Dinesh Sarda

Outcome analysis of shunt surgery in hydrocephalus

Aim: To study the clinical outcome of shunt surgeries in children suffering from hydrocephalus. Methods: A prospective study of 50 children with hydrocephalus who underwent a ventriculo-peritoneal shunt insertion over a period of two years. These patients were then followed up for shunt related complications, shunt revisions and outcome. Results: Twenty six of the 50 patients (52%) suffered from complications. The most common complications were shunt blockage (n=7) and shunt infection (n=6). These complications necessitated repeated shunt revisions. Conclusions: Infective complications of hydrocephalus are more likely to leave behind an adverse neurological outcome in the form of delayed milestones and mental retardation.

Spontaneous Bowel Perforation in a Neonate with Anorectal Malformation

Gastrointestinal perforation in neonates with anorectal malformations is extremely uncommon. Delayed patient presentation is an important factor that demands special attention. We present a neonate with anorectal malformation and meconium peritonitis following spontaneous bowel perforation. A day 1 neonate was referred with features suggested of peritonitis. After adequate resuscitation and drainage under local anesthesia, patient was successfully operated for a sigmoid perforation and is now awaiting definitive surgery for the anorectal malformation.

Duodenal atresia with 'apple-peel configuration' of the ileum and absent superior mesenteric artery: A rare presentation

According to the current understanding, duodenal atresia is considered to be a primary malformation resulting from the errors in recanalisation in early gestation. We report a rare case of duodenal atresia with apple-peel configuration of remaining small bowel with absent superior mesenteric artery in a preterm child, which indicates that in rare circumstances vascular accidents may be the underlying cause for duodenal atresia, and jejuno-ileal atresia; only second such case to be reported in the English literature.

Double meningomyelocele: Embryogenesis

We report a case where two distinct meningoceles (thoracic and lumbosacral) with a normal intervening spinal canal was encountered. It was successfully treated by operative intervention.

Mediastinal tuberculosis presenting as traction diverticulum of the esophagus

A 7-year-old male presented with history of low-grade fever, epigastric pain and dysphagia. Ultrasound of abdomen and thorax revealed presence of paraesophageal lymphadenopathy. ‘Barium swallow’ and computerized tomography scan thorax with oral contrast suggested a provisional diagnosis of paraesophageal diverticulum. Esophagoscopy was normal. Endoscopic ultrasonography with biopsy confirmed tuberculosis. The patient was started on four-drug antitubercular treatment.

Double dumb-bell calculus in childhood

An eight-year old male was admitted with complaints of right scrotal swelling, dysuria and intermittent retention of urine for 10 days. On per-rectal examination, a hard mass was palpable in the posterior urethra. An X-ray (KUB) of the abdomen revealed a double dumb-bell calculus at the base of bladder, extending into the posterior urethra. A cystolithotomy via the suprapubic approach was successfully curative.

Extragonadal Germ-Cell Tumour of Vagina.

A 7-month-old female child was admitted with a short history of bleeding and mass protruding from the vagina. Alfa-feto protein levels were raised. Biopsy taken of the tumour mass was suggestive of Endodermal sinus tumour (yolk sac) of vagina. Neoadjuvant chemotherapy was given. Organ preserving resection of tumour was done successfully.

Pneumonectomy in a child with congenital bronchiectasis: A case report and review of literature

Williams-Campbell syndrome was first described in 1960 as a rare form of bronchiectasis. Its pathogenesis is characterized by the absence of or markedly diminished bronchial cartilage. We describe a case of a 4-year-old male child in whom respiratory symptoms developed in neonatal period and were found to have histopathological changes consistent with Williams-Campbell syndrome. A brief review of literature has been discussed.

Tubularized incised plate urethroplasty with de-epithelialized flap

AIM To improve the results of tubularized plate urethroplasty by adding de-epithelized flap. PATIENTS AND METHODS Twenty-five cases of hypospadias who underwent Snodgrass urethroplasty using de-epithelialized flap were studied. The minimum period of follow-up in this series was 1 year. RESULTS The resultant neo-meatus was vertically oriented and slit like. Glans was conical which is cosmetically well accepted. Penile raphe was in the midline. None of the patient had residual chordee, penile torsion, or glans dehiscence. Excellent cosmetic results were observed in all cases. The complication rate in our series was 8% (two cases). Two patients developed fistula. CONCLUSION De-epithelialized flap is a simple method to provide additional covering to the constructed neourethra after Snodgrass urethroplasty. It achieves our goal of noncrossing suture lines and providing maximum vascularity.

Lipoma of the sole: Usual tumor but unusual location

A six-year-old girl approached with complaint of gradually progressive swelling on her left sole since one year. The patient had pain while walking. On examination, there was a single swelling of size 4x3 cm on plantar aspect of sole. It was mainly located over the balls of lateral three digits. Toe movements as well as gait of the patient were normal. Laboratory parameters were normal. Three centimeter incision was taken over the swelling. A single surgeon adheres to certain principles. Optimum exposure 3x3 cm well defined capsulated lipoma was excised [Figure is the key to total eradication of soft tissue lesions and to 1]. It was not attached to deeper planes. Histopathology proper maintenance of wound healing. revealed predominantly mature adipocytes, admixed with collagenic streaks. Patient was discharged on 10 th REFERENCES postoperative day. There was no recurrence in one-year follow up. 1. Pontious J, Zielaskowski LA, King G Extensive lipoma of the sole. J Am Podiatr Med Assoc 2003;93:402-5. Lipoma is defined as benign tumor usually composed of 2. Feldman M, Healey K, Nach W, Kaplan N, Taylor H. Plantar approach mature fat cells. They are most commonly found in areas for excision of bilateral soft tissue masses in a child. J Sole Surg. 1989;28:60-3. of abundant adipose tissue, which may explain why they are rarely found in the sole. Reports of lipoma in the sole D. K. Sarda, P. Kothari, P. Adivarekar, exist, but the occurrence of the tumor in this location is D. Raghunath, K. Ravikumar, B. Kulkarni very rare. Department of Pediatric Surgery, Lokmanya Tilak Medical College and Lokmanya Tilak Municipal General Hospital, Plantar incisions are ideal in specific cases as long as the Sion, Mumbai 400022, India