John Ratan

Cystic Duplication of the Cecum with Segmental Dilatation of the Ileum: Report of a Case

Abstract Duplication cyst and segmental dilatation are rare congenital anomalies of the gastrointestinal tract, both of which are known to result in intestinal obstruction. We describe herein a case of intestinal obstruction in a neonate, caused by a duplication cyst in the cecum. A small dilated segment of ileum was also present at the site where Meckels diverticulum would be expected, which was not causing obstruction to the luminal contents. Although it is well known that either of these conditions may coexist with a number of congenital malformations, their concurrent occurrence has never been reported before.

Large Benign Cystic Teratoma of the Mesosigmoid Causing Intestinal Obstruction: Report of a Case

Abstract.We report the case of a large benign cystic teratoma of the mesosigmoid in a 2-year-old child. To the best of our knowledge, this type of lesion has never been described in the English literature, although there are a few reports of teratomas arising from the greater and lesser omentum. There was diagnostic confusion due to the rarity of a teratoma arising from the peritoneal folds and also because calcification was not detected radiologically. A brief review of the literature on the diagnosis and treatment of similar lesions is presented.

Association Among Duration of Unconsciousness, Glasgow Coma Scale, and Cranial Computed Tomography Abnormalities in Head-Injured Children

The impact of head trauma leads to generation of forces that cause both the intracranial injuries and loss of consciousness. Glasgow Coma Score (GCS) and cranial CT scan are widely used to gauge the severity of head injury. Milder cranial impacts insufficient to cause intracranial injuries generally cause no or minimal loss of consciousness. Nevertheless, cases with contradictory findings are also seen. This study was undertaken to find out the association among the three above-stated variables. A knowledge of such an association can enable the attending clinician in prognosticating a cranial injury and selecting out those patients with mild head injuries who deserve closer observation. While a significant positive association was found between duration of unconsciousness and GCS, no signifficant association of either of these variables with CT scan findings was noted.

Lipoblastoma of the neck.

Lipoblastoma and lipoblastomatosis are benign tumours arising from embryonal fat cells. These rare tumours essentially occur in infancy and early childhood. The males are affected more than females often in the ratio of 3∶1. These tumours usually arise in extremities. The involvement of neck is rare with only 10 cases reported so far in English literature. We herein report lipoblastoma of the neck in a 3 year old girl.

Risk factors for mortality within first 24 hours of head injury.

Objective Immediate or instantaneous death following cranial trauma occurs due to unpreventable primary brain insults. However, death occurring within 24 hours of head injury can be averted by timely institution of the therapeutic measures that could prevent secondary brain insults. From the management point of view, this is the most important subset of all head injured patients. Therefore, it is important to study risk factors associated with such deaths.Methods: In a retrospective study undertaken at Trauma Center, Safdarjang Hospital, New Delhi, the demographic characteristics, neurological and radiological findings were studied for 100 head injured children admitted in the pediatric surgical ward, who later died after surviving the initial neurosurgical resuscitation. Death occurring within first 24 hours of head injury was defined as “early “death; and “late death”, if it occurred thereafter.Results: Bivariate analysis revealed the severity of head injury GCS<=8(OR:3.09;95%CI:1.22–7.8), a finding of diffuse brain edema, (OR: 3.73; 95% CI : 0.95-14.74), midline shift (OR:4.8; 95% CI: 1.03-22.37) on cranial CT scans were found to be statistically associated with early deaths. Child’s age or gender, the mode of injury and the presence of extracerebral injuries were not found to be significantly associated. When these variables were simultaneously considered in a multivariate logistic regression model, the diffuse brain edema on head CT scan was found to be both clinically and statistically significant of early death (Adj. OR : 527;95% CI : 1.23-22.6). However, absence of hemorrhagic contusion was clinically important predictor of an early death (Adj. OR : 6.45;95% CI : 0.68.-62.5) though not statistically significant due to a small number of study subjects in this group.Conclusion : Findings of this study could serve as useful guideline in identifying the subset of head injured children for urgent institution of preventive measures.

A neonate with anorectal malformation with rare limb defects report of a case

A 2-day-old male infant, born of a non-consanguineous marriage and uneventful pregnancy was found to have anomalies of vertebral, anal, cardiac, tracheo-esophageal, radial and limb (VACTERL) association. The striking feature was the simultaneous occurrence of two rare limb defects of right upper and lower limb in the baby who also had imperforate anus and ventricular septal defect. These limb defects were-meromelia of the right upper limb (due to transverse deficiency of right humerus and absence of all the bony elements distally), and a short right lower limb due to co-existence of proximal femoral hypoplasia and fibular hemimelia. We could not trace the co-existence of these rare skeletal defects in any case with VACTERL association in the existing English literature, as was observed by us. The simultaneous occurrence of the defects involving distant anatomic sites supports the hypothesis of ‘axial mesodermal dysplasia’ in our patient, rather than ‘caudal regression syndrome’, as is popularly held in patients with anorectal malformation (ARM). Further, it points to occurrence of an early embryonic insult, probably taking place at blastogenic stage, when the developing embryo can be considered a polytopic development field. However, in absence of antenatal history suggestive of exposure to a known teratogen and a chromosomal analysis, it appears that the spectrum of anomalies in this neonate might have resulted secondary to early amniotic leak and temporary oligohydramnios.

Laryngotracheo-esophageal cleft in a neonate with esophageal atresia and tracheo-esophageal fistula: report of a case.

Abstract Laryngotracheo-esophageal cleft (LTEC) is a congenital anomaly, rarely found in neonates with esophageal atresia (EA) and tracheo-esophageal fistula (TEF), that poses diagnostic and treatment dilemmas for the attending surgeon. In most cases previously reported, the diagnosis of this association was made either at surgery or at autopsy. We present herein the case of a neonate with EA and distal pouch (type C) TEF who was also found to have a LTEC (Evans type III) at the time of surgery. The salient clinical and radiological features of this association are highlighted to increase awareness of the possibility of this rare association and to help promote its early detection.

Mediastinal cystic hygroma in infancy and childhood

Two cases of mediastinal cystic hygroma are reported. Case I had extension to the neck; the surgical approach was unique in that no cervical incision was required for its removal. Case 2 was an extremely rare presentation of skeletal involvement in addition to isolated bilateral mediastinal cystic hygroma.

Perineal accessory scrotum.

A boy with perineal accessory scrotum but without any other congenital anomaly is being described. He presented with a rugose skin tag on a midline perineal mound and the diagnosis could be confirmed by the histological findings of subcutaneous smooth muscles. Other reports of perineal scrota have been reviewed and a simple classification has been proposed for such cases, based on the appearance of the accessory scrotum and the associated anomalies.

Mercurochrome as an adjunct to local preoperative preparation in children undergoing hypospadias repair

Objective To determine whether the local application of mercurochrome over genital skin before surgery, in addition to soap/water scrubs, can help to decrease the incidence of infection patients undergoing hypospadias repair, and thereby the incidence of fistula formation.