Mansour Ali

Congenital duodenal obstruction associated with Down's syndrome presenting with hematemesis

Congenital duodenal obstruction is usually characterized by onset of early vomiting due to high bowel obstruction. Presentation of congenital duodenal obstruction with acute gastrointestinal bleeding is very uncommon. We present an unusual case of congenital intrinsic duodenal obstruction associated with the Downs syndrome presenting with hematemesis secondary to duodenitis. This is a rare presentation of congenital duodenal obstruction associated with Downs syndrome in addition to seven cases previously reported in the English literature.

Visceral basidiobolomycosis: An overlooked infection in immunocompetent children

Visceral basidiobolomycosis is an unusual fungal infection of viscera caused by saprophyte Basidiobolus ranarum. It is very rare in healthy children and poses a diagnostic challenge due to the non-specific clinical presentation and the absence of predisposing factors. We report a case of gastrointestinal basidiobolomycosis in a 4-year-old healthy girl who presented with a short history of abdominal pain, bleeding per rectum, fever, and weight loss. The diagnosis was based on high eosinophilic count, classical histopathology findings of fungal hyphae (the Splendore-Hoeppli phenomenon), and positive fungal culture from a tissue biopsy. Fungal infection was successfully eradicated with a combined approach of surgical resection of the infected tissue and a well-monitored course of antifungal therapy. The atypical clinical presentation, diagnostic techniques, and the role of surgery in the management of a rare and lethal fungal disease in an immunocompetent child are discussed.

Troubling toys: rare-Earth magnet ingestion in children causing bowel perforations.

Ingestion of foreign bodies in the pediatric population is common and magnet ingestion is known to cause a significant morbidity. Rare-earth magnets are small 3–6 mm diameter spherical powerful magnets that are sold as popular desk toys for adults and were previously found in construction toys in attractive colors for children to play with. We describe 2 young healthy children who ingested rare-earth magnets Buckyballs while playing with these magnetic toys and later presented in emergency with acute abdomen. Abdominal imaging revealed several (26 and 5) pieces of rare-earth magnets in the bowel loops. Emergency surgical exploration revealed multiple gastrointestinal perforations and fistula formation at sites of bowel entrapment in between strong magnets apposed to one another. We highlight the potential dangers of rare-earth magnets in children and suggest increasing public awareness about risks involved in rare-earth magnets ingestion by children to overcome this serious public health issue.

Accessory urethra in a male infant: A case report

Accessory urethra is a rare congenital anomaly and has varied presentations. Multiple surgical techniques have been described for its correction. We report a case of accessory urethra in a male infant, which was recognized incidentally. Diagnosis requires a high index of suspicion and optimal knowledge of the anomaly is mandatory for the surgical team to achieve a good outcome.

Mucocele of the tongue

A 4-year-old girl was referred for evaluation of a pedunculated mass in the midline of the ventral surface of the anterior tongue. The lesion had fluctuated in size since it was first noted 3 months earlier. She denied any history of local trauma, tongue piercing or insertion of a foreign body, although her parents admit she casually bit her tongue repetitively. She was otherwise asymptomatic. The oral examination revealed an 18 × 8 mm lesion of firm consistency, smooth-walled and small elephant trunk-like shape arising from the ventral surface of the tongue (Fig. 1). The area around the lesion was clear of any local pathology. The lesion was excised completely. Following resection, she has been re-evaluated in outpatient clinic and a 9-month follow-up revealed no recurrence. Histopathology findings revealed extravasation mucocele. Haematoxylin and eosin-stained section showed squamous mucosa containing a disrupted extravasation mucocele overlying a predominantly minor salivary gland (Fig. 2). Mucoceles by definition are cavities filled with mucus and are known to occur in varying locations on the oral mucosal surfaces overlying accessory minor salivary glands. However, they occur more frequently in the lower lip followed by the tongue. The tongue consists of three distinct sets of minor salivary glands, namely the glands of Von Ebner, the glands of Weber and the glands of Blandin–Nuhn. Von Ebner glands are located in a trough circling the circumvallate papillae on the dorsal surface of tongue near sulcus terminals, whereas the Weber’s glands are located in superior portion of tonsils in the peritonsillar space. The glands of Blandin– Nuhn are small, mixed mucus and serous glands that are embedded within the musculature of the ventral surface of anterior tongue and covered by a thin layer of mucosa. Each gland is approximately 8 mm wide and 12–25 mm deep. The glands have been histologically described as consisting of seromucous acini in their anterior portion and of mucous acini capped seromucous demilunes in their posterior portion. Mucoceles of glands of Blandin–Nuhn are rare and are hardly reported to occur in the paediatric age group. Kheur et al. performed a search of Medline archives and noted only 106 (6.26%) cases of mucoceles of glands of Blandin–Nuhn in both adults and children out of the 1691 mucoceles reported in literature during last 50 years. Mucoceles of the glands of Von Ebner and Weber have not been reported. Mucoceles are described as extravasation or retention type. The term mucus extravasation phenomenon (or escape reaction) is used when mucus has been extruded into the connective tissue and is surrounded by a granulation tissue envelope. The term mucus retention cyst is used to describe a cyst with retained mucin, which is lined by ductal epithelium. Trauma to the mucus glands, causing rupture and release of mucus into the surrounding tissue, is

A Triad of Congenital Diaphragmatic Hernia, Meckel’s Diverticulum, and Heterotopic Pancreas

Congenital diaphragmatic hernia is a common developmental anomaly encountered by paediatric surgeons. It is known to be associated with extradiaphragmatic malformations, which include cardiac, renal, genital, and chromosomal abnormalities. Herein, we report a newborn born with concurrent congenital diaphragmatic hernia, Meckels diverticulum, and heterotopic pancreatic tissue. This is the first case report of such a triad with description of possible mechanisms of the development.