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.

Management of Liver Abscess in Children: Our Experience.

INTRODUCTION: Liver abscess is common in pediatric population in India. Children have unique set of predisposing factors and clinical features. Liver abscesses are infectious, space-occupying lesions in the liver; the two most common abscesses being pyogenic and amebic. Its severity depends on the source of the infection and the underlying condition of the patient. MATERIALS AND METHODS: A total of 34 patients less than 12 years were assessed in a retrospective study from January 2012 to 2016. Patients were assessed in terms of age of presentation, etiology, bacteriology, diagnosis, and modality of treatment. RESULTS: The mean age of presentation was 6.3 years. Average volume of abscess was 164 cc. Nine patients (26.4%) underwent percutaneous needle aspiration under ultrasound guidance with wide bore needle (18 G disposable needle). Three patients required more than two sittings of aspiration. Patients with volume more than 80 cc were treated with catheter drainage. Twenty patients (58.8%) underwent ultrasound-guided percutaneous catheter drainage. Two patients required catheter drainage for large abscess and needle aspiration for the smaller abscess. CONCLUSION: Antimicrobial therapy along with percutaneous drainage constitutes the mainstay of treatment, whereas open surgical drainage should be reserved for selected cases.How to cite this article: Waghmare M, Shah H, Tiwari C, Khedkar K, Gandhi S. Management of Liver Abscess in Children: Our Experience. Euroasian J Hepato-Gastroenterol 2017;7(1):23-26.

Management of Traumatic Liver and Bile Duct Laceration.

Posttraumatic major bile leak in children is uncommon, with few cases reported in the literature. These injuries are seen in high-grade liver trauma and are difficult to diagnose and manage. We describe a 7-year-old boy with grade IV hepatic trauma and bile leak following blunt abdominal trauma. The leak was successfully managed by percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP) stenting of the injured hepatic duct. How to cite this article: Tiwari C, Shah H, Waghmare M, Khedkar K, Dwivedi P. Management of Traumatic Liver and Bile Duct Laceration. Euroasian J Hepato-Gastroenterol 2017;7(2):188-190.

Mayer-Rokitansky-Kuster-Hauser syndrome associated with rectovestibular fistula.

A female neonate with two openings in the introitus and an absent anal opening at the anal site presents a diagnostic challenge. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome associated with rectovestibular fistula, though rare, should be kept in mind as a differential diagnosis of this presentation. We present such a case in a one-year-old female child with MRKH syndrome and rectovestibular fistula.

Delayed presentation of jejunal atresia.

Type I intestinal atresias (webs) are rare causes of gastrointestinal obstruction in infants, the most common site being the second portion of the duodenum. According to the Louw and Barnard classification, type 1 atresia has been defined as an intra-luminal web which results in either complete (web with no perforation) or incomplete (web with central perforation) intestinal obstruction. The jejunum is a rare site of such webs. Diagnosis of an incompletely obstructing web due to central perforation is usually difficult and challenging. We present two cases of jejunal web with a central perforation in which the presentation was delayed. Both were managed by excision of the web.

Ovarian yolk sac tumour in a girl - case report.

Yolk sac tumours are rare ovarian malignancies accounting for less than 1% of malignant ovarian germ cell tumours. They are mostly seen in adolescents and young women and are usually unilateral making fertility preservation imperative. Raised alpha-feto protein level is the hallmark of this tumour. We describe stage III yolk sac tumour in a girl child.

Cysts of Gastrointestinal Origin in Children: Varied Presentation.

PURPOSE: Abdominal cysts of gastrointestinal origin are rare. Their rarity and varied clinical presentations make their pre-operative diagnosis difficult. METHODS: Fourteen patients with histological diagnosis of cysts of gastrointestinal origin admitted between 2009 and 2015 were retrospectively analyzed with respect to age, sex, clinical presentation, diagnostic modality, site and type of cyst, management, outcome and follow-up. RESULTS: The mean age at presentation was 4 years and there were six males and eight females. Abdominal pain was the most common presenting symptom. Five patients had an acute presentation-three had distal ileal mesenteric cysts and two had ileal duplication cyst sharing a common wall with ileum. Six patients presented with chronic abdominal pain and lump-three patients had omental cysts and three had mesenteric cysts-two of these in distal ileum and one in sigmoid colon. Two patients presented with antenatally diagnosed palpable abdominal lump. One had a mesenteric cyst of the ileum and the other had a distal ileal duplication cyst which required excision with resection and anastomosis. One patient had an atypical presentation. He was a known case of sickle cell trait and had presented with vague abdominal pain, recurrent cough and multiple episodes of haemoptysis over a period of one year. At laparotomy, gastric duplication cyst was found which was excised completely. Histopathology confirmed the diagnosis. CONCLUSION: Cysts of gastrointestinal origin are rare and have varied presentation. Surgical excision is the mainstay of treatment. The results and prognosis are good.

Neonatal Gartner Duct Cyst: Two Case Reports and Literature Review.

Vaginal cysts are rare, particularly in the newborn. They usually present as one of these three entities in the newborn: paraurethral cysts (Skene duct cysts), Gartner duct cysts (mesonephric ductal remnants) or a covered ectopic ureter. Abdominal ultrasound should always be included in the clinical evaluation in search of renal anomalies. We report two cases of Gartner cysts in neonates.

Cystic Congenital Scalp Inclusion Dermoid: A Case Report.

Dermoid cysts are developmental tumours that develop from germ cells displaced between the 3rd and 5th week of embryogenesis. Although dermoid cysts are known to be the most common scalp swellings; cystic congenital inclusion dermoid of the anterior fontanelle is a very rare scalp swelling. It is a benign, slow-growing, non-tender, soft swelling which is covered with intact skin. Ruling out intracranial extension is necessary. Computed Tomography is the investigation of choice for its diagnosis. We describe such a rare case of cystic congenital inclusion dermoid of the anterior fontanelle where the cyst was completely excised.

A Case of Biliary Peritonitis following Spontaneous Common Bile Duct Perforation in a Child.

Spontaneous common bile duct (CBD) perforation leading to biliary peritonitis is a rare entity in children. It is an unusual cause of acute abdomen and is potentially fatal. Preoperative diagnosis is rare. A 10-year-old girl was referred from a private hospital after laparotomy for acute abdomen. Intraoperatively, bile was found in the peritoneal cavity which was drained, and the patient was referred to Topiwala National Medical College. Endoscopic retrograde cholangiopancreaticography (ERCP) and stenting was done. The stent was removed after 8 weeks, and the girl is doing well during follow-up. HOW TO CITE THIS ARTICLE: Sharma C, Desale J, Waghmare M, Shah H. A Case of Biliary Peritonitis following Spontaneous Common Bile Duct Perforation in a Child. Euroasian J Hepato-Gastroenterol 2016;6(2):167-169.

Mesenteric cyst(s) presenting as acute intestinal obstruction in children: Three cases and literature review.

BACKGROUND AND OBJECTIVES: Mesenteric cysts are rare in paediatric age group and usually present as asymptomatic abdominal lumps. Acute presentations are uncommon and their preoperative diagnosis is difficult. DESIGN AND SETTINGS: This is a retrospective observational study describing three children with mesenteric cysts who presented with symptoms and signs of acute intestinal obstruction. PATIENTS AND METHODS: Three children with mesenteric cysts who presented with acute abdomen are described as per their age, presenting symptoms and signs, investigations, management, and outcome. RESULTS: The three children presented in emergency with symptoms and signs of acute intestinal obstruction. On exploration, all had mesenteric cyst and were managed by deroofing, marsupilisation and excision. All patients recovered uneventfully. CONCLUSIONS: Presentation of mesenteric cyst as acute obstruction in paediatric age group is rare and preoperative diagnosis is difficult. The larger cysts are more likely to have an acute presentation.

Our experience with adnexal masses in the pediatric age group and review of literature.

BACKGROUND AND OBJECTIVES: Adnexal masses are rare in the pediatric age group. We present our experience with 20 patients with adnexal masses. DESIGN AND SETTING: This retrospective observational analysis was performed on 20 children with adnexal masses who were treated at our institute between May 2011 and November 2015. PATIENTS AND METHODS: Fifteen pediatric patients who were admitted between May 2011 and November 2015 were reviewed and retrospectively analyzed based on their age at the time of admission, their presenting complaints, clinical and radiological findings, tumor markers, management and follow-up. RESULTS: The patients' age at the time of admission ranged between 3 days and 12 years. Abdominal pain and lump were the most common presenting complaints.Four patients (20%) had antenatally diagnosed cystic ovarian lesions. On postnatal scan, two patients had a simple cyst measuring less than 6 cm, which resolved on follow-up ultrasound at 3 months. One neonate had a simple cyst, larger than 6 cm on postnatal scan, which was managed by marsupialization. One antenatally diagnosed patient had a dermoid cyst that required oophorectomy.Ten patients (50%) had dermoid cyst and underwent complete surgical excision of the mass. Based on histopathologic results, two of these patients had immature teratoma and required adjuvant chemotherapy (Bleomycin, Etoposide, and Cisplatin). The serum AFP levels of these patients were carefully monitored.One patient with bilateral ovarian cysts was diagnosed with Van Wyk-Grumbach syndrome, which resolved significantly after a 3-month regimen of thyroxin supplementation.Five patients presented with torsion and required emergency surgery-three had mature teratoma, one had an immature teratoma and one had large simple cysts. CONCLUSION: The majority of ovarian tumors are benign. Accurate staging, complete resection and chemotherapy for the treatment of malignant tumors have contributed to excellent survival rates in these patients.