Planned Second look laparotomy in neonatal volvulus: a safe approach for bowel salvage

Midgut volvulus can result in gangrene and loss of large segments of intestine. After correction of volvulus the viability of intestine may improve and if given sufficient time a large portion of intestine may be saved. A planned second look laparotomy in babies with volvulus and doubtful gut viability can be helpful in saving large bowel segment. We present a case of a newborn baby admitted with bilious vomiting, abdominal distension and melena. An urgent exploratory laparotomy showed midgut volvulus with near gangrene of about 35 cm of proximal jejunum and bluish discoloration of the rest of the small bowel. After de-rotation and warm packs, the vascularity of ileum and distal jejunum returned to normal, however the proximal jejunum remained dusky and bruised. Ladd's procedure was done and a decision was made to close the abdomen with a plan for a 2nd look laparotomy after 24 hours. A relook laparotomy performed after 24 hours showed, a well vascularized small bowel. No bowel resection was required and abdomen was closed. The baby improved and was discharged in stable condition with no long-term ischemic complications. This case indicates that a second look laparotomy may provide time for revascularization of the intestine with doubtful vascularity and avoid unnecessary bowel resection

Macrosonic babies: Anthropometric comparison between diabetuc and non - diabetic pregnancies

The incidence of perinatal morbidity is directly related to fetal macrosomia [birth weight >/= 4000 g], but this morbidity is more common in macrosomic infants born to diabetic mothers. Aim: To measure the anthropometric parameters in two groups of full term macrosomic infants who were born from diabetic and non-diabetic pregnancies and to compare their morbidities. Method: Gestational assessment and anthropometric measurements were done on 133 consecutive macrosomic infants, out of which 72 were born to non-diabetic mothers and 61 to diabetic mothers. The morbidity of the two groups were recorded and compared. Result: Although the macrosomic neonates born to diabetic pregnancies had the same lengths and head circumference when compared to fetal macrosomia of non-diabetic mothers, the former group was significantly heavier with larger mid-shoulder and chest circumferences and greater shoulder to head and chest to head disproportion. Among macrosomic infants of diabetic pregnancies, Erb's palsy occurred in 3, sboulder dystocia in 2 and one had fracture of clavicle, whereas only one Erb's palsy was found among macrosomic babies of non-diabetic pregnancies. Although our data revealed higher morbidity in macrosomic infants of diabetic compared to non-diabetic pregnancies the number of patients in study groups were too few to draw any conclusions. This study suggests that if fetal macrosomia is suspected, especially in a diabetic pregnancy, ultrasonic measurement of anthropometric parameters could be of value to select the route of delivery and to minimize birth trauma

Zellweger syndrome: a case report

Zellweger syndrome, an autosomal recessive disorder, is generally considered as the prototype of the group of the rare peroxisomal disorders. Infants with Zellweger syndrome have a striking constellation of clinical features, which usually suggest the diagnosis. The condition has been reported in all races and from all parts of the world. Considerable progress has been made recently in the biochemical and molecular aspects of the disease as well as identifying the genetic defects involved. Here we present a case of Zellweger syndrome and discuss the pathophysiology of the disease. To our knowledge, this is the first case of Zellweger syndrome reported from United Arab Emirates