Giant Calyceal Diverticulum in a Child with Solitary Kidney: A Rare Experience.

Calyceal diverticuli are rare entities which are difficult to diagnose radiologically as they mimic various other pathology. Close follow up is essential even in asymptomatic individuals to prevent complications. The authors present a giant calyceal diverticulum in a solitary kidney in a child that was managed by open surgery.

Pyloric stenosis in a patient with pure esophageal atresia: A difficult diagnosis.

Hypertrophic pyloric stenosis is brought to attention by its characteristic non-bilious vomiting. In a patient with pure esophageal atresia and a feeding gastrostomy, the symptoms were modified and the diagnosis was delayed. This case report highlights the clinical features of this rare combination, whose diagnosis was easily established once the entity was considered.

Pedicled omental split skin graft: A novel method for reconstruction of full-thickness abdominal wall defect.

Although rare in children, aggressive fibromatosis or desmoid tumors require wide surgical excision for durable relief. The resultant defect poses many challenges for reconstruction. The authors report reconstruction of such a wound using a pedicled omental split skin graft, which resulted from the excision of a locally recurrent desmoid tumor.

Lumbotomy for multicystic dysplastic kidney: A trap for the unwary.

This is a report of a case of multicystic dysplastic half of a horseshoe kidney (HSK) at surgery for multicystic kidney. During the surgery, through a lumbotomy approach, there was inadvertent injury to a lower polar artery and the pelvis of the normal contralateral half of the HSK, leading to a stormy postoperative course. This report emphasizes the need for accurate preoperative diagnosis before embarking on a lumbotomy, and also reviews the entity of multicystic dysplasia in one half of a HSK.

Gastric, pancreatic, and ureteric duplication.

We report a case of an 8-month-old, asymptomatic child who was incidentally detected to have two cystic structures in the abdomen. Surgical exploration revealed a gastric and pancreatic duplication cyst along with a blind-ending duplication of the right ureter. Excision of the duplications was relatively straightforward, and the child made an uneventful recovery. This constellation of duplications has not been reported before.

Neonatal gastric volvulus: another cause of "Mucousy baby" with gasless abdomen.

Neonatal acute gastric volvulus is rare and often associated with diaphragmatic anomalies. Patients usually present with vomiting and respiratory distress, but excessive salivation, failure to pass a nasogastric tube beyond 20 cms and the presence of a space occupying thoracic lesion should also prompt a search for the entity. The authors describe a case presenting with these atypical findings and stress the importance of the plain radiograph chest to make a diagnosis.

Spontaneous fecal fistula in a neonate.

A 19-day-old male neonate was brought to us with a left upper quadrant abdominal wall defect through which bowel was prolapsing, with a double intussusception appearance typical of a patent omphalomesenteric duct. However, the history showed that the defect was not congenital, the child had a normal umbilicus, and at surgery the lesion was shown to be a mid jejunal perforation with prolapse of bowel along both the ascending and descending limbs. Histology revealed presence of inflammation and no heterotopic tissue. We believe this is the first ever report of such a fecal fistula and we speculate on the cause of this entity.

Patent omphalomesenteric duct and exomphalos minor: a rare and interesting association.

A completely patent omphalomesenteric duct was seen in association with two cases of exomphalos minor. Both the patients also had limb anomalies, and one patient had an ileal duplication and colonic atresia. Both babies underwent emergency surgery to correct the anomalies, and one survived. There have been few reports of this combination of anomalies, and there is increasing appreciation that these lesions occur together more often than by chance.

Is gastropexy required for all cases of gastric volvulus in children?

Gastric volvulus (GV) is rare in the pediatric age group. The presentation is varied, and surgery in the form of gastropexy is recommended. We examine the place of gastric fixation in the management of these patients. The authors retrospectively reviewed five cases of gastric volvulus treated at their institute and noted presenting symptoms and signs, studies performed, associated anomalies, surgery done, and outcome. All patients had associated diaphragmatic abnormalities. Two patients had acute volvulus; three had a chronic presentation. Chest X-ray and barium meal were diagnostic. All patients underwent surgical correction of the diaphragmatic anomaly with detorsion of the stomach. Gastropexy was done in only one patient. All patients recovered without any complications and have been well. GV must be suspected in the appropriate clinical setting; chest X-rays and barium meals are the best studies in suspected cases. Gastropexy or gastrostomy is not necessary for a successful outcome in secondary volvulus.

Intercostal lung hernia in a 7-year-old boy.

The authors report a case of a lateral chest wall lung hernia, which was presumably congenital. Lung herniations are extremely rare, and congenital herniation of the lung through an apparently intact thoracic cage has not yet been reported. The hernia was repaired by the interposition of a polypropylene mesh. The literature of this rare condition is briefly reviewed.

Osteosarcoma of the rib.

Primary osteosarcomas arising from the rib are very rare. The authors report an 11-year-old boy with a primary fibroblastic osteosarcoma of the rib, who underwent wide excision and reconstruction of the chest wall followed by chemotherapy. He is disease free after a follow up of 24 months. The relevant literature is reviewed briefly.

Surgical implications of snakebites.

OBJECTIVE: Snakebites are a common problem in the pediatric age group. Local complications such as necrosis and compartment syndrome threaten limb survival even after control of systemic manifestations. Few recommendations exist about the nature and timing of surgical treatment. METHODS: A retrospective review of all children with snakebites presenting to the hospital was undertaken over a 6-year period. Records were reviewed with special emphasis on the type of surgical lesions seen and the treatment offered and their results. RESULTS: 44 of the 58 children required some form of local therapy. In the majority conservative treatment was successful. 28% of the patients needed debridement for local necrosis, and only 5 needed a skin graft, with good functional results over a period of 1 to 45 days. One child underwent an above knee amputation. Patients who required surgical intervention received significantly more vials of antivenin. CONCLUSION: Local complications of snakebite are frequent, but can be managed conservatively. Delayed excision of the resultant local necrosis is associated with good outcomes. The need for fasciotomy is rare.

A prospective comparison of two regimes of bowel preparation for pediatric colorectal procedures: normal saline with added potassium vs. polyethylene glycol.

We prospectively evaluated the safety and efficacy of total gut irrigation (TGI) using normal saline with added potassium (NS) and polyethylene glycol (PG) in patients undergoing a variety of colorectal procedures including single-stage pull-through for Hirschsprung's disease (HD). Fifty-four patients were randomly assigned into one of the two groups (NS or PG). Pre- and post-TGI weight, abdominal girth, and serum electrolytes were assessed. Patients were also evaluated for vomiting and abdominal discomfort. At surgery, bowel preparation was evaluated, and postoperative complications were recorded. Both NS and PG are safe and effective agents for TGI. No patient in either group had any clinical or statistically significant change in the evaluated parameters. The amount of NS required for TGI was significantly higher than PG, and PG was better tolerated than NS. All patients with HD completed TGI, although one patient with long segment HD had abdominal distension.

Lingual thyroid gland: clinical evaluation and management.

The authors present three illustrative cases of lingual thyroid gland in paediatric age group with a protocol for diagnosis and management of the condition. Elements in the diagnostic and therapeutic evaluation are outlined with attention to the clinical findings, laboratory tests and radiographic imaging studies employed in confirming the diagnosis and planning appropriate treatment. Presentations varied from swelling noticed on routine evaluation for upper respiratory tract infection in one, to dysphagia in the next and sore throat in the third patient. On examination they had swelling on the tongue just behind the circumvallate line. 99mTc thyroid scan confirmed the swelling as lingual thyroid with no thyroid tissue in the normal location. All three children had raised TSH levels and were put on suppressive L-thyroxine. At follow up patients are asymptomatic.

Polycystic ovaries, precocious puberty and acquired hypothyroidism: The Van Wyk and Grumbach syndrome.

Long-standing acquired hypothyroidism can rarely be associated with precocious puberty and polycystic ovaries. The authors report such a case, which responded to the simple replacement of thyroid hormone. It is important to look for hypothyroidism in girls with ovarian masses and precocious puberty to avoid surgery on the ovaries.

Oral tumors in newborn.

Tumors arising from the oral cavity in the newborn are rare. Congenital epulis and epignathus are the two lesions usually seen. They cause problems because of their position and size and have the potential to cause respiratory obstruction. These lesions must be diagnosed and excised early, as they have an excellent prognosis if treated properly. We describe two such patients, and provide a brief review of the literature to highlight the management strategy for these rare tumors.

Parahiatal hernia with gastric obstruction in a child.

Parahiatal hernia refers to herniation of abdominal viscera into the chest adjacent to an intact hiatus. Spontaneously occurring parahiatal herniae are extremely rare. We report a 4-year-old boy who presented with intermittent vomiting and had such a hernia, where the herniated stomach had undergone partial volvulus. He was symptom-free after surgical repair.