Tuberculous intestinal perforation in a case of Burkitt lymphoma on chemotherapy - A case report.

Intestinal perforation induced by chemotherapy in a patient of Burkitt lymphoma is a known potential complication which carries high mortality. Perforation may also occur as a result of the transmural nature of the tumour. Patients on chemotherapy are prone to contract infectious diseases due to a compromised immune system. Pulmonary tuberculosis has been reported in these patients, but abdominal tuberculosis has not. We report the case of a five year old boy on chemotherapy for Burkitt lymphoma, and who developed a tuberculous jejunal perforation. The patient underwent drain insertion and stabilization followed by exploratory laparotomy with resection of the pathological segment and closure of the duodenal stump at the fourth part. Bowel continuity was re-established by gastrojejunostomy. Histopathologic examination of the resected segment revealed intestinal tuberculosis. Anti -tubercular therapy was started and continued for nine months. The last cycle of chemotherapy was administered 1 month after surgery. At 1 year of follow up the patient is asymptomatic and thriving well.

An unusual presentation of rectal atresia with rectal duplication cyst in a neonate: A case report.

A 10 days old male baby brought with abdominal distension and cystic swelling in the left buttock. Radiological investigations suggested para-rectal abscess or rectal duplication cyst. Patient underwent transverse loop colostomy and later definitive surgery by posterior sagittal approach. Intra-operative findings were suggestive of small atretic rectal segment with duplication cyst of the rectum. To the best of our knowledge, neonatal rectal atresia with rectal duplication cyst has not been reported in English literature.

Tubularized incised plate urethroplasty with de-epithelialized flap

Aim: To improve the results of tubularized plate urethroplasty by adding de-epithelized flap. Patients and Methods: Twenty-five cases of hypospadias who underwent Snodgrass urethroplasty using de-epithelialized flap were studied. The minimum period of follow-up in this series was 1 year. Results: The resultant neo-meatus was vertically oriented and slit like. Glans was conical which is cosmetically well accepted. Penile raphe was in the midline. None of the patient had residual chordee; penile torsion; or glans dehiscence. Excellent cosmetic results were observed in all cases. The complication rate in our series was 8(two cases). Two patients developed fistula. Conclusion: De-epithelialized flap is a simple method to provide additional covering to the constructed neourethra after Snodgrass urethroplasty. It achieves our goal of noncrossing suture lines and providing maximum vascularity

Congenital paraesophageal hernia presenting with severe gastroesophageal reflux.

Paraesophageal hernia in children is relatively rare entity. These children usually present with recurrent respiratory tract infection or vague GI symptoms. An 11 year female presented with episodic vomiting, heartburn and features of hypocalcemic tetany. Investigations revealed right paraesophageal hernia. Reduction of the contents and repair of the defect with fundoplication was done. Patient is asymptomatic on follow-up.

Atypical presentation of Tuberculosis.

Incidence of tuberculosis is increasing with emergence of many cases of multi-drug resistance and extrapulmonary manifestation. We report three cases of tuberculosis presenting in very atypical ways.

ABCD syndrome revisited.

A four-day-old neonate presented with severe abdominal distention, intermittent bilious vomiting, typical black lock, partial albinism and heterochromatic iris. Ileostomy was done proximal to the transition zone at mid-ileal region (50 cms proximal to ileo-cecal region) All biopsy specimens till the transitional zone were negative for ganglion cells. Distinct features of total colonic aganglionosis and recto-sigmoid Hirschsprung's disease are delineated here.

Neonatal lower extremity gangrene.

Four neonates suffering from bilateral lower limb gangrene were referred to us for further management. Two neonates had no contributory etiology. All four received appropriate treatment thus avoiding mortality but morbidity could not be avoided. All four neonates recovered uneventfully.

Congenital segmental dilatation of colon with colonic atresia.

Congenital segmental dilatation of the colon belongs to a group of Hirschsprung's-like diseases with normal ganglion cells. The presentation is with chronic constipation affecting older children. We report a neonate with congenital segmental dilatation of the colon associated with sigmoid atresia. The child is well after a colostomy.

True tail in a neonate.

Distinction between true and pseudo trail in lumbo-sacral region is important since treatment and prognosis are different. Fewer than 40 cases have been reported in literature. The authors report a case of true tail in a neonate, a rare event.

Multiple tubular and cystic intestinal duplications.

Duodenal and colonic duplication presenting as mass in a neonate is rare. We report a 52-cm-long tubular, total colonic and 5-cm-long cystic duodenal duplication in a two-day-old neonate. Both the duplications could be excised without resection of the normal bowel.

Disseminated spina ventosa.

Spina Ventosa is a rare condition. A rare case of disseminated tuberculosis of bones and skin without primary foci is presented. Gross sclerosis of the short bones of hand and leg were noted.

Perforation in a jejunal duplication lined by ectopic gastric mucosa.

We report a 3-year-old child with jejunal duplication with localized perforation and bleeding in the adjacent normal intestine. The entire duplicated jejunum was lined by gastric mucosa. This was successfully treated by mucosal excision of the duplicated intestine and resection of a short segment of normal jejunum.

Pulmonary gangrene complicating bacterial pneumonia.

Two cases of pulmonary gangrene involving left lower lobe in an 18-month and 4-year-old female children are reported. The patients looked like having empyema following Klebsiella pneumonia. The diagnosis was made following computerized tomography scan and during decortication respectively.

Perineal canal: an uncommon entity with good prognosis.

This article reports two patients with perineal canal (anovestibular fistula) who were treated at Dept. of Pediatric Surgery, LTMG Hospital, Mumbai. Both the patients had normal anus and a fistula between the anal canal and the vestibule. They were treated by vestibulo anal pull through procedure. The pathogenesis of this condition and the pertinent literature is reviewed.