Fetus in fetu is a rare developmental aberration, characterized by encasement of partially developed monozygotic, diamniotic, and monochorionic fetus into the normally developing host. A 4-month-old boy presented with abdominal mass. Radiological investigations gave the suspicion of fetus in fetu. At surgery a fetus enclosed in an amnion like membrane at upper retroperitoneal location was found and excised. The patient is doing well after the operation.
Fetus in fetu; Teratoma; Abdominal mass
Decorative crystal gel balls are used for decoration purpose. Due to their attractive appearance they may be ingested by children. This may result in grave complications. A case of decorative crystal ball ingestion is being reported in a 6 months old infant who presented with sub acute intestinal obstruction and was operated. Crystal gel balls were causing obstruction of jejunum. Enterotomy and removal of the mass of jelly balls was done with primary closure. The patient was re-operated for anastomotic disruption on 6th postoperative day. Baby developed septicemia, and succumbed after 2 days of second operation.
Crystal balls; Jelly balls; Mortality
Foreign body ingestion is common in children. Sharp foreign bodies are potentially harmful and can result various complications. An 8-month-old infant presented with incarcerated umbilical hernia. With a suspicion of strangulation, operation was performed that revealed a loop of ileum being stuck in the umbilical defect. The loop of ileum was freed from the umbilicus which demonstrated open ends of safety pin piercing out of bowel lumen. The enterotomy followed by removal of safety pin was performed.
Safety pin ingestion; Strangulated umbilical hernia; Intestinal perforation
Cloacal malformations are challenging as to the surgical correction. A case of cloacal malformation who underwent reconstructive surgery is being reported. The patient had colostomy in the neonatal period and reconstruction was performed at the age of 6 year. The surgical management included abdomino-perineal anorecto-urethro-colo-vaginoplasty. The patient is fully continent of urine and achieved fair continence of feces at 9 months of follow up.
Persistent cloaca; Urogenital sinus; Anorectal malformation; Fecal continence
Acute gastric volvulus secondary to malrotation of gut is a rare surgical emergency. We report a case of an eight years old cerebral palsy (CP) child who presented to us with sudden upper abdominal distension and non productive retching. X-ray abdomen revealed a huge gas shadow on left side of abdomen with paucity of distal gas shadows. On exploration organoaxial gastric volvulus with gastric ischemia, secondary to malrotation of gut, was found. Volvulus derotated and Ladd’s procedure was done. Gastropexy and fundoplication was not done due to gastric ischemia. Early diagnosis and surgical management can save the patient from fatal complications of gastric perforation due to gastric ischemia.
Acute gastric volvulus; Gastric ischemia; Malrotation; Gastropexy
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
Meconium ileus is one of important causes of neonatal intestinal obstruction. Many patients respond well to nonsurgical management with enemas, however, few patients may develop complications in the postnatal period thus requiring urgent operation. A 2 day old newborn presented with clinical features of intestinal obstruction. There was a suspicion of meconium ileus. Contrast x-ray with gastrografin enema was suggestive of unused colon with beaded appearance. Patient had to be surgery as repeated enemas did not improve the condition and progressive abdominal distension occurred. At exploration twist of the dilated, meconium filled loop of small bowel found. De-twisting of the volvulus done and Bishop Koop ileostomy fashioned. Patient made an uneventful recovery. Stoma was closed six months later.
Meconium ileus; Volvulus; Complications
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
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
Colonic atresias are the rare malformations of the colon and constitute about 1.7 to 15% of all gastrointestinal (GI) atresias. A 6-month old infant presented with recurrent episodes of sub-acute intestinal obstruction since birth. During the index admission, patient had clinical signs of complete intestinal obstruction. The patient was operated and type I sigmoid-colon atresia found which on further exploration tuned out to be of perforated mucosal web variety. The resection of the involved part of colon and a primary end to oblique colo-colic anastomosis was performed.
Colonic atresia; Colonic stenosis; Perforated colonic web; Intestinal obstruction
Esophageal foreign bodies (FB) are common in adults and children. These are rarely reported in infants and neonates. A 2-day-old newborn was referred to our hospital with history of accidental intrusion of soft silicone suction catheter into the upper gastrointestinal tract (GIT). X-ray chest and abdomen confirmed the presence of suction tube in esophagus and stomach. The suction catheter was retrieved successfully at direct laryngoscopy.
Esophageal foreign body; Neonate; Laryngoscopy
Gastroschisis is an abdominal wall defect through which intestine and rarely other organs eviscerate. It is less frequently associated with anorectal malformations. Abnormal size and shape of the defect is rarely identified in these patients. We report a case of gastroschisis with an unusual abdominal wall defect, imperforate anus and an ectopically placed vestibule. The defect was extended from right side of umbilicus to the perineum. There was evisceration of entire gastrointestinal tract (GIT), liver, gallbladder and urinary bladder. The defect was not manageable with a spring loaded silo and a sterilized blood bag was used to cover the defect. The unusual defect, associated anomalies and evisceration of unusual viscera are the main reasons for reporting the index case.
Gastroschisis; Imperforate anus; Evisceration
Gastric duplication cysts are rare variety of gastrointestinal duplications. Sometimes they may present with complications like hemorrhage, infection, perforation, volvulus, intussusception and rarely neoplastic changes in the gastric duplication cyst. We present one and half year old male child who developed sudden abdominal distension with pain and fever for two days. Ultrasound revealed a cystic mass in the hypochondrium and epigastric regions. On exploration an infected and perforated gastric duplication cyst was found. Surgical excision of most part of cyst wall with mucosal stripping of the rest was performed. Histopathology confirmed the diagnosis of gastric duplication cyst. Early surgical intervention can result in good outcome.
Gastric duplication cyst; Acute abdomen; Peritonitis