Yogesh Kumar Sarin

Intestinal mucormycosis in a neonate: A case report and review

Mucormycosis is a fungal disease that may rarely invade the gastrointestinal tract of newborn, resulting in high morbidity and mortality. Clinically, it may be indistinguishable from the neonatal necrotizing enterocolitis and the diagnosis is usually made on autopsy or histopathology of excised surgical specimen. We report a neonatal survivor of the illness.

Mediastinal enteric duplication cyst containing aberrant pancreas

Objective : The purpose of the study is to report a unique association of clinical and pathological findings in a neonate. Foregut enteric duplication cysts-rare developmental anomalies that are associated with midline vertebral fusion anomalies.Methods : We had a neonate with foregut duplication cyst who presented at birth with respiratory distress. The child also had associated communicating hydrocephalus. The patient underwent excision of the duplication cyst alongwith a ventriculo-peritoneal shunt.Result : The excised specimen revealed a duplication cyst lined by aberrant pancreatic tissue.Conclusion : The present case demonstrates histologically the presence of both pancreatic and gastric tissue.

Congenital duodenal obstruction due to a preduodenal portal vein

Only about 80 cases of pre-duodenal protal vein (PDPV), a rare congenital anomaly of portal vein development that was first described by Knight in 1921, have been reported till date. We report a neonate with duodenal obstruction caused by PDPV and briefly review the available literature.

Congenital pouch colon in female subjects

Over a period of 5-year (May 2000 to April 2005) 29 patients of congenital pouch colon (CPC) were managed by single pediatric surgeon in the Department of Pediatric Surgery of a tertiary hospital. Of these, 11 were girls (M: F: 1.6:1). Detailed anatomy could be studied in nine patients, were included in this study. Age of presentation in female subjects ranged 1 day to 8 years. On examination, eight of the nine patients had single perineal opening suggesting a very high incidence of association of cloaca in female subjects with CPC. Four had short urogenital sinus with colonic pouch opening in the posterior wall of urinary bladder. In other two patients, CPC terminated in short cloaca. Anomalies of mullerian structures such as uterus didelphus and septate vagina ware commonly encountered. Proximal diversion with or without pouch excision was done as the initial preliminary treatment for all those patients who presented in early life. Of the nine girls, two died after the preliminary surgery. Only five patients have undergone definitive surgery. Definitive surgery included abdomino-perineal pull-through of proximal normal colon ( n =2), tubularization of pouch with abdomino- posterior sagittal- pull through ( n =2) and abdomino-posterior sagittal urethra-vaginoanorectoplasty with pull through of tapered pouch colon in one patient. Two of these patients had concomitant bowel vaginoplasty. Three patients with tubularized pouches had constipation and spurious diarrhea. However, good pseudo-continence of bowel was achieved on regular bowel washes. The cosmetic appearance of perineum in all these three patients was acceptable. The patients in whom pouch excision was done had diarrhea and severe perineal excoriation resistant to conservative management.

Bowel vaginoplasty in children

OBJECTIVES: To describe our experience with bowel vaginoplasty done in children. MATERIALS AND METHODS: This is a retrospective study of eight children aged 10 months to 8 years, who underwent bowel vaginoplasty over a period of 5 years (2000-2005). The indications of bowel vaginoplasty included anorectovestibular fistula (ARVF) associated with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome (n=6) and cloaca (n=2). The bowel segment used for vaginoplasty included colon (n=3), ileum (n=2) and duplicated rectum (n=1). In two patients of ARVF associated with uterovaginal agenesis, the distal- most part of ARVF was transected at the level of peritoneal reflection and left as neovagina, whereas the proximal bowel was pulled through at the proposed neo-anal site. All the patients were advised daily home dilatation of the neo vaginal orifice with Hegars dilators, for a period of six weeks. RESULTS: Bowel vaginoplasty was done in eight patients. None had any significant per-operative complication. Two patients had abdominal wound dehiscence, requiring secondary suturing. Two patients had mucosal prolapse of the neovagina, which required trimming. One patient died two months after discharge, because of meningitis. Out of the eight patients, seven are in regular follow-up. Six patients have neovagina, cosmetically acceptable to the parents; all have been radiologically proven to have adequate length. One patient had unacceptable perineal appearance with nipple-like vaginal orifice and scarred perineal wound, that merits a revision. None of the patients had vaginal stenosis and excessive mucus discharge, during follow-up visits. Although post surgical results are acceptable to the parents cosmetically, the sexual and psychological outcome is yet to be assessed. Conclusions: Bowel vaginoplasty is a safe and acceptable procedure to treat the pediatric patients of uterovaginal agenesis and cloaca.

Superior vesical fissure associated with urethral duplication in a male neonate

Abstract The authors report an unusual variant of bladder exstrophy in a baby boy—superior vesical fissure associated with a partial sagittal duplication of the urethra.

Scope and limitations of minimal invasive surgery in practice of pediatric surgical oncology

Management of Solid tumors in children needs a comprehensive multimodality protocol based treatment plan. Open surgical removal of the tumors occurring in any of the sites such as abdomen, thorax, chest wall, HFN (head, face, neck), brain and extremities, is the option which has been traditionally practiced even in the present era and in most of the centers. Nevertheless with the advances in science and technology and with ever increasing usage and expertise of laparoscopy in children, it’s application has extended to treatment of solid tumors in children. A review of the scope of such intervention as well as the limitations of minimal invasive surgery in this specialized field of pediatric surgery has been attempted in this article.

Heterotopic pancreas causing duodenal obstruction in a patient previously treated for choledochal cyst

A 9-year-old boy presented with duodenal pancreatic rest causing obstruction and required surgical intervention. He had been treated at the age of 4 months for a choledochal cyst. Both choledochal cyst and heterotopic pancreas are entities that are commonly encountered in children, but the incidental presence of both the entities in the same child, albeit presenting metachronously, is extremely rare.

Wilms’ Tumor- Roadmaps of Management

The management of Wilms’ tumor emerging of the outstanding clinical trials undertaken in the developed world in the last four decades has led to excellent longterm outcomes. The scenario in developing country like India is different; late presentation with massive tumors and advanced stage, lacunae in staging, nonavailability of pediatric medical oncologists and poor follow-ups are common. A comprehensive summary of available therapeutic modalities is provided here along with clear roadmaps of management of Wilms’ tumor as per Société Internationale d’Oncologie Pédiatrique (SIOP) and National Wilms’ Tumor Study Group/Children’s Oncology Group (NWTSG/COG) protocols in simple tabulated form.

Pediatric surgical training in India: Proposal of a new scheme

Training in pediatric surgery is a constant source of concern and debate. It is notoriously dissimilar not only between countries 5, 8] but also within the same country. 9, 10] The need for a better system of pediatric surgical training (PST) has been long felt in India. 11-13] The suggestions range from minor issues like staff pattern, uniformity in teaching and library facilities 13, 14] to radical change in the policy of training. 15]