Archana Puri

Conservative management of isolated splenic abscess in children

INTRODUCTION Isolated splenic abscesses (SAs) are rare in children. We report a single-center experience with emphasis on their diagnosis, etiology, treatment, and outcome. METHODS This is a retrospective review. RESULTS Eighteen children (age, 3-16 years; male-female ratio, 5:1) were managed over a period of 8 years in a tertiary-care institution. Presenting symptoms included fever, abdominal pain, and anorexia. Splenomegaly was present in 12 (67%), leukocytosis in 9 (50%), and thrombocytosis in 12 (67%) patients. Associated diseases were thalassemia (1), tuberculosis (1), and typhoid fever (9). Solitary and multiple SAs were seen in equal numbers. Blood culture grew Salmonella paratyphi A in 1 case. Splenic aspirate culture was positive in 3 (Escherichia coli [1], S paratyphi A [1], Acinetobacter [1]). Widal serology was positive in 9 (50%) patients. Management consisted of intravenous broad-spectrum antibiotic therapy in all patients, together with percutaneous aspiration in 10 (56%) cases where the abscess size was greater than 3 cm. All patients responded, and complete resolution was observed. CONCLUSION Isolated SA in children responds favorably to conservative treatment with intravenous broad-spectrum antibiotics and percutaneous drainage without the need for splenectomy.

Fetal renal anomaly: Factors that predict survival

OBJECTIVE To find out the relative prevalence of renal anomalies detected in the antenatal period, and to look at factors that predict the postnatal outcome. METHODS In this prospective study, all antenatal-detected renal anomalies booked at the tertiary health centre were evaluated and counselled. Aspects such as type of renal anomaly, oligohydramnios and presence of additional anomalies were noted. Stillborn babies underwent autopsy; all live born babies were followed for one year. Appropriate statistical analyses were performed to compare the antenatal factors with outcomes. RESULTS Renal anomalies were detected in 136 out of 587 cases with major fetal anomalies. Most of the women were primiparous (65.4%). The mean gestation at presentation was 30 weeks; in 12 cases, diagnosis was possible before 20 weeks (8.8%). Antenatal hydronephrosis was the most commonly seen anomaly, with 61 cases; this was followed by bilateral cystic kidney in 50 cases. Out of the 136 cases, 12 (8.8%) underwent termination of pregnancy and 60 (44.1%) babies were stillborn. Autopsy was performed in 58 out of 72 (80.6%) cases after consent. Karyotyping was performed in 49 cases and abnormalities were detected in two (4.1%) of them. A total of 64 (47.1%) babies were live born; after one year, 49 (36.0%) of them were alive. Postnatal survival was highest in unilateral disease (85.7%). In cases with oligohydramnios, there was only 3.4% survival after one year; none of the cases with cystic kidney and oligohydramnios survived. The period of gestation at presentation of non-survivors was 25.9 weeks compared to 32.5 weeks with survivors. Among the cases with extra renal anomaly, 7.0% survived; none of the cases with associated cranio-vertebral defect or polydactyly survived after a year. CONCLUSION Out of the different renal pathologies that were diagnosed, survival was highest in the unilateral group. The factors associated with poor prognosis included bilateral disease, absence of amniotic fluid and presence of associated malformation.

Intrapericardial diaphragmatic hernia: a rare type of congenital diaphragmatic hernia

An extremely rare case of congenital intrapericardial diaphragmatic hernia is presented. Since 1981, only 14 cases have been reported in the literature. A 5-year-old girl presented with dyspnea on exertion and easy fatigability. Computed tomography was suggestive of an anterior diaphragmatic hernia. Laparoscopy followed by successful open repair of hernia was performed.

Endodermal sinus tumor of vagina posing a diagnostic challenge and managed by chemotherapy and novel posterior sagittal surgical approach: Lessons learned

Vaginal germ cell tumor (GCT) is a rare gynecological malignancy with no more than 100 reported cases in the international medical literature. It is an unusual, but an important, cause of premenarchal vaginal bleeding in a child. This article describes a 2‐year‐old child with vaginal GCT, initially misdiagnosed as rhabdomyosarcoma (on imprint smear cytology) and then as clear cell adenocarcinoma. The authors highlight the salient differentiating clinical, radiological and histological features to prevent misdiagnosis in future. The report emphasizes the need for increased awareness and screening for vaginal GCT by estimation of serum α‐fetoprotein levels, in all patients with premenarchal vaginal bleeds, to prevent inadvertent operative interventions.

Postnatal outcome of congenital anomalies in low resource setting

This study aimed to determine the postnatal outcome of congenital malformations in a tertiary care hospital of India.

Pseudoaneurysm of the radial branch of the splenic artery with pancreatic pseudocyst in a child with recurrent acute pancreatitis: treatment with endovascular stent graft and cystogastrostomy

Splenic artery pseudoaneurysms (SAPs) are rare in children and usually follow abdominal trauma. Although pancreatitis is a well-known cause for SAP in adults, pancreatitis resulting in SAP has only sporadically been reported in children. Before the refinements of endovascular techniques for management of SAP, surgery used to be the mainstay of treatment, often resulting in splenectomy. Recent technical advancements, including development of smaller delivery systems and microcatheters, have made endovascular treatment feasible in children with SAP and increased chances of splenic preservation. In this article, we report a rare case of SAP associated with a pancreatic pseudocyst in a 5-year-old boy with recurrent acute pancreatitis that was managed by endovascular stent graft and cystogastrostomy.

Ovarian tumors with elevated CA-125 levels and severe juvenile hypothyroidism: A need for increased awareness

A 15-yr-old girl presented with bilateral gross ovarian tumors, clinical features of long-standing unrecognized hypothyroidism and markedly elevated CA-125 levels. Ovarian resection was avoided, as the presentation was consistent with the Van Wyk and Grumbach syndrome; and the patient was treated with replacement of thyroid hormone. Regression of the ovarian tumors occurred 6 months after initiation of the treatment. The authors emphasise the need for increased awareness and screening for hypothyroidism in patients with ovarian tumors, in order to prevent inadvertent operative interventions.

Congenital ovarian cyst: A report of two cases

Journal of Laboratory Physicians / Jan-Jun 2012 / Vol-4 / Issue-1 63 symptoms are perimenopausal and postmenopausal bleeding per vagina followed by amber-coloured vaginal discharge and abdominal pain. [2] But all these features are present in 6% of cases.[3] Tubal carcinoma usually originates in the ampulla and its pattern of growth can be nodular, papillary, and infiltrative.[1] These tumors are relatively confined to the tube and may not have any alteration in size and shape of the fallopian tube, or it may feature diffuse swelling, a sausage-shape resembling hydro, hemato, and pyosalpinx. Histo-pathological examination reveals a papillary adenocarcinoma extending into submucosa and muscularis layer, as was seen in our case.[2] Preoperative diagnosis of the fallopian tube carcinoma is seldom made prior to surgery. It is suspected in fewer than 5% of cases preoperatively. Primary ovarian neoplasm is the most common preoperative diagnosis made in these patients. Since it is difficult to differentiate the primary fallopian tube carcinoma from epithelial ovarian cancer, Hu et al established diagnostic criteria for their differentiation in 1950, which were modified in 1978. Patients with at least one of the following criteria should have the diagnosis of primary fallopian tube carcinoma.[4-6] • The tumour arises from the endosalpinx. • The histological pattern reproduces the epithelium of tubal mucosa. • Transition from benign to malignant epithelium is found. • The ovaries and endometrium are either normal or contain less tumor than the tube.

The anomalous clinical anatomy of congenital pouch colon in girls.

BACKGROUND/PURPOSE The aim of this study was to evaluate the anomalous clinical anatomy of congenital pouch colon (CPC) associated with anorectal agenesis in 22 consecutive girls managed over a study period of 7 years. METHODS The 22 patients were categorized into 2 groups. Group A consisted of 10 patients who presented during the neonatal period (n = 9) or as a young infant (n = 1). In these patients, only preliminary assessment results were available. Group B (12 patients) comprised 5 newborns who remained on follow-up and 7 patients who presented after the age of 1 year. These 12 patients were assessed and investigated in more detail. RESULTS In group A patients, apart from absence of the normal anal opening, the appearance of the external genitalia and perineum was essentially normal. Retraction of the labial folds showed radiation of folds inward from the margins of the vulval vestibule toward the center, at a point of confluence located at a higher level. At laparotomy, the subtypes of CPC were type I (n = 4), type II (n = 5), and type III (n = 1). In 8 patients, uterus didelphys was present. In all group B patients, the appearance of the external genitalia was similar to that in group A patients. However, separate openings of the urethra, septate vagina, and vestibular fistula (if present) were visible in 5 patients, whereas in 3 patients, a single perineal opening was identified. A total of 9/12 patients (75%) had urinary incontinence. Examination under anesthesia and endoscopy revealed a septate vagina in all 12 patients and an open, incompetent bladder neck with reduced bladder capacity in the 9 patients with urinary incontinence. The terminal fistula of the colonic pouch opened just distal to the bladder neck (n = 1), just posterior and cephalad to the urethral opening (n = 2), low in the vestibule (n = 5), and undetermined (n = 4). The subtypes of CPC were type I CPC (n = 2), type II CPC (n = 9), and type III CPC (n = 1). All 12 patients had uterus didelphys. CONCLUSIONS The characteristics in the anomalous clinical anatomy of CPC in girls, as described here, appear to be almost invariable and, especially in regions where CPC is common, should alert the clinician to the presence of this malformation.

Congenital pouch colon and segmental dilatation of the colon: A report of two unusual cases

This report describes two unusual cases of anorectal malformation. The first had a type III congenital pouch colon with a colovesical fistula. In the other very similar case, segmental dilatation of the colon was present along with penoscrotal hypospadias and, distally, a length of normal colon ending in a rectourethral fistula. In both patients, the appendix was short, stubby and a Y-shaped duplication of the normal colon was present just proximal to the dilated segment of colon.