetate Tc99m scans in the diagnosis of Meckel's diverticulum

A retrospective study was conducted of our experience with sodium pertechnetate Tc99m scans for diagnosing suspected Meckel's diverticula. Seventy-seven cases scanned between 1979 and 1994 were reviewed. Eighty per cent of the group presented with bleeding per rectum, 12% with pain, and 6.5% with anaemia. Ten scans were positive with 7 true-positive and 3 false-positive. Of the 67 negative scans, 3 were false-negatives. There were six Meckel's diverticuli and four duplication cysts between the true-positive and false-negative groups. All presented with major gastrointestinal (GI) bleeding and gastric mucosa was identified on histology. The three false-positive cases had inappropriate laparotomies on the basis of scan results. The test sensitivity was 70% with a specificity of 95%, giving an overall accuracy of 92%. The Meckel's scan is a useful investigation for GI bleeding in children. Surgical intervention should be guided by the full clinical picture and the scan, rather than the scan result alone.     

Carcinoma of the thyroid in children: A 25-year experience

Over the past 25 years, 23 children with carcinoma of the thyroid have been treated at the Christie Hospital, Manchester. Twenty-one cases were well-differentiated carcinoma, and two were medullary carcinoma. They were all treated by resection, 14 with total thyroidectomy and 9 with lobectomy or subtotal thyroidectomy. Sixteen children also had surgery for nodal disease. Two children presented with lung metastases. Sixteen children received post-operative radiotherapy (4 external beam, 12¹³¹I). Median follow-up of 67 months (range 7–233), was the same for the 21 well-differentiated carcinomas and the whole group including the two medullary carcinomas. All 21 children with well-differentiated carcinomas are alive with no evidence of progressive disease. Two relapsed after total thyroidectomy, but both were salvaged, one with external beam radiotherapy, one with ¹³¹I. One child with medullary carcinoma died with progressive disease after 43 months, the other is alive, but with slowly progressive disease 145 months after diagnosis. Ten of 14 children experienced post-operative hypocalcaemia following total thyroidectomy, in 7 cases it persisted long-term. ¹³¹I and external beam radiotherapy were both well tolerated. The long-term results of treatment of well-differentiated carcinoma of the thyroid are excellent, but there remains disagreement over the extent of treatment required. Some authors believe the condition is multifocal and requires total thyroidectomy, others argue that lobectomy or subtotal thyroidectomy avoids the possible post-operative complications of total thyroidectomy and gives equal long-term cure rates. We agree with the latter view. Although a small series cannot be conclusive, we feel that our results are consistent with this. We also believe, that for children, radiotherapy can be reserved for relapse only, as long as regular follow-up is available. Med. Pediatr. Oncol. 29: 103–107, 1997. © 1997 Wiley-Liss, Inc.     

Wnt5a在肛门直肠畸形患儿末端直肠组织中的表达及意义

目的：通过检测Wnt5a在肛门直肠畸形（ARM）患者末端直肠壁的表达,探讨其与ARM之间的可能关系。方法：应用免疫组化和Western blot方法检测20例ARM患儿、7例后天性肠瘘和6例非胃肠道疾病患儿(对照组)末端直肠壁Wnt5a的表达并对比分析。结果：对照组Wnt5a表达于直肠壁内肌间神经丛、黏膜层及黏膜下层,ARM组的末端直肠壁内Wnt5a表达较对照组减少,尤其高位畸形组减少更为明显。Western blot蛋白印迹结果：ARM高位组、中位组和低位组Wnt5a蛋白表达均明显低于对照组和后天肠瘘组（P<0.01）。高位组和中位组Wnt5a蛋白表达明显低于低位组（P<0.01）。后天瘘组与对照组比较差异无统计学意义。结论：Wnt5a在ARM末端直肠的表达水平减低,可能与ARM的发生密切相关。     

Cystic duplication of the caecum mimicking intussusception.

Diagnosis of gut duplications are often only made intraoperatively as they are uncommon and do not feature strongly in the differential diagnoses. A case of caecal cystic duplication mimicking intussusception is discussed with the aim of improving diagnostic accuracy in future cases. A 7 month old boy presented with the classical triad of abdominal pain, bleeding per rectum and a palpable mass. Barium enema revealed a mass in the caecum suggestive of an intussusceptum. Repeated attempts at hydrostatic reduction were unsuccessful as the mass was immobile. Laparotomy revealed cystic duplication of the caecum without intussusception. The bleeding per rectum was due to an ulcer in the colonic epithelium overlying the cyst.     

Bleeding per rectum in pediatric population: A pictorial review

Bleeding per rectum in children can be seen in congenital as well as acquired conditions that may require medical or surgical management. The present review article is aimed to discuss the imaging findings of some common and uncommon causes of bleeding per rectum in children.     

Ectorectal seromuscular colon cuffing

A new surgical technique is presented for the treatment of Hirschsprung's disease in which the rectum is retained to give the sensation of defaecation and the pelvic dissection is minimised. A seromuscular cuff is formed by everting the distal end of the normally innervated colon. The full-thickness area of the normally innervated colon is anastomosed to the rectum using nonabsorbable sutures establishing continuity of the bowel. The seromuscular cuff, which acts as a single functional unit, is then cuffed ectorectally and its distal end is tucked around the anorectal junction with 5 to 6 silk sutures. The mass peristalsis that occurs in the colon exerts pressure on the nonfunctioning rectum and facilities effective evacuation of its contents. A protective right transverse colostomy is done simultaneously. Three weeks later the colostomy is closed, as by this time the newly formed colorectal pouch has begun functioning. Additional advantages are the absence of faecoloma and stricture formation and the fact that the technique is entirely pelvic. A total of 12 cases have been operated upon and the results after 2 years of follow-up are very encouraging.     

Benign lymphoid polyps of the rectum

Benign lymphoid polyps are a rare histologic entity and should not be confused with malignant disease of the colon and rectum. Although retention polyps are the single most common type of colonic polyp in children, the presence of multiple clustered polyps in the rectum should alert the radiologist to the possibility of benign lymphoid polyps. A representative case is described and a review of the pediatric experience with this entity is discussed.