Year : 2012 | Volume
: 17 | Issue : 1 | Page : 43--44
Akshay Kumar Saxena
Associate Professor, Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigrah-160012, India
Akshay Kumar Saxena
Associate Professor, Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigrah-160012
|How to cite this article:|
Saxena AK. Author's reply.J Indian Assoc Pediatr Surg 2012;17:43-44
|How to cite this URL:|
Saxena AK. Author's reply. J Indian Assoc Pediatr Surg [serial online] 2012 [cited 2020 Apr 7 ];17:43-44
Available from: http://www.jiaps.com/text.asp?2012/17/1/43/91090
We thank Dr. Pandey and colleagues for their interest in our article.  They correctly mention that plain radiographs are not the confirmatory diagnostic radiological modality in several surgical conditions mentioned in the article. However, we wish to clarify that we also have referred to the plain radiographs as the "initial" radiological modality in the introduction of our article. The intent of the article was to sensitize the readers regarding the possibility of sigmoid colon in children occupying right iliac fossa to avoid misinterpretation. For example, in a clinically suspected case of Hirschsprung's disease, misinterpretation of sigmoid colon as cecum or ileum can lead to a barium meal follow through study. Not only such a study will be non diagnostic, it is also likely to result in persistence of barium in small and large bowel for next few days. Persistence of barium in small and large bowel will, in turn, result in postponement of barium enema study which will cause further delay in ascertaining the diagnosis.
Accidental puncture of sigmoid colon during cecostomy procedures is not yet reported. However, given the significant prevalence of sigmoid colon occupying right iliac fossa, we believe that this can be a potential complication for cecostomy procedures. Furthermore, non reporting of such a complication in the published literature cannot be equated with non-occurrence in clinical practice. Apart from actual non occurrence of this complication, the other possible reasons include inability of the radiologist to compile data and/or write it for possible publication as also the un-willingness/inability of the journals to publish this. While Dr. Pandey and colleagues have suggested a long prospective study to ascertain the risk of this complication, we believe that a retrospective multi institutional study can be a better alternative. Electronic surveys are particularly useful in collecting and analyzing such data.
We agree with Dr. Pandey and colleagues that our data cannot be extrapolated to general population and the same was mentioned as the limitation of our study.  We recommend future studies involving evaluation of abdominal computed tomography and magnetic resonance imaging scans in patients not suspected of large bowel disease to ascertain whether redundancy of sigmoid colon secondary to large bowel disease can be the cause of sigmoid colon occupying right iliac fossa in children.
|1||axena AK, Sodhi KS, Tirumani S, Mumtaz HA, Rao KL, Khandelwal N. Position of a sigmoid colon in right iliac fossa in children: A retrospective study. J Indian Assoc Pediatr Surg 2011; 16:93-6.|