Aditya Pratap Singh

Left-Sided Gastroschisis with Meckel’s Diverticulum: A Rare Presentation

A 1-day-old female baby, the product of spontaneous vaginal delivery weighing 2.0 kg and delivered to 22 years old primipara, presented to the emergency room with evisceration of intestine from abdomen. Prenatally she was diagnosed with gastroschisis. On examination, defect was about 2 cm × 0.5 cm in size on the left side of umbilicus with evisceration of intestine. The eviscerated bowel was oedematous and dusky in colour. Patient was stabilised by putting him in warmer, oxygen supply and adequate intravenous fluids. After stabilisation patient was shifted to the operation theatre. Midline upper abdominal incision was extended to the defect laterally on left side. Intraoperative findings showed presence of Meckel’s diverticulum and there was no distinction between large and small bowel. There was no situs inversus. Mechanical stretching of anterior abdominal wall was done. The eviscerated bowel was reduced into the abdominal cavity. Skin closure of the defect was performed. Postoperative recovery was uneventful.

Foreign Body in Duodenum Mimicking a Duplication Cyst on Imaging

Paediatric age group is most vulnerable for the accidental foreign body (FB) ingestion which may go unnoticed. These patients present with symptoms or complications as a result of FB and may mimic other conditions on various investigations. We describe a 9-month old infant who ingested crystal gel ball and presented with vomiting for a month. On radiological imaging it was interpreted as duplication cyst of the duodenum. At operation, crystal gel ball was retrieved. Our case vindicates importance of keeping various possibilities in mind as differential diagnoses during evaluation and management of surgical ailments such as the duplication cyst of duodenum.

Chylous Lymphatic Cyst in a Child-A Rare Variant of Mesenteric Cyst

Chylous lymphatic cysts are the rarest variety of the mesenteric cyst. These are the lymph containing cysts. The underlying pathology is benign proliferations of the lymph vessels due to obstruction in the lymphatic system. These have a variable clinical presentation. We are presenting here a case of a chylous mesenteric cyst in a 5 years old male child with acute intestinal obstruction.

Surgical management of stage III pediatric empyema thoracis

Aim and Objective: This study aims to report 100 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response to surgical intervention, and follow-up. Materials and Methods: All the children who underwent open decortication for stage III empyema thoracis during the study period January 2015–December 2016 were included. Preoperative workup included hemogram, serum protein, chest radiographs, and contrast-enhanced computed tomographic (CECT) scan of the chest. Results: One hundred (65 males, 35 females) (age 2 months–13 years, mean 4.5 years) were operated during a 2-year period. Among them, 90% patients were referred 3 weeks after the onset of disease. Intercostal chest drainage (ICD) had been inserted in (95) 95% cases. Thickened pleura, multiloculated pus, and lung involvement were invariably seen on CECT scan. Bronchopleural fistula was present in five patients. Decortication and removal of necrotic tissue were performed in all the patients. Mean duration of postoperative ICD was 4 days. Follow-up ranged from 1 month to 2 years (mean 12 months). There was no mortality. Five patients had proven tuberculosis. Only 10% presented within the early period of the disease. Conclusion: The duration of the disease had a direct relationship with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery. Meticulous open surgical debridement gives gratifying results. The status of the lung at the end of surgery is a major prognostic factor.

Midline Spinal Hamartoma

Congenital midline spinal hamartomas are rare lesions composed of mature and well-differentiated elements at an abnormal location.[1] The components of the hamartoma are mature and identical to those found in the remainder of the organ, but are arranged in a disorganized fashion. Presenting with a skin dimple, cutaneous angioma, subcutaneous mass, or normal overlying skin, these lesions have no neurological deficit at birth, however, associated tethering of cord may produce late sequelae.[1] MRI is extremely useful in characterizing these masses and differentiating it from other spinal cord lesions although not performed in our case. Surgery is curative and can deal associated spinal cord tethering which was not observed in the index case.

Congenital hernia of the umbilical cord with patent vitello-intestinal duct in a newborn: A rare case

Congenital hernia of the umbilical cord is a less frequent entity in newborns and occasionally associated with other maladies. Sometimes, a large umbilical cord hernia is confused with small omphalocele. We report an unusual case of umbilical cord hernia associated with patent vitello-intestinal duct in a male newborn who underwent surgery and discharged with good general condition.

Multiple Jejunoileal Atresia and Stenosis with Duplication Cyst in a Newborn

Jejunoileal atresia is a congenital anomaly that is characterized clinically by bilious vomiting and abdominal dis-tension. It has been associated with various other anomalies but its association with mesenteric cyst is rare. We are presenting a patient with antenatally diagnosed duplication cyst with multiple jejunoileal atresia and stenosis with possible etiology behind such an association.

Multiple Congenital Granular Cell Tumor in a Neonate - A Rare Case

Congenital granular cell tumor (CGCT) is an uncommon congenital benign epulis in neonates. A preliminary diagnosis is usually put forth clinically but may be confused with other anomalies. Herein, we report an unusual case of intra oral congenital granular cell tumor in a 4-day-old female newborn. The tumor was excised completely. At 3-month follow-up, the baby is doing fine without any recurrence.

Antenatally Diagnosed Suprarenal Mature Cystic Teratoma with Down Syndrome

Background: Teratoma is a germ cell tumor (GCT) arising from totipotent stem cells that differentiate into the tissues that are foreign to the anatomic site. Teratoma at the suprarenal location is extremely rare. The associa-tion with the Down syndrome also makes it unusual. Case Report: We are presenting here a case of one-year-old female infant with Down syndrome who had an antenatal diagnosis of right suprarenal mass. Laparotomy revealed a large cystic mass in the right suprarenal location which was completely excised. Right adrenal gland could not be seen separately from the mass. The histological diagnosis was a mature cystic teratoma. Conclusion: Adrenal teratoma is rare and may be considered in the differential diagnosis of antenatally diag-nosed suprarenal lesion. Its association with Down syndrome is rare finding.

Pneumatic reduction of intussusception in children

Context and Aims: Pneumatic reduction has a higher success rate and lower incidence of complications compared to barium enema and hydrostatic reductions. What is deterrent to its common use is the cumbersome technique. Our technique is simple that can be used in any hospital with locally available facilities. Settings and Design: This was a prospective study. Subjects and Methods: A total of 25 children were enrolled in the study between September 2015 and June 2016 at our institute. Patients were given air enema under US guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 100 mmHg. A total of three attempts of 3 min each were allowed. Statistical Analysis Used: We just used simple statistic to calculate average. Results: There were 17 males and 8 females. The average age of the patients was 8.5 months. Twenty-two (88%) of the cases were reduced successfully while 3 (12%) failed to reduce. A majority of those that did not reduced had symptoms for at least 4 days. No bowel perforation occurred in our study. All cases of the intussusception have length < 5 cm were reduced with pneumatic reduction in our study. Conclusions: The technique described is easy to assemble, safe, and effective. We recommend it for regular use in pneumatic reduction of intussusception, especially in the center have limited resources.