Emergency surgical management of a massive anterior mediastinal teratoma in a neonate

Generally an anterior mediastinal teratoma is diagnosed because of space occupying effect which produces respiratory distress and pneumonic episodes. However there have been few reports where there was the need to address the problem soon after birth [Fig. 1] because of severe respiratory compromise 2, 3. This was also the case in our patient. A full term baby who had to be transferred from 1000 Km. distance because of none availability of neonatal surgical facility there. He was transported with respiratory support after having been diagnosed on a plain x-ray and on MRI. [Fig. 2, 3, 4]. Emergency resuscitation and management resulted in successful outcome. Details of treatment are presented in this care report

Colocolic intussusception-a rare entity in children a case report

Colocolic intussusception is an unusual cause of intestinal obstruction in children. We are reporting two cases ofcolocolic intussusception; one presented with the clinical features of intestinal obstruction but lacking typical history of intussusception and other had a typical presentation of intussusception. Both cases were treated successfully with bowel resection and end-to-end anastomosis

Tubularized incised plate urethroplasty of hypospadias

To describe tubularized incised plate [TIP] urethroplasty, for the treatment of anterior hypospadias. Design: Descriptive study. Place and Duration of Study: This study was carried out in the Department of Pediatric Surgery, The Children hospital, Pakistan Institute of Medical Sciences Islamabad, from January 2003 to February 2004. Materials and There were 30 patients with anterior hypospadias. Children between 2-years to 12 years were included in the study. Tubularized incised plate urethroplasty [Snodgrass procedure] was performed in all the patients. Meatus was matured taking care not to close too much to avoid stenosis. Dressing was kept to prevent haematoma and oedema formation. Frequent irrigation of the stent was done to avoid blockage. Procedure was successful in 22 patients. Meatal stenosis was noted in three patients, two required dilatations only and in one patient meatotomy was performed. Three patients developed single urethrocutaneous fistula. One patient had complete breakdown. Tubularized incised plate urethroplasty was found to be a useful procedure for distal or anterior hypospadias with less complications. Special precautions like maturing the meatus to avoid stenosis and keeping the stent patent with frequent irrigation helps in minimizing fistula formation. The dressing technique prevented postoperative hematoma and edema of penile stuff

Bilateral adrenal abscesses - A rare entity: a case report with review of literature

To report a very rare condition of bilateral adrenal abscesses in an infant. From literature it appears to be the third case being reported. On ultrasound imaging on several occasions it was considered to be bilateral adrenal hemorrhage. Hence our objective is to highlight the possibility of such masses to be adrenal abscesses. Design: Report of an unusual problem in an infant. Setting: Department of Pediatric Surgery, Children's Hospital, PIMS, Islamabad. Successfully treated with surgical drainage. Bilateral suprarenal abscesses usually results as an uncommon complication of bilateral adrenal hemorrhage. Ultrasound is the most helpful examination in distinguishing a suprarenal lesion from an intrarenal pathology and in demonstrating the morphology of an abscess. Percutaneous biopsy of supra renal mass should be avoided if pheochromocytoma is in the differential as was in our case

Prostatic phabdomyosarcoma in an infant with neurofibromatosis

we are reporting an unusual case of a tumor in early infancy causing complete urinary obstruction. The patient was an infant with external signs of neurofibromatosis who presented with acute urinary retention prostatic rhabdomyosarcoma and was managed by total cystectomy and urinary diversion

Tracheobronchial foreign bodies: a review and analysis during past one year at children's hospital, PIMS, Islamabad

In view of changing patterns, to identify most common type of foreign bodies in tracheobronchial tree of children. To make recommendations for appropriate measures to prevent the incidence of inhalation. This descriptive study was carried out between April 2001 to March 2002 on 108 children. Department of Pediatric Surgery, Children Hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad. We studied 108 patients out of whom 68 were male [63%] and 40 were female [37%]. The mean age was 3.97 years. Most common symptoms were dyspnoea in 88 [81%]. 35 patients [32%] had insignificant X-ray findings. 65 patients [60%] had hyperinflation. 3 patients [2.7%] had atelectasis. One patient had bronchiectasis, one with emphysematous change and one had pleural effusion. The most common organic foreign bodies 28 had pieces of peanuts [26%] and next most common 11 had beetle nuts [10%]. Most common inorganic foreign bodies 26 in our series was a whistle [24%], followed by 13 metallic rings [12.2%], metal nails, safety pins, pallets, watch batteries and ring stones. Aspiration of foreign body into tracheobronchial tree in children carries a high risk to life but adequate and prompt treatment is associated with very low mortality. Health care education is the key to prevention. Industrial manufacturing laws with regard to quality control and safety of production of various toys to which children are commonly exposed should be forcefully implemented

Twin fetus in fetu-a very rare entity: a case report with review of literature

1] To report a very rare condition of conjoined twining in fetus in fetu in an infant. From literature it appears to be the 4th case being reported. 2] To emphasize the importance of proper examination of the fetus in fetu grossly by doing extensive dissection, radiologically and detailed histological tissue examination from several sites. Design: Detailed report of an unusual intra-abdominal mass in an infant. Setting: Department of Pediatric Surgery, Children Hospital, PIMS, Islamabad. Successfully treated with surgical removal and interesting diagnosis emerged. Twin fetus in fetu [FIF] is a very rare anomaly due to an abnormal embryogenesis of fetus during pregnancy. Malformed fetus grows in the body of co-twin and it is frequently detected as an abdominal mass. There is no clear distinction between the term of FIF and fetiform teratoma [FT]. We are reporting a case in which a girl was referred as a case of nephroblastoma but at operation and on detailed examination of the specimen it turned out to be a case of twin fetus in fetu

Palliative surgery for advance osteosarcoma of shoulder region

We are presenting here eight cases of advanced osteosarcoma of shoulder region involving scapula and upper humerus in children upto the age of thirteen years. All patients had complete loss of movement. Five patients underwent fore quarter amputation. Extensive amputation although a major mutilating procedure, provides patients a dramatic relief for the period that he survives