Rohit Prasad Yadav

Intrauterine omphalic ileal entrapment as an unusual cause of ileal Atresia: Report of a case

We report a case of ileal atresia (IA) caused by an omphalic ring closure anomaly. A 2-day-old male neonate started vomiting bile, accompanied by abdominal distention. Laparotomy revealed that the distal part of the ileum was entrapped within the omphalic ring and that this entrapped segment of ileum was atretic. To our knowledge, this potential mechanism of IA has not been described before.

Doppler Study of Splanchnic Hemodynamics in Hirschsprung’s Disease

Background: Doppler studies of splanchnic vessels have demonstrated alteration in blood flow in bowel obstruction and strangulation. The aim of this study was to evaluate hemodynamic changes in celiac artery (CA), superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) using pulsed Doppler sonography (PDS) in Hirschsprung’s disease. Material and Methods: Fasting splanchnic flowmetry of CA, SMA, and IMA arteries was performed using PDS preoperatively in 13 patients with Hirschsprung’s disease and 13 healthy age- and sex-matched controls. Diagnostic workup for Hirschsprung’s disease included a barium enema and a rectal biopsy. A primary transanal pull through was performed if the transition zone was at rectosigmoid or midsigmoid. Doppler studies were repeated on the 1st and 7th postoperative day under similar conditions. Mean flow velocity (Vmean) and the pulsatility index (PI) of the three major vessels was measured. Results: Patients with Hirschsprung’s disease showed increased blood flow velocities in CA, SMA, and IMA (p < 0.001), an increased resistance to blood flow in IMA (p < 0.001) and a decreased resistance to blood flow in CA and SMA (p < 0.005 and p < 0.001, respectively). The blood flow velocity for IMA normalized after resection of the aganglionic segment (r = 0.41, p < 0.005, 95% CI: 45.4–52.7). Conclusions: Hirschsprung’s diseaseis associated with alterations in splanchnic vessel hemodynamics which are reversible after corrective surgery. Doppler studies may play an important role in the assessment of bowel function after surgery.

Delayed presentation of congenital pulmonary airway malformation type 4 mimicking lobar emphysema.

© 2008 Japan Pediatric Society Congenital pulmonary airway malformation (CPAM), previously termed ‘congenital cystadenomatoid malformation’, is a rare but potentially life-threatening pulmonary anomaly. 1 Approximately half to two-thirds of children with CPAM present with some form of respiratory distress in the neonatal period. 2 The remainder are discovered incidentally or present with chest infections generally before the age of 6 years. The diagnosis of CPAM in the older group can be confusing because the radiological and histologic features of the mass are often altered by hyperinfl ation, pneumothorax or superimposed infection. 3,4 Although computed tomography (CT) is helpful in these cases for diagnosis and delineating the extent of the lesion, 5 we report a child with CPAM that masqueraded as lobar emphysema on chest X-ray (CXR) and CT scan.

One-stage Correction of Rectovestibular Fistula by Transfistula Anorectoplasty (TFARP)

BackgroundThe present article details a new technique for the repair of rectovestibular fistula.Materials and MethodsTwenty-five patients with rectovestibular fistula, between 13 days and 4 years of age underwent surgical correction by transfistula anorectoplasty (TFARP). The technique, described in detail, involves mobilization of the fistula and the rectum through the fistula and creation of a new anus in the anatomically normal site by preserving both the perineal skin bridge (skin between the neo-anus and the posterior fourchette) and the levator muscle.ResultsThe mean operating time was 85 min, and the mean hospital stay was 5 days. Moderate anal stenosis developed in 1 patient and was treated successfully by anal dilatations using Hegar dilators. A diverting colostomy was not required in any patient, and none of the patients developed rectal prolapse. Eleven patients who are now 3 years of age or older have voluntary bowel movements with good fecal continence scores. The 14 neonates and infants, who are still too young to be evaluated for continence, have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination. The average number of bowel movements per day was three to five, without the need for any laxative or enema.ConclusionsTransfistula anorectoplasty is a simple surgical procedure that does not divide the levator muscle or the perineal body. Preservation of these structures contributes significantly toward improvement of the aesthetic appearance of the perineum and of fecal continence.