Unusual cause of upper gastrointestinal tract bleeding in a child

We report a case of gastric teratoma in six years old female child who presented with abdominal pain, vomiting and hematemesis. Child underwent exploratory laparotomy and the mass was excised completely. On histopathology it came out mature gastric teratoma

Factors affecting survival in patients with oesophageal atresia and tracheo-oesophageal fistula

To evaluate the various factors affecting survival in babies with oesophageal atresia and tracheo-oesophageal fistula. Descriptive study. The study was carried out at the Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad from March 2004 to March 2005. All neonates with oesophageal atresia [EA] and tracheo-oesophageal fistula [TEF] during the study period were included in the study. Patients having isolated EA were excluded. A total of 80 patients were included in the study. Patients were received from the emergency department, OPD and Neonatal ICU. Diagnosis was confirmed by passing a radio opaque orogastric tube. Investigations were done to look for other associations. After stabilisation, right thoracotomy was performed, fistula was ligated and divided. An attempt was made to do a primary oesophago-oesopahgostomy. Nasogastric feeding was started on 2nd post-operative day. A contrast oesophagogram was performed on the 7th postoperative day and having ruled out leak, oral feeding was started. Out of the total, 33 [41%] survived and 47 [58%] patients died. Out of 47 deaths 20 [25%] died before surgery and 27 [34%] died after surgery. Mean follow up period was 6 months. Sixteen [20%] patients had anastomotic leak, 24 [30%] had anastomotic stricture, and 64 [80%] patients had postoperative pneumonia. We conclude that proper antenatal check ups will detect the problem early, avoid home deliveries and hence improve survival. Pneumonitis and septicaemia significantly affect survival. Availability of ICU is one of the main determinants of survival. The likely cause of high mortality rate in pre-operative patients in our series is non-availability of NICU due to limited space in our setup

Comparative study of Mathieu and Snodgrass repair for anterior hypospadias

This study was carried out to compare the operative time and rate of complications of Mathieu and Snodgrass procedures for the repair of primary anterior hypospadias. This study was carried out in the Department of Pediatric Surgery, The Children hospital, Pakistan Institute of Medical Sciences Islamabad, from March 2003 to Feb 2005. We managed 90 patients with primary anterior hypospadias. Children between 2 years to 12 years were included in the study. Those who had previous repair were excluded from the study. Only those patients were selected who never had their hypospadias repaired. Those with significant chordee were also excluded from the study. Patients were divided into two groups. Group I had Mathieu repair and Group II had Tubularized Incised Plate [TIP] urethroplasty [Snodgrass procedure]. Stent was kept patent by frequent irrigation. Operative time was calculated for both the procedures separately. Patients were followed for subsequent complications. A total of 90 cases were studied. Mathieu repair was performed in 45 patients and tubularized incised plate [TIP] urethroplasty [Snodgrass procedure] in the rest of 45 patients. Cosmetic results were excellent with Snodgrass repair with a normal looking slit like meatus. Meatal stenosis and wound breakdown was equal in each group whereas urocutaneous fistula and proximal urethral stricture were seen more frequently in Mathieu group

Colocolic intussusception-a rare entity in children a case report

Colocolic intussusception is an unusual cause of intestinal obstruction in children. We are reporting two cases ofcolocolic intussusception; one presented with the clinical features of intestinal obstruction but lacking typical history of intussusception and other had a typical presentation of intussusception. Both cases were treated successfully with bowel resection and end-to-end anastomosis

Tubularized incised plate urethroplasty of hypospadias

To describe tubularized incised plate [TIP] urethroplasty, for the treatment of anterior hypospadias. Design: Descriptive study. Place and Duration of Study: This study was carried out in the Department of Pediatric Surgery, The Children hospital, Pakistan Institute of Medical Sciences Islamabad, from January 2003 to February 2004. Materials and There were 30 patients with anterior hypospadias. Children between 2-years to 12 years were included in the study. Tubularized incised plate urethroplasty [Snodgrass procedure] was performed in all the patients. Meatus was matured taking care not to close too much to avoid stenosis. Dressing was kept to prevent haematoma and oedema formation. Frequent irrigation of the stent was done to avoid blockage. Procedure was successful in 22 patients. Meatal stenosis was noted in three patients, two required dilatations only and in one patient meatotomy was performed. Three patients developed single urethrocutaneous fistula. One patient had complete breakdown. Tubularized incised plate urethroplasty was found to be a useful procedure for distal or anterior hypospadias with less complications. Special precautions like maturing the meatus to avoid stenosis and keeping the stent patent with frequent irrigation helps in minimizing fistula formation. The dressing technique prevented postoperative hematoma and edema of penile stuff

Prostatic phabdomyosarcoma in an infant with neurofibromatosis

we are reporting an unusual case of a tumor in early infancy causing complete urinary obstruction. The patient was an infant with external signs of neurofibromatosis who presented with acute urinary retention prostatic rhabdomyosarcoma and was managed by total cystectomy and urinary diversion

Twin fetus in fetu-a very rare entity: a case report with review of literature

1] To report a very rare condition of conjoined twining in fetus in fetu in an infant. From literature it appears to be the 4th case being reported. 2] To emphasize the importance of proper examination of the fetus in fetu grossly by doing extensive dissection, radiologically and detailed histological tissue examination from several sites. Design: Detailed report of an unusual intra-abdominal mass in an infant. Setting: Department of Pediatric Surgery, Children Hospital, PIMS, Islamabad. Successfully treated with surgical removal and interesting diagnosis emerged. Twin fetus in fetu [FIF] is a very rare anomaly due to an abnormal embryogenesis of fetus during pregnancy. Malformed fetus grows in the body of co-twin and it is frequently detected as an abdominal mass. There is no clear distinction between the term of FIF and fetiform teratoma [FT]. We are reporting a case in which a girl was referred as a case of nephroblastoma but at operation and on detailed examination of the specimen it turned out to be a case of twin fetus in fetu