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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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   2010| July-September  | Volume 15 | Issue 3  
    Online since October 18, 2010

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Popliteal pterygium syndrome
Santosh Kumar Mahalik, Prema Menon
July-September 2010, 15(3):110-111
DOI:10.4103/0971-9261.71747  PMID:21124670
  8,209 149 1
Posterior urethral valves: Morphological normalization of posterior urethra after fulguration is a significant factor in prognosis
Prema Menon, K. L. N. Rao, S Vijaymahantesh, RP Kanojia, R Samujh, YK Batra, KS Sodhi, AK Saxena, A Bhattacharya, BR Mittal
July-September 2010, 15(3):80-86
DOI:10.4103/0971-9261.71744  PMID:21124660
Aim: To assess the changes in urethral morphology 3 months post fulguration of posterior urethral valves (PUVs) on micturating cystourethrogram (MCUG) and correlate these changes with the overall clinical status of the patient. Materials and Methods: A total of 217 children, managed for PUVs during a period of 6 years in a single surgical unit were prospectively studied. The ratio of the diameters of the prostatic and bulbar urethras (PU/BU) was calculated on the pre- and post-fulguration MCUG films. They were categorized into three groups based on the degree of normalization of posterior urethra (post-fulguration PU/BU ratio). Results: Group A: Of the 133 patients, 131 had normal urinary stream and 4 (3%) had nocturnal enuresis. Vesicoureteral reflux (VUR), initially seen in 83 units (31% units), regressed completely at a mean duration of 6 months in 41 units (49%). Of the 152 non-VUR, hydroureteronephrosis (HUN) units, 11 were poorly functioning kidneys. Persistent slow but unobstructed drainage was seen in 23 units (16%) over a period of 1.5-5 years (mean 2.5 years). Group B: All the 11 patients had a normal stream. Four (36.4%) had daytime frequency for a mean duration of 1 year and one (9%) had nocturnal enuresis for 1 year. Grade IV-V VUR was seen in five patients (three bilateral), which regressed completely by 3 months in five units (62.5%). In the non-VUR, HUN patients, slow (but unobstructed) drainage was persistent in two units (14%) at 3 years. Group C: Of the 16 patients, only 5 (31.3%) were asymptomatic. Six patients (nine units) had persistent VUR for 6 months to 3 years. Of the 20 units with HUN, 17 (85%) were persistent at 1-4 years (mean 2 years). Eight patients (50%) required a second fulguration while 3 (18.7%) required urethral dilatation for stricture following which all parameters improved. Conclusions: Adequacy of fulguration should be assessed by a properly performed MCUG. A postop PU/BU ratio >3 SD (1.92) should alert to an incomplete fulguration or stricture. Patients within normal range ratio have faster recovery of slow draining units, reflux and less voiding dysfunction. There is a strong correlation between incomplete fulguration and persistent slow draining units, uremia, voiding dysfunction and urinary tract infections.
  6,711 318 9
Pyloric and antral strictures following corrosive acid ingestion: A report of four cases
Ram Mohan Shukla, Madhumita Mukhopadhyay, BB Tripathy, KC Mandal, B Mukhopadhyay
July-September 2010, 15(3):108-109
DOI:10.4103/0971-9261.71749  PMID:21124669
This study reports four children who developed complete stricture of pylorus and antrum of the stomach following accidental ingestion of corrosive agent (toilet cleaner).
  5,582 153 4
Neonatal intestinal obstruction due to double jejunal web causing Windsock deformity
Aejaz A Baba, Altaf H Shera, Afak Y Sherwani, Iftikar H Bakshi
July-September 2010, 15(3):106-107
DOI:10.4103/0971-9261.71751  PMID:21124668
Windsock deformity (WD) is a rare anomaly. A case of double jejunal web with WD causing neonatal intestinal obstruction is being reported.
  5,202 131 2
Cancellation of elective cases in pediatric surgery: An audit
Sapna Bathla, Anup Mohta, Aikta Gupta, Geeta Kamal
July-September 2010, 15(3):90-92
DOI:10.4103/0971-9261.71748  PMID:21124662
Aim: To determine the main reasons for cancellation of elective cases on scheduled date of surgery in pediatric patients. Materials and Methods: The audit was conducted in a 216 beds tertiary care pediatric super-specialty hospital. Two operation theatres (OT) provide elective surgical services to pediatric surgery, orthopedics, ophthalmology and otorhinolaryngology. The audit included all those patients who were posted for elective surgery over a period of one year. Cancelled cases were identified from predesigned OT utilization formats and the reasons for cancellation were evaluated. Results: A total of 2473 cases were posted for the elective surgery in the year 2009 and 189 (7.64%) patients had their surgery cancelled. The main reasons for cancellation were upper respiratory infections (30.68%) and shortage of time (29%). Other reasons were medically unfit patients (15.34%), precedence of emergency cases (3.7%); non-availability of ventilator and intensive care bed (4.7%); no-show by patient (4.76%); non-availability of blood (4.2%); incomplete work up (2.64%); administrative reasons (1.58%); patient not fasting (1.58%) and unspecified reasons (2.1%). Overall, 38.6% causes were preventable. Conclusions: Elective surgery cancellation is a significant problem with multifactorial etiology. Most common reasons for cancellation of planned surgery were sudden onset of respiratory tract infection in the admitted patient and shortage of time. It suggests that on many occasions, surgeons take more time than anticipated for performing the procedure.
  4,575 202 8
Small bowel hemangiomas: Diagnostic role of capsule endoscopy
Sanat Khanna, Ravi P Kanojia, Prema Menon, Surinder Rana, BR Thapa, DK Bhasin, K. L. N. Rao
July-September 2010, 15(3):101-103
DOI:10.4103/0971-9261.71755  PMID:21124666
Vascular anomalies involving the small bowel are an uncommon cause of gastrointestinal bleeding in childhood. We present here an 11-year-old boy who presented with severe anemia and malena. The routine investigations did not reveal any pathology. A capsule endoscopy study was performed, which clinched the diagnosis and identified two intestinal hemangiomas. The hemangiomas were resected and the child recovered.
  4,643 128 -
Hemostasis during hypospadias surgery via topical application of feracrylum citrate: A randomized prospective study
Brijesh K Lahoti, Gaurav Aggarwal, Arvind Diwaker, Shashi S Sharma, Ashok Laddha
July-September 2010, 15(3):87-89
DOI:10.4103/0971-9261.71746  PMID:21124661
Aim: Report of our experience with topical feracrylum citrate to minimize hemorrhage-related complications in pediatric hypospadiac patients. Materials and Methods : One hundred and fifty consecutive pediatric hypospadiac patients over 3 years (75 in study group and 75 controls - random allocation) were studied. One hundred milliliter of 1% feracrylum citrate solution was used in study cases and equivalent normal saline in controls. The parameters assessed were frequency of cauterizations, intraoperative blood loss, wound edema and postoperative complications. Results: Average number of cauterizations was 1.55 per patient in study group and 5.7 per patient among controls. Among cases, average number of blood soaked gauge pieces was 3.56 per patient, correlating with average intraoperative blood loss of 17.8 ml. In controls, average blood soaked gauge pieces were 6.2 per patient corresponding to an average blood loss of 31 ml. Postoperative hematoma was seen in 8% cases compared with 18% controls. Wound edema appeared in 13.3% cases and 47% controls. Postoperative complications were higher among controls. Conclusions: Feracrylum is an effective and safe topical hemostatic agent to minimize significantly diffuse capillary oozing and surface bleeding. It reduced the frequency of cauterization and tissue damage, intraoperative blood loss, postoperative hematoma, wound edema and postoperative complications.
  4,076 192 2
Congenital segmental dilatation of jejunoileal region in a newborn: Unusual clinical and radiologic presentation
MM Harjai, A Katiyar, V Negi, D Yadav, M Sharma
July-September 2010, 15(3):96-97
DOI:10.4103/0971-9261.71752  PMID:21124664
Segmental dilatation of the ileum is one of the uncommon causes of intestinal obstruction in neonates. We present a case of slow transit of bowel contents leading to suspicion of functional bowel obstruction in a new born, which on exploration turned out to be a case of segmental dilatation of the jejuno-ileal region. The clinical and radiological evaluation was suggestive of hypomotility disorder of gut, resulting in diagnostic dilemma and delayed surgical intervention.
  4,071 114 1
Intestinal mucormycosis in a neonate: A case report and review
Yogesh Kumar Sarin
July-September 2010, 15(3):98-100
DOI:10.4103/0971-9261.71753  PMID:21124665
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.
  3,822 152 2
Modified port placement and pedicle first approach for laparoscopic concomitant cholecystectomy and splenectomy in children
Kamalesh Pal
July-September 2010, 15(3):93-95
DOI:10.4103/0971-9261.71750  PMID:21124663
Aim : Laparoscopy is becoming the preferred modality for concomitant cholecystectomy and splenectomy (CAS). Usually, six to seven ports are employed for CAS, and spleen is removed by classical lateral approach or anterior approach. We report here our modified five-port and pedicle first approach for CAS in children to minimize the intraoperative bleeding and maximize the access. Materials and Methods : Twenty-one children underwent laparoscopic CAS with this new approach and their data were recorded prospectively. Following cholecystectomy (with ports 1-4), left side was elevated by 30°. The spleen was lifted by a grasper/fan retractor through port no. 5. The pedicle was dissected and splenic vessels were divided by ligasure (vessels < 8 mm), and for bulkier pedicle, vascular endo-GIA stapler was used. Short gastric and gastrosplenic ligament, lower pole and phrenico-colic attachments and upper pole attachments were dissected by ligasure in that sequence. Spleen was placed in endosac and delivered by digital fracture technique. Occasionally, lower transverse incision was made to deliver a massive spleen. Results : There were 12 males and 9 females with an average age of 8 years. Fourteen had sickle cell disease (SCD) and 7 had SCD and beta thalassemia. All CAS were completed successfully without any complication. Total duration was 160 minutes. Cholecystectomy took an average of 35 minutes. Average blood loss was 140 ml. The mean splenic weight was 900 g and mean length was 20 cm. Duration of hospitalization was 3-4 days. Conclusion : CAS can be successfully performed by five ports. The pedicle first approach is extremely helpful in moderate to massive spleens as it reduces splenic size, vascularity and bleeding from capsular adhesions or inadvertant lacerations.
  3,734 149 1
Bowel conservation in a case of giant jejuno-ileal duplication
Minakshi Sham, Dileep Phadke, Dasmit Singh
July-September 2010, 15(3):104-105
DOI:10.4103/0971-9261.71754  PMID:21124667
The management of very long tubular bowel duplications poses a special challenge to even the most skilled surgeon. In these cases, mucosal stripping is usually employed. We report a novel case of a two-year-old boy, with 120 cm long jejuno-ileal duplication, wherein, bowel salvage was achieved, utilizing the Bianchi principle, originally described for bowel lengthening in cases of short bowel syndrome.
  3,723 109 1
Posterior urethral valves: Should we have objective criteria on the adequacy of fulguration?
K. L. N. Rao
July-September 2010, 15(3):79-79
DOI:10.4103/0971-9261.71742  PMID:21124659
  2,789 223 1
Obstetrical fractures of the femur in developing countries: Predisposing factors and therapeutic approach
Gabriel Ngom, Mbaye Fall, Issa Amadou, Désiré Alumeti Munyali
July-September 2010, 15(3):112-112
DOI:10.4103/0971-9261.71743  PMID:21124671
  2,825 110 -
Embryogenesis of esophageal atresia: Is localized vascular accident a factor?
Ralf-Bodo Tröbs, Ingo Stricker
July-September 2010, 15(3):112-113
DOI:10.4103/0971-9261.71745  PMID:21124672
  1,286 68 -
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