Primary Hydatid Cyst Posterior Triangle of Neck in a Child of 10 Years of Age.

A case of hydatid cyst involving posterior triangle of neck in a 10 year old male child is reported. Diagnosis was confirmed by MRI. Surgical excision of the cyst was done. Hydatid cyst in posterior triangle should be considered one of the possibilities in evaluating a cystic swelling in this region.

Congenital Descending Colonic Stenosis with Perforation of Transverse Colon in a Neonate: A Case Report.

Colonic atresia and stenosis are rare causes of intestinal obstruction in the infant. Only 10 cases have been reported in Literature since 1966 and only one late-onset case has been reported in Literature until now. We describe the case of a 3 day old baby presenting with abdominal distension, failure to pass meconium and vomiting. X-ray of the abdomen showed dilated gut loops. Exploratory laparotomy was performed. At the junction of descending and sigmoid colon a stenosis was found, laparotomy also revealed a perforation of transverse colon. Transverse colostomy and a mucous fistula of sigmoid colon was performed after resecting stenosing segment and colon distal to perforation site upto stenosing site. Diagnosis was confirmed on histopathology. Colostomy was close after six weaks with uneventful recovery. Considering both the Literature and our case, congenital colonic stenosis should be considered one of the rare differential diagnoses in a neonate presenting as complete or partial intestinal obstruction.

Pre-operative manometry of the blind rectal pouch to predict post-operative potential for continence in anorectal malformation.

AIM: Despite technical advances in the surgical repair of anorectal malformation, many children suffer post-operative faecal incontinence. There are many ways to assess postoperative continence in these patients but there is no manometry-based method to assess and make predictions pre-operatively. In this pilot study an attempt was made to correlate the pre- and postoperative manometry and electromyography findings in order to use the pre-operative findings to predict the postoperative potential for continence. METHODS: Ten patients aged 12 to 54 months were subjected to pre-posterior sagittal anorectoplasty manometry by introducing the balloon catheter probe through the distal colostomy into the blind rectal pouch. Electromyography activity in the striated muscle complex was also studied by placing electromyography needles in the midline in the anal dimple. A second study was repeated after posterior sagittal anorectoplasty (PSARP), the probe was introduced into the rectum via the neo-anus and the electromyography needles were placed on either side of the neo-anus. A third study was done, similar to the second study, after colostomy closure along with Kelly's scoring. Results of the three studies were compared. RESULTS: Pre-posterior sagittal anorectoplasty rectal pouch pressures were in the range of 18.3-93.3 cm H2O and electromyographic activity was between 43.6 and 383.0 microv. Post-posterior sagittal anorectoplasty studies showed anal canal pressure in a similar range of 16.0-95.5 cm H2O and electromyographic activity between 57.0-340.7 microv. The post-colostomy closure anal canal pressures ranged from 22.7 to 99.1 cm H2O and electromyographic activity ranged from 65.7 to 335.7 microv. The Kelly's score ranged from 1-6. CONCLUSION: Since, the pre-and postoperative manometry findings are quite similar and they correlate well with the surgical outcome, it may be possible to predict such an outcome before PSARP. Also, the pressure profiles and EMG activity in post-operative assessments suggest intact neural pathways despite blind pouch mobilisation.

Manometric evaluation of postoperative patients with anorectal anomalies.

AIM: To evaluate the outcome of surgical treatment in patients with anorectal malformations and to correlate the clinical, manometric and electromyographic studies in assessment of postoperative continence in these patients. METHODS: Forty-one patients operated on for anorectal malformations were evaluated retrospectively. These included 13 patients with low anomalies, 24 with high anomalies, and 4 with congenital pouch colon. Functional results after surgical correction were assessed on clinical basis using the Kelley's scoring system and by anorectal manometry. In addition, the electrical activity of contraction of the external sphincter muscle was studied using electromyography. RESULTS: There was direct correlation between anal canal pressures and Kelley's score in patients with both high and low anomalies; Kelley's score of 6, 5, 4, 3 and less had pressures ranging between 60-75, 45-59, 30-44, 15-29 and less than 15 cm H2O, respectively. However, the electromyographic activity did not correlate well with Kelley's score. CONCLUSIONS: Anorectal manometry correlates well with Kelley's scoring system and may be a more objective method of analyzing the results of surgery. Poor correlation between Kelley's score and electromyography may be a reflection of poor compliance with instructions to voluntarily contract the muscles of continence.

Sacrococcygeal teratoma with anorectal malformation.

A 7-month-old child presented with imperforate anus, penoscrotal hypospadias and transposition, and a midline mucosa-lined perineal mass. At surgery the mass was found to be supplied by the median sacral artery. It was excised and the anorectal malformation was repaired by posterior sagittal anorectoplasty. Histologically the mass revealed well-differentiated colonic tissue. The final diagnosis was well-differentiated sacrococcygeal teratoma in association with anorectal malformation.

Duplications of the alimentary tract in children.

This study was conducted to assess the clinical, diagnostic and therapeutic approach in patients with alimentary tract duplication and review the relevant literature. A retrospective analysis of 28 patients of alimentary tract duplications treated between January 1990-December 1999 was carried out. There was a male preponderance (25:3); 71% of the patients were under 2 years of age. The presenting features were related to the anatomic location. Three patients were diagnosed antenatally. Real time ultrasonography and CT scan was undertaken for preoperative evaluation in the majority of patients. In selected cases a 99m-Tc-pertechnetate scan and barium meal follow through examination were also performed. Majority of duplications were in the jejunum and ileum. Twenty percent of our patients had thoracoabdominal duplication as compared to 2% reported in literature. Four patients required to be operated upon in the emergency for related complications. In the remaining patients complete excision of the cyst was done in 21 and only mucosectomy in 3 patients. Because these lesions are rare and can present with a wide range of clinical manifestations or may even be encountered intraoperatively, the appropriate surgical management requires the surgeon to be familiar with the anatomy and clinical characteristics of these lesions.