Antenatally detected fetus in fetu case report.

Fetus in fetu (FIF) is an extremely rare pathology in which a malformed fetus is located in the body of its twin. It may occur as a result of an aberration of the twinning process. It is important to distinguish this condition from a teratoma. This article emphasizes the importance of the various modalities in the antenatal diagnosis and post-natal follow-up of FIF. An appropriate early intervention if instituted results in a good prognosis. Only few cases of FIF have been reported in medical literature. We present a case which was antenatally diagnosed and proven on histopathology post-natally. This case report illustrates the importance of multimodality imaging techniques in the diagnosis of this condition.

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.