Intezar Ahmed

Vaginal agenesis: Experience with sigmoid colon neovaginoplasty.

Aim: Objective of this study is to report our experience with sigmoid vaginoplasty in adolescents. Materials and Methods: A retrospective study of children with vaginal atresia and Mayer–Rokitansky–Kuster–Hauser syndrome. The sigmoid segment was used for vaginoplasty in all the cases. Results: Eight children were studied over a period of 7 years. The postoperative complications were ileus in 2, mucosal prolapse of the neovagina in 1, and minor wound infection in 1 patient. Seven patients are on regular follow-up. All the neovaginas were patent and functional. One patient had unacceptable perineal appearance, that is, badly scarred perineum as a late complication. None of the patients had vaginal stenosis or excessive mucus discharge, during follow-up visits. Out of the 7 patients, 2 patients are sexually active and satisfied. Conclusions: Sigmoid vaginoplasty is a safe and acceptable procedure for vaginal agenesis with good cosmetic results and acceptable complications rate. Sigmoid colon vaginoplasty is the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, and short recovery time.

Prolapse of bowel via patent vitello intestinal duct—a rare occurrence

This report describes the presentation of prolapse of small bowel through the patent omphalomesenteric or vitello intestinal duct in a child. In spite of diagnosing the anomaly earlier, there was delay in surgical intervention that led to prolapse of the small bowel through patent remnants, which was life threatening. The patient presented to us with questionable viability of prolapsed bowel. Early surgery is recommended for this entity. As this is a very rare occurrence, it is being reported with a brief review of the relevant literature.

Congenital lumbar hernia: 20 years' single centre experience.

Aim:  Congenital lumbar hernia is an uncommon anomaly with only few cases reported in the English literature. This study was done to study the incidence, associated conditions, management and complications of congenital lumbar hernia repair in paediatric patients.

Complicated Rapunzel syndrome mimicking intussusception

A 5-year-old girl presented with a 3-day history of pain and distension of abdomen, bilious vomiting, bleeding per rectum and a hard lump in the left iliac fossa. Intussusception was clinically diagnosed. On exploratory laparotomy, trichobezoar showing cast of the stomach, duodenal C-loop and tail were extracted. The stomach cast was impacted at the distal ileum, while its tail traversed the ileum, ileocecal valve and extended up to the hepatic flexor. At the site of impaction, a large ileal perforation, covered by bezoar was present. Hence, x-ray did not reveal pneumoperitoneum. There was no evidence of trichobezoar in the stomach. Perforation was exteriorised as loop ileostomy. She was of normal intelligence. Psychological evaluation of the child was performed and a behaviour therapy was advocated. Ileostomy closure was done after 2 months. At 6 months follow-up, no recurrence was found.

Chronic abdominal pain in a child

Figure 1: Contrast-enhanced computed tomography showing a huge heterogeneous mass occupying left abdomen; anteromedial to colon and shift of whole of small bowel to the right side. A 6-year-old boy presented to our out patients department with recurrent lower abdominal pain. Pain was started 2 years before intermittently, but it worsened over the past 6 months. Pain aggravated after eating meals. Patient’s parent also gave a history of episodes of abdominal distension and constipation. Other symptoms, as well as his past history and family history, were otherwise unremarkable. Physical examination revealed a slightly distended abdomen. There was a huge intra-abdominal mass occupying the center of the abdomen. It was a single mass, freely mobile, firm in consistency, smooth surfaced with well defined margins, and nonballotable. Routine blood tests, including renal function and urine analysis, were normal. Computed tomography of the abdomen and pelvis revealed a huge heterogeneous mass extending from epigastrium to pelvis [Figure 1]. The entire small bowel loop was displaced laterally by the mass. There was no lymphadenopathy, and invasion of mass into the adjacent organ.

Management of rupture of choledochal cyst

One of the rare complications of choledochal cysts is rupture. In majority of the cases, the cause of rupture is unknown. Reconstructive surgery is the treatment of choice. We describe three patients with choledochal cyst rupture, who were admitted with acute abdomen. Diagnosis of biliary ascites with peritonitis was made in all the three patients. At surgery, two patients underwent T-tube placement, and definitive repair was done electively. One patient underwent definitive repair of ruptured choledochal cyst, but died due to septicemia. External bile drainage would be safer in emergency condition.

A newer variant of congenital pouch colon with rectal agenesis: management strategy and review of the literature.

A 3-day-old male baby presented with clinico-radiological features of rectal atresia with colo-urinary fistula. There was no radiological evidence of congenital pouch colon (CPC), but per-operatively CPC of unusual anatomy was found. The CPC was intermediate between type I and type II of Narsimha’s classification. The pouch had rudimentary appendix and proximal colovesical fistula. The distal end of CPC was free. In the first stage, diverting ileostomy was done. In follow-up, after 1 month because of rectourinary fistula baby developed hyperchloremic metabolic acidosis and uremic sepsis. First metabolic correction and control of sepsis were done. Thereafter, abdomino-posterior saggital approach was used for excision of colovesical fistula, appendectomy, coloplasty and colorectal anastmosis. The ileostomy was left undisturbed. The infant at present is waiting for the third stage ileostomy closure.

Immature extragastric teratoma of infancy: a rare tumour with review of the literature

A full term otherwise healthy, 4-months-old male infant presented with progressive distension of abdomen from 2 months. The clinical examination showed shifting dullness only but no definite lump palpable. The abdominal radiography revealed calcification in right hypochondrium. Serum α-feto protein (AFP), neuron specific enolase, β human chorionic gonadotrophin and urinary vanillymandelic acid (VMA) were appropriate for age-range. Contrast enhanced abdominal CT showed predominantly multicystic lesion in right hypochondrium with central solid component and calcification, but no definite organ of origin determined. The exploratory laparotomy showed extra gastric multilobulated cystic mass sized 23×15×8 cm lesion arising from the lesser curvature of body of stomach. The tumour was feeding through short pedicle based on left gastric artery. There was no infiltration to adjacent areas. Histopathology of excised specimen showed immature teratoma. The child was discharged with appropriate advice and had no recurrence in 1 year of follow-up.

Association of anorectal malformation with duplicated colon, sacral meningomyelocele and scrotal anomalies.

A 3-day-old male baby presented with anorectal agenesis, sacral meningomyelocele (MMC), bifurcated scrotal raphae, abdominal distension and septicaemia. X-ray in the prone position cross table view showed high anorectal malformation. On exploration for colostomy, an 8 cm terminal (sigmoid and descending colon) colonic tubular duplication was found. Both the colonic segments were communicating proximally to each other and distally with urinary bladder, along with complete anorectal agenesis. The excision and repair of the colovesical fistula were done. The colonic segment communicating proximally to the normal colon was exteriorised by window colostomy. The high-resolution ultrasonography of the scrotum revealed two well-developed testis. The bifurcated scrotal raphae and sacral MMC were left to be treated in the future. Unfortunately, the baby died in the immediate postoperative period due to ongoing sepsis.

Neurothekeoma: a rare sacrococcygeal tumor in a child

Neurothekeoma is a rare, benign, and asymptomatic tumor of the skin. Most tumors are located on the head, shoulders, and arms. It is classified as a nerve sheath tumor and epidemiologically occurs in young adults. It is rare to find this tumor in children. This report describes a case of neurothekeoma in a 10-years-old boy at an uncommon site: the sacrococcygeal region. Being an uncommon entity, it is reported with a brief review of the relevant literature.