Pankaj Dwivedi

Management of paediatric psoas abscess: our experience

Background: Ilio-psoas abscess (IPA) is uncommon in children. It has varied clinical presentation causing difficulties in diagnosis. We present our experience with management of psoas abscess in 23 children. Materials and methods: Records of 23 patients managed at a tertiary institute between March 2011 and December 2016 were reviewed and retrospectively analysed on the basis of age at presentation, presenting complaints, clinical and radiological findings and management. Results: Age of presentation ranged between 20 days and 11 years. Most of the patients presented with fever (n = 20) followed by abdominal pain (n = 11), hip pain (n = 9) and back pain (n = 6). Abscess volume ranged from 20 ml to 300 ml. Ten patients with unliquified abscesses were managed by intravenous antibiotics. Six patients underwent USG-guided aspiration of abscesses (volumes: 20 ml to 150 ml). Pigtail catheter was inserted in 7 patients with partially liquefied abscesses of volume 150 to 300 ml. Clinical response was rapid. The catheter was removed after drainage was stopped and USG confirmed the absence of residual collection. The 15 patients with fixed flexion deformity underwent skin traction. Bacteriological examination was performed in 13 patients – there was no growth in 4 patients, methicillin-resistant Staphylococcus aureus ( MRSA ) in 1 patient, methicillin-sensitive Staphylococcus aureus ( MSSA ) in 6 patients and acid-fast bacilli ( AFB ) in 2 patients. Conclusion: IPA is a rare disease in children. Intravenous antibiotics covering S. aureus and image-guided percutaneous drainage are effective in managing most patients. Open drainage is required if percutaneous drainage fails to completely resolve the abscess and clinical symptoms deteriorate despite antibiotic treatment.

Transurethral incision of ureteroceles in paediatric age group.

Objective Ureteroceles are a great clinical challenge because of variations in anatomy and clinical presentations. We present our experience with primary transurethral incision of ureteroceles in children. Material and methods Data of thirteen children managed for ureterocele from 2009 to 2016 was retrospectively analyzed with respect to age, sex, clinical presentation and symptomatology, type and localization of ureterocele, investigations, surgical management and follow-up. Results A total of 13 patients with ureteroceles were managed. There were 7 males and 6 females. Six were neonates with antenatal diagnosis of ureteroceles. Five patients presented with urinary tract infection and two were diagnosed during ultrasound for abdominal pain. The ureteroceles were on the right side in 7 patients and left in 6 patients. Six patients had a duplex system-five on right side and bilateral in one. Two patients had ureteroceles in solitary kidney. Four patients had associated hydronephrosis and hydroureter and two had only hydronephrosis alone. One patient had bilateral grade III reflux in the bilateral lower moieties of the patient with bilateral duplex system. Two patients had poorly functioning kidney on radionuclide scan. All patients underwent cystoscopic incision of the ureteroceles. Eleven had intravesical ureteroceles and two had large caeco-ureteroceles. Two patients required ureteric reimplantation during follow-up. Conclusion Though the approach of managing a patient with ureterocele should be individualized, transurethral incision remains valuable as a primary intervention with regular follow up. It may even prove to be the only intervention required in most of the patients.

Low-grade fibromyxoid sarcoma in a child presenting as a popliteal fossa swelling

Popliteal fossa masses are rare in paediatric age group. Even rarer are the malignancies of this area. Low-grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma. It is a rare tumor with benign histologic appearance but high metastasizing potential. We describe an 11-year-old child with a popliteal fossa mass, which was excised, and histopathological report revealed LGFMS.

Management of Traumatic Liver and Bile Duct Laceration.

Posttraumatic major bile leak in children is uncommon, with few cases reported in the literature. These injuries are seen in high-grade liver trauma and are difficult to diagnose and manage. We describe a 7-year-old boy with grade IV hepatic trauma and bile leak following blunt abdominal trauma. The leak was successfully managed by percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP) stenting of the injured hepatic duct. How to cite this article: Tiwari C, Shah H, Waghmare M, Khedkar K, Dwivedi P. Management of Traumatic Liver and Bile Duct Laceration. Euroasian J Hepato-Gastroenterol 2017;7(2):188-190.

Collagen dressings in the management of partial thickness pediatric burns: Our experience

Background: Burns in the pediatric patients are usually caused due to accidental spillage and scalding by hot liquids. These are usually partial thickness burns. Collagen dressings have a better outcome in the management of partial thickness burns. Methodology: One hundred patients <12 years of age were included in a retrospective study from January 2013 to 2016. Patients were analyzed in terms of age and sex of the patient, type of burns, duration of presentation, degree and percentage of burns, and complications. Results: The mean age of presentation was 4 years. Ninety-eight percent of children had burns secondary to scalding. Collagen was applied for all patients. Ninety-two patients had no complication. Eight patients had minor complications. Conclusion: Collagen sheet is very useful in first- and second-degree burns in children. It is well tolerated, provides multiple benefits, and it has fewer complications.