Penetrating brain injury (PBI) is rare and the severest form of head injury with a high morbidity and mortality. A 3.5-year-old girl presented with PBI with a wheel spoke. Computerized tomography scan with three-dimensional skull reconstruction depicted its extent from the medial side of the roof of the right orbit to the right frontal lobe with a cavitation around the spoke. The spoke was removed by manipulation under general anesthesia from the entry site without a formal craniotomy. Postoperative outcome was uneventful.
Frontal lobe injury; penetrating brain injury; wheel spoke
We report a case of persistent cloaca and type I congenital pouch colon associated with ileovesical and colovesical fistulae. Such a malformation has not been reported so far.
Congenital pouch colon; Ileovesical fistula; persistent cloaca
Pulmonary sequestration cyst is a rare entity in pediatric patients. Most of the time, it is diagnosed as an incidental finding. It is associated with other congenital anomalies, especially congenital diaphragmatic hernia. We report a patient of cerebral palsy presented with vomiting and recurrent chest infections. He was diagnosed to have hiatal hernia on computed tomography scan of chest. At operation, a pulmonary sequestration cyst along with hiatal hernia, malrotation, and meckel's diverticulum was encountered. The sequestration cyst was managed through transhiatal approach.
Bronchopulmonary sequestration; foregut malrotation; hiatal hernia; meckel's diverticulum
Crystal jelly balls are used for decorative purpose in homes and offices. They swell on contact with water. We managed a patient with a clinical diagnosis of acute abdomen. At surgery, there was fecal peritonitis and three ileal perforations caused by previously ingested decorative crystal balls.
Acute abdomen; crystal balls; generalized peritonitis; intestinal perforation; missing foreign body
A number of diseases can present as acute right iliac region pain. Lymph node infarction, located adjacent to the cecum, mimicking acute appendicitis in a 13-year-old boy is presented here.
Lymph node infarction; Acute appendicitis; Pain right iliac region
Gastric teratomas are extremely rare tumors. A 15-day-old neonate presented with abdominal mass. Ultrasound of abdomen showed mixed echogenicity lesion. CT scan showed a mass with solid and cystic components and internal calcifications. At operation a tumor arising from the posterior wall of the stomach found. It was exogastric as well as endogastric in location. Biopsy report was suggestive of mature teratoma.
Gastric teratoma; Endogastric tumor; Exogastric tumour
Intrapulmonary sequestrations are quite uncommon in pediatric age group. The preoperative diagnosis of pulmonary sequestration is not possible in most of the cases. A 2-year-old boy presented with recurrent episodes of chest infections and respiratory distress. A preoperative diagnosis of congenital lobar emphysema was made on the basis of chest radiograph and computed tomography scan. At operation, an intralobar pulmonary sequestration was found. The sequestration cyst was excised with uneventful recovery.
Congenital lobar emphysema; pediatric age group; pulmonary sequestration
Terminal myelocystocele is a rare spinal dysraphism that present as lumbosacral mass. Magnetic resonance imaging (MRI) is the modality of choice for preoperative diagnosis. A 2.5 months old female baby presented with lumbosacral skin covered mass. There were no associated neurological deficits. MRI of the lesion suggested two cysts, one of which was continuous with the central canal of the spinal cord. At operation terminal myelocystocele was found with tethering of the spinal cord. Untethering of the spinal cord and repair of the myelocystocele performed with uneventful recovery.
Terminal myelocystocele; Spinal dysraphism; Myelomeningocele
Cystic hygromas are the cystic variety of lymphangioma, common locations being cervico-facial regions and axilla. Respiratory distress, recurrent infections or cosmetic reasons are the main indications of the treatment. The ideal treatment is complete surgical excision; however, there is a gradual conversion towards sclerosant therapy. This article reviews the current literature and discusses the various problems encountered during the management of these lesions.
Cystic hygroma; surgical excision; bleomycin; complications
Inguinal hernia is a frequent surgical condition encountered of pediatric age group. It may get incarcerated and at times strangulated requiring prompt intervention. However if lesion is not treated timely a host of complications may occur. Enteroscrotal fistula is one such rare complication that may follow such discourse. We report a case of 25-days old male neonate who presented with enteroscrotal fistula due to incarcerated right inguinal hernia. Patient was explored through abdomen and the involved part of ileum was resected and ileo-ileal anastomosis performed.
Strangulated inguinal hernia; Enteroscrotal fistula; Neonate
Gastric teratomas are very rare tumours in children. They usually present with a palpable mass in the upper abdomen. We report a case of gastric teratoma in one and half month old male infant who presented with a palpable mass in abdomen, extending from epigastrium to the pelvis. Ultrasound of abdomen revealed a huge mass with solid and cystic components. CT scan delineated calcifications in the mass. The preoperative diagnosis was a teratoma but not specifically gastric one. The mass was excised completely with seromuscular layer of the stomach wall. The histopathology confirmed it to be grade-3 immature gastric teratoma. The rarity of the origin of teratoma in addition to its immature variety prompted us to report the case.
Gastric teratoma; Immature teratoma; Infant
Complete or partial avulsion of common bile duct is a very rare injury following blunt abdominal trauma in children. A 7-year old boy presented to ER following blunt abdominal trauma by a moving motorcycle. X ray abdomen revealed free air under diaphragm and CT scan showed pancreatic contusion injury. At operation anterior wall of common bile duct (CBD) along with a 2mm rim of duodenal tissue on either side of anterior wall of CBD were found avulsed from the duodenum. The avulsed portion of CBD and duodenum were reanastomosed and a tube cholecystostomy performed. The patient had an uneventful recovery.
Common bile duct; Avulsion; Blunt abdominal truama; Duodenal perforation
Duodenal atresia is a common cause of intestinal obstruction in neonates. It is associated with other congenital anomalies like Down's syndrome, annular pancreas etc.
We present a case of a two days old male baby presented to us with bilious vomiting since birth. It was associated with Down's syndrome, Annular pancreas and Malrotation.
Duodenal atresia is associated with other congenital anomalies but more than one congenital anomalies in a single patient is very rare.
Transvaginal ultrasound is used conventionally as initial investigation of patients with abnormal uterine bleeding but saline contrast sonohysterography is a better technique to reliably distinguish focal from diffuse endometrial lesions. This study was performed to compare the ability of transvaginal ultrasonography and saline infusion sonohysterography as initial modality for the diagnosis of endometrial abnormalities in women with abnormal uterine bleeding.
Patients and Methods:
In a prospective study, 100 women with abnormal uterine bleeding were submitted to sequential examination by transvaginal ultrasound, and sonohysterography. The presence of focal endometrial lesions and the type of lesion (endometrial hyperplasia, polyp, submucous myoma, or malignancy) were noted. Predictive values were calculated by correlating the results with final diagnosis reached by hysteroscopy and endometrial biopsy.
The sonohysterography had 92.9% sensitivity and 89.7% specificity compared to 71.4% sensitivity and 67.7% specificity achieved by transvaginal sonography. There was 91% agreement between saline contrast sonohysterography and hysteroscopy as compared to 69% for TVS (p = 0.002). The diagnostic performance of sonohysterography for 3 main endometrial abnormalities (i.e. endometrial hyperplasia, polyps and submucous myoma) was better than transvaginal sonography. The best results were seen in cases of submucous myoma where sensitivity and specificity of sonohysterography reached to 100% as compared to TVS (61.55 and 97.7% respectively).
Our results have substantiated that sonohysterography is a better tool than transvaginal sonography for the assessment of endometrial intra-cavity lesions. By providing accurate differentiation between focal and diffuse endometrial lesions, it can help in decision making regarding selection of cases for hysteroscopy and directed biopsy. We recommend that saline contrast sonohysterography should be used as an initial investigation in cases of abnormal uterine bleeding.
Ultrasound; transvaginal sonography; sonohysterography; hysteroscopy; abnormal uterine bleeding