Hirschsprung's disease; diagnosis and management: experience at Ibn E Siena and Nishtar hospital, Multan

To determine the frequency of Hirschsprung's Disease as a cause of neonatal intestinal obstruction, to compare the results of treatment with others and to suggest means and ways to improve the deficiencies in our circumstances. Nishtar hospital and Ibn-e-Siena Hospital, Multan from January, 2008 to June, 2012. A total number of 115 patients from neonatal age to more than 5 years were diagnosed and treated for Hirschsprung's Disease. Hirschsprung's Disease was a cause of neonatal obstruction in 26 [22.6%] patients. Hirschsprung's Disease was a cause of recurrent diarrhea in 37 [32.17%] patients. 76 [66.08%] patients presented with chronic constipation. 27 patients underwent for pull-through operation. The overall complications rate and stooling pattern after Soave's procedure are not significantly different from others

Congenital aganglionosis; single stage transanal pullthrough, a big relief to patients

To report early and late outcome after a one stage operation and comparison with others similar work and to see feasibility of this procedures in our limited resources. We have performed transanal pull through in department of Paediatric Surgery, Nishtar Hospital Multan during May 2010 to May 2013. Fifty patients out of 117 were selected, older than one year, non marasmic and diagnosed as short segment aganglionosis by barium enema were selected. Transanal Swenson's pull through was performed, aganglionic segment was decided on gross appearance [narrow] due to lack of frozen section facility, anastomosis made with 4/0 vicryl. Procedure completed on an average within one hour, without any transfusion. Feeding was started from day one, manageable complications were observed in 25% patients, no mortality seen. Hospital stay was on an average 6 days. Transanal one stage pull through is very practical, can be done without facility of frozen section

Hirschsprung's disease; enterocolitis during the course

To determine the frequency of Hirschsprung's Disease associated enterocolitis in pre and post operative patients. Nishtar Hospital and Ibn-e-Sina Hospital, Multan from January 2008 to June 2012. A total number of 114 patients aged from less than 6 months to more than 5 years were diagnosed and treated for Hirschsprung's Disease after rectal biopsy and internal sphinterotomy. In total of 114 patients 32 [28%] developed enterocolitis before and 5 [18.5%] after definite surgery. The results of this study implicates that the early diagnosis and to make measures to decrease the post pull-through anastomostic anorectal stenosis can reduce the frequency of pre and post operative Hirschsprung's disease associated enterocolitis

Mid gut atresia; A study on the management by different surgical procedures

This study is conducted to assess most successful surgical procedure in such patients. Prospective comparative study. Nishtar Medical College and Hospital, Multan from July 2010 to July 2012 [two years]. All patients of mid gut atresia [duodenal atresia, annular pancreas, jejunal atresia and ileal atresia] during this period were included in the study. Patients with associated congenital anomalies in other systems, in sepsis and patients operated out of Nishtar Hospital, Multan but referred due to complications. The study included 52 patients of duodenal, jejunal and ileal atresia. End to end anastomosis, Bishop Koop enterostomy and Santulli's enterostomy were constructed according to convenience. Transanastomotic tube was retained in half the patients. Thorough washing of distal unused intestine was done during surgery, postoperatively tube was used for early feeding and saline dilatation, micro enemas were repeatedly done to help dilatation of unused gut. ln two years 52 patients of mid gut atresia were operated. ln duodenal obstruction all three patients survived with TAT and RDP unlike two out of three without TAT and RDP. 10 patients of jejunal atresia out of 12 survived after TAT and RDP Santulli's enterostomy was most fruitful method [05 survived out of 05] in ileal atresia, initial response after double barrel enterostomy was also good [03 out of 03 survived]. Ln patients of Duodenal obstruction transanastomotic tube [passed through nasal route] with early dilatation plan gives good results after end to end anastomosis. ln Jejunoileal atresia same is good after passing TAT through abdominal wall and in patients of lleal atresia Santulli's chimney give good results.

Sternal tuberculosis discharging through the skin: a rare presentation of disseminated tuberculosis

Tuberculosis of sternum with skin involvement is a rare manifestation of disseminated tuberculosis especially in paediatrics. A 13-year-old girl presented with a swelling over the sternum, which had been drained twice and many antibiotics had been used without any benefit. On investigations, it turned out to be tuberculosis of the sternum. A small, restricted ventricular septal defect was also present

Oesophageal atresia and tracheosophageal fistula

Forty-six neonates with esophageal atresia and tracheoesophageal fistula were admitted in Mayo Hospital Lahore over a three and half years period from Jane 1995 to December 1998. Of these 76.08 percent were male. Delayed referral of 24 hours or more was noted in 78.20 percent. Among the neonates admitted 88 percent had moderate to severe chest infection and 70 percent weighed three or more than three kilograms. Associated congenital anomalies were noted in 41.3 percent, of which high imperforate anus accounted for more than 50 percent. Ligation of fistula and primary oesophageal end to end anastormosis was performed in 28 patients and in 4 neonates oesophagostomy and gastrostomy were performed. Survival rate of category A was 80 percent and overall survival was 40.63 percent