Management of undescended testis in Gezira national center for pediatric surgery [2009-2011]

Undescended Testis [UDT] or Cryptorchidism is the most common genital problem encountered in paediatrics. Untreated UDT/cryptorchidism clearly has deleterious effects on the testis over time. In Gezira National Center for Pediatrics Surgery [GNCPS] UDT/Cryptorchidism had been treated since early 80s. During this period no study was taken to evaluate this condition. This is a retro-prospective descriptive study done over a 2 year period from Oct 2009 to Oct 2011 including all patients with UDT operated on in the GNCPS. Patients were evaluated regarding the age at presentation, age at surgery, site of the UDT, location of the testes, investigations done and treatment modality. A total of 232 children underwent orchidopexy for UDT in GNCPS, 81.5% of those patients were older than 2 years. Bilateral cases were 16.8%. Nonpalpable testes found in 36.6% of cases. Dartos pouch fixation was used in 79.8% of the cases. the majority of children with UDT presented at an age older than two year which reflect the delay in diagnosis due to lack of adequate neonatal examination

Esophageal perforation following foreign body ingestion in children: report of three cases

We report three cases of foreign body esophagus, in two of them the foreign body was a coin, and the third child ingested a disc battery. In all three cases the foreign body was impacted in the mid esophagus. All were initially evaluated by chest X ray which confirmed the diagnosis.One underwent flexible endoscopic extraction initially followed by rigid esophagoscope later and in the other two extractions was performed using rigid esophagoscope, two of them ended with perforation of the esophagus and treated conservatively with only chest tube insertion and supportive management. In the third child who ingested a disc battery, esophagoscopy revealed necrosis and perforation at the site of impaction with formation of trachea-esophageal fistula, extraction was performed but the fistula necessitated surgical closure which failed and therefore underwent stent placement to end with complete cure

Snake bite in Gezira revision of 63 envenomed child

Sixty three patients admitted to the Gezira National Center of Pediatric Surgery with snake bite were analyzed. All patients were envenomed and the snake was positively identified. In 39 patients [61.9%] the offending snake was [washash] [Echis carinatus] and in 24 patients [38.1%] [Abdafan] [atractaspis microlepidata was identified. All patients were from rural Gezira where children are actively involved in agriculture and harvesting. The median age group was 9.3 years. Females were equally involved as males. The mean time elapsed since the bite was 56 hours. Quicker arrival at hospital was seen in severe envenomation. Fifty patients had already received native remedies which was observed to increase the local wound complications. Most bites [79%] occurred in the leg .The majority of the bites occurs in the early rainy summer months. All patients presented initially with progressive painful swelling. Local necrosis was observed in seventeen patients [26.9%]. Fourteen patients [22.2%] developed compartment syndrome and three patients [4.76%] developed fingertip gangrene, one patient [1.6%] developed extensive bilateral common iliac vein thrombosis. D1C developed in 21 patients [33.3%]. Two patients [3.2%] of theses developed intracranial haemorrhage. Four patients [6.3%] with local necrosis presented few month later with extensive chronic osteomyelitis.Treatment options included cardiovascular support, local wound debridement, fasciotomy and minor amputation. Patients with DIC were managed with fresh frozen plasma, blood transfusion and heparin. Antivenin was not administered to our patients. All patients eventually recovered except one child [1.6%] who succumbed of massive intracerebral haemorrhage

[Penile fracture epigrams from our experience in 15 Sudanese patients]

To review clinical pattern and outcome of fracture penis retrospectively from January 2000 to January 2008 in Gezira hospital for renal diseases and surgery, Sudan. Total number of patients were 75 and the range of age was 15-45 years with a mean age of 25 years. Diagnosis was established mainly through clinical work up. Most patients were subjected to a surgical intervention. The defects in the tunica was approximated by the used 2-0 proleine with inverted knot and/or delayed absorbable sutures and Foley catheter was routinely fixed after insurance of the integrity of the urethra. Most of cases presented with penile pain [13 patients, 87%], swelling due to extension of a haematoma [9 patients, 60%], bruises and detumescence [10 patients, 67%], curvature and fracture of erection were the presenting claim for the delayed patients [3 patients, 20%]. Most of them developed complications [8 patients, 53%], this included [4 patients, 27%] developed erectile, dysfunction, [2 patients, 13%] developed curvature and one patients [6%] developed calcification urethral stricture. We concluded that early surgical intervention, antibiotics administration and early seeking of medical advice are recommended in order to preserve penile function in cases of fracture penis. Investigations got minor role in the diagnosis of fracture penis

Polyorchidism: case report and literature review

Polyorchidism is a rare congenital anomaly frequently associated with maldescent testis, hernia, and torsion. Reports in the literature show an increased risk of testicular malignancy in the presence of polyorchidism. This entity has characteristic sonographic features and the diagnosis is often made on the basis of sonography. A conservative approach is the treatment of choice in uncomplicated cases. We report a male of 26-years old with 2 testicles in right side diagnosed by ultrasound. A brief history and review of the literature is also presented

Fine needle aspiration cytology [FNAC] in diagnosis of tumoral calcinosis, a report of three cases

Tumoral calcinosis [T.C.] is very rare and generally of unknown aetiology characterized by calcific deposits in the soft tissues. Commonly seen in the second decade of life [reported age range 15 months to 83 years]. We are reporting 3 cases of T. C. who were initially diagnosed by FNAC. Two of the 3 cases were female siblings who were referred to us as possible cases of recurrent fibrosarcomas following surgical excision. [1] Two female siblings aged 17 and 14 years - complaining of large swelling in the upper outer right thigh and the left outer upper thigh around the hip joints respectively. There was no limitation of movement. The masses recurred within a short period after total excision. Neither specimen was subjected to histopathology. Clinical examination showed two masses each approximately 30cm maximum diameter and 10 cm width. In addition the younger sister showed an additional mass 4.5 cm in the outer aspect of her right elbow. [2] 18 months old female child, unrelated to the above two cases, presented with an egg-sized mass in the mid-lateral aspect of her right thigh - cystic and mobile. There is a history of quinine injection in the same area. No positive family history of a similar condition. All three cases showed normocalcaemia and hyperphosphataemia with specks of calcification on x - ray and cysts in ultrasound. FNAC showed structureless gung, calcium granules and inflammatory cells including foreign body type multinucleated giant cells. Histopathology confirmed the diagnosis of T. C. Described the three types of T. C. [familial, idiopathic, and that in patients of chronic renal failure on dialysis]. The differential diagnoses were also discussed as well as lines of management such as Ca[++] supplementation, phosphate restriction, acetazolamide, parathyroidectomy and the treatment of choice is total surgical excision. To our best knowledge this is the first time to report the use of fine needle aspiration cytology in the diagnosis of T. C. in Sudan