Mucosal colonic tube fistula with antireflux wrap for antegrade colonic enema

Antegrade enemas can provide children with excellent faecal continence in situations where adequate control has been compromised because of underlying congential anomaly or poor surgical outcome in their treatment. The enema is often delivered through an appendicostomy. If the appendix is absent or utilized for another purpose, then placement of a chait tube or caecostomy button can provide access to the colon for the enema. However, these devices may be associated with breakages, accidental removal and leakage and replacement may require another operative procedure under a general anaesthetic. Full thickness colonic tubes can also be constructed at any point along the colon but in the author’s experience, they can be associated with significant leakage of both gas and faecal material. The construction of a mucosal colonic tube with anti-reflux wrap is a technique that avoids the above problems and offers a distinctive advantage in selected situations. The technique relies on tabularising mucosa alone to create a continent fistula. Six children with severe soiling underwent the technique. The outcomes were evaluated using a modified quality of life score (QOLI) [1, 2]. The score included assessment of soiling, staining, odour, self-esteem and socialization measure. Technical evaluation included analysis of the ease of catheterization and continence of the mucosal fistula site. All six patients had dramatic improvement in their faecal continence with complete resolution of soiling in all six. Follow up median is 42 months and the range is 6–48 months. QOLI scores improved from a total of 4.75 to 18.5. Possible range is 0–21. All the six fistula sites catheterize easily and no stenosis or faecal leakage has occurred. Two patients required treatment of minor granulations at the entry site of the fistula during the early healing phase.     

中药保留灌肠联合吡喹酮治疗血吸虫性结肠病

采用中药保留灌肠联合吡喹酮治疗血吸虫性结肠病并观察其临床疗效，结果显示，经过1～2个疗程治疗后总有效率可达95％。     

儿童肠套叠空气灌肠整复成功与否的相关因素探讨

目的探讨影响儿童肠套叠空气灌肠的整复成功率的相关因素。方法回顾分析2004年1月至2007年6月中236例儿童肠套叠空气灌肠整复率和其中32例灌肠复位失败的情况。所有病例对整复率与病程的长短、套叠部位的关系进行了分析。结果整复率与病程的长短（〈12h为95.2%,12-24h为87.1%,24-72h为53.3%）、套叠部位远近（肝曲近侧为92.59%,横结肠的整复率为85.20%,降结肠到乙状结肠为80.20%）密切相关;整复率随病程延长而递减;套叠部位愈远,整复率愈低。结论影响空气灌肠整复成功与否有多种因素,两种以上因素组合较单一因素更能预示灌肠复位的难易。     

先天性巨结肠新生儿期手术病例的影像学表现

目的:研究新生儿期HD手术病例的重要x线征象的特点.方法:回顾性分析5年共20例患者的腹部平片和钡灌肠资料,对其影像学征象进行观察、分析.结果:(1)病理类型构成中,长节段类型比例高,略占25%.(2)新生儿HD表现为肠动力性改变、结肠梗阻和低位小肠梗阻,以肠动力改变和结肠梗阻更多见(共15例).肠穿孔发生率高,本组2例.(3)除开2例胎儿型结肠,其余13例钡灌肠中,多数病例出现典型的狭窄段(12例)、移行段(13例)和扩张段(12例),重要征象有直肠痉挛切迹(12例)、扩张段的高张力征(10例)和痉挛收缩征(12例)、24h钡残留(13例)和钡便混合征(10例).结论:新生儿期HD的临床表现、构成类型和影像学表现具有不同于其他时期的特点,各种影像征象主要集中在狭窄段和扩张段,对扩张段的功能变化规律有必要进行系统研究.     

一种新的清洁灌肠卧位及应用

目的：探讨一种新的清洁灌肠卧位。方法：选择100例需要清洁灌肠的妇科手术病人随机分成传统卧位和改良卧位两组，进行肠道清洁情况、灌肠次数、总灌肠量，术后血便的比较。结果：两种卧位效果存在显著性差异（P〈0．01），改良卧位明显优于传统卧位。结论：改良卧位灌肠次数少，灌肠效果好，副作用少，值得临床推广。     

中药保留灌肠对重度黄疸肝炎的退黄作用观察

[目的]观察中药保留灌肠对重度黄疸肝炎的退黄作用。[方法]高胆红素血症的慢性病毒性肝炎患者87例，随机分为2组，治疗组予中药保留灌肠及常规护肝降酶退黄中西医治疗。对照组予常规护肝降酶退黄中西医治疗。观察6周。[结果]治疗组6周后总胆红素下降幅度大于对照组P〈0.01。ALT，AST，r—GT的改善，治疗组优于对照组P〈0．01。[结论]中药灌肠治疗重度黄疸肝炎有效。     

Intussusception: recurrence following gas (oxygen) enema reduction

Over a 38-month period, prospective data were collected on all episodes of intussusception treated at the Royal Children's Hospital, Melbourne. There were 170 initial episodes for which a gas enema was performed, 127 of which were reduced successfully. Recurence occured in 10 patients following initial successful gas enema reduction, a recurrence rate of 7.9%, which compares with a recurrence rate of 8.9% with barium (P = 0.896). We conclude that the gas enema does not have a higher rate of recurrence than barium and that there is no evidence of a significant incidence of incomplete reduction unrecognised at the time of gas enema. Correspondence to: S. W. Beasley     

Enema reduction of intussusception with a small dose of iopamidol may have advantages over barium

Barium enema (B-enema) has been the standard method for hydrostatic reduction of intussusception, although recently air enema has been used due to the lower risk when perforation occurs. Recently, we have administered a small dose of iopamidol during enema reduction (I-enema) in children with intussusception. From November 1989 to December 1993, we treated 50 children with intussusception at Kiyama Hospital. Barium was used in the first half of the period, and iopamidol in the second half. Reduction was successful in 22 of 24 patients with barium (92%) and 23 of 26 with iopamidol (88%); 25 children had the ileocolic type and 25 the ileoileocolic (-cecal) type of intussusception. Operations were carried out in 3 patients from each group. I-enema avoids some of the drawbacks of barium and air enemas. It is a new method of enema reduction, as a contrast medium is injected first. It is possible to obtain a good image of the advanced portion with a small dose of contrast medium, which is important for treatment. For institutions performing B-enemas, I-enemas can be performed easily with the same equipment and technique. It causes less contamination upon leakage than a B-enema, and also has less influence on the intestinal membrane with very few risks if perforation occurs. Better images are obtained than with air. A large dose of contrast medium is not needed, thereby reducing medical expenses to a minimum. Iopamidol can be used safely for enema reduction of intussusception with an expected high success rate.     

The diagnostically difficult intussusception: its characteristics and consequences

In the absence of classical symptomatology, the diagnosis of intussusception may be difficult to make. A retrospective review of 630 episodes of intussusception admitted to the Royal Children's Hospital, Melbourne, over a 15-year period revealed difficulties in diagnosis in 318 cases. The adverse effect of an incorrect initial diagnosis on duration of symptoms at the commencement of treatment, need for surgery, resection rate, complications, and hospital stay is examined. Problems in the assessment of children with intussuception are identified and discussed in the hope that an increased awareness of the diagnostic difficulties and potential pitfalls will reduce the morbidity of this common paediatric condition. Offprint requests to: S. W. Beasley     

Detection of colorectal carcinoma on double contrast barium enema when double reporting is routinely performed: an audit of current practice

PURPOSE: To determine the sensitivity of double contrast barium enema (DCBE) in the detection of colorectal carcinoma (CRC) when double reporting is routinely performed. METHOD AND MATERIALS: Over a 1-year period all patients with a diagnosis of CRC within a large teaching hospital were identified. Using computer records, any patient with CRC who had had a DCBE within 5 years of diagnosis was identified. During this time period all DCBE were double reported by the radiographer or radiology trainee who performed the enema and by a consultant radiologist specializing in gastrointestinal radiology. RESULTS: Over the 1-year period 169 patients were identified with a diagnosis of CRC. Seventy patients had had a DCBE within the preceding 5 years. Sixty-four patients had had CRC diagnosed on the DCBE. One patient had a sessile polyp diagnosed, which was removed at colonoscopy and found to be an invasive adenocarcinoma. In five cases (7%) the CRC was not diagnosed on DCBE. In three cases the lesions could be seen retrospectively, in one case the lesion could not be seen and in one case the examination had been incomplete. CONCLUSION: In our series the miss-rate for CRC was 7%. Previous studies have shown miss-rates of 15-24%. These studies have not routinely employed double reporting. Our results suggest that double reporting of DCBE significantly reduces the miss-rate and that this reduction is due to fewer perceptive errors.