Isolated tubercular liver abscess in children treated with percutaneous isoniazid infusion.

Isolated Tubercular liver abscess is mainly reported in adult patients. We report two cases of isolated tubercular liver abscess in paediatric patients. Diagnosis was made by clinical and ultrasound guided aspiration of pus showing acid fast bacilli in one case. In second case, biopsy of the abscess wall was confirmatory. In both cases percutaneous drainage of pus and transcatheter infusion of Isoniazid was given. After two weeks of infusion no acid fast bacilli was detected and cavity size decreased. Direct infusion of anti-tubercular drugs is more efficient than systemic therapy alone. This is first of its kind in treating isolated tubercular abscess in paediatric patients. So, percutaneous infusion of anti-tubercular agents can be considered in the treatment of tubercular liver abscess.

Bilateral eventration of the diaphragm with malrotation and unilateral renal agenesis.

Bilateral eventration of the diaphragm associated with malrotation of gut and unilateral renal agenesis is a very rare entity. The authors treated a seven mth old male child who presented to them with respiratory distress and gastrointestinal problem. The child was anemic and was in type II respiratory failure. His X-ray chest showed bilateral eventration of diaphragm and ultrasonography abdomen was consistent with left renal agenesis which was confirmed by radionuclide scan. Bilateral plication of the diaphragm done with correction of malrotation which was diagnosed peroperatively. The association of these three anomalies are rare and to be kept in mind whenever treating a patient with bilateral eventration of the diaphragm.

Tuberculosis in Transverse Testicular Ectopic testis a diagnostic dilemma: Case report.

Transverse testicular ectopia is a rare entity where one testis migrates to the other inguinal area. Genital involvement due to tuberculosis is rare in children. Tubercular involvement in transverse testicular ectopic testis has not been reported earlier. A case of tuberculosis in transverse testicular ectopic testis is reported here where the testicular mass mimicked as a tumour. Histopathological examination confirmed the diagnosis.

Segmental testicular infarction.

Segmental testicular infarction is described in 11-years-old-child presented with acute left hemiscrotal pain and swelling. Clinical examination suggested left testicular tenderness with no evidence of intratesticular mass and the rest of the scrotal contents were normal. Color doppler study suggested a well circumscribed avascular lesion in the upper pole of left testis and provided a clue to diagnosis. Partial orchidectomy resulted in a satisfactory recovery and provided histopathological confirmation of diagnosis. Authors review their experience with this rare entity and the pertinent literature.

Pararectal duplication.

An unusual case of pararectal duplication is described in a 2 months old female infant presented with abdominal lump and constipation. The unusual clinical presentation and the management protocol of this rare entity are discussed. Authors review their experience with the present case and the pertinent literature.

Primary biliary tuberculosis in a child.

A case of primary biliary tuberculosis is described in an eight year old female child. The clinical and radiological features suggested presence of chronic cholecystitis. Surgical exploration revealed thick walled gall bladder distended with caseous material with adherent caseating portal lymph nodes. Cholecystostomy along with antitubercular therapy resulted in satisfactory recovery. Histopathological examination of lymph node biopsy and microbial examination of pus confirmed diagnosis of tuberculosis. Authors review their experience with this rare entity and the pertinent literature.

Acute appendicitis presenting as acute hemiscrotum in a boy.

A 6-year-old boy presented with diffuse abdominal pain, nausea and vomiting followed by features of acute scrotum. Laboratory and radiological evaluation suggested presence of infective pathology in the inguinoscrotal region. Surgical exploration revealed patent right processus vaginalis with purulent collection resulting from the presence of perforated tip of appendix in the hernial sac. Appendectomy with drainage of scrotal collection and ligation of hernial sac resulted in satisfactory recovery.

Hirschsprung's disease complicating colonic atresia.

A case of colonic atresia associated with Hirschsprung's disease is described in a full term neonate presented with intestinal obstruction. Laparotomy revealed type III colonic atresia. Histopathological examination suggested total aganglionosis in the postatretic colonic segment. The child recovered satisfactorily following two stage Duhamel - Martin's pull through procedure. Authors present their experience with the present case and the pertinent literature.

Gastrointestinal perforations in neonates with anorectal malformations.

We describe the presentation and management of gastrointestinal perforation in four neonates with anorectal malformations. Two neonates with high malformation had pneumoperitoneum on X-ray; surgery revealed sigmoid perforation in one patient and transverse colon perforation in the other. Colostomy was done, followed by posterior sagittal anorectoplasty at four months; both recovered satisfactorily. The third neonate had no radiological feature of gut perforation but cecal perforation was found at surgery; the neonate recovered following right hemicolectomy with stoma followed by anorectoplasty at five months. The fourth neonate presented with clinical and radiological features of perforation and recovered satisfactorily after anoplasty and colostomy.

Spontaneous gall bladder perforation: a rare entity in infants.

Spontaneous gall bladder perforation in infants is rare. We report a 3-month-old male infant who presented with progressive abdominal distension, low-grade fever, bilateral hydrocele and acholic stools. Ultrasonography showed free fluid in the peritoneal cavity, which was bile-stained on paracentesis. Surgical exploration revealed sterile biliary peritonitis and a gangrenous gall bladder. Partial cholecystectomy with external biliary drainage resulted in satisfactory recovery.

Spontaneous biliary perforation: a rare entity in late infancy and childhood.

Spontaneous perforation of the biliary tract is rare in infants & children with less than 100 cases reported in English Literature till date. We report two cases of this rare clinical entity in a 9-month-old boy and other of a 2-year old boy. Both patients presented with clinical features of acute peritonitis. Laparotomy revealed sterile biliary peritonitis with a normal cholangiogram in the infant and biliary perforation in other child. Simple drainage in the former and cholecystostomy with external biliary drainage in later resulted in a satisfactory outcome.