The diagnosis of extra-renal Wilms’ tumor is often missed at initial clinical presentation leading to a delay in initiating appropriate therapy. A 5-year-old girl presented with a 3-week history of a painless lump in the pelvis. Radiological investigations suggested an ovarian neoplasm. Tumor markers for ovarian malignancy were in normal range. Trucut biopsy also suggested the possibility of an ovarian neoplasm. The tumor was excised and final histopathology revealed it a Wilms’ tumor.
Wilms' tumor; Extra-renal; Pelvic mass
Segmental dilatation of ileum (SDI) is a rare clinical entity and so is anterior thoracic meningomyelocele (AMC). There has been no reported association between these two clinical entities. We hereby report a very rare presentation of these two in a 4 year old boy who presented with swelling in the right lower abdomen. Preoperative diagnoses were partial cecal volvulus and duplication cyst. At operation, SDI along with AMC was found.
Segmental dilatation of ileum; Anterior meningomyelocele; Undescended testes
Clear cell sarcoma of kidney (CCSK) is an aggressive renal neoplasm. We report two boys aged three and half, and three years with CCSK, one of whom had a disease free survival of four years and eight months. These patients were managed with surgery, chemotherapy and radiotherapy. One of the patients discontinued treatment early and lost to follow up. Aggressive multimodality therapy is the keystone to improved outcome.
Clear cell sarcoma; Kidney; Wilm's tumor
A case of hydatid cyst within a congenital cystic adenomatoid malformation (CCAM) of the right lower lobe of lung in an 8-year-old girl is reported. Presence of CCAM was confirmed on histopathology of the lung tissue attached to the specimen.
Hydatid cyst; Congenital cystic adenomatoid malformation; Pericystectomy
A neonate sustaining iatrogenic rectal injury that led to acquired rectal atresia is reported. It was successfully treated by transanal, end-to-end, rectorectal anastomosis.
Neonate; Rectal perforation; Acquired rectal atresia
We report a case of prenatally diagnosed Fetus-in-fetu (FIF) residing in the left retro-peritoneum in a 2-week-old neonate which was also associated with ipsilateral testicular atrophy. A comparison of features differentiating FIF from a retroperitoneal teratoma, and various theories of origin of FIF are described. The causal relationship of ipsilateral atrophic testis with FIF in this case is also discussed.
Fetus-in-fetu; parasitic twin; testicular atrophy; teratoma
Aim: To compare the outcome of patients with jeuno-ileal atresia (JIA) associated with the intraoperative finding of volvulus of small bowel (group A) with that of JIA without volvulus (group B).
Materials and Methods: It is a retrospective observational study conducted at one of the two units of Pediatric Surgery, in a tertiary care public hospital of India, from January 2001 to December 2010. Hospital records were retrieved and analyzed. During this time period, 65 patients with JIA were operated of which 40 (61.5%) had ileal atresia (IA) and 25 (38.5%) had jejunal atresia (JA). Eleven (16.9%) patients had associated intraoperative finding of volvulus of small bowel (Group A) and were studied and compared with group B- not associated with intraoperative findings of volvulus of small bowel (n=54). The demography, clinical features, operative findings, associated anomalies, anastomotic leakage, and outcome were compared.
Results: Group A comprising of 6 boys and 5 girls, had 8 IA and 3 JA; one case each of Type 3b and Type 4 JIA was seen. Associated anomalies included meconium ileus (n=2), Down’s syndrome (n=1) and malrotation (n=1). Anastomotic leak rate was 75% for IA and 66.7% for JA. The mortality was 91% in Group A, 100% for IA and 67% for JA. Group B comprising of 37 boys and 17 girls, had 32 IA and 22 JA; 2 cases of Type 4 and 1 case of Type 3b JIA was seen. Associated anomalies were malrotation (n=2), meconium ileus (n=1), exomphalos (n=1), gastroschisis (n=1) and ileal duplication cyst (n=1). The anastomotic leak rate for JA was 8/21 (38.1%) and IA was 3/28 (10.7%); persistent obstruction was seen in 3/21(14.3%) JA and 1/28 (3.6%) IA patients. In group B, overall mortality rate was 8/22 (36.4%) for JA and 9/32 (28%) for IA. The morbidity and mortality was significantly higher in group A when compared to group B.
Conclusions: JIA associated with volvulus (without malrotation) is a sinister entity with a dismal outcome in our experience.
Jejunoileal atresia; volvulus; leakage; outcome
Peritonitis due to rupture of liver hydatid cyst secondary to blunt abdominal trauma can present with fatal consequences. Timely diagnosis and appropriate surgical management can be life saving. We report a case of ruptured liver hydatid cyst in the peritoneal cavity following trauma and its successful operative management in a preadolescent previously asymptomatic boy. Importance of detailed physical examination and early diagnosis by using appropriate radiological investigations is highlighted.
Hepatic hydatid cyst; Peritonitis; Trauma
Aim: To describe the management and outcome of patients with duodenal webs, managed over a period of 12 ½ years in our unit.
Methods: It is a retrospective case series of 18 patients with congenital duodenal webs, managed in our unit, between 1999 and 2011. The medical record of these patients was retrieved and analyzed for demographic details, clinical presentation, associated anomalies, and outcome.
Results: The median age of presentation was 8 days (range 1 day to 1.5 years). Antenatal diagnosis was made in only 2 (11.1%) patients. The commonest presentation was bilious vomiting. Associated anomalies were present in 8/18 patients, common being malrotation of gut. Down’s syndrome was seen in 2 patients and congenital heart disease in 1 patient. One patient had double duodenal webs. There was a delay in presentation of more than 5 days of life in 11/18 (61%) patients. Three patients who presented beyond neonatal age group had fenestrated duodenal membranes causing partial obstruction. In addition, the diagnosis was missed in patients operated for malrotation elsewhere (n=2), imperforate anus (n=2) and esophageal atresia with tracheo-esophageal fistula (n=1). A lateral duodenotomy with excision of the obstructive membrane was done in all patients. A trans-anastomotic tube (TAT) for enteral feeding was used in 8 patients The mortality rate was 4/18 (22%); the main causes being sepsis, prematurity, very low birth weight and associated congenital anomalies. The mean hospital stay for the 14 survivors was 18 days. Total parental nutrition (TPN) was not given to any patient.
Conclusions: Congenital duodenal webs are different as the diagnosis is often missed especially in case of perforated webs. Outcome depends upon the time of presentation and associated anomalies. The use of TAT feeding for nutritional support is an easy alternative to TPN.
Duodenal web; duodenal atresia; windsock diaphragm
Retroperitoneal teratomas are usually asymptomatic, though there have been isolated reports of retroperitoneal teratomas presenting as intra-abdominal abscesses and peritonitis in adults. A 7-year-old girl who had presented with acute abdomen due to ruptured retroperitoneal teratoma is reported.
Retroperitoneal teratoma; Peritonitis; Infected teratoma; Mature teratoma
Infant feeding tubes (IFT) have been universally used as urethral catheters in neonates and children for several decades. Though generally a safe procedure, it may cause significant morbidity if the catheter spontaneously knots inside the bladder. We report this complication in three children including a neonate.
Urinary catheter; Catheterization complication; Intravesical knotting; Posterior sagittal anorectoplasty
Extra-abdominal desmoid tumors are circumscribed but non-capsulated neoplasms of differentiated fibrous tissue arising
from musculoaponeurotic tissues. They tend to be locally infiltrative, resulting in a high rate of local recurrence without
metastasis, following surgical resection. We report a 9-year-old boy who had a large desmoid tumor in his right buttock that
was successfully excised.
Desmoid Tumor; Aggressive fibromatosis; Musculoaponeurotic fibromatosis; Fibrosarcoma; Recurrence
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.
Amphotericin B; mucormycosis; necrotizing enterocolitis; neonate; rhizopus
We report a newborn with esophageal atresia (EA) in whom right tracheal bronchus (TB) and a tracheal diverticulum were identified intra-operatively. The right TB was further confirmed on MRI scan performed post-operatively. Such a tracheal trifurcation associated with EA has not been reported hitherto from Indian subcontinent.
Esophageal atresia; Tracheo-esophageal fistula; Tracheal bronchus; Tracheal trifurcation
Intrauterine intussusception (IUI) is the one of the rarest recognized causes of jejuno-ileal atresia (JIA). We report on a 15-day old full-term neonate presenting with features of intestinal obstruction, wherein on exploration, a visible ileo-ileal intussusception resulting in ileal atresia was found. The relevant literature has been reviewed.
Intrauterine Intussusception; Jejuno-ileal atresia; Neonatal intestinal obstruction; Etiology
Isolated soft tissue cysticercosis of the trunk in the absence of concurrent central nervous system involvement is uncommon and may be difficult to diagnose. We report 4 such cases in the pediatric age group. Preoperative diagnosis of soft tissue cysticercosis was considered only in 1 patient, the rest were diagnosed only after biopsy. Complete excision (without rupture) was done. All of them underwent a CT scan head along with ophthalmic examination to rule out the more common sites of occurrence of cysticercosis. No further treatment was undertaken as the evaluation was negative. In endemic areas like ours we must suspect this entity not only in the limb muscles, but also in the subcutaneous tissues of the trunk. If diagnosed accurately, it can be treated medically, eliminating the need for surgery.
Cysticercosis; Taenia solium; Parasitic cyst
The presentation of extra hepatic biliary-atresia (EHBA) as well as choledochal cyst (CDC) in the neonate may be similar. Since the surgical management and prognosis are entirely different, it is important to differentiate between the two entities. We present a case with co-existing EHBA and CDC which led to a diagnostic dilemma.
Extra hepatic biliary atresia; Choledochal cyst; Neonatal obstructive jaundice
Background: To assess the prognosis of surgical neonates at admission and the factors responsible for mortality in neonates.
Material and Methods: A prospective study was conducted in a tertiary level hospital over 15 months and various clinical and biochemical parameters were collected and analyzed using STATA® and SPSS®.
Results: On multivariate analysis of 165 neonates, early gestational age, respiratory distress and shock at presentation were the factors of poor prognosis in neonates. The factors could be related to poor antenatal care and sepsis acquired before transfer of the baby to the nursery.
Conclusion: The improvement in antenatal care and asepsis during transfer and handling the babies is of utmost importance to improve the prognosis of surgical neonates.
Surgical neonates; Prognosis; Mortality; Scoring systems
Management of Solid tumors in children needs a comprehensive multimodality protocol based treatment plan. Open surgical removal of the tumors occurring in any of the sites such as abdomen, thorax, chest wall, HFN (head, face, neck), brain and extremities, is the option which has been traditionally practiced even in the present era and in most of the centers. Nevertheless with the advances in science and technology and with ever increasing usage and expertise of laparoscopy in children, it’s application has extended to treatment of solid tumors in children. A review of the scope of such intervention as well as the limitations of minimal invasive surgery in this specialized field of pediatric surgery has been attempted in this article.
Indications and limitations; minimally invasive surgery; solid tumors