Giant congenital solitary nonparasitic cyst of the liver causing respiratory distress in a neonate.

A 3-day-old male neonate delivered at 34 weeks of gestational age was brought with breathing difficulty since birth. The abdomen was massively distended. A soft cystic mass was occupying almost the entire abdomen and causing obvious respiratory distress. On exploration, a huge, solitary, unilocular cyst was found between the two lobes of the liver. Growing extrahepatically between the two lobes, it had displaced them laterally on either side. Enucleation of the cyst and marsupialization of its base was done. Histopathology showed evidence of congenital solitary nonparasitic cyst of the liver. Symptomatic presentation of CSNCL in children, especially in a neonate is extremely rare and not considered as a differential diagnosis of an abdominal mass. Hence, the case report.

Neonatal ilio-psoas abscess: report of two cases.

Ilio-psoas abscess (IPA) is rare in children and exceptional in the neonate. However, we recently managed two consecutive male neonates with right-sided IPA. The first baby was born two days after rupture of the membranes and had thick meconium-stained amniotic fluid. There was no such high risk factor in the second child. Diagnosis was made by ultrasonography in both the patients. Extraperitoneal surgical drainage was done and systemic antibiotics were given. Delay in presentation and uncontrolled sepsis, led to mortality in the first case. On the contrary, relatively early presentation, prompt drainage of the abscess and good response to higher antibiotics, lead to successful salvage of the second baby.

Near total jejuno-ileal atresia: a management challenge.

A 2-day-old female neonate with the clinical picture of proximal small bowel atresia, on exploration, turned out to have intestinal atresia of a rare variety, i.e., a near-total jejuno-ileal atresia. The baby had total small bowel length of less than 10 cm. She survived for 3 months on enteral feeding after end-to-back duodeno-ileal anastomosis and thereafter succumbed to septicemia. The case is presented for it's extreme rarity and consideration of this extreme form of small bowel atresia as an offshoot of the existing classifications of jejuno-ileal atresia since it has dismal prognosis and presents as a management challenge even today.

Management of child victims of acute sexual assault: Surgical repair and beyond.

AIM: To evaluate the outcome of definitive repair of anogenital injuries (AGI) in child victims of acute sexual assault. SETTINGS AND DESIGN: It is a prospective study of emergency care provided to child victims of acute sexual assault at a tertiary care Pediatric Surgical Unit in Maharashtra, India. MATERIAL AND METHODS: Out of 25 children, who presented during January 2009-December 2010 with suspected sexual assault, five children (one male and four female, between 4-9 years of age), had incurred major AGI. These children underwent definitive repair and a diverting colostomy. Perineal pull-through was performed in the male child with major avulsion of rectum. One 4-year-old girl with intraperitoneal vaginal injury required exploratory laparotomy in addition. RESULTS: The postoperative period and follow-up was uneventful in all our patients. Four out of five patients have excellent cosmetic and functional outcome with a follow-up of 2-4 years. Our continence results are 100%. CONCLUSION: Children with acute sexual assault need emergency care. To optimally restore the distorted anatomy, all major AGI in such children should be primarily repaired by an expert, conversant with a child's local genital and perineal anatomy. Along with provision of comprehensive and compassionate medical care, prevention of secondary injuries should be the ultimate goal.

Anorectal malformations: Definitive management during and beyond adolescence.

AIM: To evaluate our results of definitive repair of anorectal malformations in patients with delayed presentation, during and beyond adolescence. MATERIAL AND METHODS: It is a retrospective analysis of all adolescent patients presenting for the first time for definitive repairs and innate patients - colostomy performed during the neonatal period, but who had lost to follow-up. It includes 15 patients (2 male and 13 female) aged from 13 to 32 years. Three well-decompressed female patients were managed by primary anterior sagittal anorectoplasty (ASARP). Twelve patients underwent staged procedures. Five patients (two male and three female) underwent posterior sagittal anorectoplasty (PSARP). The oldest male patient underwent abdominal-PSARP. RESULTS: All of them attained socially acceptable fecal continence at follow-up of 1-4½ years. They are satisfied with the functional and cosmetic outcome of repair of their anomalies. CONCLUSIONS: Prospects of fecal continence are good when definitive repair of anorectal malformations is done by an expert, even in the adolescent age group and beyond.

Bowel conservation in a case of giant jejuno-ileal duplication.

The management of very long tubular bowel duplications poses a special challenge to even the most skilled surgeon. In these cases, mucosal stripping is usually employed. We report a novel case of a two-year-old boy, with 120 cm long jejuno-ileal duplication, wherein, bowel salvage was achieved, utilizing the Bianchi principle, originally described for bowel lengthening in cases of short bowel syndrome.