Anand Singh Kushwaha

Experience with 40 cases of congenital pouch colon

Aim : The aim of this study was to analyze the clinical and management aspect of congenital pouch colon. Materials and Methods : This retrospective study was carried out on 40 cases of congenital pouch colon managed in the department of paediatric surgery from 01, January 2000 to 31, December 2005. Results : The incidence of congenital pouch colon (CPC) in the present study was 11.290 % (40 of 354) of all anorectal malformations (ARM) and 19.60% (40 of 204) of high ARM. Of these 40 cases of CPC included in the study, 82.5% were male and 17.5% were female. The average age of presentation to hospital was 3.36 days with a range of 1-11 days; of these 25% patients were admitted with poor general condition. Preoperative diagnosis of CPC was possible in 75% of cases in our study. 60% ( n =24) of cases had incomplete pouch colon (Type III and IV) while 40% ( n =16) had complete pouch colon (Type I and II). Right transverse colostomy was done in 16 patients and colostomy at descending colon just proximal to pouch in two patients for incomplete (Type III and IV) CPC as a primary initial procedure. Ileostomy was done in 14 patients and window colostomy in three patients for complete (Type I and II) CPC. As definitive procedures, pouch excision and abdomino-perineal pull-through of colon was done in 17 patients, coloplasty and abdomino-perineal pull-through of coloplasty colon was done in four patients and pouch excision and abdomino-perineal pull-through of terminal ileum in four patients in our series. None of our patients underwent primary single stage procedure. Conclusion: (1) CPC comprises 11.290 % of all ARM and 19.60% of high ARM. (2) Right transverse colostomy was opted for incomplete pouch colon, while Ileostomy and window colostomy were opted for complete pouch colon as initial surgical procedures. (3) Staged surgical procedures for management of CPC were well tolerated in our series.

Embryonal rhabdomyosarcoma tongue in a male child

We report a two and half years old male child, who at the age of 2 years developed a small 3 x 3 cm, reddish lesion on his right side of dorsum of tongue. There was a history of bleeding from the lesion, off and on. There was no family history of malignancy or history of exposure to radiation, etc to the child. Incision biopsy was done on July 2005 and the histological findings were consistent with an embryonal rhabdomyosarcoma. Parents of the child were reluctant for any further treatment. He was re-admitted in September 2005 with a massive growth over the tongue, protruding from the mouth [Figure 1]. The child was unable to close his mouth and was also unable to swallow solid food. He was accepting liquids only in small amounts. The growth was arising from the anterior part of tongue and extending up to the base of it. On examination, the growth was 8x6x10 cms, red, bosselated, with nodular ulcerated surface, well defined margins and was hard in consistency. Lower lip was ulcerated and compressed. There was no cervical lymphadenopathy. Other systemic examinations were normal. Skiagram of mandible and chest and ultrasonography of abdomen were normal. The patient was assigned a clinical stage 1 and international rhabdomyosarcoma study (IRS) Group III. Near total excision of mass was done [Figure 2]. Histopathological examination showed embryonal rhabdomyosarcoma. He received one cycle of combination chemotherapy (vincristine, actinomycin D & cyclophosphamide). The child is now able to swallow liquids as well as solids and he is on regular follow-up for chemotherapy and is doing well.

Giant retroperitoneal cystic lymphangioma in a seven-months-old girl

A seven-month-old girl presented with complaints of gradually increasing abdominal lump for four to five months. Clinical examination revealed grossly distended abdomen with an ill-defined nontender, cystic lump, 30 × 15 cm, involving the entire abdomen more on the left side with a positive transillumination test and fluid thrill [Figure 1]. Other systemic examinations and routine laboratory investigations were within the normal limits.

Prune belly syndrome associated with incomplete VACTERL

A Prune Belly syndrome with VATER/VACTERL association is an extremely rare. They are either stillborn or die within few days of life, only few such cases have been reported in literature. We are presenting here a male neonate of Prune Belly syndrome associated with incomplete VACTERL with brief review of literature.

C S F pseudocysts peritoneal cavity following V P shunt surgery: Report of three cases in children and review of literature

Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication following ventriculo-peritoneal (VP) shunt. The following reports our experience with three cases of CSF pseudocyst in children. VP shunt was done earlier for communicating hydrocephalus following tubercular meningitis (TBM) in all cases. Clinical presentation was with progressive abdominal distension and features of intestinal obstruction. Clinically we were able to diagnose all cases as CSF pseudocyst peritoneal cavity. Ultrasound examination confirmed the clinical findings in all. CT scan of abdomen and pelvis showed a large unilocular CSF pseudocyst with shunt catheter within it on one patient (case 3). Ultrasound guided aspiration of cyst was done in case 1 alone, but failed to resolve the symptoms. All patients needed formal exploration. Near total cyst excision, adhesiolysis and relocation of peritoneal end of VP shunt catheter in right supra hepatic space was done in all. Two patients who developed shunt tract infection needed shunt removal. The follow up period is 6-8 months.

Placento-cranial adhesion: A report of two cases

due to obstructed labour on A ugust 27, 2006. Antenatal history was nothing significant. He weighed 2.5 kg including placenta, which was adherent to his head. A preterm, eight hour-old male with cranio-facial Also evident were associated exencephaly and cleft of deformities was born normally at a hospital to a GP lip and palate on the right side [Figure 2]. He also had

Intrathoracic esophageal rupture following blunt trauma chest in a ten months old girl

A 10 months old girl child was admitted on June 05 2005, with a history of blunt injury of chest and respiratory distress for 2 days. Chest skiagram showed effusion on right side of chest, with shift of mediastinum to opposite side. Right intercostal chest drainage was done for pyopneumothorax. Rupture of esophagus was suspected, when the chest drain showed milk. Water-soluble contrast study confirmed rupture of thoracic esophagus. Conservative management was successful in the form of intercostal chest drainage, broad-spectrum antibiotics, nasogastric feeding, parenteral nutrition, etc. A repeat contrast study showed no stricture or leak. At a follow up of 3 months, she is doing well. To the best of our knowledge, this is the youngest patient with blunt injury of chest, leading to intrathoracic esophageal rupture.