Browsing by Author "Alexander, A"

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    Iatrogenic pneumatosis intestinalis and pneumatosis hepatis
    (2007) Bickler. W S; Alexander, A; Pitcher, R D; Wieselthaler, N; Rode, H
    A term male fetus with meconium-stained liquor was delivered at a peripheral hospital. He developed abdominal distension and bile-stained vomiting shortly after birth. Meconium ingestion was suspected. Gastric lavage was attempted using inappropriately high volumes and concentrations of sodium bicarbonate in this newborn with undiagnosed jejunal atresia. Subsequent abdominal radiographs documented the presence of the jejunal atresia and pneumatosis intestinalis (PI), together with air in both the porta hepatis and liver parenchyma (Figs 1 - 3). The latter features were interpreted as representing necrotising enterocolitis. The child was transferred to Red Cross Children’s Hospital, Cape Town, for corrective surgery.
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    The risks of gastrointestinal injury due to ingested magnetic beads
    (2014) Cox, S; Brown, R; Millar, A; Numanoglu, A; Alexander, A; Theron, A
    Accidental ingestion of foreign bodies is a common problem in children. Magnetic bead toys are hazardous, having potentially lethal consequences if ingested. These magnets conglomerate in different segments of bowel, causing pressure necrosis, perforation and/or fistula formation anywhere along the gastrointestinal tract. A clinical diagnostic pitfall is that the appearance on the initial abdominal radiograph may be misinterpreted by the uninitiated as a single metallic object without any intervening intestinal wall. Symptoms do not occur until complications have developed, and even then, unless magnet ingestion is suspected, treatment may initially be mistakenly expectant, as with any other foreign body. After observing a case of multiple magnet ingestion that led to the rapid onset of small-bowel inter-loop fistulas and peritonitis, we attempted to reproduce the likely sequence of events in a laboratory setting using fresh, post-mortem porcine bowel as an animal model and placing magnetic toy beads within the bowel lumen. Pressure-induced perforation appeared extremely rapidly, replicating the operative findings in two of our cases. We propose that if magnet ingestion is suspected, early endoscopic or surgical retrieval is mandatory. Appropriate, rapid surgical intervention is indicated. Laparoscopy offers a minimally invasive therapeutic option.