Rang Shawis

Management of rectal prolapse in children.

PURPOSERectal prolapse in children is not uncommon and usually is a self-limiting condition in infancy. Most cases respond to conservative management; however, surgery is occasionally required in cases that are intractable to conservative treatment. This study was designed to analyze the outcomes of rectal prolapse in children and to propose a pathway for the management of these cases in children.METHODSA retrospective analysis of all cases of rectal prolapse referred to our surgical unit during a period of five years was performed. End point was recurrence of prolapse requiring manual reduction under sedation or an anesthetic. Results are presented as median (range) and statistical analysis was performed using chi-squared test; P < 0.05 was considered significant.RESULTSA total of 49 children (25 males) presented with symptoms of rectal prolapse at a median age of 2.6 years (range, 4 months –10.6 years). All children received an initial period of conservative treatment with watchful expectancy and/or laxatives. Twenty-five patients were managed conservatively without any additional procedures (Group A), and 24 patients had one or more interventions, such as injection sclerotherapy, Thiersch procedure, anal stretch, banding of prolapse, and rectopexy (Group B). Management of rectal prolapse was successful with no recurrences in 24 patients (96 percent) in Group A vs. 15 patients (63 percent) in Group B at a median follow-up period of 14 (range, 2–96) months. An underlying condition was found in 84 percent of patients in Group A vs. 54 percent in Group B (P = 0.024). The age at presentation was younger than four years in 88 percent of patients in Group A vs. 58 percent in Group B (P = 0.019).CONCLUSIONSRectal prolapse in children does respond to conservative management. A decision to operate is based on age of patient, duration of conservative management, and frequency of recurrent prolapse (>2 episodes requiring manual reduction) along with symptoms of pain, rectal bleeding, and perianal excoriation because of recurrent prolapse. Those cases presenting younger than four years of age and with an associated condition have a better prognosis. The authors propose an algorithm for the management of rectal prolapse in children.

Diagnostic Difficulties in the Management of H-type Tracheoesophageal Fistula

Purpose: To evaluate the diagnostic difficulties and pitfalls in establishing the diagnosis of congenital H-type tracheoesophageal fistula. Material and Methods: A retrospective review of all cases of H-type tracheoesophageal fistula that were diagnosed in a single unit over a 6-year period. The variables assessed were age at presentation, presenting symptoms, time to diagnosis, investigations, and time to surgical repair of H-type fistula. The investigations leading to a definitive diagnosis are assessed and discussed. Results: Between 1998 and 2004, five cases of H-type tracheoesophageal fistula presented to our unit. All cases had an upper gastrointestinal contrast study/tube esophagogram. In addition, four cases had a chest radiograph, three cases had a bronchoscopy, and one case an esophagoscopy. The median delay from the time of first presentation to diagnosis of H-type tracheoesophageal fistula was 14 days (7–58 days). Median age at surgery was 15 days (8–60 days). Conclusion: Although symptoms are usually present from birth, the diagnosis of H-type fistula is difficult and often delayed. The various diagnostic techniques are not entirely reliable and fistula identification can be elusive. The authors present recommendations for the diagnostic work-up, which may increase the diagnostic potential and avoid unnecessary delays in the diagnosis and management of H fistula.

Perineal groove: A rare congenital abnormality of failure of fusion of the perineal raphe and discussion of its embryological origin

We present a case where a baby girl was born with failure of fusion of the perineal raphe. To our knowledge, there has been limited reports of this form of congenital abnormality in the literature and is referred to as “perineal groove.” The incidence of perineal groove is unclear but it is considered to be rare. This case reviews the embryological origin of this congenital abnormality. Clin. Anat. 22:823–825, 2009.© 2009 Wiley‐Liss, Inc.

Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans

BACKGROUND We previously reported our short-term experience of foreskin preputioplasty as an alternative to circumcision for the treatment of foreskin balanitis xerotica obliterans (BXO). In this study, we aimed to compare this technique with circumcision over a longer period. METHODS Between 2002 and 2007, boys requiring surgery for BXO were offered either foreskin preputioplasty or primary circumcision. The preputioplasty technique involved triradiate preputial incisions and injection of triamcinolone intralesionally. Retrospective case-note analysis was performed to identify patient demographics, symptoms, and outcomes. RESULTS One hundred thirty-six boys underwent primary surgery for histologically confirmed BXO. One hundred four boys opted for foreskin preputioplasty, and 32, for circumcision. At a median follow-up of 14 months (interquartile range, 2.5-17.8), 84 (81%) of 104 in the preputioplasty group had a fully retractile and no macroscopic evidence of BXO. Of 104, 14 (13%) developed recurrent symptoms/BXO requiring circumcision or repeat foreskin preputioplasty. In the circumcision group, 23 (72%) of 32 had no macroscopic evidence of BXO. The incidence of meatal stenosis was significantly less in the foreskin preputioplasty group, 6 (6%) of 104 vs 6 (19%) of 32 (P = .034). CONCLUSION Our results show a good outcome for most boys undergoing foreskin preputioplasty and intralesional triamcinolone for BXO. There is a small risk of recurrent BXO, but rates of meatal stenosis may be reduced.

Delays in the diagnosis of anorectal malformations are common and significantly increase serious early complications.

AIM To clarify the extent of delayed diagnosis of anorectal malformations and the consequences of delaying this diagnosis. METHODS We performed a retrospective case review of all neonatal admissions with an anorectal malformation to a tertiary paediatric surgery unit. A delayed diagnosis was considered to be one made 24 h or more after birth. RESULTS 75 patients were included in the study group: 31 (42%) had a delay in the diagnosis; 44 (58%) had no delay in the diagnosis. The time of diagnosis where a delay had occurred ranged from 2-16 (median 2) d. A delay in diagnosis could not be accounted for by differences in age, sex, birthweight, gestational age, the severity or visibility of the lesion, the need for neonatal special or intensive care, or the presence of other anomalies. There were significantly more complications (including one death) amongst the group of children who had a delay in the diagnosis of an anorectal malformation. There was no significant difference in long-term functional outcome. CONCLUSION Delays in the diagnosis of anorectal malformations are much more common than previously thought. A delay in diagnosis significantly increases the risk of serious early complications and death.

H‐type tracheoesophageal fistula masquerading as achalasia cardia in a 13‐year‐old child

Abstract:  H‐type tracheoesophageal fistula is rare. Although symptoms are present from birth, its rarity and overlap of symptoms with other respiratory conditions makes diagnosis difficult and delayed. We report a case of H‐type fistula in a 13‐year‐old girl that was detected incidentally during investigations for achalasia cardia.

H-type tracheoesophageal fistula with type III laryngotracheoesophageal cleft

H-type tracheoesophageal fistula and laryngotracheoesophageal cleft are both rare anomalies. Laryngotracheoesophageal clefts are identified as a part of Opitz-Frias syndrome. We report a neonate with this combination of rare congenital anomalies. These associated malformations can have major implications in terms of resuscitation, diagnosis and surgical management, which are discussed.

Hirschsprung's disease associated with Mowat-Wilson syndrome.

A term male infant was born after an uneventful pregnancy and normal vaginal delivery with a birth weight of 3480 g. There was no consanguinity among parents. He required no resuscitation at birth. He had typical dysmorphic facial features such as square-shaped face, a prominent but narrow triangular chin, deep set but large eyes, hypertelorism, saddle nose, broad nasal bridge, open mouth, everted lower lip, posteriorly rotated ears and large uplifted ear lobes with a central depression. Recognition of the characteristic facies led to referral for genetic counselling. He had delayed passage of meconium with abdominal distention and bilious vomiting on second day of life. He responded well to saline rectal washouts and …

Breast at back passage-neonatal central perineal accessory breast at the site of an imperforate anus

A term baby girl weighing 3400 g was born by normal vaginal delivery following normal prenatal scans and an uneventful pregnancy. Baby did not pass meconium for 24 h. She was found to have an imperforate anus and at the site of the presumed anus, there was a soft lump instead without any secondary changes. Nasogastric tube size 10 could be passed easily into the stomach and there was no perineal fistulous opening or any tracts with meconium and a high variety of anorectal malformation with a …

Repetitive eructation (belching) in children: Is it pathological?

Eructation (belching) is a common symptom encountered in clinical practice. It has a similar mechanism as gastroesophageal reflux disease (GORD), which is transient lower oesophageal relaxation and is generally assumed to be a manifestation of GORD. Repetitive eructation can be distressing and its management can be difficult and challenging. This report highlights this problem in two adolescent children with a comprehensive review and discussion of its etio-pathogenesis.