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Papers by John Paul Sanson

Gynäkologisch-geburtshilfliche Rundschau, 1968

Journal of Pediatric Surgery, 1967

ECENTLY, WE encountered a newborn with what we thought was meeonium ileus with meconium peritonit... more ECENTLY, WE encountered a newborn with what we thought was meeonium ileus with meconium peritonitis which was unusual because both layers of the muscularis were congenitally absent in multiple large zones of the small intestine. A review of the literature failed to reveal a similar report. CASE REt'O~T A white male was born at 37 weeks of gestation after an uneventful pregnancy to a gravida IV, para III mother and on the first day of life, was noted to have a distended abdomen with prominent abdominal veins. Two other siblings died in infancy of multiple congenital anomalies but autopsy records were unobtainable. The baby was well-developed, well-nourished, conscious, irritable and in moderate distress. Birth weight was 2523 Gm. Bowel sounds were high pitched and the Madder was empty. Rectal examination revealed a patent rectum, and a rectal tube inserted 17 era. produced no meconium. Blood count revealed hemoglobin of 15.5 Gin. per cent with a normal retieulocyte count, red blood cells and hematocrit. Feedings of glucose water at 12 hours were followed by mild spitting. Milk was given on the second day and more regurgitation was observed. Abdominal distention persisted and vomiting of green, foul-smelling material began. A tap water enema with 1% hydrogen peroxide was given, with no results. Roentgenograms of the abdomen demonstrated small bowel obstruction with no gas in the colon. Electrolytes were within normal limits and CO~ content 23 mEq./L. A gastric tube was inserted and intravenous fluids were administered. At 52 hours, laparotomy showed a small intestine that looked like "one sausage attached to another" from the second portion of the duodenum to the cecum. Short lengths of normal appearing intestine followed distended intestine 13-15 em. in length and again the intestine was reduced to its normal caliber for 2-50 cm. (Fig. 1). The surgeon, unaware of the unusual pathology, attempted to resect all the distended portions of the small bowel segments without muscle and anastomose bowel of normal caliber. Five such connections were made. The baby tolerated this surgical procedure poorly. Cyanosis and shallow respirations did not respond to oxygen and he expired in the tenth post-operative hour. The surgical specimen consisted of 5 segments of small intestine (Fig. 1). The shortest measured 2 cm. in length by 1 cm. in diameter, and the longest was 50 cm. in length and 3 cm. in diameter. The serosa of all the segments was covered focally by fibrinous exudate. On opening, no area of complete obstruction was noted. The lumen contained thick, sticky, green meconium. The mueosa was congested with flattening of the folds in the dilated segment. Microscopically there was segmental absence of muscular layers (Fig, 2). The mucosa, lamina propria of the mucosa and submucosa were present and appeared normal. The outer-most portion of the submucosa was lined by mesothelial cells. The other segments contained all the layers of the intestine.

Gynäkologisch-geburtshilfliche Rundschau, 1968

Journal of Pediatric Surgery, 1967

ECENTLY, WE encountered a newborn with what we thought was meeonium ileus with meconium peritonit... more ECENTLY, WE encountered a newborn with what we thought was meeonium ileus with meconium peritonitis which was unusual because both layers of the muscularis were congenitally absent in multiple large zones of the small intestine. A review of the literature failed to reveal a similar report. CASE REt'O~T A white male was born at 37 weeks of gestation after an uneventful pregnancy to a gravida IV, para III mother and on the first day of life, was noted to have a distended abdomen with prominent abdominal veins. Two other siblings died in infancy of multiple congenital anomalies but autopsy records were unobtainable. The baby was well-developed, well-nourished, conscious, irritable and in moderate distress. Birth weight was 2523 Gm. Bowel sounds were high pitched and the Madder was empty. Rectal examination revealed a patent rectum, and a rectal tube inserted 17 era. produced no meconium. Blood count revealed hemoglobin of 15.5 Gin. per cent with a normal retieulocyte count, red blood cells and hematocrit. Feedings of glucose water at 12 hours were followed by mild spitting. Milk was given on the second day and more regurgitation was observed. Abdominal distention persisted and vomiting of green, foul-smelling material began. A tap water enema with 1% hydrogen peroxide was given, with no results. Roentgenograms of the abdomen demonstrated small bowel obstruction with no gas in the colon. Electrolytes were within normal limits and CO~ content 23 mEq./L. A gastric tube was inserted and intravenous fluids were administered. At 52 hours, laparotomy showed a small intestine that looked like "one sausage attached to another" from the second portion of the duodenum to the cecum. Short lengths of normal appearing intestine followed distended intestine 13-15 em. in length and again the intestine was reduced to its normal caliber for 2-50 cm. (Fig. 1). The surgeon, unaware of the unusual pathology, attempted to resect all the distended portions of the small bowel segments without muscle and anastomose bowel of normal caliber. Five such connections were made. The baby tolerated this surgical procedure poorly. Cyanosis and shallow respirations did not respond to oxygen and he expired in the tenth post-operative hour. The surgical specimen consisted of 5 segments of small intestine (Fig. 1). The shortest measured 2 cm. in length by 1 cm. in diameter, and the longest was 50 cm. in length and 3 cm. in diameter. The serosa of all the segments was covered focally by fibrinous exudate. On opening, no area of complete obstruction was noted. The lumen contained thick, sticky, green meconium. The mueosa was congested with flattening of the folds in the dilated segment. Microscopically there was segmental absence of muscular layers (Fig, 2). The mucosa, lamina propria of the mucosa and submucosa were present and appeared normal. The outer-most portion of the submucosa was lined by mesothelial cells. The other segments contained all the layers of the intestine.