Abstract:
BACKGROUND/PURPOSE:Diagnosis and management of the acute abdomen in patients with spina bifida (SB) can be problematic. There are at least 4 clinical factors that can predispose to the development of acute abdominal symptoms and signs, and patients with a thoracic level lesion can have a partially insensate abdomen. The authors analyzed their accumulated experience to determine the annual incidence of acute abdominal signs and symptoms in children and young adults with spina bifida, the differential diagnosis, the operative management, and the outcome. The pertinent literature was reviewed. METHODS:Cases were ascertained during a 10-year period at 1 institution and reviewed retrospectively. RESULTS:Twenty-two episodes of acute abdominal symptoms and signs in 19 children and young adults with SB were ascertained over 10 years at 1 institution, for an annual incidence of 0.74%. More patients had a thoracic level lesion (n = 12; 60%) than in the clinic population as a whole (27%; P =.04), but the gender distribution was similar (58% girls), as was the prevalence of ventriculoperitoneal shunts (VPS; 95%). The median age was 13 years (range, 1 year to 26 years). Hospitalization was necessary for 19 (86%) of the 22 episodes. The duration of symptoms before diagnosis was a median of 3 days (range, 1 to 14 days). Most patients (82%) presented with abdominal pain. Fever was present in 27%, shock in 23%, and peritoneal signs in 23%. There were 14 different final diagnoses, 10 (71%) of which were associated with a predisposing factor. Of the 22 episodes, 18 (82%) could be attributed to an underlying factor: (1) neurogenic bladder (9; 41%); (2) neurogenic bowel (3; 14%); (3) VPS (4; 18%); (4) complications from previous surgery (2; 9%). Thirteen patients (59%) underwent a total of 20 surgical procedures of 12 different kinds. Despite awareness of the complexities involved, 3 patients (14%) died: 1 from complications resulting from bladder perforation; 1 from urosepsis and shock; and 1 from peritonitis caused by VPS infection. CONCLUSION:The differential diagnosis of the acute abdomen in patients with SB is broad, conditions requiring surgery are frequently diagnosed, and the mortality rate is substantial, despite aggressive management.
journal_name
J Pediatr Surgjournal_title
Journal of pediatric surgeryauthors
Worley G,Wiener JS,George TM,Fuchs HE,Mackey JF,Fitch RD,Oldham KTdoi
10.1053/jpsu.2001.26375subject
Has Abstractpub_date
2001-09-01 00:00:00pages
1381-6issue
9eissn
0022-3468issn
1531-5037pii
S0022-3468(01)88273-7journal_volume
36pub_type
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:1991-03-01 00:00:00
abstract:BACKGROUND/PURPOSE:The authors have shown previously that surgical specimens from infants with acute necrotizing enterocolitis (NEC) show upregulation of inducible nitric oxide (NO) synthase (iNOS) and interferon-gamma mRNA. However, the contribution of other inflammatory cytokines such as interleukin-8 (IL-8), IL-11, ...
journal_title:Journal of pediatric surgery
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更新日期:2001-08-01 00:00:00
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更新日期:2019-01-01 00:00:00
abstract::Penile agenesis is a rare condition requiring gender reassignment and staged perineal reconstruction. This report describes two children reconstructed by taking advantage of the posterior sagittal approach. This approach allows a precise anatomic dissection, construction of a neovagina and accurate positioning of all ...
journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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更新日期:2011-11-01 00:00:00
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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abstract::Thirty-six patients with benign neonatal sacrococcygeal teratoma (SCT) were treated in our medical center from 1972 to 1990. Mean gestational age was 38.6 +/- 3.3 weeks with a mean birth weight of 3,484.0 +/- 938.5 g. Twenty-nine patients (89%) were females. The majority of the tumors (75%) contained cystic components...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:1993-09-01 00:00:00
abstract:PURPOSE:Adaptive growth of the intestinal mucosa in response to massive gut loss is fundamental for autonomy from parenteral nutrition. Although angiogenesis is essential for cellular proliferation in other tissues, its relevance to intestinal adaptation is unknown. We tested the hypothesis that resection-induced adapt...
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pub_type: 杂志文章
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更新日期:2009-06-01 00:00:00
abstract::A rare disease that can mimic acute appendicitis is infarction of accessory spleen. It may occur in children and is difficult to diagnose preoperatively. Greater awareness of this entity may show not only that it is associated with other intraabdominal anomalies but also that it is more common in the tropics than else...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:1978-04-01 00:00:00
abstract::Nine infants underwent operations for perforation of a Meckel's diverticulum over a 21-yr period. All of the infants were acutely ill when initially seen by the surgical service. Lethargy, irritability, anorexia, fever, abdominal tenderness, and passage of blood in the stools were common clinical manifestations. The p...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/0022-3468(75)90277-8
更新日期:1975-04-01 00:00:00
abstract::We present a case of intestinal obstruction owing to a gallstone ileus in a patient 20 years after a Kasai procedure for biliary atresia in which a stapled antireflux valve was constructed to treat recurrent cholangitis. The etiology of this rare presentation is discussed. ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2006.09.027
更新日期:2007-01-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:2016-06-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 临床试验,杂志文章
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更新日期:2002-10-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:2001-01-01 00:00:00
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更新日期:2012-06-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:1992-09-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:1987-03-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:2008-07-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1053/jpsu.2002.30828
更新日期:2002-03-01 00:00:00
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journal_title:Journal of pediatric surgery
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更新日期:1983-12-01 00:00:00
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journal_title:Journal of pediatric surgery
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更新日期:1999-08-01 00:00:00
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journal_title:Journal of pediatric surgery
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更新日期:1983-06-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:2009-11-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
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更新日期:2006-11-01 00:00:00