A case of acute appendicitis occurring in a 10- month-old infant is reported. The difficulties of an early preoperative diagnosis are highlighted. Perforation has usually occurred on presentation. However, prognosis may not necessarily be poor if active measures are instituted soon after perforation. The importance of active and aggressive preoperative resuscitation with fluids and electrolyte and intravenous antibiotics is stressed.
The results of a 10-year study of intussusception seen in the General Hospital Kuala Lumpur is presented. Incidence among Indians was found to be the lowest in comparison to the other two major racial groups. In 63.5 percent of infants there was no pain. A large number of patients presented with diarrhoea (21.8 percent), constipation (31 percent) and abdominal distension. (43.7 percent). Overall mortality rate was high (14.4 percent). This could be attributed to late presentation (only 30.8 percent) of cases were seen within 24 hours of onset of symptoms) which also accounted for a higher resection rate. A high incidence of lead points (28.7 percent) was also seen. The usefulness of barium enema reduction in this country is discussed. Mainstay of management in the majority of cases is operation with adequate pre and postoperative care.
Over a 21-month period, 108 of 45,770 neonates born in the Maternity Hospital, Kuala Lumpur, developed necrotising enterocolitis (NEC). The incidence of NEC was 2.4 per 1000 livebirths or 2.7 per 100 special care nursery (SCN) admissions in this Hospital. There was no significant difference in the incidence between the sexes or among the different races. NEC was most common (9.4%) in the very low birthweight (VLBW: neonates weighing less than 1500 grams) and the preterms of less than 34 week gestation (8.4%). 54.6% of the patients developed the condition during the first week of life. NEC occurred throughout the year in our nursery with clustering of cases intermittently. The case fatality ratio of the condition was 28.7%. NEC accounted for 5.7% of our Hospital's neonatal (less than 28 days of life) and postneonatal (greater than or equal to 28 days of life) deaths. There was no significant difference in the rates of occurrence of placental praevia, prolonged rupture of amniotic membranes, maternal pregnancy-induced hypertension, birth asphyxia, apnoea, respiratory distress, patent ductus arteriosus and exchange blood transfusion in neonates with NEC and those in the control group. Our findings on Malaysian neonates were comparable with those reported in the literature on neonates in developed countries.
The diagnosis of mullerian duct or utricular cyst should be considered in a child with urinary difficulties and a palpable midline, anterior rectal mass. Endoscopic cannulation of the cyst has been found to be the most useful diagnostic test. Infection should be treated with the appropriate antibiotics before definitive treatment. Surgical excision offers the best result. The transperitoneal and posterior parasacral approaches have been described but we favour the transvesical, transtrigonal approach which we find highly satisfactory. The risk of malignancy at a later age is an added indication for surgery.
Obturator hernia is a rare clinical entity usually presenting with strangulation. Preoperative diagnosis is seldom made and this has contributed to a high. mortality. One should suspect a strangulated obturator hernia in an elderly thin female patient presenting with vague abdominal symptoms or intestinal obstruction associated with a positive Howship-Romberg sign. Urgent laparotomy is indicated to establish the diagnosis and for resection of bowel if indicated.