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Mark M. Ravitch (1910-1989) was the most prolific surgeon-author of the 20th Century as well as an outstanding clinical surgeon, scholar, historian, and researcher. While today he would not be considered a "pure pediatric surgeon," he was a charter member of the American Pediatric Surgical Association and received the William E. Ladd medal from the Surgical Section of the American Academy of Pediatrics and the Denis Brown Medal from the British Association of Pediatric Surgeons. He contributed to the treatment of benign colon and rectal disease, intussusception, and chest wall deformities. His most enduring contribution was surgical stapling, a technology that he brought from Russia during the Cold War that opened the door to minimally invasive surgery., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Mark M. Ravitch is a surgeon worth acknowledging. He is credited for revolutionizing pediatric surgery as a subspecialty, mastering chest wall deformities and introducing the surgical stapler to the United States, to name a few. Above all, he was a notable leader, teacher, and author. This historical vingette is a brief snapshot of his biography and various achievements.

Background: To reduce the risk of vaccine-associated intussusception, rotavirus vaccination in Norway was implemented under strict age limits (the first dose given by 12 weeks of age and the second dose by 16 weeks of age) in 2014. We estimated the incidence of intussusception in children <2 years old before vaccine introduction and the number of vaccine-associated cases under current and extended age limits for vaccine administration in Norway., Methods: To estimate the baseline incidence, we validated all diagnoses in children <2 years old registered in the national hospital registry during the pre-vaccine period of 2008-2013. Using national vaccine coverage data and international estimates of intussusception risk after rotavirus vaccination, we calculated the numbers of expected vaccine-associated intussusception cases to compare with the estimated numbers of averted rotavirus cases. Uncertainty was accounted for by several scenario analyses using current and extended age limits for vaccine administration., Results: The pre-vaccine incidence of intussusception was 26.7 (95% CI 23.1-30.6) cases/year per 100,000 children <2 years old and 37.1 (95% CI 31.2-43.8) cases/year per 100,000 children <1 year old. In the 2016 birth cohort (approx. 60,000) vaccinated under the current age limits, 1.3 (95% CI 0.7-2.0) vaccine-associated intussusception cases were expected to occur. If age limits were extended to 16 weeks for the first vaccine dose and 24 weeks for the second dose, leading to more children vaccinated at an older age, 2.2 (95% CI 1.2-3.5) excess cases would be expected in the same cohort. Simultaneously, an estimated 1768 rotavirus hospitalizations/year in children <5 years old would be averted under current age limits, with 98 additional rotavirus hospitalizations averted under extended age limits., Conclusions: Administering rotavirus vaccines beyond current age limits in Norway would lead to a marginal increase in the number of intussusception cases, which would be offset by the benefits of vaccination., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Legend holds that treating the hundreds of children injured in the Halifax explosion of December 6, 1917, compelled Dr. William E. Ladd (1880-1967) to dedicate his career to the surgical care of infants and children. However, he had made the commitment to be a pediatric surgeon several years before when he joined the voluntary staff of the Children's Hospital of Boston in 1910. In the years before Halifax, he was among the vanguard of American surgeons who brought the mortality of intussusception to 45% from 90%, and of pyloric stenosis to 15% from 60%. Among his early innovations was the contrast enema for intussusception for diagnosis and therapy. Shortly after the explosion, Dr. Ladd led a medical relief effort of 100 doctors, nurses, and orderlies from Boston. With supplies enough for a 500-bed hospital, they battled through a blizzard, downed telegraph lines, and blocked railways to reach the strickened city on December 9. The enormity of the Halifax tragedy and the dedication of Dr. Ladd and his team led to the creation myth of the birth of pediatric surgery. The record was set straight by Dr. Ladd himself in a handwritten letter to a pediatric surgeon who had asked about when he dedicated himself to the field. "The Children's was [my] very first and most permanent love," Ladd wrote. "As soon as it became feasible after the first World War, I devoted myself exclusively to pediatric surgery and have never regretted it.", (Copyright © 2017 Elsevier Inc. All rights reserved.)

Because of its vivid manifestations of blood-stained mucus passed per rectum, the violent abdominal colic, the easily palpable abdominal mass and, in late cases, a prolapsing 'tumour' to be seen extruding through the anal verge, it is not suprising that intussusception in infants was one of the earliest causes of intestinal obstruction to be clearly recognised. Treatment was conservative. Efforts were made to reduce the mass with rectal bougies or enemas. Surgeons were encouraged to do this by the all too rare reports of successes, or by the still rarer accounts of spontaneous cure as a result of the passage per rectum of the segment of gangrenous bowel.

Aim: To discuss the possible significance of the increased incidence of intussusception in children in relation to the "Great Smog" of London in December 1952., Methods: Cases of intussusception were recorded in two hospitals in East London for the years 1951, 1952, 1953, and 1954. For 1952 the actual dates of admission were recorded., Results: During the year 1952 the total number of cases of intussusception greatly exceeded that in the previous and succeeding years. Immediately during and after the fog there was a clustering of cases, which only occurred during this period., Conclusions: The increased incidence of cases during 1952 is thought to reflect the annual variation in incidence resulting from changes in the prevalence of viruses capable of causing intussusception. The clustering of cases in relation to the fog may reflect a facilitated entry of virus through the wall of the terminal ileum due to the effect of swallowed irritants such as sulphurous acid and smoke particles.

The development of the modern intestinal suture began with the invagination operation, performed by the German surgeon P.F. Ramdohr in Wolfenbüttel in 1727. Today this fact is largely forgotten. Yet this operation stimulated not only Jobert de Lamballe (1824) but also Lembert (1826) to perform their animal experiments on sutures in the intestine. Also all later modifications of these suture techniques took into consideration the principle of invagination.

Early this century, intussusception in childhood was usually fatal. John Hunter, one of the founding fathers of scientific surgery was amongst the first to accurately describe the clinico-pathological features of the condition and one of the great nineteenth century surgeons, Sir Frederick Treves, suggested a plan of management for intussusception which remains little changed up to the present day.

Jejunogastric intussusception is an infrequently reported complication of gastroenterostomy. Prognosis and treatment are functions of the anatomic type (Shackman's classification). Gastroscopy and sometimes roentgenograms are the major diagnostic tools. Surgical treatment is required in the acute types where incarceration or strangulation occurs, and in the chronic types when function or quality of life is impaired.

From urgent tracheotomy by gas or candelight; from fear of laparotomy because of infection; from excision of the hip joint for tuberculous disease; from carbolizing fragments in fractures; from a despairing acceptance of deformed hearts and heads and bowels; and from alcohol, chloroform and ether dripped on a mask--to teaching that ensures early diagnosis; to the confident repair of major damage or deformity in all systems from birth through childhood; with skilled support before and after operation--is a spectacular story!

We present a case of adult intussusception with autoamputation and preservation of bowel continuity. Our patient, a 65-year-old man, passed a 65-cm segment of large bowel per anus with spontaneous recovery and with a two-month follow-up free of symptoms secondary to the intussusception. Mesenteric ischemia secondary to angiography with distal embolization two weeks prior to the event may have been a precipitating factor in this unusual form of intussusception.