Functional intestinal obstruction due to deficiency of argyrophil neurones in the myenteric plexus. Familial syndrome presenting with short small bowel, malrotation, and pyloric hypertrophy

Neonatal intestinal pseudoobstruction

In the past 10 years, the diagnosis of pseudoobstruction lasting more than two months was confirmed in 10 infants after sepsis, meconium ileus, and Hirschsprung's disease were excluded, and surgery or autopsy failed to demonstrate a site of mechanical intestinal obstruction. Four infants had undergone prior operation for another anomaly: gastroschisis (2) and ileal atresia (2). Five of the remaining infants also had megacystis. The lack of coordinated intestinal motility was best appreciated by radiocontrast small bowel studies, which showed degrees of aperistalsis or segmentation. Rectal manometric studies were not helpful. Histology of the intestine was normal in seven, while a gross deficiency of nerve fibres was noted in one patient and a myopathy of smooth muscle in another. A variety of drugs used to stimulate peristalsis were ineffective. Seven patients had 25 operations, often to exclude mechanical causes of obstruction. The mainstay of treatment was TPN and intestinal decompression. Six children survived; their ages ranged between 8 months and 9 years (median age, 16 months). There has been improvement in intestinal peristalsis in five children, three of whom now tolerate a regular diet and two of whom are on TPN and are currently increasing oral intake. Four infants died, two from sepsis, two from TPN-related hepatic failure. In contrast to previous reports, we conclude that intestinal pseudoobstruction may be self-limited in some neonates, including those with megacystis. Therapy should consist of long-term nutritional support and treatment of other anomalies that may be present.

Familial congenital short small bowel with associated defects. A long-term survival

In 1974, Royer et al. described a familial syndrome consisting of a short and sluggish small bowel, malrotation of the gut, and pyloric stenosis. These authors stressed the uniformly fatal outcome of their four cases, as well as other possibly unrecognized cases previously described in the literature. The present report deals with two more familial cases, of which one represents a long-term survivor of the syndrome. The intensive work of maintaining nutrition, controlling infection, and managing the complications of associated defects are described.

Functional intestinal obstruction associated with malrotation and short small-bowel

Two siblings are presented in whom a recognized syndrome of functional small-bowel obstruction with malrotation and short small-bowel was diagnosed. The previously described association with pyloric stenosis was not present in our cases. They do, however, support the view that this syndrome has an autosomal recessive model of inheritance. A deficiency of argyrophil neurones in the myenteric plexus has been noted in this syndrome but more precise neurohistochemical studies are required to define the exact deficit involved.

Cytomegalovirus infection of the bowel in infancy: pathogenetic and diagnostic significance

Three infants had cytomegalovirus (CMV) infection of the bowel. Infected enteric ganglion cells were found in two, one of whom had hypoganglionosis and colonic dysmotility. The third infant had classic short segment Hirschsprung's disease and colitis with CMV inclusions in vascular endothelium, a situation wherein viral transformed cells may have led to misinterpretation of the diagnostic biopsy.

Infantile hypertrophic pyloric stenosis: a review

Infantile hypertrophic pyloric stenosis is a relatively common condition and there is some recent evidence that the incidence is increasing in this country. Gastric outlet obstruction is caused by hypertrophy of the pyloric smooth muscle and the clinical presentation is with non-bilious vomiting starting at the age of 3-4 weeks. The diagnosis can usually be made by palpation of the hypertrophied pylorus. Operation has now superseded medical treatment as the treatment of choice but meticulous assessment and correction of fluid and electrolyte imbalance is essential preoperatively. The operation of pyloromyotomy as described by Ramstedt in 1912 is simple and effective, but attention to detail is necessary if minimal morbidity and zero mortality are to be achieved. Untreated, the mortality is high but, after successful treatment, these babies are healthy and normal, so that treatment is both worth while and gratifying. The aetiology is obscure; a polygenic pattern of inheritance has been shown to be a predisposing factor, but the postnatal precipitating factors are less defined. Early hopes that the hormone gastrin might prove to be the key have not been sustained by more recent research, but the role of other gastrointestinal hormones awaits clarification.

Paralysis of the small bowel resembling mechanical intestinal obstruction

In some instances, particularly in the neonate, paralytic ileus affects predominantly the small bowel, thus resembling intestinal obstruction. Localized paralysis of the small bowel occurs secondary to regional events in a segment of gut and resembles mechanical obstruction even more closely. In localized paralysis the bowel lumen is usually dilated without abrupt distal transition to collapsed intestines. If there is radiographic and clinical recognition of localized, transitory bowel paralysis, surgery is usually unnecessary.

Organic constipation in adults

Four cases of non-Hirschsprung megacolon in adults are presented. The histology of the myenteric plexus suggests that this may be an anomaly of development.