Singing magnets ingestion: a rare cause of intestinal obstruction in children

Foreign body ingestion is a common problem in children. Ingested foreign bodies include coins, needles, pins and button batteries. Ingestion of multiple magnets is very rare and poses a unique hazard of intestinal obstruction in children. The ingested magnets may reside in different loops of intestine and attract each other causing necrosis of the intervening wall of intestine. We present the case of a 7-year old child who presented with acute intestinal obstruction due to ingestion of multiple magnets. Patient underwent laparotomy. The loops of small intestine with necrotic walls were found to contain three oblong shaped magnets. Removal of magnets along with resection and anastomosis of affected segment of intestine was performed

Double Meckel's diverticulum in a boy

Meckel's diverticulum is the remnant of vitello-intestinal duct and the most common congenital anomaly of gastrointestinal tract. Usually it is a single diverticulum. Finding a duplication of Meckel's diverticulum is an extremely rare incident. We report a ten year old boy who presented with abdominal pain in whom, at exploration double Meckel's diverticulum was found

Intestinal obstruction in children

To identify various causes and the outcome of intestinal obstruction in children older than one month of age. Descriptive case series. Department of Paediatric Surgery Chandka Medical College Hospital Larkana, from January 2010 to December 2011. Patients above one month of age who presented with signs and symptoms of intestinal obstruction were included. Patients with history of chronic constipation, trauma, post diarroheal distention, obstruction resulting from compression by tumors. Those with free gas on x-ray abdomen and where management done conservatively were excluded from the study. During the study period a total of 55 cases, 41[74.5%] males and 14 [25.5%] females were operated. The age of patients ranged from 1 month to 14 year. The main presenting features were not passing stools [100%], pain abdomen [89.09%], vomiting [85.45%], abdominal distension [81.81%], fever [21.81%], bleeding per rectum [18.18%] and mass abdomen [16.36%]. The causes of intestinal obstruction found were intussusception [27.3%], Meckel's diverticulum with band causing obstruction [16.4%], obstructed inguinal hernia [14.5%], post operative adhesions [9.1%], congenital peritoneal bands [7.3%], Hirschsprung's disease [7.3%], abdominal tuberculosis [5.5%], typhoid ileal perforation [5.5%], malrotation [3.6%] and umbilical hernia [3.6%]. Fifty-four [98.18%] patients recovered and discharged while one [1.81%] patient died. Intussusception and Meckel's diverticulum with a band were the most frequent causes of intestinal obstruction. One patient in this series died.

Perineal ectopic testis - a rare encounter in paediatric surgical practice

Perineal ectopic testis is a rare form of testicular maldescent. We report 2 patients with perineal ectopic testes, in one of them, the condition was bilateral [only the 6th case of this variety]. Surgery was performed in both cases and testicles were mobilized and fixed in the scrotum. Gubernaculum testis was found to be fixed in the perineum. Examination of patient with empty scrotum [maldescent testes] should include examination of sites like perineum to look for ectopic testis

Fibrous hamartoma of infancy

Fibrous hamartoma of infancy [FHI] is one of the rare tumor-like malformation. This benign tumor can cause much concern and confusion about being malignancy. We report a case of 10 months old infant who presented with a mass at posteriomedial surface of left upper arm. The mass was excised completely and histopathology confirmed the lesion as FHI

Ischiopagus tripus conjoined twins: a case report

Conjoined twins are one of the rarest congenital anomalies. We present a case of Ischiopagus tripus conjoined twins. The twins were fused at abdomen and pelvis, having two well formed lower limbs and one abnormal lower limb. There was only a single fused pelvis and only one set of well formed male external genitalia and absent anal opening. Anoplasty was done for imperforate anus and later on surgical separation attempted

Hypospadias: experience with Mathieu's repair

To determine the effectiveness of Mathieu's urethroplasty for anterior hypospadias. Design: Descriptive Study. Place and Duration: Department of Paediatric Surgery, Chandka medical College Hospital, Larkana, from January 2003 to December 2003. Patients And A Total of 30 boys who presented with sub coronal and distal penile hypospadias without chordee were included in the study. The neourethra was constructed by utilizing the flap of skin proximal to the meatus. Urethral catheter was used as stent and for diversion of urine. The age at presentation ranged between 1 and 12 years with a mean of 4.86 years. Twenty Three [76.66%] patients presented with distal penile hypospadias while the meatus was subcoronal in 7[23%] patients. The only complication encountered was minute urethrocutanems fistula in 2[6.66%] cases. The cosmetic results were satisfactory. The well established Mathieu's urethroplasty provides excellent result in terms of having minimal complication rate and excellent cosmetic and functional result

Double phallus

A 2.8 kg newborn was brought to the hospital soon after birth because of absence of anal opening and duplication of penis. Examination of cardiovascular, central nervous system and respiratory system was normal. His abdomen was distended. Examination of perineum revealed absence of anal opening. His genital examination showed two penises with normal scrotum. One penis was larger, looking apparently abnormal. The other penis was smaller, normal in appearance and present to the right of large penis. Both penises had patent urethral meatuses. The scrotum contained both testes. X-ray invertogram showed an intermediate type of anorectal malformation. His Micturiting cystourethrogram [MCUG] showed pooling of contrast in accessory urethra. Initially a sigmoid colostomy was performed for anorectal malformation to relieve the intestinal obstruction and stabilize the clinical condition. After few days the accessory penis was also excised. Postoperative recovery was uneventful. Biopsy showed fibromuscular tissue surrounded by skin with a central cystic space lined by urethral mucosa. Vascular spaces and neural tissue also seen. Patient has been visiting our outpatient department every month for follow-up and for the management of his colostomy

Hypospadias repair: a five year experience

Ninety cases of hypospadias were operated in the Department of Paediatric Surgery, Chandka Medical College, Larkana, from January 1993 to December 1997. The most common age group was between 1-5 years [63.3%] and the most common variety of hypospadias was penile [68.8%]. Chordee was present in 76 patients [84.5%] and other associated anomalies were present in 8 patients [9%]. Family history of hypospadias was present in 3 patients [3.3%]. Patients without chordee were selected for single stage repair and those with chordee were selected for two stage Byar's method of repair. Chordee was corrected in 76 cases, out of which 37 patients are waiting for urethroplasty. Urethroplasty has been done in 53 patients; single stage urethroplasty in 16 patients and two stage Byar's urethroplasty in 37 patients. Overall complication rate of urethroplasty was 36%. Fistula was the most common complication [28.3%]. Byar's method of hypospadias repair was found most satisfactory and adaptable to all degrees of hypospadias

Surgical complications of typhoid fever

This is a prospective study, carried out in the Department of Paediatric Surgery. Chandka Medical College Hospital, Larkana from January 1993 to December, 1997. A total of 90 cases of typhoid fever with surgical complications were admitted in the unit. Of 90 patients, 88 had gut and 2 had gall bladder perforations. In majority of patients [61.2%], duration of fever was two or more weeks. Leucopenia was found in 33.3% and pneumoperitoneum in 72.2%; Widal test was positive in 33.3% and blood culture, though done in 40 patients, were positive in all. Laparotomy was done in 89 patients. In 70 patients single and in 17 patients, multiple ileal perforations were present. Surgical procedures performed were: simple double layer closure [80], resection and anastomosis [5], hemicolectomy [2], and cholecystesctomy [2]. Postoperative complications occurred in 36 patients [44.4%]; wound infection being the most common complication [38.2%] in our series. Average hospital stay was 14.2 days. Seven patients [7.7%] died, one preoperatively and six postoperatively