Cystic lesions of lung in infancy

Objective: to describe clinical presentations, investigations performed for diagnosis, treatment provided and outcome of cystic lesions of the lung in infancy

Study design: descriptive case series

Place and Duration of Study: department of Paediatric Surgery, National Institute of Child Health Karachi, from January 2010 to February 2012

Methodology: infants admitted with respiratory distress and later suspected of having structural / anatomical cause for the dyspnea were included. X-ray chest was performed in all the cases. CT scan was advised for detail assessment

Results: a total of twelve patients were managed during the study period. There were seven male and five female patients. Seven lesions were in left lung and five in right lung. This included seven cases of congenital lobar emphysema [CLE], two of pneumatocele, one each of bronchogenic cyst, isolated lung cyst and necrotizing pneumonia. All patients underwent thoracotomy and procedure was tailored according to the pathological lesion. Excision of involved segment of lung was performed in cases of CLE [five left upper lobes and two right middle lobes] and necrotizing pneumonia [right upper lobe]. Lung cyst was found in the fissure between right upper and middle lobes. In two cases of pneumatocele cyts were opened and after partial excision of the wall. Margins of cysts were over sewed. In a single case of bronchogenic cyst which was adherent to left bronchus excision of cyst and repair of bronchus was done. One patient died in this series

Conclusion: cystic lesions presents in a spectrum; most common being acute respiratory distress. An early diagnosis and prompt surgical intervention is required to prevent morbidity and mortality

Laparoscopy in children

Objective: To analyze data related to different laparoscopic procedures performed on children so as to document pattern over the years at a public sector hospital

Study design: Retrospective chart review

Place and Duration of study: Department of Paediatric Surgery National Institute of Child Health Karachi, from January 2011 to December 2013

Methodology: The data of all the laparoscopic procedures was reviewed for the indications, type of surgical procedure performed, operative details including time taken for completion of the procedure, difficulties / conversion rate and complications. Data was entered into SPSS version 16 and descriptive statistics were used for analysis

Results: Total number of patients who underwent laparoscopic procedure was 201. There were 164 [81.6%] males and 37 [18.4%] females. Most of the patients [n=122 - 60.7%] were above five year of age. Clinically impalpable testis [n=124 - 61.7%]] was the most common surgical condition for which laparoscopy was performed. This included first, second stage Stephen Fowler procedure, single stage orchiopexy and orchiectomy. Other procedures included appendectomy [n=27-13.4%] and cholecystectomy [n=12 - 6%]. Diagnostic laparoscopy was performed in 11 [5.5%] babies with persistent jaundice to find out surgical cause of hyperbilirubinemia. There were 7 [3.4%] cases with disorders of sex development [DSD]. Complications occurred in 19 patients which included port site infection [n=8], port site bleeding [n=5], bowel injury [n=2] and others. In only seven [3.5%] cases procedure was converted to open surgery

Conclusions: Laparoscopy was a safe surgical procedure in children performed for different indications. Learning curve over period improved procedure related outcome

Floating death in pericardium

A 12-year-old boy referred from another facility after sustaining stray bullet injury to chest on left side with no exit wound. He remained stable through out although chest intubation was done in referring hospital. In our Emergency Room he remained well therefore shifted to surgical unit. Investigations revealed bullet in pericardial cavity. It was decided to remove the bullet on elective basis. Surgery was deferred at the request of parents. Six months later child was operated. Initially thoracoscopy was performed but it was converted to open thoracotomy as bullet could not be identified. It was then retrieved easily from paricardial cavity. Post operative recovery was uneventful

Splenic hydatid cyst: a rare site of involvement

A case of splenic hydatid cyst is reported in which the only complaint was left sided abdominal pain. Hydatid disease was diagnosed on ultrasound abdomen and CT scan. IHA was also significantly raised. Patient was kept on albendazole pre-operatively. On splenic exploration due to the presence of good splenic tissue cystectomy and capitonnage was done

Intralesional bleomycin injection- A primary therapy for peripheral lymphangiomas

To evaluate the efficacy of intralesional Bleomycin Injection [IBI] as a primary therapy for peripheral lymphangiomas in children. A prospective study was conducted at NICH Karachi from January 2003 to December 2005. Patients with peripheral lymphangiomas were included in the study. Exclusion criteria included previously treated lymphangiomas, infected lesions, intra-thoracic and intra-abdominal lesions. Thirty three patients were included in the study. All were treated with Intralesional Bleomycin Injection [IBI]. After aspiration of fluid from the lesion, 0.5 mg/kg of Bleomycin diluted in saline was administered at different sites into the lesion. Depending upon the size of lesion and age of patient, procedure was performed in operating theatre under local or general anesthesia. Reduction in size was seen in 90% cases [n=29], out of them 30% [n=10] showed near complete disappearance and 63% [n=21] showed good response. Two patients [6%] showed poor response and they underwent surgery. Few patients had minor complications like fever, pain, redness and increase in the size after injection. All these complications were managed conservatively with symptomatic treatment and no patient required hospitalization. IBI is an effective therapy for lymphangiomas, with results comparable to surgical excision. It has the added advantage of avoiding inadvertent injury to vital structures, scarring and other complications of surgery. We recommend it as a primary therapy for all peripheral lymphangiomas