Arch Surg Chicago
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This report analyzes the course of 146 pediatric patients with colostomies in reference to problems with colostomy formation, management, and subsequent closure. Colostomy was performed predominantly for Hirschsprung's disease (70 cases) and imperforate anus (46 cases). A transverse colostomy was done in 120 patients (82%), and a sigmoid colostomy in the remaining patients. ⋯ Major complications occurred in 16 cases (15%). There were no deaths related to colostomy closure. The use of a sigmoid colostomy when possible and close attention to technical details, principles of stomal care, and proper parental instruction should minimize morbidity.
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The accuracy of peritoneal lavage in patients with gunshot wounds has not been previously reported. A prospective study comprised of 168 patients was designed to determine the reliability of physical examination and peritoneal lavage. Patients sustaining gunshot wounds to the lower chest and abdomen underwent clinical assessment followed up by lavage prior to operation. ⋯ Six of 15 patients with false-negative lavage results had RBC counts less than 1,000/cu mm. Gunshot wounds differ from stab wounds because of the unpredictable trajectory, blast effect, and high likelihood of visceral injury. It can be concluded from this study that because of the inconsistent results of both lavage and physical examination, patients who sustain gunshot wounds are best treated by exploratory celiotomy.