An Gangopadhyay

Abdominal cocoon in children: A report of four cases

Abdominal cocoon is a rare cause of intestinal obstruction. The authors report four cases (3 boys, 1 girl; age range, 6 to 8 years) that presented with features of intestinal obstruction. There was no history of previous surgery, peritonitis, or prolonged drug intake in any of these cases. One patient presented with acute intestinal obstruction and gangrene of bowel. The etiology, preoperative diagnosis, and management of this condition are discussed.

Twenty years' experience of steroids in infantile hemangioma - a developing country's perspective.

BACKGROUND Hemangioma is a common vascular tumor. Though it involutes spontaneously, results are unpredictable. Steroid therapy is an effective mode of its regression. We present our experience of largest series and possible recommendations for treatment. MATERIALS AND METHODS A total of 2398 patients were treated during the study period of 20 years. They were given oral prednisolone, intralesional triamcinolone, or combination of both as per the protocol and followed for the response. Response to the treatment was graded as excellent, good, poor, or no response. RESULTS The male-to-female ratio was 1:2.3. In 81% of patients, hemangioma was noticed within first month of life. The commonest site of involvement was head and neck (57%). The commonest clinical presentation was discoloration and swelling. Mean age and size were 8.43 +/- 7.04 months and 23.64 +/- 20.13 cm(2). Response rate was highest for superficial type using any modality of treatment. Patients younger than 1 year showed better response (90.3%) in comparison with children older than 1 year (80.8%). The specific complications occurring were infections in 249 (12.4%), cushingoid facies and growth delay in 62 (3.1%), and hypertension in 51 (2.5%) patients. CONCLUSION Steroid therapy either oral or intralesional as per the requirement is an easy and safe modality. Results are good to satisfactory in most patients. The complications are minimal. If treatment is needed, it should be used as a first-line therapy, especially when cost is an important concern.

Twin fetus in fetu in a child: a case report and review of the literature

IntroductionFetus in fetu is an extremely rare condition wherein a malformed fetus is found in the abdomen of its twin. This entity is differentiated from teratoma by its embryological origin, its unusual location in the retroperitoneal space, and the presence of vertebral organization with limb buds and well-developed organ systems. The literature cites less than 100 cases worldwide of twin fetus in fetu.Case presentationA two-and-a-half-month-old Asian Indian baby boy had two malformed fetuses in his abdomen. The pre-operative diagnosis was made by performing an ultrasound and a 64-slice computer tomography scan of the babys abdomen. Two fetoid-like masses were successfully excised from the retroperitoneal area of his abdomen. A macroscopic examination, an X-ray of the specimen after operation, and the histological features observed were suggestive of twin fetus in fetu.ConclusionFetus in fetu is an extremely rare condition. Before any operation is carried out on a patient, imaging studies should first be conducted to differentiate this condition from teratoma. Surgical excision is a curative procedure, and a macroscopic examination of the sac should be done after twin or multiple fetus in fetu are excised.

An unusual case of heteropagus twinning.

A 3-day-old boy baby presented with a cystic umbilical swelling covered mostly by skin and partly by amnion. On the surface, an early embryo-like structure was attached (facial features and limb buds). The deeper aspect of it was composed of large cystic and tubular structures and solid organs resembling liver and spleen. It was labeled as acardiac amorphous parasitic twin, the first of its kind to be reported.

Hydatid disease in children may have an atypical presentation.

Abstract Although there is voluminous literature describing various aspects of hydatid disease in children, little attention has been paid to the small group of patients whose symptoms result in atypical presentation. This article addresses this problem, describing the features in ten children aged from 2 to 12 years. The sites of involvement were within a choledochal cyst (1). the pelvic cavity (1), the spleen (1), and transverse mesocolon. Albendazole was efficacious in the treatment of one recurrent case, as well as in preventing recurrence.

Conservative management of ulcerated haemangioma – twenty years experience

Ulceration is the most common complication of haemangioma and occurs in 5–15% of cases. The present study was carried out to evaluate the clinical features of ulcerated haemangioma and efficacy of the management protocol adopted by us over a period of 20 years. All patients with ulcerated haemangioma were evaluated on the basis of age at presentation, sex, rural or urban distribution and site of haemangioma. Treatment included application of topical antibiotic and systemic antibiotic and analgesic for pain. The total number of patients was 608. The male to female ratio was 1: 2·28. The rural:urban distribution was 2·43:1. The most common site of involvement was head and neck. Mean age of patients was 5·60 ± 2·44 months. Mean size of haemangioma and ulceration was 47·30 ± 20·67 cm2 and 7·49 ± 4·52 cm2, respectively. The mean time for ulcer healing was 40·06 ± 19·41 days. Ulcer size of more than 10 cm2 took more time to heal. Response to treatment was satisfactory. Ulcerated haemangioma usually occurs before completion of 1 year of age; hence, every patient with haemangioma needs careful attention. Adequate treatment and regular follow up brings satisfactory response in the patients.

Intralesional bleomycin in lymphangioma: An effective and safe non-operative modality of treatment

Introduction: Lymphangiomas are benign hamartomatous lymphatic tumors. The mainstay of the therapy is surgical excision, but due to its infiltration along the nerves and muscles, total excision is not always possible. In the present study, we have evaluated the clinical profile of all the cases of lymphagiomas coming to our department and evaluated the efficacy of intralesional Bleomycin as a sclerosing agent in its management. Materials and Methods: In this prospective study, all patients were evaluated clinically and color Doppler ultrasonography (USG). The required dose was calculated as 0.5 mg/kg body weight, not exceeding 10 units at a time. The response was assessed clinically and on the basis of color Doppler USG. Results: Thirty-five patients of lymphangioma were included in the study. The neck region was the most common site of involvement. The response was excellent in 7 (20%), good in 26 (74.29%), and poor in 2 (5.71%) patients. The complications included fever, transient increase in size of swelling, local infection, intraluminal bleed, and skin discoloration in 10 patients. Conclusion: This therapy may be used as primary modality instead of surgery in selected group of patients.

Anatomical variations in termination of the axillary artery and its clinical implications.

Variations in the termination of the axillary artery (AA) were observed in 51 out of 356 axilla during routine dissections. The incidence of variation was higher on the right axilla in 17.42% cases (CI: 11.60-22.51) than the left axilla 11.24% cases (CI: 6.46-15.55) and was found to be 12.33% in male and 40.63% in female cadavers. The variations were divided into four groups. The first group showed that the terminal end of the AA divided into lateral and medial divisions in 6.16% (CI: 2.21-9.82) male and in 15.63% (CI: 2.76-25.25) female cadavers. The second group variation showed that the terminal end of the axillary artery divided into deep and superficial divisions in 2.74% (CI: 0.10-5.27) male and in 6.25% (CI: -1.87-13.13) female cadavers. The third group showed that the terminal end of the AA divided into three branches in 2.74% (CI: 0.10-5.27) male and in 6.25% (CI: -1.87-13.13) female cadavers. The fourth group showed the tapering of the terminal end of AA in 0.68% (CI: -0.63-1.99) male and 12.50% (CI: 0.97-21.46) female cadavers. The variable origin of the circumflex humeral, subscapular and profunda brachii arteries was also observed. These variations in the terminal end of the axillary artery are not only of significant clinical importance to orthopaedic and reconstructive surgeons but also have very significant medico-legal implications.

Pediatric carcinoma of rectum - Varanasi experience

BACKGROUND Primary gastrointestinal system malignancies constitute approximately 2% of pediatric neoplasm and of these; colorectal carcinoma is the second most common malignancy. This is one of the rarer diseases in children. AIM We reviewed our records to study the clinical features, outcome and the follow-up of this condition with evaluation of the prognostic factors. SETTINGS AND DESIGN Tertiary care Pediatric Surgery centre. Retrospective study. MATERIALS AND METHODS The data of all patients with diagnosis of colorectal carcinoma from January 1986 to January 2006 were reviewed. The confirmation of the diagnosis was by biopsy from the lesion. The age, sex, family history, clinical features, response to the treatment and follow-up were studied. RESULTS There were four male patients. All had bleeding per rectum as the presenting complaint. Three patients had advanced disease at presentation. All the patients had signet cell adenocarcinoma. The two patients expired and one was lost to follow-up. One patient is alive after one year of follow up and is receiving treatment. CONCLUSION Colorectal cancer in children though rare can be a reality, hence any children presenting with pain in abdomen along with doubtful history of constipation and rectal bleeding should be examined carefully with special emphasis on digital rectal examination.

Sigmoid volvulus in childhood : report of six cases

Abstract Sigmoid volvulus is a common cause of large-bowel obstruction in elderly individuals, but is quite rare in childhood. We report six cases in patients under 20 years of age. One had Hirschprungs disease. Gangrenous sigmoid colon was found in three cases and resection was performed. Sigmoidopexy (one case) and extraperitonealization (two cases) were performed for viable sigmoid colon. There were no recurrences after 5.7 years of follow-up.