Separation of thoraco-omphalopagus Siamese twin.

A pair of female thoraco-omphalopagus twins, with two pairs of lungs, common diaphragm and separate pleural cavities was separated at the age of 5(1/2) months after a parasitic relationship had developed between them. Before separation both the babies developed recurrent respiratory tract infection and frequent diarrhea. They were treated with medical therapy and made fit for anesthesia. The combined weight of the twins was 4(1/2) kg at birth and the combined weight at the time of separation was 9(1/2) kg. One baby was smaller in growth compared to the other baby. The closure of anterior abdominal wall was difficult in both babies. However, we could close it without use of any biodegradable patches or tissue expander. Both the babies survived and are doing well after 3 months of separation.

Oral tumors in newborn.

Tumors arising from the oral cavity in the newborn are rare. Congenital epulis and epignathus are the two lesions usually seen. They cause problems because of their position and size and have the potential to cause respiratory obstruction. These lesions must be diagnosed and excised early, as they have an excellent prognosis if treated properly. We describe two such patients, and provide a brief review of the literature to highlight the management strategy for these rare tumors.

Pyriform sinus fistula.

Pyriform sinus fistulae/sinuses are rare causes of recurrent cervical abscess, especially on the left side. They can also present as acute thyroiditis. Treatment in the form of simple incision and drainage is invariably unsuccessful, and the entity may be confused with the residual tract of a second branchial arch anomaly. We report a case of pyriform sinus fistula, and believe that this is only the second case report in India. We feel that greater awareness can lead to proper and appropriate diagnosis of this anomaly.

Soave procedure for infants with Hirschsprung's disease.

OBJECTIVE: Traditionally the surgical treatment of Hirschsprung's disease (H.D.) includes preliminary colostomy in normally innervated bowel followed by one of several pull through procedures. The transanal single stage Soave procedure eliminated the need for preliminary colostomy and intraabdominal dissection. It is a recent concept in the management of this disease, and this is the first experience to be reported from India. METHODS: Four children aged 3 weeks to one year underwent transanal pull through procedure over a two month period. A rectal mucosectomy was performed starting 0.5 cm. proximal to the dentate line and extending proximally to the level of intraperitoneal rectum. The muscular sleeve was divided circumferentially to allow the full thickness mobilization of the proximal colon. Ganglion cells were confirmed by frozen section and bowel was transected. The rectal muscular cuff was divided longitudinally and the anastomosis was completed. RESULTS: Operative time including the frozen section averaged 160 minutes and average length of the bowel resected was 22 cm. There were no postoperative complications and all patients were discharged on seventh postoperative day. Median follow-up was 5 months (4-6 months) and stool output ranged from 2-4 per day. CONCLUSION: The authors conclude that a single stage transanal Soave's pull through for Hirschsprung's Disease can be performed successfully in infants. When compared to conventional pull through procedure, it has the potential advantage of lower cost, less risk of damage to pelvic structures, absence of any abdominal incision, a lower incidence of intraperitoneal bleeding and adhesion formation. The preliminary functional results suggest that the patients gain early bowel function post operatively without soiling or constipation.

Spontaneous duodenal perforation in a newborn.

A full-term 4-day-old male baby presented with spontaneous duodenal perforation into the lesser sac. Exploration revealed a perforation in the posteromedial wall of the second portion of the duodenum. The perforation was closed and the baby recovered uneventfully.