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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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   2018| April-June  | Volume 23 | Issue 2  
    Online since March 29, 2018

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Laparoscopic ladd's procedure in children: challenges, results, and problems
A Suyodhan Reddy, Rasik S Shah, Dattaguru R Kulkarni
April-June 2018, 23(2):61-65
DOI:10.4103/jiaps.JIAPS_126_17  PMID:29681694
Background: Laparoscopic correction of malrotation in children is challenging. Authors review their experience with indications, results and problems of laparoscopic correction of malrotation. Materials and Methods: This is a retrospective study of 41 cases of children who were diagnosed as Intestinal malrotation on clinical and radiological evaluation. Results: Successful laparoscopic Ladd's procedure was accomplished in 35 cases. There were six conversions to open surgery. The mean hospital stay was 4 days (range 3-12days). Restoration of complete feed was achieved on an average of 3 days (range 2-4days). Post-operative recurrence of symptoms was seen in nine cases. Of which, five cases had incomplete correction, three cases had duodenal kinking due to adhesive intestinal obstruction and one had intra luminal duodenal obstruction. All patients underwent open surgery for recurrent symptoms. Conclusion: Laparoscopic Ladd's procedure is feasible in children with intestinal malrotation with or without associated volvulus. However, some of them need conversion to open surgery due to difficult local anatomy. For persistent symptoms, they may require redo surgery, which may be due to incomplete correction, adhesive obstruction or intraluminal obstruction.
  7,775 202 7
Anorectal malformations in adolescent females: A retrospective study
Jiledar Rawat, Sudhir Singh, Nitin Pant
April-June 2018, 23(2):57-60
DOI:10.4103/jiaps.JIAPS_125_17  PMID:29681693
Context: While most of the females with anorectal malformations (ARMs) present in either neonatal period or early infancy, a small percentage presents in their adolescence. Aim: The aim is to study the causes of delay in presentation, management, and postoperative outcome in these cases. Settings and Design: This is a retrospective observational study conducted in the Department of Paediatric Surgery, King George's Medical University, Lucknow. Subjects and Methods: Records of females with ARM managed in one unit of the department from 2010 to 2015 were scrutinized. Of these, record of females who primarily presented in adolescence was reviewed. Data regarding the demographics, clinicoradiological presentation, management, postoperative stay, and follow-up were analyzed. Causes for delay in presentation were looked for. Statistical Analysis Used: Statistical analysis used was not required. Results: Out of 627 cases of ARM managed over 5 years, ten girls (5.3%) presented between 12 and 18 years (average 14.4 years). Main reasons for the delay in presentation were misinformation, illiteracy, and poverty. These comprised of anovestibular fistula (n = 5), anterior ectopic anus (n = 3), perineal canal (n = 1), and rectovestibular fistula (n = 1). Three (30%) girls had no problem apart from an abnormal anal orifice. Five (50%) girls had constipation as a major additional symptom. Four cases had a normal to mildly enlarged rectum on contrast study, whereas the rectum was moderately to hugely dilated in the remaining six cases. Six cases were managed with posterior sagittal anorectoplasty while an anterior sagittal anorectoplasty was done in four. Minor wound dehiscence developed in two cases. There was no mortality. In a mean follow-up of 16 months (8–26), constipation and soiling were seen in 5 (50%) girls. The overall outcome in these girls was satisfactory. Conclusion: Presentation of females with ARM in adolescence is not uncommon in the third world. A primary pull through is possible in these girls with mild-to-moderate rectal dilatations. A diverting colostomy before pull through is always a safe option in cases with severely dilated rectum and also otherwise. Moreover, a greater awareness regarding these malformations in the general public is required.
  4,903 182 1
Penile dislocation with inversion: A rare complication of blunt pelvic injury
Ravindra Sahadev, Vinay Jadhav, Narendra Babu Munianjanappa, Gowri Shankar
April-June 2018, 23(2):90-92
DOI:10.4103/jiaps.JIAPS_71_17  PMID:29681700
Penile injuries in children are usually uncommon and are predominantly associated with pelvic trauma or as postcircumcision injuries. The authors present a rare case of penile dislocation with penile inversion in a 5-year-old child occurring due to blunt pelvic injury. The child presented 3 months after pelvic injury with a suprapubic catheter for urinary diversion and absent penis with only penile skin visible. The presence of dislocated penile body was detected on magnetic resonance imaging, which was subsequently confirmed intraoperatively. During the surgery, the dislocated penis was identified and mobilized into its normal anatomical position within the remnant penile skin. Very few cases of penile dislocation have been reported in the literature. Pubic fracture with pulling of suspensory ligament resulting in dislocation of the penis would have been the probable mechanism of injury.
  4,477 91 1
Ratio of preoperative and postoperative serum bilirubin levels predicts early outcome following biliary atresia surgery
Kashish Khanna, Veereshwar Bhatnagar, Sandeep Agarwala, Maddur Srinivas, Siddhartha Datta Gupta
April-June 2018, 23(2):81-86
DOI:10.4103/jiaps.JIAPS_192_17  PMID:29681698
Aim: This study investigates the fall in total serum bilirubin levels within 1 week after surgery, as a marker to predict early outcome in biliary atresia (BA) patients post-Kasai portoenterostomy (KP). Methods: The ratio of total serum bilirubin levels at the 7th postoperative day to the preoperative level (TB7/TB0) in patients undergoing KP was calculated (January 2011–July 2015). Patients were stratified after 3-months follow-up into outcome groups depending on the clinical clearance of jaundice and TB7/TB0 ratio was correlated to outcome and liver histopathological changes in these groups. Results: Sixty-one patients (M:F = 44:17), median age 75 days were included. At the end of 3 months, 27 (44.39%) were anicteric while 26 (42.6%) were still clinically jaundiced. Patients with a higher median value of TB7/TB0, that is, 0.856 were more likely to have jaundice at the end of 3 months as compared to patients with a lower median value of 0.615 (P < 0.0001). A cutoff TB7/TB0 ratio >0.723 predicted the KP outcome with 84.6% sensitivity and 81.5% specificity. The difference in TB7/TB0 ratio between patients with varying severity of liver histopathological changes was also significant, namely, cholestasis (P = 0.01), hepatocellular damage (P = 0.03), portal inflammation (P = 0.04), and portal fibrosis (P = 0.02). Conclusions: The rapidity of fall in the total serum bilirubin levels within 1 week post-KP was able to predict the likely outcome in BA patients.
  4,247 151 1
Bronchoscopic airway foreign body extraction without using optical forceps
Shalini Hegde, Umesh Bahadur, Ravi Prakash Kanojia, Monika Bawa, Ram Samujh
April-June 2018, 23(2):87-89
DOI:10.4103/jiaps.JIAPS_85_17  PMID:29681699
Aim: Airway foreign body (FB) is a very common pediatric surgical emergency. On certain difficult occasions, the extraction of FB with optical forceps (OFs) is difficult. These conditions create a life-threatening scenario. We present some of the alternative methods of FB extraction for these situations. Patients and Methods: This is a retrospective case review of patients presenting to pediatric emergency with airway FB. All patients had a chest X-ray done before the procedure. Rigid bronchoscopy was performed in all patients for retrieval. Results: A total of 20 patients (6 females) were successfully scoped. The age ranged from 1.5 years to 12 years (mean 3.5 years). Bronchoscopic removal was aided by dormia basket (DB) in 13, Fogarty's catheter (FC) in 6, and magnet aided removal in 1. Complete removal was achieved in all patients. Conclusions: We recommend that DB, FC, and a magnet should form an indispensable part of bronchoscopy set. The use of these alternative methods is successful and allows ventilation during the removal in contrast to removal by OFs. These should be kept as an option if retrieval is difficult.
  4,029 139 3
Kluth type iiib6esophageal atresia: Diagnostic dilemma and pitfalls of using infant feeding tube
Rahul Gupta, Pramila Sharma, Ram Babu Goyal
April-June 2018, 23(2):96-99
DOI:10.4103/jiaps.JIAPS_181_17  PMID:29681702
We describe three male neonates where infant feeding tube (IFT) passed 18–20 cm in the upper esophageal pouch. A blunt-tipped red rubber catheter confirmed esophageal atresia (EA) with long upper pouch in all three cases. Definitive management revealed EA with tracheoesophageal fistula and long overlapping upper esophageal pouch consistent with Kluth Type IIIb6variant in two patients. Importance of using red rubber catheter at the pediatric practice instead of IFT is stressed.
  3,857 101 3
Estimation of renal functional reserve in children with different grades of vesicoureteric reflux
Rafey Abdul Rahman, Veereshwar Bhatnagar, Sandeep Agarwala, Rakesh Kumar
April-June 2018, 23(2):74-80
DOI:10.4103/jiaps.JIAPS_213_17  PMID:29681697
Background: Vesicoureteric reflux (VUR) is one of the most common anomalies encountered in pediatric urology. The concept of renal functional reserve (RFR) as the ability of the kidney to increase glomerular filtration rate (GFR) following a protein load was introduced in the 1980s. Aim: This study aims to evaluate RFR using 99Tc diethylenetriamine pentaacetic acid (DTPA) as the filtration agent for GFR estimation in children with VUR. Materials and Methods: RFR was estimated in 53 children, of which 31 patients had unilateral VUR (Group I) and 22 patients had bilateral VUR (Group II), by subtracting baseline GFR from stimulated GFR following an intravenous protein load. GFR was determined by double compartment-2 sample method using 99Tc DTPA radioisotope as the filtration agent. Both the groups were further subgrouped into low-grade (IA, IIA) and high-grade VUR (IB, IIB). Results: The RFR was significantly lower in unilateral high-grade VUR (Group IB) as compared to unilateral low-grade VUR (Group IA) (P = 0.024). RFR was significantly lower in bilateral high-grade VUR patients (IIB) as compared to unilateral low-grade VUR group (IA) (P = 0.0226). Furthermore, the stimulated GFR shows very strong correlation to baseline GFR in both major groups (r = 0.9659 and P = 0.001 in Group I and r = 0.9856 and P = 0.001 in Group II) concluding that the baseline GFR and the stimulated GFR increase or decrease in tandem in both the groups. Conclusion: The RFR is impaired in children with both unilateral high-grade VUR and bilateral high-grade VUR while it is relatively preserved in unilateral low-grade VUR and bilateral low-grade VUR.
  3,788 151 1
Use of pretherapy core biopsy in the diagnosis of pediatric renal tumors
Jujju Jacob Kurian, Kenneth R L. Nongpiur, Susan Jehangir
April-June 2018, 23(2):66-69
DOI:10.4103/jiaps.JIAPS_245_16  PMID:29681695
Background: Pretreatment core biopsy of pediatric renal tumors has been advocated by United Kingdom Children's Cancer Study Group to circumvent the disadvantage of International Society of Paediatric Oncology protocol, where neoadjuvant chemotherapy initiated without histopathological confirmation can result in over- or under-treatment. Aim: This study aims (a) to assess if pretherapy core biopsy correlates with the nephrectomy biopsy; (b) to assess if neoadjuvant chemotherapy changes Wilms tumor (WT) histology, and (c) to assess the incidence of biopsy site recurrence. Materials and Methods: Seventy-six children from 2005 to 2016 with renal tumors who underwent a pretherapy core biopsy were included in the study. The biopsy was performed through the posterior flank post-ultrasound marking of the renal mass, by administering intravenous anesthesia. Results: Of the 62 children with WT, an accurate diagnosis was possible in 61. Accurate prediction of anaplasia was possible only in 25%. Reduction in blastemal elements was seen in 26 patients with 10 of them showing completely necrotic tumor. Eleven of the 14 children with non-WT were accurately diagnosed. Core biopsy corroborated with the nephrectomy biopsy in all but 4 patients. Two specimens were inadequate and two cases of congenital mesoblastic nephroma were inaccurately diagnosed, one as spindle cell neoplasm and the other as WT. Biopsy site recurrence was seen in 1 child. Conclusion: Pretreatment posterior flank core biopsy in the diagnosis of pediatric renal tumors is safe, simple, and cost-effective with minimal complications.
  3,794 129 2
Cloacal malformation variant in a male neonate
Rahul Gupta, Pramila Sharma, Arvind Kumar Shukla, Manisha Goyal, Ashok Gupta
April-June 2018, 23(2):106-108
DOI:10.4103/jiaps.JIAPS_118_17  PMID:29681705
Cloacal malformation is a rare entity and is invariably referred only to females. We are reporting a very rare case of cloacal malformation variant in a 6-day-old male neonate who presented with absent anal opening along with passage of urine and meconium from an abnormal opening in the perineum.
  3,724 118 1
Live workshops: A time to rethink
Subhasis Saha
April-June 2018, 23(2):55-56
DOI:10.4103/jiaps.JIAPS_46_18  PMID:29681692
  3,509 109 -
Cytomegalovirus as a cause of colonic stricture-simulating hirschsprung's disease
Chiranjiv Kumar, Meera Luthra
April-June 2018, 23(2):103-105
DOI:10.4103/jiaps.JIAPS_218_17  PMID:29681704
Colonic stenosis/atresias account for only 5%–15% of all atresias. Colonic stenosis is rarer than atresia and mostly occurs in ascending and transverse colon. Gastrointestinal sequelae of cytomegalovirus (CMV) are rare, frequently requires surgical intervention for diagnosis and management. We describe a 5-month-old female child with complaints of recurrent abdominal distension, vomiting, and constipation for 2 months simulating Hirschsprung's disease. After barium enema, the baby was taken up for surgery. Intraoperatively, we found a colonic stricture in the descending colon. The biopsy showed localized CMV infection.
  3,512 98 1
Esophageal lung-clinical images
Vivek Kumar Singh, Anjan Kumar Dhua, Manisha Jana, Veereshwar Bhatnagar
April-June 2018, 23(2):109-110
DOI:10.4103/jiaps.JIAPS_167_17  PMID:29681706
Esophageal lung (EL) is a highly rare anomaly, wherein the bronchus of a lung connects directly with the esophagus. Repeated lower respiratory tract infection (LRTI) is the hallmark of this condition. We present the clinical images of a 5-month-old boy who presented with repeated LRTI since birth. On evaluation, EL was diagnosed. Excision of the lung with abnormally communicating bronchus and primary repair of the esophagus was curative.
  3,442 102 -
Technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy
Kanoujia Sunil, Archika Gupta, Digamber Chaubey, Anand Pandey, Shiv Narain Kureel, Ajay Kumar Verma
April-June 2018, 23(2):70-73
DOI:10.4103/jiaps.JIAPS_81_17  PMID:29681696
Aim: To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy. Materials and Methods: Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status. Results: At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one. Conclusions: The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction.
  3,385 137 -
Torsion of a splenule in a case of splenogonadal fusion mimicking a strangulated inguinal hernia
Ravikiran Cheelenahalli Srinivasa Rao, Veerabhadra Radhakrishna, Nilima Rao, Susmita Rakshit
April-June 2018, 23(2):100-102
DOI:10.4103/jiaps.JIAPS_191_17  PMID:29681703
Splenogonadal fusion (SGF) is a rare anomaly, and to the best of our knowledge, none have mimicked a strangulated inguinal hernia. A 6-year-old boy presented with a painful left inguinal swelling mimicking a strangulated hernia but turned out to be a SGF, which was managed successfully with an inguinal procedure.
  3,410 80 1
Congenital benign intrahepatic cyst with cystobiliary communication: An intraoperative diagnostic enigma
JS Kishore, Richa Lal, Abhishek Chinya, JB Nijagal Mutt
April-June 2018, 23(2):93-95
DOI:10.4103/jiaps.JIAPS_50_17  PMID:29681701
This manuscript reports a 15-month-old male presenting with a congenital solitary benign intrahepatic cyst, wherein the presence of a cyst with frank bile and a large cystobiliary communication came as an intraoperative enigma. The stepwise approach to diagnosis, management, and review of relevant literature carry a useful message.
  3,124 80 -
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