Tubular duplication of esophagus: rare congenital malformations require individualized and innovative procedures

Rare congenital problems generally have no standardized diagnostic or operative technique. Because of some variation within the spectrum, diagnosis and management has to be individualized and tailored according to the local findings to relieve the symptoms. We report a diagnostic dilemma and surgical management of a child with proximal tubular duplication of esophagus with complete remission of symptoms after surgery. To diagnose rare malformations a high index of suspicion is required when differential diagnoses are being considered

Bilateral adrenal abscesses - A rare entity: a case report with review of literature

To report a very rare condition of bilateral adrenal abscesses in an infant. From literature it appears to be the third case being reported. On ultrasound imaging on several occasions it was considered to be bilateral adrenal hemorrhage. Hence our objective is to highlight the possibility of such masses to be adrenal abscesses. Design: Report of an unusual problem in an infant. Setting: Department of Pediatric Surgery, Children's Hospital, PIMS, Islamabad. Successfully treated with surgical drainage. Bilateral suprarenal abscesses usually results as an uncommon complication of bilateral adrenal hemorrhage. Ultrasound is the most helpful examination in distinguishing a suprarenal lesion from an intrarenal pathology and in demonstrating the morphology of an abscess. Percutaneous biopsy of supra renal mass should be avoided if pheochromocytoma is in the differential as was in our case

Tracheobronchial foreign bodies: a review and analysis during past one year at children's hospital, PIMS, Islamabad

In view of changing patterns, to identify most common type of foreign bodies in tracheobronchial tree of children. To make recommendations for appropriate measures to prevent the incidence of inhalation. This descriptive study was carried out between April 2001 to March 2002 on 108 children. Department of Pediatric Surgery, Children Hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad. We studied 108 patients out of whom 68 were male [63%] and 40 were female [37%]. The mean age was 3.97 years. Most common symptoms were dyspnoea in 88 [81%]. 35 patients [32%] had insignificant X-ray findings. 65 patients [60%] had hyperinflation. 3 patients [2.7%] had atelectasis. One patient had bronchiectasis, one with emphysematous change and one had pleural effusion. The most common organic foreign bodies 28 had pieces of peanuts [26%] and next most common 11 had beetle nuts [10%]. Most common inorganic foreign bodies 26 in our series was a whistle [24%], followed by 13 metallic rings [12.2%], metal nails, safety pins, pallets, watch batteries and ring stones. Aspiration of foreign body into tracheobronchial tree in children carries a high risk to life but adequate and prompt treatment is associated with very low mortality. Health care education is the key to prevention. Industrial manufacturing laws with regard to quality control and safety of production of various toys to which children are commonly exposed should be forcefully implemented

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

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

Glant sacrococcygeal teratomas

This is a report of two cases of giant sacrococcygeal teratoma [SCT] with completely different clinical appearance, histological pattern, and hematological findings. In the first case, the malignant nature of the tumor was apparent at birth, whereas the second patient had mature, non-malignant tumor and presented after eight months of birth. In the first case early and complete excision cured him completely of his tumor as was evident in his three years follow up with normal alpha-fetoprotein levels. Whereas in the second patient, the benign and mature nature of the tumor prevented malignant change although patient presented late. In both patients reconstruction of anatomical structures was performed. Early and late postoperative appearance was comparable to normal

Histopathological interpretative difficulties of a soft tissue tumour. a case report

This case is reported to explain the histological difficulties in differentiating soft tissue tumours. A childhood fibrosarcoma is reported which was misdiagnosed even on several reviews of histopathology slides. Though prognosis and treatment of soft tissue tumours are almost the same, there is still a need for proper histologic diagnosis, to place them in an appropriate group

Omphalocele major: conservative management

In our community, majority of deliveries are at home and most have no intra-uterine fetal monitoring. Many congenital anomalies, including omphaloceles, are diagnosed after birth. Almost all such cases are transported to health facilities, wrapped in dirty clothing, and are heavily contaminated with established sepsis. Even in tertiary centers like ours, resuscitative and ventilatory facilities have several limitations. Under these circumstances, we have devised a line of management on conservative lines and in stages, for contaminated omphalocele major. This seems to offer the best chance of survival to the infants. The present report is of three children presented at the Children's Hospital PIMS, Islamabad. Their mode and state of presentation and method of management are discussed, which highlights several important features of this condition in our set-up. A review of literature is also presented

Management of an ancurysmal bone cyst

Aneurysmal bone cyst is a rare, non-neoplastic, expansile bony lesion that mainly affects children and young adults. It may cause diagnostic confusion with a bone tumor. These cysts are frequently treated surgically, but recurrence is very common and surgery is hazardous, especially when the lesion is adjacent to the growth plate. A case report of an aneurysmal bone cyst in an 11 year old child is presented with serial radiographic changes and discussion on its management

Congenital longitudinal deficiency of femur: an experience with three cases

We encountered three children with congenital longitudinal deficiency of femur at the Children's Hospital, between January 1987 to December 1994. The deficiencies were of varying severity ranging from proximal focal deficiency to complete aplasia. The various associated abnormalities and management strategies are discussed along with a review of literature

Conjoined twins- a review of literature with two case studies

Two cases of conjoined twins have been reported. A review of literature is given

Tracheo-bronchial foreign bodies in children

A study of 70 cases of tracheo bronchial foreign bodies is presented which were successfully managed in the department of general surgery, children hospital Islamabad. The period is March 1988 to October 1990. 59% were male children, 74% were below 5 years of age 60% belonged to low socic-economic group. There were variety of materials but betel nut and pea nut constituted the major bulk of foreign bodies. 67% patients came to the hospital on the first day of inhalation. In 60% cases the foreign body was found in the right main bronchus. 7% patients were initially treated in the medical unit with the diagnosis of bronchopneumonia. All the foreign bodies were removed by bronchoscope