CAFRITZ AND GREENBERG Annals of Surgery

regurgitated. A Miller-Abbott tube was passed into the duodenum on the 5th postoperative
day, but could not be advanced beyond this point. Oral feedings were again not retained.
Nothing was passed per rectum. The patient lost weight and her clinical course moved
steadily downhill.
On the ioth day of life a second laparotonlj was performed under open drop ether
anesthesia. At this time a catheter was passed rectally and it extended through the
anastomosis and into the ileum. The ileal dilatation was observed to have decreased in
size at this time. In handling the bowel a rent was accidentally made in the colon, and
fecal material escaped into the peritoneal cavity.
CONGENITAL MICROCOLON AND
PORTION OF ILEUM WITH YOLK SAC
The postoperative course was stormy; there were frequent emeses; and repeated
episodes of dyspnea and cyanosis supervened. The patient expired on her i8th day of life.
Autopsy Findings. The body is that of a poorly nourished and poorly developed white
female infant. The skin and sclerae are moderately jaundiced. Right rectus incision
8-9 cm. in length near the midline and a second, smaller incision to the left of the umbilicus
containing a "cigarette" drain, which exude a slight quantity of purulent material.
Heart weighs 30 Gm. (normal I9 Gm.) but valvular and myocardial measurements
are normal. Lungs are grossly normal except for a few atalectatic patches. Brain shows
engorgement of blood vessels, but otherwise normal.

CONGENITAL MICROCOLON

The small intestine is greatly distended with air and fecal material, and is covered
with a patchy, yellowish exudate. The loops are tightly adherent, and multiple adhesions
to the abdominal wall and abdominal organs are present. The wall of the third part of
the duodenum appears gangrenous (probably caused by the mercury bulb of the Miller-
Abbott tube), and its external surface is covered with thick, yellowish exudate. The
ileocolostomy appears secure and functional. The underdeveloped terminal ileum measures
i6 cm. to its cecal attachment, but is only 0.5 cm. in width. The lumen is patent.
The ascending and transverse colon appear normal in length, but measure only o.6 cm. in
width. The descending and sigmoid colon measure I.2 cm. in width. A normal appearing
rectum admits a finger easily. The mucosa of the entire intestinal tract is dark red.
The liver is enlarged and weighs 222 Gm. (normal I23 Gm.). Surface and cut
sections appear icteric. Histologically, hepatic lobules are compressed and individual
cells show atrophic changes.
Left adrenal is twice the size of the right, and has convex and bulging surfaces. Cut
sections reveal a pale, necrotic, cheesy material distending the medulla and compressing
the cortex.
The right kidney weighs I8.3 Gm. (normal I5 Gm.), and the left I9.5 Gm. The cut
surfaces show diffuse congestion, but cortical and medullary boundaries are readily
distinguishable. Histologically, the tubular epithelium displays marked degenerative
changes.
Cultures of brain and heart blood exhibit bacterial contamination. E. coli hemolytica
grown from peritoneal fluid.
Pathologic Diagnosis: Peritonitis, ileocolostomy, hypoplasia and stenosis of terminal
ileum, stenosis of entire colon, passive congestion of liver, cerebral congestion, jaundice.