CONGENITAL OBSTRUCTION OF INTESTINE hBnrr 767 MmWICAI Jouiu-x. strongly advocated (Rickham, 1952). Most paediatricians will agree that certain congenital abnormalities such as oesophageal atresias and genito-urinary malformations require the specialized surgical techniques available only at regional contres. Abdominal malformations of the alimentary tract, particularly obstructions of the small intestine, are probably the most urgent of the remedial congenital malformations. Early diagnosis and immediate pre-operative treatment are required. Available statistics suggest that after 96 hours the operative mortality even in the most capable hands is practically 100%. The delay and disturbance necessarily involved in transferring such cases from outlying hospitals to regional centres is unjustified. Rickham (1952) points out that a surgeon working in one hospital group is unlikely to see more than one or two such cases a year, and therefore unlikely to gather enough experience to deal correctly with the complicated surgical problems. On the other hand, the general surgeon, owing to the development of other surgical specialties, is a specialist in abdominal surgery, and neonata,l abdominal surgery should rightly remain within his province.
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