Sajad A Wani

Solitary crossed ectopia with vesicoureteric junction obstruction: A rare case report

Solitary crossed renal ectopia (SCRE) is a very rare anomaly of urinary tract. Most cases are diagnosed incidentally. We report a case of SCRE associated with vesicoureteric junction obstruction in a 7-year-old child which has not been reported in the literature till date.

Late-presenting congenital diaphragmatic hernia

Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH) cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India) during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients) to non-specific gastrointestinal complaints (5 patients). In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 14 patients chest, X-ray revealed the diagnosis of CDH and in remaining five patients (including the two patients with misdiagnosis) further investigations were undertaken to establish the diagnosis. Age ranged from 45 days to 17 years with an average age of 58.9 months. There were 12 male and 8 female patients. In all the 20 patients, surgical procedures were undertaken with the retrieval of herniated contents from the thoracic cavity and repair of the diaphragmatic defect. There was no mortality in our series. All the 20 patients were followed-up for a period ranging from 6 months to 5 years (median 3.1 years). Conclusions: Late-presenting CDH can have diverse clinical presentation. Late diagnosis and misdiagnosis can result in significant morbidity and potential mortality if these cases are not managed properly at an appropriate stage. Outcome is favourable if these patients are expeditiously identified and surgically repaired.

Post-partum pyogenic abscess containing Ascaris lumbricoides

We report an unusual case of multiple pyogenic liver abscesses containing Ascariasis lumbricoides in a 35-year-old post-partum female who had delivered 1 month back. Open drainage of liver abscess along with liver worm was done. Patient did well post-operatively.

Buck's fascia repair with glanuloplasty in hypospadias surgery: A simple approach with excellent outcome

BACKGROUND Hypospadias is a common problem encountered in surgical practice and its repair is challenging because of various complications. Urethro-cutaneous fistula is the most common postoperative complication (incidence of 0-33%). Different types of intermediate protective layers have been used in attempts to decrease UCF formation; however, no single surgical technique is ideal. OBJECTIVE The aim of this study was to compare use of dartos fascia and Bucks fascia as intermediate layers in prevention of the formation of UCF. STUDY DESIGN This was a prospective, comparative study conducted over a period of 2 years from January 2014 to December 2015. Patients with primary hypospadias without or with mild ventral penile curvature were included in the study. Patients were categorised into two groups, A and B, with alternate patients assigned to each group. Patients in group A underwent Snodgrass repair with urethroplasty by two-layer subepithelial closure and dartos tissue as an intermediate layer. Patients in group B underwent a urethral repair followed by Bucks fascia repair as intermediate layer and glanuloplasty after excision of a triangular skin strip on either side of the urethral plate. Patients were followed at regular intervals for a minimum of 6 months and complications were noted. RESULTS Over a period of 2 years, 160 patients were included in the study: 80 patients in group A and 80 patients in group B. The age of patients ranged from 1 year to 4.6 years, with a mean age of 1.8 years. Postoperative complications are listed in the summary table. DISCUSSION A protective intermediate layer between the neourethra and the skin can be used to reduce fistula formation. We describe a technique of urethroplasty using Bucks fascia as intermediate layer and glanuloplasty, with excellent results. Bucks fascia over the corpora spongiosum which is deficient ventrally in hypospadias is not completely absent, and can be easily used to cover the neourethra, needs minimal dissection and hence vascularity of tissues is preserved (summary Fig.). We used this Bucks fascia as a second protective layer over the neourethra in an attempt to decrease UCF formation, and compared it with use of dartos fascia. In our study, UCF occurred in 2.5% of patients in the Bucks fascia group and 12.5% of patients in the dartos group, a statistically significant difference. We believe that the native Bucks fascia lateral to spongiosum is a more appropriate, natural, and strong layer to cover the neourethra. CONCLUSION Use of Bucks fascia as an intermediate layer along with glanuloplasty is simple and very effective in preventing UCF formation and glanular dehiscence. We recommend the use of Bucks fascia as an intermediate layer to cover the neourethra to reduce incidence of postoperative complications and improve results.

Management Congenital Colonic Stenosis

Background: Colonic Stenosis (C.S) is a rare entity. It has been reported either as an isolated disorder or in association with other anomalies like Hirschsprung’s disease, craniofacial and musculoskeletal abnormalities. This survey was conducted to study the clinical profile and challenges in the management of this rare anomaly. Material and methods: Retrospective analysis of 6 patients diagnosed to have colonic stenosis during 2007-2014. The diagnosis was confirmed in 5 patients during the surgical exploration. Results: In one patient colonic stenosis was detected pre-operatively. In most cases X-ray findings included multiple air fluid levels and absent gas in pelvis. All the patients presented in neonatal period. One patient had ascending colon, one had transverse colon, 2 descending colon and 2 patients had sigmoid colon stenosis. In 5 patients resection anastomosis was done and in one stoma was formed. All the patients are on follow-up and are doing well. Conclusion: Colonic atresia should always be kept in mind while managing cases of suspected partial /complete intestinal obstruction in a neonate.

Inguinal Hydatid cyst in a child: A rare case report

Highlights • Hydatid disease caused by Echinococcus granulosus is a common health problem in developing countries.• Hydatid cyst in inguinal canal is very rare and fewer than five cases in adults but no case in children has been reported in literature.• We describe a four year male child with right inguinal Hydatid cyst, which was removed and hernial sac was closed.• HPE of the cyst confirmed the diagnosis of Hydatid disease and patient was put on albendazole therapy for three months.

Pulmonary Sequestration: Early Diagnosis and Management

Intralobar sequestration is characterized by aberrant formation of nonfunctional lung tissue that has no communication with the bronchial tree and receives systemic arterial blood supply. Failure of earlier diagnosis can lead to recurrent pneumonia, failure to thrive, multiple hospital admissions, and more morbidity. The aim of this case report is to increase the awareness about the lung sequestration, to diagnose and treat it early, so that it is resected before repeated infection, and prevent the morbidity and mortality.