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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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   2008| January-March  | Volume 13 | Issue 1  
    Online since August 19, 2008

 
 
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CASE REPORTS
Congenital paraesophageal hiatus hernia with gastric volvulus
Ashok Y Kshirsagar, SL Shinde, MD Ahire, YB Langade
January-March 2008, 13(1):36-37
DOI:10.4103/0971-9261.42574  PMID:20177487
Paraesophageal hiatus hernia is rarely seen in the neonatal period. An intrathoracic gastric volvulus complicating such a hernia is rarer. The upper gastrointestinal tract contrast study is diagnostic. Rapid diagnosis and treatment is essential. It avoids lethal complications as gastric dilatation, gangrene and perforation, which in turn may lead to cardiopulmonary arrest.
  4 2,906 211
Fetus in fetu: A report of two cases
Ibrahim Karaman, Derya Erdogan, Semire Ozalevli, Ayse Karaman, Y Hakan Cavusoglu, M Kemal Aslan, Ozden Cakmak
January-March 2008, 13(1):30-32
DOI:10.4103/0971-9261.42572  PMID:20177485
Fetus in fetu is a rare condition that has been defined as the presence of one of the twins in the body of the other. It is most frequently located in retroperitoneal area; however, it has been reported in other locations as well. This report presents two cases of "fetus in fetu" cases: one located in the retroperitoneal area and the other in the sacrococcygeal area.
  3 3,793 244
ORIGINAL ARTICLES
Effect of submucosal alcohol injection on prolonged rectal prolapse in infants and children
Ali Bahador, Hamid Reza Foroutan, Seyed Mohammad Vahid Hosseini, Sam Zeraatian Nejad Davani
January-March 2008, 13(1):11-13
DOI:10.4103/0971-9261.42566  PMID:20177479
Aim: Our aim in this study is to evaluate the effect of ethanol as a sclerosing agent on subset of pediatric patients with prolonged rectal prolapse. Materials and Methods: From 1997 to 2003, 165 cases of primary rectal prolapse were treated by submucosal injection of ethyl alcohol (96%) after 8 weeks of conservative therapy. Around 1.5-2 ml of alcohol was linearly injected in three sites (two laterals and one posterior). Results: Twelve of the 165 cases lost the follow-up and 153 cases were followed from 9 months to 6 years. One hundred and six patients (69.3%) had a duration of prolapse for 3-7 months. Forty patients (26.1%) had prolapse for more than 7 months and seven patients had prolapse for more than 1 year. One hundred and forty-seven out of 153 (96%) patients responded to single injection. Three of the children required a second injection. Three patients with age of more than 13 did not respond to the treatment. Twenty five cases had fecal soilage for few days. No infectious complication and no recurrence were observed. Conclusion: We concluded that 4-6 ml of ethyl alcohol (96%) is effective for the treatment of rectal prolapse. The duration of rectal prolapse had no deleterious effect on treatment; however, patients with age more than 13 years did not respond to sclerosing agent, probably due to different etiology.
  3 3,352 249
CASE REPORTS
Antenatally diagnosed ovarian cyst with torsion managed laparoscopically
AK Singal, KG Vignesh, Sarah Paul, John Matthai
January-March 2008, 13(1):28-29
DOI:10.4103/0971-9261.42571  PMID:20177484
Ovarian cyst are the most common intra-abdominal cyst in female neonate. With the help of ultrasound one can make an antenatal diagnosis. We present one such neonate, she was managed by laparoscopic excision. We conclude that neonatal laparoscopy is technically feasible for management of such cysts.
  2 2,956 221
ORIGINAL ARTICLES
Posterior sagittal approach in complicated Swenson's pull-through
OA Sowande, O Adejuyigbe
January-March 2008, 13(1):14-17
DOI:10.4103/0971-9261.42567  PMID:20177480
Context: Swenson's pull-through is one of the standard operations for the treatment of children with Hirschsprung's disease. Complications arising from the operation are difficult to treat because of fibrosis in the pelvis. The posterior sagittal approach may be a safer alternative. Aims: The aim of this paper is to highlight our experience with the use of the posterior sagittal trans-sphincteric approach to treat unusual complications of Swenson's pull-through. Settings and Design: A retrospective study of four patients who had posterior sagittal repair of their complications of Swenson pull-through at the Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria. Materials and Methods: Four cases of Hirschsprung's disease that developed post-Swenson pull-through complications are presented. There were three males and one female. Their age ranged between 10 months and 15 years. The patients had rectovaginal fistula, rectourethral fistula, high trans-sphincteric fistula-in-ano and complete anastomotic disruption. Result: All the patients were successfully treated using the posterior sagittal approach. The approach was used twice in one patient without significant sequelae. The three patients were old enough to be assessed and had a Kelly score of 4-6 at follow-up. Conclusion: The posterior sagittal technique offers a safe approach to treat the complications of Swenson pull-through.
  2 3,357 249
Diaphragmatic crural eventration
K Sivakumar
January-March 2008, 13(1):18-21
DOI:10.4103/0971-9261.42568  PMID:20177481
Aim: We evaluated patients with gastric volvulus secondary to diaphragmatic pathology. Materials and Methods: Eight patients (5 males and 3 females) presented to the author in a tertiary care center during 1997-2006 were analyzed in terms of age, sex, symptomatology, diagnosis and predisposing factors. Observations: Six had an acute presentation and rest had chronic symptomatology. The two patients who had total gangrene stomach died postoperatively and one patient died preoperatively due to aspiration. All the cases presented with acute symptoms had diaphragmatic pathology, and out of these, three cases had the specific entity, which is named as diaphragmatic crural eventration. Conclusions: Diaphragmatic crural eventration is characterized by the defective development of the right crus of diaphragm, and this is embryologically significant as the right crus and ligaments of the stomach develop from dorsal mesoesophagus and mesogastrium. The author recommends a closer look for this defect of diaphragm while operating a case of gastric volvulus.
  1 3,586 239
CASE REPORTS
Penetrating abdominal injury and peritonitis: A rare case of birth Injury
Shreeprasad P Patankar, Shilpa S Patankar
January-March 2008, 13(1):22-24
DOI:10.4103/0971-9261.42569  PMID:20177482
The incidence of birth injuries has decreased considerably because of the identification of risk factors at an earlier stage and taking the decision for caesarian section (LSCS) at proper time. Fractures, nerve palsies and central nervous system injuries comprise the majority of "birth injuries." In this study, we report a newborn that had a birth injury during LSCS. The baby sustained a penetrating abdominal injury by the knife of the surgeon, while performing LSCS. The bowel was injured at two sites, proximal jejunum and descending colon. The baby developed meconeum spillage and peritonitis. Exploratory laprotomy was done and the injuries were identified. The injured portions were resected and bowel continuity was reestablished. The baby had an uneventful recovery.
  - 3,764 210
Infantile epididymitis with calcification
Katsumi Muramori, Koji Nagata, Noritoshi Handa
January-March 2008, 13(1):25-27
DOI:10.4103/0971-9261.42570  PMID:20177483
A 1-month-old infant presented with a case of calcifying chronic epididymitis. Differential diagnosis was made from a testicular torsion and neoplasm. Serial ultrasound examination revealed a calcified lesion adjacent to the normal testis, thereby avoiding an unnecessary orchiectomy. Infantile epididymitis has been thought to be rare; however, it is occasionally encountered in the literature and calcification with chronic epididymitis in an infant has not been previously reported. On the other hand, an infant with scrotal calcification should be suspected of neoplasm. However, the tumor markers a-fetoprotein (AFP) and Human Chorionic Gonadotropin β (HCG β ) were within the physiological range. Therefore, a diagnosis must be carefully made to avoid an unnecessary orchiectomy.
  - 3,422 247
Persistently erected penis in a child for 6 months: A management dilemma
Sukanta Das, Dipak Ghosh, Akhilesh Agarwal, Suranjan Haldar
January-March 2008, 13(1):33-35
DOI:10.4103/0971-9261.42573  PMID:20177486
Priapism is the presence of a persistent, usually painful, erection of the penis unrelated to sexual stimulation or desire. It is a true emergency requiring urgent intervention. Priapism is frequently idiopathic in etiology, but it is associated with a number of important medical conditions and pharmacologic agents. Cases have been reported in world literature on children having priapism, the etiology of these cases are mostly hematological. Our case is a child having persistently erected penis for more than 6 months. Despite a thorough search, no report of similar case could be found in world literature.
  - 6,279 402
Terminal ileal trichophytobezoar with perforation: A rare presentation with review
Ronald Scorpio, Devesh Sharma
January-March 2008, 13(1):38-40
DOI:10.4103/0971-9261.42575  PMID:20177488
Trichophytobezoars are uncommon foreign bodies, formed by hairs and vegetable matter with impacted food particles. We report an unusual case of a 5-year-old girl with large terminal ileal trichophytobezoar causing perforation peritonitis.
  - 3,724 186
EDITORIAL
Enhancing the stature of JIAPS: Our immediate plans
KL Narasimhan
January-March 2008, 13(1):1-1
DOI:10.4103/0971-9261.42563  PMID:20177476
  - 1,893 166
ORIGINAL ARTICLES
Esophageal atresia: Factors influencing survival - Experience at an Indian tertiary centre
RK Tandon, Satendra Sharma, Shandip K Sinha, Kumar Abdul Rashid, Ravi Dube, SN Kureel, Ashish Wakhlu, JD Rawat
January-March 2008, 13(1):2-6
DOI:10.4103/0971-9261.42564  PMID:20177477
Objective: To study the clinical profile of the cases of esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) and various factors affecting the surgical and early postoperative management and their outcome. Materials and Methods: A prospective analysis of 127 cases of EA from February 2004 to May 2006 was performed. Waterston prognostic criteria were used for grading. Results: EA with TEF was the commonest type in 117 cases (92%). Associated congenital anomalies were present in 52 (41%) patients, the commonest being the cardiac anomalies, which was followed by the gastrointestinal anomalies. VACTERL was found in 6 (5%) cases. Prematurity, associated congenital anomalies, gap between esophageal ends and preoperative respiratory status were the significant factors affecting the survival ( P = < 0.001). Primary extrapleural repair was the surgical approach in most of the patients. Azygos vein was preserved in 46 cases and no retropleural drainage was used in 27 cases. Staged procedures were performed in 19 cases, including 6 cases of isolated esophageal atresia. Pneumonitis and sepsis were the most common early postoperative complications (42%). Hypoxia and cardiorespiratory arrest were the most common causes of mortality (11 cases). Anastomotic leak complicated 13 cases, including 9 major and 4 minor leaks. Major leak followed by sepsis caused 7 deaths. Survival as per Waterston criteria was 100% in group A, 83% in group B and 22% in group C. Conclusion Factors affecting the survival are major or life-threatening associated anomalies, long gap, pneumonia and sepsis at presentation or that acquired during hospitalization and major leaks. The high incidence of low birth weight, delayed diagnosis, poor referral, low-socio economic status and lack of advanced neonatological back up are important contributory factors to poor outcome.
  - 5,504 448
The role of gastrostomy in the staged operation of esophageal atresia
Seyed Mohammad Vahid Hosseini, Sam Zeraatian Nejad Davani, Babak Sabet, Hamid Reza Forutan, Maryam Sharifian
January-March 2008, 13(1):7-10
DOI:10.4103/0971-9261.42565  PMID:20177478
Introduction: The aim of this study is to recommend criteria for selection of patients who benefited from the use of gastrostomy rather than emergency fistula closure during the staged operation of esophageal atresia (EA). Materials and Methods: Between August 2004 and July 2006, 75 cases of EA, were consecutively operated. Nineteen out of 75 (25%) underwent routine gastrostomy because they required a type of staged operation: Group I: Five cases with pure atresia had gastrostomy and esophagostomy; Group II: Six with severe pneumonia and congenital heart disease (Waterson class C) had gastrostomy and conservative management; Group III: Eight with long gap EA (2-4 vertebras); four out of 8 cases underwent primary anastomosis with tension and the other four had delayed primary anastomosis plus primary gastrostomy. Results: GI: Only three cases survived after esophageal substitution; GII: Three out of six cases with severe pneumonia (fistula size: f > 2.5 mm) underwent emergency fistula closure with only one survival, but all (f < 2.5 mm) recovered without complication, GIII: Four patients with long gap and primary anastomosis with tension developed anastomotic leakage; they required gastrostomy following the leakage, except for those with delayed primary anastomosis, and all of them recovered without early complications. Conclusion : All the cases with long gap, although two esophageal ends can be reached with tension, should undergo delayed primary closure with primary gastrostomy. Those were brought with Waterson class C and the fistula size greater than 2.5 mm should undergo emergency fistula closure; however, if fistula size was less than 2.5 mm, it is better to be delayed by primary gastrostomy for stabilization. In this study, we had a better outcome with gastric tube for substitution than colon interposition in infants.
  - 3,950 310
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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

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