ABSTRACT
Communicating bronchopulmonary foregut malformations (CBPFM) are extremely rare. We present a complex case of type IB CBPFM with esophageal atresia and distal tracheoesophageal fistula (EA/TOF), duodenal atresia/annular pancreas (DA/AP), and intestinal malrotation who underwent primary repair for EA/TOF on day 3. Bilious aspirates on day 8 prompted an upper gastrointestinal (GI) contrast revealing a duodenal obstruction and communication between the right lung lower lobe and the esophagus (T8-T9 level). DA/AP and malrotation were repaired by a gastrojejunostomy and Ladd's procedure. A repeat contrast swallow identified a 2nd communication from the esophagus into the right lower lobe (T5-T6 level) raising the suspicion of a recurrent TOF. Computed tomography (CT) thorax confirmed above findings with an anomalous blood supply to right lung. An exploratory thoracotomy identified a three-lobed lung. However, the lower lobe was enlarged and connected in two separate locations to the esophagus. The child recovered after the disconnection of the esophageal connections and partial right lower lobectomy. CBPFM are extremely rare anomalies requiring a high index of suspicion, use of an upper GI contrast series, and CT scans for diagnosis. The treatment of choice is resection of the affected lung and disconnection of the esophageal communications.
ABSTRACT
Background YouTube (YT) is the most common video platform accessed by surgical trainees for the preparation of surgery. However, the quality of the YT videos has been questioned time and again. This study was performed to comprehensively assess the quality of the available YT videos on pediatric laparoscopic pyeloplasty (LP). Materials and Methods The term "laparoscopic pyeloplasty in children" was searched in YT on June 3, 2021, and ten most-viewed videos on LP were included. The percentage video power index (%VPI), the Journal of American Medical Association (JAMA) benchmark criteria, and the laparoscopic surgery video educational guidelines (LAP-VEGaS) video assessment tool were used to assess the video popularity, the quality of medical information, and the overall quality of the included videos respectively. Videos were defined as acceptable (score of 11 or more) or poor quality (score <11) based on LAP-VEGaS scores. The inter-observer agreement, in terms of the LAP-VEGaS scoring, was observed among two surgeons using the kappa statistics. Results The median values of the %VPI and JAMA scores of the included YT videos were 68.1 (range 0-13570) and 2 (range 1-2) respectively. The median LAP-VEGaS score of these videos was 6.75 (range 2-16.5) with only two videos having acceptable quality. The quality of these videos was poor in 7/9 domains of the LAP-VEGaS tool. A moderate inter-observer agreement (kappa=0.542) was observed in terms of the LAP-VEGaS scores assigned to the videos (p<0.0001). Conclusion A comprehensive assessment of the ten most-viewed YT videos on pediatric LP revealed poor overall quality. The included videos depicted sub-optimal presentation of the medical information and weak conformity to the LAP-VEGaS guidelines.
ABSTRACT
Duplication cysts of the gastrointestinal tract are rare and have varied presentations. Complete excision of the cyst is the treatment of choice, either by the open method or laparoscopic method. Authors describe the case of a jejunal duplication cyst excised by robotic minimally invasive surgery. A more safe and precise excision of bowel duplication cysts without bowel resection is possible with the help of robotic assistance.
ABSTRACT
INTRODUCTION: Cecal duplication is a rare congenital anomaly and to the best of our knowledge, only 43 cases have been reported in the literature till date. Most of them present within the first year of life. They can mimic intussusception, and the delay in diagnosis can lead to high morbidity. CASE REPORT: A five-year boy presented with pain abdomen for a week. He was found to have ileocolic intussusception. The intussusception could only be partially reduced by the hydrostatic method. On laparotomy, a submucosal solid mass was found in the cecum with multiple enlarged lymph nodes. Mass was resected with clear margins and lymph nodes sampled. Histopathology was conclusive of cecal duplication. Post-operative course was uneventful, and the child is thriving well, last reviewed at three-year follow-up. CONCLUSION: Incomplete reduction of intussusception, intussusception with atypical presentation or intussusception in atypical age group should alert to the possibility of cecal duplication.