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Objective?The word “telemedicine” literally translates to “healing at a distance.” In the current scenario of the coronavirus disease 2019 (COVID-19) pandemic and shut outpatient department, the patients are facing difficulty in consultation. This article evaluated the use of telemedicine in the management of pediatric surgical patients. Materials and Methods?In this observational cohort study, from April 2020 to August 2020, all patients who took advice on phone/WhatsApp were assessed for addressing their complaints. The data was collected and analyzed. Result?A total of 307 patients were provided consultation via telecommunication. The male to female ratio was 2.3:1. Fifty-six (18.2%) patients called on an emergency basis, while the remaining 251 (81.8%) patients called for nonemergency or routine problems. Of these, attendants of 25 (8.14%) patients were not able to state the situation adequately. They were called to the department. Of these, 11 (3.5% of total) patients were admitted. One-hundred and eighty-three (59.6%) patients were in the department's follow-up, while the remaining 124 (40.4%) were new patients. The attendants of 296 (96.4%) patients were satisfied by using this modality of consultation. Conclusion?In the current scenario, telecommunication may help us to avoid unnecessary travel to the hospital. It may be helpful to deal with minor clinical complaints and evaluating for an emergency.
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One of the rare complications of choledochal cysts is rupture. In majority of the cases, the cause of rupture is unknown. Reconstructive surgery is the treatment of choice. We describe three patients with choledochal cyst rupture, who were admitted with acute abdomen. Diagnosis of biliary ascites with peritonitis was made in all the three patients. At surgery, two patients underwent T-tube placement, and definitive repair was done electively. One patient underwent definitive repair of ruptured choledochal cyst, but died due to septicemia. External bile drainage would be safer in emergency condition.
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Spontaneous perforation of extrahepatic bile duct is rare. The cause is idiopathic once trauma and choledochal cyst are ruled out. The condition presents a diagnostic dilemma. Preoperative recognition is necessary as early surgical intervention gives excellent prognosis. We report clinical observations made in three cases with acute presentations. Diagnosis is to be suspected by the presence of jaundice after an initial anicteric period of good health with biliary ascites. This is confirmed by bilious abdominal paracentesis, signs of peritonitis and absent free gas on X ray. The constellation of these three findings was constant in three patients. The presented paper highlights the same as reliable clues to diagnosis.