Surgical neonates with coronavirus infectious disease-19 infection: An experience with five cases at high-volume tertiary care centre of India.

Coronavirus infectious disease-19 (COVID-19) has caused serious threat to global health. With progression of time, more and more cases are being reported in paediatric age group. Management of COVID-19-positive neonates with surgical condition is challenging as apart from medical management of COVID-19-induced morbidities, they also require surgical intervention. Various guidelines have been proposed for the management of neonates with coronavirus infection and surgical pathologies. In this original article, we are sharing our experience in managing such neonates. We managed five neonates with different surgical pathologies who were positive for the coronavirus at the time of admission. They received medical management initially. Three of these five neonates were operated after they were negative for the virus. The remaining two patients were operated in positive state due to their condition requiring urgent surgical intervention. All the recommendations as per the COVID-19 protocol were followed. Four of these babies survived. One neonate with the diagnosis of gastroschisis expired during stay in designated COVID-19 neonatal intensive care unit. Authors conclude that COVID-19-positive status of neonates should not scare the health-care workers. COVID-19 positivity in neonates does not alter the outcome.

Vitellointestinal Duct Anomalies in Infancy.

BACKGROUND: Vitellointestinal duct (VID) or omphalomesenteric duct anomalies are secondary to the persistence of the embryonic vitelline duct, which normally obliterates by weeks 5-9 of intrauterine life. METHODS: This is a retrospective analysis of a total of 16 patients of symptomatic remnants of vitellointestinal duct from period of Jan 2009 to May 2013. RESULTS: Male to female ratio (M:F) was 4.3:1 and mean age of presentation was 2 months and their mode of presentation was: patent VID in 9 (56.25%) patients, umbilical cyst in 2(12.25%), umbilical granuloma in 2 (12.25%), and Meckel diverticulum as content of hernia sac in obstructed umbilical hernia in 1 (6.25%) patient. Two patients with umbilical fistula had severe electrolyte disturbance and died without surgical intervention. CONCLUSION: Persistent VID may have varied presentations in infancy. High output umbilical fistula and excessive bowel prolapse demand urgent surgical intervention to avoid morbidity and mortality.

Congenital Pyloric Atresia with Distal Duodenal Atresia- Role of CT Scan.

The mainstay of diagnosis of congenital pyloric atresia is by plain X-ray of the abdomen showing a large gas bubble with no gas distally. But very rarely it can be associated with distal duodenal atresia when the baby may present as lump abdomen. In such a situation apart from the X-ray, another radiological investigation is needed to delineate the exact nature of the lump. Since the role of ultrasonography is limited in intestinal pathologies and contrast studies are not informative in atresias, the CT scan is the ideal choice. We had managed a case of pyloric atresia with similar presentation with preoperative CT scan.

Congenital spigelian hernia and cryptorchidism: another case of new syndrome.

Spigelian hernia (SH) is rarely seen in pediatric age group and is usually associated with cryptorchidism on the same side; termed as a syndromic association of the defect in the Spigelian fascia and absence of gubernaculum and inguinal canal. The absence of the inguinal canal has surgical implication as to placement of the undescended testis into the scrotum. A 3-month-old baby presented with spigelian hernia and ipsilateral impalpable testis. The spigelian hernia was repaired and undescended testis which was present in abdominal wall layers was brought to scrotum with cord structures anterior to external oblique muscle.

Tunica vaginalis: an aid in hypospadias fistula repair: our experience of 14 cases.

BACKGROUND: Urethrocutaneous fistula is the most common complication of hypospadias surgery. The correction of such fistula is associated with a failure rate of 10 to 40%. The step in successful repair of a fistula is separation of the suture lines in the urethra and skin using well vascularized elastic tissue. We report our experience of using the tunica vaginalis flap as a layer between the neourethra and skin suture line in repair of recurrent urethrocutaneous fistula. PATIENTS AND METHODS: We have used the tunica vaginalis flap for the repair of recurrent urethrocutaneous fistula in 14 children with a mean age of 6.5 years (range 3-14 years). All patients had undergone previous hypospadias repair and at least one previous attempt to close the fistula had failed. Surgery was initiated by injecting a povidone solution via urethral meatus to identify all fistulae. The fistulae were closed primarily and urethral suture line was covered with a flap of tunica vaginalis which was harvested either through a small scrotal incision and mobilized via a subcutaneous tunnel into the penile shaft (8/14) or by the same incision as for fistula closure (6/14). The testis was fixed to the scrotum. A urethral catheter was kept for urinary diversion for 10 days. RESULTS: The repair was successful in all but one patient in whom there was leak from the fistula site. One patient in whom tunica vaginalis fascia was tunnelled into neourethra developed scrotal haematoma which needed drainage. Penile cosmesis was acceptable without any significant postoperative testicular complication in 13/14 patients. CONCLUSION: Repair of recurrent urethrocutaneous fistula with a tunica vaginalis flap is highly effective regardless of fistula location. This flap is easy to mobilize and provide effective coverage of urethral suture line. Putting a glove drain should be considered into scrotal wound if perfect haemostasis is doubtful.

Idiopathic unilateral lower limb gangrene in a neonate.

We are reporting a very unusual case of unilateral lower limb gangrene in 12 days neonate, who was brought to us with bluish discoloration of left foot with gangrene of toes. A negative sepsis screen, normal Doppler study, normal magnetic resonance angiography and absence of evidence of hypercoagulable state prompted us to make the diagnosis of idiopathic unilateral lower limb gangrene in this newborn. Because of the rarity we are reporting this case with vide review of literature.

Congenital diaphragmatic hernia: Misdiagnosis in adolescence.

We report 3 cases of congenital diaphragmatic hernia (CDH) in the second decade of life which were misdiagnosed on initial presentation. The first case had an iatrogenic gastric injury because of intercostal tube drainage for suspected pleural effusion. The second case was treated for pulmonary tuberculosis for 6 months before being diagnosed as a case of CDH. The third case presented as acute chest pain on the left side. It was treated accordingly for 1 month and was diagnosed as a CDH on a CT scan of the chest when seen by a surgeon.

Primary leiomyosarcoma of broad ligament: case report and review of literature.

INTRODUCTION: Primary leiomyosarcoma of the broad ligament (LBL) is a very rare and highly malignant gynecological tumor. MATERIALS AND METHODS: A 45 year old hysterectomized woman with this rare tumor is presented. Treatment consisted of resection of the tumor along with omental and peritoneal sampling and adjuvant chemotherapy. No evidence of metastasis was present after 15 months of follow up. CONCLUSION: Complete surgery along with adjuvant chemotherapy or radiation and a close follow up for recurrence are advocated to optimize disease free survival.

Perforated duodenal ulcer a rare cause of acute abdomen in infancy: a report of two cases.

Duodenal ulcer perforation is very uncommon in infants and children, that is why it is not usually considered in the differential diagnosis of acute abdomen in this age group. Moreover, the diagnosis of this condition is usually overlooked because of vague and variable symptoms and low index of suspicion on the part of the treating physicians. In this brief report, we are reporting two cases of successfully managed perforated duodenal ulcer in infancy.

Caecal volvulus in pregnancy: is delay in diagnosis avoidable?

Intestinal volvulus is not an uncommon cause of obstruction in pregnancy. Diagnosis is often delayed due to poor knowledge of the condition and a hesitation to use abdominal X-rays in a pregnant patient. Here, two cases of caecal volvulus in pregnancy are reported. Proper diagnosis and early treatment of the condition is emphasized.

Neurilemmoma of cervical sympathetic chain.

Neurilemmoma of the cervical sympathetic chain is a rare nerve tumour. Less than 40 confirmed cases have been reported in the literature.1 2 Sometimes they can he mistaken as carotid body tumour but usual presentation of these lesions is an asymptomatic neck mass. Because of the rarity of the tumour we report another case of neurilemmoma arising from cervical sympathetic chain in a 19 years old male.