Unusual Presentation of Postoperative Intussusception in Two Infants.

We present two infants with postoperative intussusception following stoma formation for stricture bowel due to necrotizing enterocolitis. They had unusual clinical features which need a high index of suspicion to diagnose.

Superior Mesenteric Artery Injury during Radical Nephrectomy in an Infant: Delayed Diagnosis and Successful Management.

Superior mesenteric artery (SMA) injury during a left radical nephrectomy is an uncommon complication in children with a potentially devastating outcome. Successful management depends on early diagnosis and re-establishing SMA perfusion. We report the successful management of an iatrogenic SMA injury during radical nephrectomy in a 10-month-old boy with left upper polar Wilms' tumor.

Bedside laparotomy in newborns -A single institute experience.

BACKGROUND/PURPOSE: Intra hospital transfer of sick newborns is known to cause adverse events with potential morbidity. Interventions at the bedside in a sick neonate can reduce the need for transport and in turn, potential hazards of transfer. Our single institute experience of performing bedside laparotomies in unstable newborns is reported here. MATERIALS AND METHODS: Seven-year data was collected from electronic medical records. This was a retrospective comparative study with level III evidence. Twenty-eight neonates operated at bedside for intraabdominal sepsis due to Necrotising Enterocolitis (NEC), Spontaneous Intestinal Perforation (SIP), complicated meconium ileus and perforation secondary to atresias were included Group A. Group B had 60 neonates operated for similar indications in the conventional operation theatres. RESULTS: The average corrected gestational age at surgery, associated co-morbidities, average volume of blood loss and duration of surgery were compared between the groups. Group A had lower weight at surgery (1098 vs 1872 gs), greater percentage of neonates on inotropic support (78% vs 20%) with requirement of High Frequency Ventilation (HFO) (50% vs none). A quarter of neonates (7 of 28) in Group A had NEC Totalis as against only one case in group B. There was 25% survival in group A and 76.67% in group B. The lower survival in group A can be attributed to lower weight at surgery, higher inotrope requirement and need for unconventional modes of ventilation. CONCLUSION: Bedside laparotomy is a feasible option in unstable neonates deemed unsuitable for transport.

Congenital Midline Cervical Cleft with Respiratory Epithelium: A Rare Association.

Congenital midline cervical cleft is a rare anomaly and is clinically apparent at birth. Histology of this defect is consistent with the presence of stratified squamous epithelium. However, we present a case of 1-year-old boy with chronic mucocutaneous candidiasis associated with two cysts and presence of focal respiratory epithelium. We attempt to discuss the presentation, the histological differences, and the optimal surgical treatment for the same.

Laparoscopic ipsilateral ureteroureterostomy for the management of children with duplication anomalies.

AIM: Ipsilateral ureteroureterostomy is an established method for the treatment of duplication anomalies in children. With the advent of pediatric laparoscopy, many urologic procedures in children are being performed using minimal access techniques. We present our experience with laparoscopic ipsilateral ureteroureterostomy (LIUU) for duplex anomalies. PATIENTS AND METHODS: The data of children who underwent LIUU was reviewed for demographic parameters, clinical and operative details, follow-up and results. RESULTS: Over 3 years period, LIUU was performed in eight children (age 6-60 months). Five children had complete ipsilateral duplication with ectopic upper moiety ureter, one child each had ipsilateral incomplete duplication and bilateral duplex systems (with ipsilateral ectopic upper moiety ureter). One child had ipsilateral complete duplex with Grade V vesicoureteric reflux into the lower moiety ureter. Four children had antenatal diagnosis of hydronephrosis; three children had a urinary infection and two children presented with urinary incontinence. The surgical procedure consisted of cystoscopy, retrograde studies and cannulation of the recipient ureter. Then, LIUU was performed using three ports. The ectopic (donor) ureter was divided at the pelvic brim; the recipient ureter was opened and end-to-side LIUU was performed with 5/0 vicryl stitches over a double J (DJ) stent placed in the recipient ureter. Bladder catheter was removed after 2 days, and DJ stent was removed after 4 weeks. At a mean follow-up of 19 months (3-36), all children are asymptomatic and continent, with a significant reduction in hydroureteronephrosis on ultrasound. The cosmetic results were excellent. CONCLUSION: LIUU is a safe and effective technique in the management of duplication anomalies in children. It could be performed with minimal blood loss, minimal postoperative pain, excellent cosmesis and good success.

A simple technique of trocar fixation during pediatric laparoscopy with foley catheter sleeve.

We describe a simple method of fixing trocars to the abdominal wall in infants and children using small pieces of 16- or 18-Fr Foley catheter as a sleeve over the trocar. The sleeve holds the trocar snugly and is fixed to the skin with silk stitch. This technique is simple, quick, efficacious, and inexpensive, and it does not require any special equipment and can be used with any trocar size.