Anindya Chattopadhyay

Polycystic ovaries, precocious puberty and acquired hypothyroidism: The Van Wyk and Grumbach syndrome

Long-standing acquired hypothyroidism can rarely be associated with precocious puberty and polycystic ovaries. The authors report such a case, which responded to the simple replacement of thyroid hormone. It is important to look for hypothyroidism in girls with ovarian masses and precocious puberty to avoid surgery on the ovaries.

A prospective comparison of two regimes of bowel preparation for pediatric colorectal procedures: normal saline with added potassium vs. polyethylene glycol

We prospectively evaluated the safety and efficacy of total gut irrigation (TGI) using normal saline with added potassium (NS) and polyethylene glycol (PG) in patients undergoing a variety of colorectal procedures including single-stage pull-through for Hirschsprung’s disease (HD). Fifty-four patients were randomly assigned into one of the two groups (NS or PG). Pre- and post-TGI weight, abdominal girth, and serum electrolytes were assessed. Patients were also evaluated for vomiting and abdominal discomfort. At surgery, bowel preparation was evaluated, and postoperative complications were recorded. Both NS and PG are safe and effective agents for TGI. No patient in either group had any clinical or statistically significant change in the evaluated parameters. The amount of NS required for TGI was significantly higher than PG, and PG was better tolerated than NS. All patients with HD completed TGI, although one patient with long segment HD had abdominal distension.

Osteosarcoma of the rib

Primary osteosarcomas arising from the rib are very rare. The authors report an 11-year-old boy with a primary fibroblastic osteosarcoma of the rib, who underwent wide excision and reconstruction of the chest wall followed by chemotherapy. He is disease free after a follow up of 24 months. The relevant literature is reviewed briefly

Surgical implications of snakebites.

Objective : Snakebites are a common problem in the pediatric age group. Local complications such as necrosis and compartment syndrome threaten limb survival even after control of systemic manifestations. Few recommendations exist about the nature and timing of surgical treatment.Methods: A retrospective review of all children with snakebites presenting to the hospital was undertaken over a 6-year period. Records were reviewed with special emphasis on the type of surgical lesions seen and the treatment offered and their results.Results: 44 of the 58 children required some form of local therapy. In the majority conservative treatment was successful. 28% of the patients needed debridement for local necrosis, and only 5 needed a skin graft, with good functional results over a period of 1 to 45 days. One child underwent an above knee amputation. Patients who required surgical intervention received significantly more vials of antivenin.Conclusion: Local complications of snakebite are frequent, but can be managed conservatively. Delayed excision of the resultant local necrosis is associated with good outcomes. The need for fasciotomy is rare.

Oral Tumors in Newborn

Tumors arising from the oral cavity in the newborn are rare. Congenital epulis and epignathus are the two testons usually seen. They cause problems because of their position and size and have the potential to cause respiratory obstruction. These lesions must be diagnosed and excised early, as they have an excellent prognosis if treated properly. We describe two such patients, and provide a brief review of the literature to highlight the management strategy for these rare tumors.

Unilateral inguinal ectopic scrotum with covered exstrophy.

Abstract.A case of ectopic scrotum located in the right inguinal area and associated with covered exstrophy and ipsilateral renal agenesis is described. Initially, repair of the exstrophy was performed. Scrotal reconstruction was carried out after 1 year, during which time the patient developed an inguinal hernia in the ectopic scrotum. The literature is reviewed and the scrotal reconstruction procedure is discussed.

Necrotizing fasciitis with chickenpox

Necrotizing fasciitis can be observed in a wide variety of clinical settings in the pediatric age group. But necrotizing fasciitis as a complication of chickenpox is rare. Five cases of necrotizing fasciitis following chickenpox were treated in the authors’ institutions. Clinical signs like fever, tachycardia, pallor, erythema, marked edema of the affected area and patchy areas of discoloration or gangrene of the skin were present and were the important clues to the seriousness of infection. Patients were treated with aggressive surgical debridement, frequent dressings, broad-spectrum antibiotics, nutritional support, and split skin grafting. Early diagnosis and aggressive surgical therapy are critical. Literature search showed necrotizing fasciitis following chickenpox has not been reported in India. We feel early suspicion and aggressive management can decrease the morbidity and mortality in this rare complication.

Duodenojejunal obstruction by a hemangioma

Abstract.Gastrointestinal obstruction by hemangiomas is exceedingly rare. We report a case of a duodenojejunal obstruction caused by a large hemangioma. The patient underwent a gastrojejunostomy for relief of the obstruction and has been symptom-free, although the hemangioma persists.

Spontaneous biliary perforation presenting as gastric outlet obstruction.

Spontaneous biliary perforation (SBP) is a rare, surgically correctable cause of jaundice in neonates. The presenting feature is usually biliary ascites, and in rare cases, biliary peritonitis. This article reports a case of SBP, which presented with features of gastric outlet obstruction, leading to an erroneous preoperative diagnosis. Most probably this is the first report of such an unusual presentation of SBP. The child underwent exploratory laparotomy and a bilio-enteric bypass with drainage of the right subhepatic space, which led to a prompt resolution of the symptoms

Soave procedure for infants with Hirschsprung's disease

Objective Traditionally the surgical treatment of Hirschsprung’s disease (H.D) includes preliminary colostomy in normally innervated bowel followed by one of several pull through procedures. The transanal single stage Soave procedure eliminated the need for preliminary colostomy and intraabdominal dissection. It is a recent concept in the management of this disease, and this is the first experience to be reported from India.Methods: Four children aged 3 weeks to one year underwent transanal pull through procedure over a two month period. A rectal mucosectomy was performed starting 0.5 cm. proximal to the dentate line and extending proximally to the level of intraperitoneal rectum. The muscular sleeve was divided circumferentially to allow the full thickness mobilization of the proximal colon. Ganglion cells were confirmed by frozen section and bowel was transected. The rectal muscular cuff was divided longitudinally and the anastomosis was completed.Results: Operative time including the frozen section averaged 160 minutes and average length of the bowel resected was 22 cm. There were no postoperative complications and all patients were discharged on seventh postoperative day. Median follow-up was 5 months (4–6 months) and stool output ranged from 2–4 per day.Conclusion: The authors conclude that a single stage transanal Soave’s pull through for Hirschsprung’s Disease can be performed successfully in infants. When compared to conventional pull through procedure, it has the potential advantage of lower cost, less risk of damage to pelvic structures, absence of any abdominal incision, a lower incidence of intraperitoneal bleeding and adhesion formation. The preliminary functional results suggest that the patients gain early bowel function post operatively without soiling or constipation