Gastrointestinal Problems In Children Research Articles

Laparoscopic Full‐Thickness Intestinal Biopsies in Children

ABSTRACTBackgroundLaparoscopy may reduce postoperative pain and hospital stay, compared with laparotomy. The use of laparoscopic surgery to obtain full‐thickness intestinal biopsies in children has not been previously reported.MethodsEleven children aged 1.6 to 19 years (median, 4.5 years) underwent laparoscopic full‐thickness biopsy of the stomach, small bowel, colon, or a combination thereof. Each procedure used one 12‐mm and two 5‐mm ports.ResultsEight children with obstructive symptoms after a pull‐through for Hirschsprung disease underwent multiple colon and small bowel biopsies (range, 3–6; median, 5); intestinal neuronal dysplasia was found in two. Two patients with cystic fibrosis had diffuse colonic narrowing; a diagnosis of enzyme‐induced fibrosing colonopathy was made in one and nonspecific inflammation was found in the other. One child had a thickened stomach, and a gastroscopic‐directed full‐thickness biopsy revealed plasmacytoma. Nine of the 11 patients had a previous laparotomy, and ports were placed through preexisting scars. Median hospital stay was 2 days. No patient required more than 24 hours of narcotics. There were no leaks, and no other morbidity or mortality occurred. None of the patients required conversion to an open procedure. Biopsy results significantly affected treatment for each patient.ConclusionsLaparoscopic full‐thickness intestinal biopsy is safe and effective for a variety of gastrointestinal problems in children. This technique is associated with a short hospital stay, minimal pain, and a very low risk of complications and can be performed even in patients who have had a previous laparotomy.

A Review of Bowel and Bladder Control Development in Children: How Gastrointestinal and Urologic Conditions Relate to Problems in Toilet Training

Urologic and gastrointestinal problems in children are of great concern to parents. In most cases, such problems represent no organic disease or serious behavior disorder but nevertheless can cause more serious complications in toilet training than parents recognize. Although bowel and bladder symptoms in otherwise healthy children typically are transient, untreated issues can spiral into physical, behavioral, and developmental problems that disrupt toilet training and maintenance of bowel and/or bladder continence. Chronic wetting and soiling may persist well into the school years and often are refractory to empirical medical treatment. Clinical experience, however, suggests that in most children these problems can be managed successfully within the realm of general pediatric practice. Two important tools for evaluation are available to the pediatrician: good normative data on bowel and bladder function in children, and management algorithms for toilet training that emphasize pathophysiologic patterns within the context of normal development. Interventions emphasize early anticipation, breaking predictable behavioral and dietary cycles that can turn acute problems into chronic problems. This is especially important during the toilet training years. Almost all children have wetting and/or soiling accidents at one time or another. As with other models of developmental milestones, transient regressions or delays in toilet training logically can be expected. Bowel maturation typically precedes bladder maturation, which is not surprising, given the respective complexities of the developmental processes.1 An estimated 15% to 20% of children will become partially toilet trained but continue to have wetting accidents after age 5.2,,3 Additionally, at least 20% of developmentally normal children 18 to 30 months of age may refuse stool toilet training at some point.4 ### Encopresis Children with encopresis (chronic fecal soiling at age 4 and older) typically soil during the day and are unaware of and unable to control their soiling accidents.5 Soiling …

GASTROINTESTINAL PROBLEMS IN THE INFANT

A great deal of information is packed into the 811 pages of this excellent book. It is liberally illustrated with 193 photographs and includes numerous, individual prototype clinical presentations, tables, and an extensive bibliography. The implication from the word infant in the title, suggests a predefined age-group limit on the subject matter. However, Dr Gryboski, Clinical Professor of Pediatrics and Chief of Pediatric Gastroenterology at Yale University Medical School, has instead produced a book with wider applicability to pediatric gastroenterology. It may readily be utilized as an initial source for researching gastrointestinal problems in children of all ages, with the full confidence that there will be an adequate bibliography to begin a search on most subjects. Many of the illustrations and case reports of various diseases throughout the book are of older children. A serious criticism may alternatively be made with respect to this anachronism, ie, that the title implies

Gastrointestinal Problems In The Infant

A great deal of information is packed into the 811 pages of this excellent book. It is liberally illustrated with 193 photographs and includes numerous, individual prototype clinical presentations, tables, and an extensive bibliography. The implication from the word infant in the title, suggests a predefined age-group limit on the subject matter. However, Dr Gryboski, Clinical Professor of Pediatrics and Chief of Pediatric Gastroenterology at Yale University Medical School, has instead produced a book with wider applicability to pediatric gastroenterology. It may readily be utilized as an initial source for researching gastrointestinal problems in children of all ages, with the full confidence that there will be an adequate bibliography to begin a search on most subjects. Many of the illustrations and case reports of various diseases throughout the book are of older children. A serious criticism may alternatively be made with respect to this anachronism, ie, that the title implies