Andrew L. Wong, MD

September 14, 2005

Also known as congenital aganglionic megacolon, this condition is characterized by a congenital absence of ganglion cells in the submucosal (Meissner) plexus and the myenteric (Auerbach) plexus in one or more segments of the colon. This is attributable to a failure of migration of nerve cell elements from the neural crest in a cephalocaudal direction along the GI tract. The absence of parasympathetic innervation causes failure of relaxation of the internal anal sphincter. An aganglionic colon does not permit normal peristalsis to occur and thus results in a functional obstruction.

September 14, 2005

An infant born to a 25-year-old gravida 2 para 1 mother by cesarean section at 36 weeks' gestation had loops of small intestine protruding from the abdominal cavity.

September 14, 2005

The parents of a 3-month-old infant sought medical advice because of a mass in the child's umbilical area. The mass increased in size when the infant cried, coughed, or strained and was reducible inside the abdomen by external pressure.

September 14, 2005

A 6-year-old boy presented with a mass on the left side of the scrotum. The mass did not vary in size and was asymptomatic; it transilluminated brightly. Physical examination showed it to be 4 × 2 cm. The spermatic cord could be felt above the mass. The left testis was impalpable separately.

September 14, 2005

The mother of a 2-year-old boy was concerned because his scrotum appeared flat and empty. (She had noticed this earlier but thought it was normal for her child's age.) On examination, the testicles were not palpable in the scrotum. They were found in the inguinal area and could not be manipulated into the scrotum. Bilateral orchidopexy was performed, and the postoperative course was uneventful.

September 14, 2005

The extent of mucosal or transmural intestinal necrosis varies. Pneumatosis progresses from the submucosa through the muscular layer to the subserosa. The distal ileum and proximal colon are most frequently involved.

September 14, 2005

Inspissated, sticky, immobile meconium causes this transient form of distal colonic or rectal obstruction in newborns. The incidence has been estimated at 1 in 500 to 1000 live births. The condition is thought to result from dehydration of the meconium.

September 14, 2005

A mass on the left side of the scrotum was the presenting complaint of a 7-year-old boy. The mass increased in size when the child cried, strained or coughed. Physical examination showed a left scrotal mass that was reducible with manipulation when the child was lying down. The left spermatic cord was found to be thickened-the "silk" sign.

September 14, 2005

This obstruction results from hypertrophy of the circular and longitudinal muscularis of the pylorus and the distal antrum of the stomach. It occurs in approximately 3 of every 1000 live births and is 4 times more common in boys. Pyloric stenosis (PS) is relatively uncommon in African American and Asian infants. The observation that it occurs primarily in first-born infants has been disputed.

September 14, 2005

A mass covered by a translucent membrane was found in the umbilical area of an infant born by cesarean section at 38 weeks' gestation to a 26-year-old gravida 3 para 2 mother.