This report describes two newborns with persistent bile-stained vomiting. Their radiological investigations revealed the existence of situs inversus and duodenal obstruction. In one, the duodenal obstruction was partial, secondary to a duodenal diaphragm with a central aperture, whereas the other child had complete duodenal atresia as well as Fallot's tetralogy. Such an association is extremely rare, with only 18 cases reported so far in the literature. Embryological aspects, investigations, and treatment are also discussed.

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A Jacobz, A Nawaz, H Matta, A Al Salem, Intussusception Secondary to Isolated Heterotopic Pancreas of the Ileum: Case Report and Review of the Literature. 2002; 22(3-4): [213][214][215] Intussusception in the pediatric age group is usually idiopathic in origin, and in a small number of patients ranging from 2% to 12%, a pathological lesion as a leading point is identifiable. [1][2][3][4] Of the variety of pathologcial lesions identified as leading points for intussusception, Meckel's diverticulum is the most common, and very rarely, isolated heterotopic pancreas of the ileum.5 This is a case report of intussusception in an infant caused by an isolated heterotopic pancreas of the ileum. The literature on the subject is also reviewed. Case ReportAn 11-month-old male infant was admitted to the hospital because of abdominal pain, fever and vomiting of two hours' duration. The infant had had diarrhea the day prior to admission, and while in hospital, he had passed one bloody stool. Clinically, he was mildly dehydrated, and no masses could be felt on abdominal examination. The possibility of intussuscpetion was raised, and this was confirmed by an abdominal ultrasound. A contrast enema revealed intussusception as far as the splenic flexure, and was partially reduced under fluroscopic control.The patient had a laparotomy through a transverse, muscle-splitting incision in the right iliac fossa. The intussusception was reduced manually, and while examining the small intestine, a small polyp was found in the distal ileum. This was excised via a small enterotomy, which was closed transversely. Postoperatively, the patient did well and was discharged home on the sixth postoperative day. Histology of the resected polyp (Figures 1 and 2) revealed a 1 cm polypoid tissue covered with a flat, severely inflamed and ulcerated intestinal mucosa. In the underlying stroma were abundant glandular ductal structures resembling those in the pancreas and surrounded by slightly irregular thin-walled blood vessels. Among the glandular structures were streaks of smooth muscle tissue as well as lymphatic hyperplasia at the margins.

Four children on chemotherapy for acute lymphoblastic leukemia presented with severe diarrhea and dehydration. Cryptosporidium was identified in the stools using modified Ziehl-Neelsen stain. Two of them received paromomycin and responded well. One was started on paromomycin for 10 days and although there was clinical improvement, his stools examination continued to be positive for Cryptosporidium. He then received azithromycin for 10 days. He responded well and his stools became negative for Cryptosporidium. The fourth patient received azithromycin from the start and responded well. Cryptosporidium should be considered in all immunocompromised children with severe or prolonged diarrhea, and since it is not seen in a routine ova and parasite examination, the laboratory should be notified for diagnostic confirmation using modified Ziehl-Neelsen stain. Immunocompromised children with Cryptosporidium diarrhea may benefit from paromomycin or azithromycin therapy.

BackgroundCongenital duodenal obstruction (CDO) is a common and usually easy to diagnose cause of intestinal obstruction in the newborn, except when the cause of the obstruction is a duodenal diaphragm. We describe our experience with eight children who had intrinsic duodenal obstruction secondary to a duodenal diaphragm.MethodsThe medical records of 22 children with the diagnosis of congenital intrinsic duodenal obstruction were reviewed for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment and outcome. Operative findings and procedures were obtained from the operative notes.ResultsEight of the 22 children (36.4%) had congenital duodenal diaphragm (CDD). In all children, the diagnosis was made from plain abdominal X-ray, which showed the classic double-bubble appearance, and barium meal, which showed duodenal obstruction. Four patients had associated anomalies, including two with Down’s syndrome. Intraoperatively, five patients were found to have duodenal diaphragm with a central hole, while the other three had complete duodenal diaphragms. Postoperatively, all patients did well. Six required total parenteral nutrition.ConclusionsThe 100% survival rate among these children is comparable to that in Western countries, and can be attributed to the lack of major associated abnormalities, good perioperative management, and the availability of total parenteral nutrition.