Clinical presentation and management of adult choledochal cyst: a retrospective review

Objectives: To determine the mode of presentation and commonest surgical procedures done for adult choledochal disease in a tertiary care hospital

Methodology: A retrospective review conducted in Lady Reading Hospital, Peshawar, from January 1995 to January 2005 with one year of follow up. All patients above 13 years of age with choledochal cyst were considered for the study. Mode of clinical presentation and commonest surgical procedures were recorded

Results: Of the total 23 patients collected, 08 [34.78%] were males and 15 [65.22%] were females. Regarding mode of clinical presentation, pain right hypochondrium with raised serum bilirubin and ALT levels was found in 21.73% of patients. Complete cyst excision was possible in 69.56% of the patients. Complete cyst excision followed by Roux-en-Y common hepatico-jejunostomy was performed in 30.43% and common hepatico-dudenostomy in 26.08%

Conclusion: The most common mode of clinical presentation of choledochal cyst was pain right hypochondrium with raised serum bilirubin and ALT levels. The commonest surgical procedure was complete cyst excision with Roux-en-Y common hepatico-jejunostomy

Frequency of urethrocutaneous fistula following snodgrass hypospadias repair in children

To determine the frequency of urethrocutaneous fistula over a period of three months following snodgrass hypospadias repair for the treatment of distal penile hypospadias in children. This descriptive study was conducted in the pediatric surgery unit, Lady Reading Hospital, Peshawar over a period of eight months from June 2009 to February 2010. Patients with distal penilehypospadia without chordee between 2 and 14 years were included and patients were excluded who had previous repair for hypospadias. All those patients fulfilling the inclusion and exclusion criteria whose parents gave informed consent after explanation of the whole protocol were admitted through outpatient department for the said procedure and data was analyzed. A total of 52 patients were included in the study. All patients were in the range of 2 to 10 years and underwent Snodgrass Tubularized Incised Plate [TIP] urethroplasty for hypospadias repair. The overall rate of urethrocutaneous fistula was 9.6% [5 out of 52 patients]. Mean operative time noted in minutes was 57.52 minutes. No major morbidity or mortality was noted in this study. TIP urethroplasty is simple, single stage operation in the management of hypospadias and has good functional and low complication rate

Congenital tuberculosis revisited: a case report and recent review of literature

Perinatal tuberculosis, including congenital tuberculosis, is rare. It is a difficult disease to diagnose in the neonatal period. There should be high index of suspicion in a neonate with sepsis-like presentation, non-resolving pneumonia or unexplained illness. Fatality is high if there is a delay in diagnosis. Improved screening of women at risk and awareness is thus essential. This case illustrates the importance of history of maternal illnesses and evaluation including endometrial biopsy; neonatal gastric aspirates for acid-fast bacilli smears and cultures and polymerase chain reaction for diagnosis. Early institution of therapy has successful outcome. A recent review of literature of congenital tuberculosis is also presented