Hydrocephalus in Children with Spina Bifida

A prospective study consisting of 50 infants having spina bifida and cranium bifidum and relationship of hydrocephalus was carried out. The male preponderance was obvious (1.7:1) with majority of infants being less than 3 months. The presenting complaint in almost all the children was swelling on back or head. Lumbar spine was affected most commonly with 36% children having lesion at this site followed by lumbosacral (20%) and occiptal (16%). Neuromuscular deficit was present in 32% cases. Clinical evidence of hydrocephalus was seen in 22% children. X-ray skull was suggestive of hydrocephalus in 22% cases. Ultrasound examination of skull confirmed the diagnosis in 52% cases. Hydrocephalus had no specific relationship with site of lesion. It was more commonly associated with neurological deficit. Sonographic examination is relatively cheaper and invaluable investigation. and should be done routinely in patients with spina bifida.

Uerthral Obstruction By a Foregin Body:An Unusal Presentation of Ano-Rectal Malformation With Recto-Urethral Fistuala.

A 16 months old male child with features of acute urinary and intestinal obstruction due to a vegetative foreign body (FB) impacted in the anterior urethra is presented. The patient had an untreated intermediate ano-rectal malformation (ARM) with wide recto-urethral fistula (RUF). Multiple other congenital anomalies were, also, seen in this patient. The foreign body was removed by an external urethral meatotomy, relieving recto-urethral obstruction. However, the child died of septicaemia 6 hours post-operativerly. To best ofOUt knowledge, this is the first case of ARM, presenting with urethral obstruction due to a foreign body.

Abdominal Tuberculosis in Surgical Practise.

Thirty patients of abdominal tuberculosis in the age group of 20-40 years weare analyzed. Majority of the cases had abdominal pain as the leading clinical presentation. A significant number of patients also had abdominal lump. Intestinal obstruction / perforation was present in 10 patients requiring surgical intervention. Barium studies (done on 27 occasions) had positive rate of 70%. All patients, where diagnosis of tuberculosis was confirmed, received three-drug anti-tubercular regimen There was no post-operative mortality.

Acute Duodenal Ulcer Perforation With Carcinoma Stomach.

A 62 year old female who presented with features of acute duodenal perforation and associated carcinoma stomach (Ca-Stomach) is reported. Upper gastrointestinal endoscopy, biopsy and barium meal showed an adenocarinoma of cat'dia and proximal 1I3rd of stomach. Such an association of pathology is not reported earlier in the literature.

Congenital Anomalies of the Diaphragm in Children.

Twenty children with various diaphragmatic anomalies, managed over a period of 3 years, are presented, These included congenital diaphragmatic hernia (CDH 10), congenital eventration of diaphragm (CDE 6) and hiatus hernia with gastro-esophageal reflux (HH-GER 4). Clinical presentation of these children was: respiratory distress (7), recurrent repiratouy tract infection with failure to thrive (11) and gastric volvulus (3). Two patients of gastric volvulus had acute surgical abdomen. The patients in respiratouy distress group were all newborns with CDH. Whereas, those who had gastric volvulus were CDE 2 and HH-GER 1. All children were operated through left subcostal transabdominal approach, except those with HH-GER who were explored through upper midline incision. Repair of diaphragmatic defect/placation was done in patients with CDH/CDE, whereas Nissen fundoplication (Loode wrap) was done in patients of HH-GER. Three newborns with CDH and one child with CDE and gastric volvulus died. All other 16 surviving children are doning well after 4 months to 3 years of follow up.