Shibsankar Barman

Intragastric pressure: Useful indicator in the management of congenital diaphragmatic hernia

Aims: To assess the role of measuring of intragastric pressure (IGP) during closure of congenital diaphragmatic hernia. Materials and Methods: Thirty-two cases were included in the study (August 2008 to February 2014), and IGP has been measured intraoperatively during closure. Result: Patients were categorized in group A (15 patients), group B (14 patients) and group C (3 patients). In group C, IGP was more than 30 cm of water pressure and all of tehm required creation of ventral hernia and ventilator support. Conclusion: Measurement of IGP as an objective, noninvasive and simple method to evaluate intra-abdominal pressure and prevention of abdominal compartment syndrome and intraoperative IGP value determines the types of abdominal closure.

Esophageal Atresia with Tracheoesophageal Fistula Associated with Situs Inversus Totalis

Esophageal atresia with tracheoesophageal fistula with situs inversus totalis is an extremely rare association. We are presenting a case of a preterm neonate suffering from similar condition. Fistula ligation with primary repair was done via left thoracotomy to avoid technical difficulties. Preoperative echocardiography should be done to confirm dextrocardia and disposition of the aortic arch.

Congenital cystic lesions of lung in the paediatric population: A 5-year single institutional study with review of literature

Background: The aim was to evaluate the clinical presentation, investigation modalities, operative management, pathology, outcome (morbidity and mortality) and short term follow-up of congenital cystic lesions of the lung. Materials and Methods: This is a retrospective study. Study period was 5 years (December 2008-November 2013) in the Department of paediatric surgery, Nil Ratan Sircar Medical College. Study population: Total number = 10 patients. Age range: 2 days-7 years. (Neonate-4). Male and female ratio = 1:1. Result: Among 10 cases of lung cyst four having congenital lobar emphysema, four having congenital pulmonary airway malformation, one sequestration and one teratoma. All patients have undergone surgical excision in terms of lobectomy or excision of the lesion. Post-operative histopathology confirmed the diagnosis. Recovery was uneventful. Conclusion: Although our experience is limited, operative management of lung cysts seems to be safe with rewarding results. However we are yet to encounter many of the other varieties of the cysts found in the lung, which may be associated with other congenital anomalies and have an impact on prognosis.

Foreign body in oropharynx: A tonsil-preserving approach in children

Children are more prone to accidental injury of the oral cavity by sharp or pointed object and may involve the tongue, teeth, gums, lips, inner cheeks, jaw, hard or soft palates, and tonsils. Tonsil has important immunological function for children so that preservation is extremely important.

Posttraumatic both loop ileal prolapse through patent vitello-intestinal duct in a neonate: A rare occurrence

Umbilical cord hernia (UCH) is consisting of 20% of all congenital abdominal wall defects. Vitello-intestinal duct (VID) is the communicating embryonic structure which disappears between the 5 th and 9 th weeks of intrauterine life. Here, we present an interesting case of ruptured UCH with both loop ileal prolapse through patent VID.

Uncommon renal tumors in children: A single center experience

Aims: Scrutiny over the clinical behaviors, management, and the final outcome of some rare renal neoplasm in order to find out some hidden facts about these tumors which are playing an important role in the disease course and its management. Materials and Methods: Retrospective evaluation of uncommon (non-Wilms′) renal neoplasm in the pediatric population in a tertiary care center. Fifteen cases of uncommon renal tumors were treated in our institution over the last 5 years (January 2008 to December 2012). The cases were tabulated in the form of age, sex, mode of presentation, preoperative investigations, intraoperative grading, pathological type, postoperative management and the final outcome. The patients were followed up for 2 years (clinically every 3 months and ultrasonography abdomen in every 6 months for first 2 years) in order to see any evidence of recurrence and complications related to postoperative chemotherapy. Results: Out of 15 cases, four cases were clear cell sarcoma (CCS) (26.6%), three cases were rhabdoid tumor (20%), three cases were congenital mesoblastic nephroma (20%), two cases were multilocular cystic nephroma (13.3%), two cases were renal teratoma (13.3%), and one case of teratoid Wilms′ tumor (6.6%). There were two deaths (one CCS and one rhabdoid tumor) due to chemotherapy-related toxicity but no recurrence. Three patients were lost during postoperative follow-up; ten patients are doing well and getting a regular visit in the follow-up clinic. Conclusion: The clinical presentations of these uncommon renal tumors are similar to that of Wilms′ tumor. Thus, preoperative diagnosis is difficult even with modern imaging techniques. Some of these tumors (CCS, rhabdoid tumor) are rapidly progressing and have a poor outcome. Hence, early intervention in the form of complete surgical resection of the tumor (whenever possible) and postoperative chemo/radiotherapy are imperative for fruitful outcome.

Congenital Short Bowel Syndrome due to Absent Midgut.

To the Editor: Short bowel syndrome (SBS) is always associated with a very high morbidity and mortality despite advanced medical and surgical interventions. Common surgical cases are gastroschisis, necrotizing enterocolitis, midgut volvulus, intestinal atresias and total colonic Hirschsprung disease. Sometimes, functional SBS is observed in severe malabsorption where the bowel length is intact. SBS due to congenital absence of midgut is extremely rare and unreported condition till date. A 1-mo-old boy (1.5 kg) was admitted for acute intestinal obstruction. On examination, abdomen was distended with visible gut loops. Straight radiograph abdomen showed single fluid level (Fig. 1). On exploration, hugely dilated duodenum with absent major portion of jejunum, ileum and appendix was found. Approximate length of the small gut was 40 cm and jejunum was directly communicating with colon (Fig. 2). The duodeno-colonic bands were excised with plication of duodenum. Postoperative contrast study showed free flow of dye into the colon. Exact etiology of absent midgut and or absent dorsal mesentery is unclear. Most accepted theory is vascular insult in the embryonic period. Congenital absence of muscle layers in small intestine is also described in literature [1]. Congenital SBS (appendicular agenesis, malrotation and hypertrophic pyloric stenosis) is another important entity which is due to deficiency of argyrophil neurons in the mesenteric plexus [2]. Both the entities are autosomal recessive disorders. We failed to speculate the definite etiology in our case. But, probability of antenatal midgut volvulus, necrosis followed by reestablishment of intestinal continuity is there. The term SBS denotes insufficient absorptive mucosal surface. Less than 200 cm of gut is regarded as SBS in adults. There is no consensus regarding pediatric SBS. The mean

Internal herniation of Meckel's diverticulum through meso-appendix in infant: An extremely rare occurrence

Intestinal obstruction due to internal herniation is rare. There is only 0.5–5.8% of incidence described in the available literature. In infancy, it is rarer. Internal herniation of Meckels diverticulum through meso-appendix in an infant is an extremely rare emergency situation, and probably the first case to be reported in the literature.

Laparoscopic sutureless cystogastrostomy in children for pseudocyst of pancreas: An innovative and simple technique.

Sir, A pseudocyst of pancreas not responding to conservative management and persisting beyond 6 weeks requires internal or external percutaneous drainage. The different techniques described for internal drainage are cystogastrostomy, cystoduodenostomy and Roux-en-Y cystojejunostomy. There are two techniques described to do this procedure laparoscopically, i.e. “transgastric” and “intragastric” approaches. The intragastric approach needs the help of a “Gastroscope” whereas transgastric method only uses the standard laparoscopic instruments. Laparoscopic anterior transgastric cystogastrostomy is the easier approach in the available options of laparoscopic treatment of retrogastric pseudocyst of pancreas. We present an improvisation of existing technique that avoids the use of any endostaplers or endosuturing during cystogastrostomy. All the cases were evaluated as per the protocol mentioned in standard textbooks. The patient was placed in the supine position and the head end was elevated 30 ̊ with a slight left side up. A 4-port technique was used for this procedure [Figure 1]. One 10-mm port was placed at the umbilicus. Next three 5-mm ports were placed at right hypochondrium, left hypochondrium and epigastrium, respectively. Both 10-mm and 5-mm telescopes (30 ̊) were used. Operating instruments were of 5-mm size. The energy source used was the ultrasonic scalpel (Harmonic, Ethicon). The pneumoperitonium was maintained with CO2 at 10 to 12 mmHg. Initial diagnostic laparoscopy with a 10-mm telescope at the umbilical port was done to delineate the size and location of pseudocyst and also to exclude any hepatobiliary pathology. The anterior stomach wall was hitched up with sutures and anterior gastrotomy was done by using the ultrasonic scalpel. Then 5-mm telescope was placed through the epigastric port. The needle aspirator was inserted through the right-sided port to aspirate the pseudocyst. Cystotomy was done using the harmonic scalpel. After creating adequate opening the interior of the cyst was seen for any necrotic material. The margin of window in the posterior stomach wall and the cyst was inspected for any bleeding [Figure 1]. The anterior stomach wall was re-approximated by endosuturing using polyglactin 3-0. All the ports were closed accordingly. The mean operating time was 110 minutes. Patients were ambulatory after 24 hours. Average hospital stay was 4-6 days. All the cases were followed up till 2-3 months post-operatively. The post-operative ultrasonography of abdomen excluded any residual disease. There were no postoperative complications. Laparoscopic cystogastrostomy was described in adults since 1994. There are many published papers regarding the laparoscopic management of pseudocyst of pancreas in children but they have either used endostaplers or endosuturing for cystogastrostomy.[1-3] By using ultrasonic scalpel like Harmonic (Ethicon) there is no need of suturing of the posterior stomach wall with the pseudocyst if hemostasis is maintained properly. With this early experience it seems to be a simple, safe and cost-effective technique in children.