Primary Pleural Inflammatory Pseudotumor in a Child.

BACKGROUND: Inflammatory pseudo tumor, a rare non-neoplastic lesion, commonly presents as slow growing solid lesion in the lung, but many extra-pulmonary locations have been described. CASE CHARACTERISTICS: A 4-year-old girl who presented with respiratory distress due to massive pleural effusion. Computed tomography revealed large hypodense non-enhancing lesion in the left hemi thorax. Surgical exploration revealed large semisolid pleural collection filled with gelatinous material with normal underlying lung. OUTCOME: Histopathology revealed spindle shaped cells with abundant myxoid stroma. Child recovered after surgery and was asymptomatic at 5 years follow-up. MESSAGE: Primary pleural inflammatory pseudotumor may be a rare cause of pleural effusion in a child.

Uncommon Presentation of an Unusual Foreign Body.

Esophageal foreign bodies (FBs) are common and can be the serious cause of morbidity and mortality in children. One-third of FBs, retained in the gastrointestinal tract, are found in the esophagus. Their management depends on the anatomical location, shape, size, and the duration of impaction. In children, unwitnessed esophageal FBs can present with respiratory symptoms such as stridor. Therefore, a high index of suspicion is generally required to avoid significant morbidity and mortality. We are reporting an unusual FB with unusual symptoms in a 2-year-old female child.

Gastric Teratoma: An Unusual Presentation and Location.

The gastric teratoma is a rare tumor that usually presents as an abdominal mass, with or without features of gastric outlet obstruction. We report two cases of gastric teratoma; one - mature in a male neonate and another - ruptured immature gastric teratoma in a female neonate.

Retained Capsule Endoscope.

BACKGROUND: Capsule endoscopy was invented to visualize the entire small intestine in a non- invasive manner in adults. CASE CHARACTERISTICS: 1 y, 9 mo-old boy presented with generalized edema for last 3 months. His routine investigations, including the upper gastrointestinal endoscopy, colonoscopy, and contrast enhanced computed tomography scan (CECT) were normal. In view of clinical suspicion of protein losing enteropathy, we planned capsule endoscopy. OBSERVATION: The capsule was not passed even after 3 weeks. Laparoscopy revealed impacted capsule in a dilated intestinal loop proximal to an ileal stricuture. MESSAGE: Capsule endoscopy should be used judiciously in children.

Glandular diphallus with urethral duplication: Conventional technique for a rare congenital anomaly.

Diphallus is a rare anomaly and its association with urethral duplication is extremely rare. Numerous associated genitourinary and gastrointestinal anomalies have been reported with this condition. Challenges in the management are incorporation of the glans and the dominant urethra during reconstruction. We report the successful management of a case of glandular diphallus with complete urethral duplication retaining the dorsal urethra.

Laparoscopic pyloromyotomy: Lessons learnt in our first 101 cases.

AIM: To analyze our experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis for the lessons that we learnt and to study the effect of learning curve. MATERIALS AND METHODS: This is a retrospective analysis of case records of 101 infants who underwent laparoscopic pyloromyotomy over 6 years. The demographic characteristics, conversion rate, operative time, complications, time to first feed and post-operative hospital stay were noted. The above parameters were compared between our early cases (2007-2009) (n = 43) and the later cases (2010-2013) (n = 58). RESULTS: 89 male and 12 female babies ranging in age from 12 days to 4 months (mean: 43.4 days) were operated upon during this period. The babies ranged in weight from 1.8 to 4.7 kg (mean: 3.1 kg). Four cases were converted to open (3.9%): three due to mucosal perforations and one due to technical problem. The mean operative time was 45.7 minutes (49.7 minutes in the first 3 years and 43.0 minutes in the next 3 years). There were 10 complications-4 mucosal perforations, 5 inadequate pyloromyotomies and 1 omental prolapse through a port site. All the complications were effectively handled with minimum morbidity. In the first 3 years of our experience the conversion rate was 9.3%, mucosal perforations were 6.9% and re-do rate was 2.3% as compared to 0%, 1.7% and 6.9%, respectively, in the next 3 years. Mean time for starting feeds was 21.4 hours and mean post-operative hospital stay was 2.4 days. CONCLUSION: Laparoscopic pyloromyotomy is a safe procedure with minimal morbidity and reasonable operative times. Conversion rates and operative times decrease as experience increases. Our rate of inadequate pyloromyotomy was rather high which we hope to decrease with further experience.