Kartik Chandra Mandal

Choledochal cyst: A review of 79 cases and the role of hepaticodochoduodenostomy

Aim: To analyze our experience of choledochal cysts. The results of complete excision of cyst and hepaticodochoduodenostomy have been analyzed in particular. Material and Methods: Period of study: January 1993 to August 2010. Apart from basic investigations, we did ultrasonography (USG) of abdomen, contrast-enhanced computerized axial tomography scan (CECT), endoscopic retrograde cholangiopancreatography (ERCP), operative cholangiogram, hepatic isotope scan (HIDA), magnetic resonance cholangiopancreatogram (MRCP) and choledochoscopy. The patients were divided into six groups according to the management done and the results analyzed. Results: The total number of cases was 79 (Male : Female = 26 : 53). The mean age of presentationwas 5.18 years. The most common mode of presentation was abdominal pain in 86% cases. Types of cysts - Type I: 63; Type IV: 12; Forme fruste: 1; Carolis disease: 1; Cyst with atresia in the lower end of common bile duct: 2. Two patients of group A (cyst excision and Roux-en-Y hepaticojejunostomy) had recurrent pain and cholangitis. One patient required revision for stricture. In group E (n=53) (excision of cyst and hepaticodochoduodenostomy), three patients developed occasional epigastric pain and they responded to omeprazole. One patient developed anastomotic stricture and was lost to follow up. One patient of cyst with biliary atresia with biliary cirrhosis died. Conclusions: In choledochal cyst, complete excision of cyst and good bilioenteric anastomosis with wide stoma should be done. Hepaticodochoduodenostomy with wide stoma is a simple, quick procedure with preservation of normal anatomy and physiology and minimum complications. It also avoids multiple intestinal anastomoses and so should be the preferred approach.

Spectrum of human tails: A report of six cases

Human tail is a curiosity, a cosmetic stigma and presents as an appendage in the lumbosacral region. Six patients of tail in the lumbosacral region are presented here to discuss the spectrum of presentation of human tails. The embryology, pathology and treatment of this entity are discussed along with a brief review of the literature.

Renal teratoma with duplication of cecum and appendix

Renal teratoma is a very rare condition. We report a case of mature renal teratoma in a 1-month-old male infant. The patient was admitted with a right-sided abdominal mass. The mass was found to arise from the right kidney. The tumor was removed successfully, and the patient had an uneventful recovery. The tumor mass also had an appendix and cecum within the tumor, along with a normal appendix and cecum with a separate blood supply.

Scrotoschisis: An extremely rare congenital anomaly.

A rare case of unilateral scrotoschisis in a full term infant delivered by Caesarean section is reported.

Spontaneous gall bladder perforation: a rare condition in the differential diagnosis of acute abdomen in children

Gallbladder perforation is very rare in children and almost exclusively is a complication of cholecystitis, which accompanies severe inflammation of the gallbladder with or without cholelithiasis. Here we present 4 cases of spontaneous gall bladder perforation, which should be kept in mind as a condition for inclusion in the differential diagnosis of an acute abdomen in children.

Gastric volvulus with partial and complete gastric necrosis

Here, we report two interesting cases of gastric necrosis in acute gastric volvulus due to eventration of the diaphragm. Both the cases presented with a significant challenge and were managed successfully. The management of the cases is presented and relevant literature is discussed. To the best of our knowledge, this is the first case report of gastric volvulus with gastric necrosis requiring complete and partial gastrectomy in the available English literature.

Ovarian cysts and tumors in infancy and childhood

Aim: Review of the clinical presentation, types (histology), and stages of presentation and overall outcome of ovarian tumors. Materials and Methods: This is a retrospective study. Forty nine girls from 3 days to 12 years were included in the study. Results: Fourteen girls had benign and thirty three had malignant ovarian tumors. One girl had bilateral ovarian non-Hodgkin lymphoma. Dysgerminoma (40%) was the commonest malignant tumor followed by malignant teratoma (16.6%). Conclusion: Pain and abdominal lump are the most common modes of presentation. Prognosis depends on the size of the tumor, stage and histology of the tumor. Conservative surgery should be the aim. Multidisciplinary management gives good prognosis.

Congenital Duodenal Obstruction with Preduodenal Portal Vein and Situs Inversus Totalis: Report of Two Cases and Literature Review

Preduodenal portal vein is a rare congenital anomaly that causes high intestinal obstruction. The authors report two interesting cases of preduodenal portal vein that were diagnosed as having congenital duodenal obstruction. As there is a high potential for surgical risk, this anomaly is of special interest to the surgeon and should be kept in mind. Here, we discuss the clinical presentation, diagnosis and management along with a review of the literature.

Giant congenital infected splenic cyst: An interesting case report and review of the literature

Splenic cysts are rare lesions. The congenital non-parasitic cysts of the spleen are rarely met in the clinical practice. Primary cysts have a cellular lining that can be caused by congenital events or parasitic infection (Echinococcus). Secondary cysts have no cellular lining and may be of hemorrhagic, serous, inflammatory, or degenerative origin. We report a rare case of congenital cyst of spleen in a child aged 10 years treated successfully by splenectomy because of total involvement of the splenic parenchyma along with involvement of hilum by the cyst, and we review the literature.

Intragastric pressure: Useful indicator in the management of congenital diaphragmatic hernia

Aims: To assess the role of measuring of intragastric pressure (IGP) during closure of congenital diaphragmatic hernia. Materials and Methods: Thirty-two cases were included in the study (August 2008 to February 2014), and IGP has been measured intraoperatively during closure. Result: Patients were categorized in group A (15 patients), group B (14 patients) and group C (3 patients). In group C, IGP was more than 30 cm of water pressure and all of tehm required creation of ventral hernia and ventilator support. Conclusion: Measurement of IGP as an objective, noninvasive and simple method to evaluate intra-abdominal pressure and prevention of abdominal compartment syndrome and intraoperative IGP value determines the types of abdominal closure.