Gowhar Mufti

Ascaris liver abscess in children

BackgroundLiver abscess in childhood is a very challenging subject both for patients and doctors. In India, pyogenic liver abscesses have been found mostly in children, especially in rural areas. Liver abscess due to wandering ascarids is a common complication in children in Kashmir, although it is rare outside.MethodsThe study was carried over a period of 10 years at Sheri-Kashmir Institute of Medical Sciences Srinagar India. Ten cases of liver abscesses due to wandering ascarids in children were encountered. The children were aged 2 years to 13 years.Results70% of the children were from rural areas. All ten patients presented with fever, while three patients presented with peritonitis. Ultrasonography was the main tool of diagnosis. All ten patients were managed by open surgical drainage.ConclusionWe conclude that Ascaris infestation should always be kept in mind while dealing with liver abscess in children.

Post ventriculoperitoneal shunt abdominal pseudocyst: Challenges posed in management

Background: In patients with hydrocephalus, the abdominal cavity has been used for absorption of cerebrospinal fluid (CSF) since 1905. Ventriculoperitoneal (VP) shunt operation is followed by abdominal complications in about 5-47% cases. Abdominal CSF pseudo cyst is an uncommon, but well described complication. Aim: This survey was conducted to study the clinical profile and management of this entity. We present our experience with cases of CSF pseudo cyst in children. Materials and Methods: Retrospective analysis of 4 cases diagnosed to have abdominal pseudo cyst following VP shunt between 2008 and 2013. All the four cases were suspected clinically and diagnosis was confirmed by abdominal ultrasonography. Results: In three patients, the cyst was multilocular and of varying size. Fourth one had a unilocular cyst at the lower end of VP shunt. All the four patients had features of varying degree raised intracranial pressure and a two patients had abdominal signs also. All the patients needed open exploration. Cyst fluid was drained and partial to complete excision of the cyst was done along with the repositioning of the shunt in abdominal cavity in three patients and exteriorization of shunt in one patient. Patients were followed for any further complication over a period of 1-year. Conclusion: Abdominal pseudo cyst is a rare complication after VP Shunt and could result in shunt malfunction or abdominal symptoms and signs. Whenever suspected it should be confirmed by imaging, followed by open exploration and repositioning of the shunt.

Solitary crossed ectopia with vesicoureteric junction obstruction: A rare case report

Solitary crossed renal ectopia (SCRE) is a very rare anomaly of urinary tract. Most cases are diagnosed incidentally. We report a case of SCRE associated with vesicoureteric junction obstruction in a 7-year-old child which has not been reported in the literature till date.

Buck's fascia repair with glanuloplasty in hypospadias surgery: A simple approach with excellent outcome

BACKGROUND Hypospadias is a common problem encountered in surgical practice and its repair is challenging because of various complications. Urethro-cutaneous fistula is the most common postoperative complication (incidence of 0-33%). Different types of intermediate protective layers have been used in attempts to decrease UCF formation; however, no single surgical technique is ideal. OBJECTIVE The aim of this study was to compare use of dartos fascia and Bucks fascia as intermediate layers in prevention of the formation of UCF. STUDY DESIGN This was a prospective, comparative study conducted over a period of 2 years from January 2014 to December 2015. Patients with primary hypospadias without or with mild ventral penile curvature were included in the study. Patients were categorised into two groups, A and B, with alternate patients assigned to each group. Patients in group A underwent Snodgrass repair with urethroplasty by two-layer subepithelial closure and dartos tissue as an intermediate layer. Patients in group B underwent a urethral repair followed by Bucks fascia repair as intermediate layer and glanuloplasty after excision of a triangular skin strip on either side of the urethral plate. Patients were followed at regular intervals for a minimum of 6 months and complications were noted. RESULTS Over a period of 2 years, 160 patients were included in the study: 80 patients in group A and 80 patients in group B. The age of patients ranged from 1 year to 4.6 years, with a mean age of 1.8 years. Postoperative complications are listed in the summary table. DISCUSSION A protective intermediate layer between the neourethra and the skin can be used to reduce fistula formation. We describe a technique of urethroplasty using Bucks fascia as intermediate layer and glanuloplasty, with excellent results. Bucks fascia over the corpora spongiosum which is deficient ventrally in hypospadias is not completely absent, and can be easily used to cover the neourethra, needs minimal dissection and hence vascularity of tissues is preserved (summary Fig.). We used this Bucks fascia as a second protective layer over the neourethra in an attempt to decrease UCF formation, and compared it with use of dartos fascia. In our study, UCF occurred in 2.5% of patients in the Bucks fascia group and 12.5% of patients in the dartos group, a statistically significant difference. We believe that the native Bucks fascia lateral to spongiosum is a more appropriate, natural, and strong layer to cover the neourethra. CONCLUSION Use of Bucks fascia as an intermediate layer along with glanuloplasty is simple and very effective in preventing UCF formation and glanular dehiscence. We recommend the use of Bucks fascia as an intermediate layer to cover the neourethra to reduce incidence of postoperative complications and improve results.

Management Congenital Colonic Stenosis

Background: Colonic Stenosis (C.S) is a rare entity. It has been reported either as an isolated disorder or in association with other anomalies like Hirschsprung’s disease, craniofacial and musculoskeletal abnormalities. This survey was conducted to study the clinical profile and challenges in the management of this rare anomaly. Material and methods: Retrospective analysis of 6 patients diagnosed to have colonic stenosis during 2007-2014. The diagnosis was confirmed in 5 patients during the surgical exploration. Results: In one patient colonic stenosis was detected pre-operatively. In most cases X-ray findings included multiple air fluid levels and absent gas in pelvis. All the patients presented in neonatal period. One patient had ascending colon, one had transverse colon, 2 descending colon and 2 patients had sigmoid colon stenosis. In 5 patients resection anastomosis was done and in one stoma was formed. All the patients are on follow-up and are doing well. Conclusion: Colonic atresia should always be kept in mind while managing cases of suspected partial /complete intestinal obstruction in a neonate.

Neonatal sepsis with atypical presentations

Sepsis in neonatal intensive care units throws formidable challenges in homoeostasis, be in metabolic, nutritional or hematological. Newborn sepsis results in considerable morbidity and mortality among neonates. Due to inability on part of the neonate to develop adequate inflammatory response to localize the infection they commonly develop disseminated systemic infection, pneumonia and/or meningitis. We have described 4 cases of neonatal sepsis with localization at unusual sites. Our first case presented as a Fourniers gangrene, an infective necrotizing fasciitis of the perineal, genital or perianal regions. We also present a very rare entity of acute digital gangrene in a newborn baby as a sole manifestation of neonatal septicemia.