Vijay C Pujar

Laparoscopic excision of intra-abdominal oesophageal duplication cyst in a child.

Duplication cysts are congenital cystic malformation of the alimentary tract consisting of a duplication of the segment to which it is adjacent. It can occur anywhere from mouth to anus. Oesophageal duplication cysts comprise 4% of the same. Of these, total intra-abdominal oesophageal duplication cysts are extremely rare. On review of literature, only 3 case reports of total intra-abdominal oesophageal duplication managed laparoscopically are found. All these cases were adults. We report the first paediatric case of intra-abdominal oesophageal duplication cyst excised laparoscopically.

Littré hernia: A surgical surprise

Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, occurring in 2-3% of the population. Littré hernia (LH) is the protrusion of MD through a potential abdominal opening in a sac. It results from improper closure and absorption of the omphalomesenteric duct. Protrusion of MD, along with coils of the intestine into the hernia sac may cause complications like obstruction, perforation, or fecal fistula. We report a very rare case of LH who presented with an irreducible mass in the left inguinal site, diagnosed preoperatively as incarcerated inguinal hernia in a 2-year-old boy.

Modified Cantwell-Ransley epispadias repair in children our experience

Introduction: We retrospectively evaluated our experience with modified Cantwell-Ransley epispadias repair at our center to determine the complications and long-term results. Materials and Methods: We retrospectively reviewed the case records of 43 male children with a mean age of 9.13 ± 1.94 years who underwent primary epispadias repair at our center. The results of epispadias repair were assessed by both physical and endoscopic examination. All children who were old enough to opine as well as all parents/guardians were interviewed during the follow-up visits. Results: Urethrocutaneous fistulae occurred in 17.85% (5/28) children of the classic bladder exstrophy group and in 13.33% (2/15) children with penopubic epispadias. Postoperative cystoscopy done 12 weeks after repair revealed a smooth urethral tube in 81.39% (35/43) of children. With the patient in a standing position, the penis was dangling downward or in a horizontal position in 88.37% (38) of children, 85% of the patients ≥18 years of age were satisfied with both the functional and cosmetic outcome, as assessed by short form 36 and 93.02% (40/43) of the patients were continent during the daytime with voided volumes of more than 200 ml. Conclusion: In our experience, Cantwell-Ransley repair creates a functionally and cosmetically acceptable penis and produces a reliably tubularized neourethra with acceptable complication rates.

Scrotoschisis: A rare cause of acute scrotum in neonates.

Spontaneous extrusion of the testis from the scrotum is a very rare cause of acute scrotum in neonates. It has been described as scrotoschisis in few case reports. The exact etiology of this condition is not known. Replacing the testes and repair of scrotum is needed and associated with good prognosis. We report two cases that presented in a short interval to us with a review of the literature.

A rare case of pediatric gastrointestinal stromal tumor arising from ileum

Malignant tumors arising from ileum are very rare in pediatric age group. Non-Hodgkins lymphoma is the most common tumor. Gastrointestinal stromal tumors belong to a group of cancers called soft tissue sarcomas seen in adults are being reported even in pediatric age group. We report a rare occurrence of CD 117 marker positive Ileal tumor in a 2 year male child presenting with Abdominal mass associated with malnutrition and anemia.

Congenital urethrocutaneous fistula: A rare isolated lesion

Urethrocutaneous fistula (UCF) are common after hypospadias repair, but occurrence of congenital UCF without hypospadias is extremely rare and only about 35 cases are reported in the literature. The etiology is not established yet. We report a rare case of isolated congenital UCF in 1 year child managed by Snodgrass technique and review of literature regarding the etiology and management.

Lower facial cleft: A rare cleft associated with foregut duplication cyst

Facial clefts are very common facial anomalies encountered in practice. However, lower facial clefts are very rare. Tessier has grouped these defects as cleft no. 30. Only 65 cases have been reported in the literature until 1996. Median cleft of the lower lip, mandible and bifid tongue with ankyloglossia has been reported in this anomaly. We report this rare cleft associated with bifid tongue with foregut duplication cyst over the floor of mouth.

Role of laparoscopy in the management of intussusceptions in children

Aim: To evaluate the role and efficacy of laparoscopic reduction of intussusceptions in children with failed initial hydrostatic reductions. Materials and Methods: This is a retrospective study of children who underwent laparoscopy for incomplete reductions following sonoguided hydrostatic reduction.Laparoscopy guided pneumatic reduction or laparoscopic reduction was done. Results: Hydrostatic reduction was successful in 76 (73.5%) of cases. Among 26 children in Laparoscopy group 8 showed completeness of reduction. Features of necrotic bowel were seen in 4 (15%) children requiring laparotomy. Among 14 children with incomplete reduction 3 (21%) children required pneumatic reduction under laparoscopic monitoring. 11 required laparoscopic reduction. None of the incomplete group with viable bowel required conversion to open surgery. No major complications were noted in any groups. The mean hospital stay was 1.8 days in hydrostatic group 4.2 days in laparoscopic group and 6.8 days in laparotomy group. No recurrence of intussusceptions noted. Conclusions: The role of laparoscopy in intussusceptions is evolving as a safe procedure and helps in avoiding laparotomy in large number of children with incomplete reduction. Non operative reduction is the gold standard in management of intussusceptions in children. Excellent results are obtained with either saline or pneumatic reductions. However, in few cases of, incomplete reduction or doubtful complete reduction with non operative technique poses problem for further management and may need laparotomy. Laparoscopy being less invasive has distinct advantage over open laparotomy. Use of Laparoscopy in the management of Intussusceptions is described in literature. We have analyzed our results of laparoscopic management of intussusceptions in children in our center.