Journal of Pediatric and Adolescent Surgery <p> <img src="" alt="Journal of Pediatric and Adolescent Surgery" width="400" height="577" /></p> <p><strong>Journal of Pediatric and Adolescent Surgery</strong> (<a title="Journal of Pediatric and Adolescent Surgery" href=""></a>) a peer-reviewed and open access hybrid medium journal published both as an electronic and print version. The journal publishes original research articles, Systematic reviews, Meta-analysis, Narrative reviews, Evidence-based reports, Short communications, Case reports, Letter to the editor, Clinical images, Radiology quiz, etc. Detail of these publication types can be seen in <a title="Download" href="" target="_blank" rel="noopener">Instruction to Authors</a>. Every manuscript will be peer-reviewed before reaching any decision. Please see the Peer review policy of the journal.</p> The Association of Paediatric Surgeons of Pakistan (APSP) en-US Journal of Pediatric and Adolescent Surgery 2708-6488 <h3>You are free to:</h3> <ul class="license-properties"> <li class="license share"><strong>Share</strong> — copy and redistribute the material in any medium or format</li> <li class="license remix"><strong>Adapt</strong> — remix, transform, and build upon the material for any purpose, even commercially.</li> </ul> <p><strong>Terms:</strong></p> <ul> <li><strong>Attribution</strong> — You must give <a id="appropriate_credit_popup" class="helpLink" style="background-color: #ffffff;" tabindex="0" title="" href="" data-original-title="">appropriate credit</a>, provide a link to the license, and <a id="indicate_changes_popup" class="helpLink" style="background-color: #ffffff;" tabindex="0" title="" href="" data-original-title="">indicate if changes were made</a>. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.</li> <li><span id="by-more-container"></span><strong>No additional restrictions</strong> — You may not apply legal terms or <a id="technological_measures_popup" class="helpLink" tabindex="0" title="" href="" data-original-title="">technological measures</a> that legally restrict others from doing anything the license permits.</li> </ul> <div id="deed-conditions" class="row"> </div> <div class="row"> </div> Congenital biliary web- a rare cause of obstructive jaundice in an infant: A case report <p><strong>Background: </strong>Congenital biliary web of the extra-hepatic biliary tree is becoming exceedingly rare cause of obstructive jaundice in children.</p> <p><strong>Case Presentation: </strong>We report a case of 5-month-old male baby who presented with acholic stools and persistent jaundice since birth. Magnetic resonance cholangiopancreatography (MRCP) showed contracted gall bladder and focal narrowing at mid portion of the common bile duct (CBD) with proximal dilatation of biliary channels. On exploration, a complete web was found just proximal to the confluence of cystic duct and common hepatic duct causing complete obstruction of biliary tree. A Roux-en-Y hepatico-jejunostomy was done. Postoperative recovery was uneventful.</p> <p><strong>Conclusion: </strong>We conclude that congenital biliary web is a rare entity and should be considered in the dif­ferential diagnosis of biliary atresia.</p> Allah Ditta Muhammad Bilal Mirza Muhammad Waqas-ur-Rehman Maria Fahim Farrakh Mehmood Satar Nabila Talat Copyright (c) 2020 Allah Ditta, Dr. Muhammad Bilal Mirza, Muhammad Waqas-ur-Rehman, Maria Fahim, Farrakh Mehmood Satar, Nabila Talat 2020-08-21 2020-08-21 1 1 10.46831/jpas.v1i1.7 Pencil spring ingestion in a neonate- a rare occurrence with cecal perforation: A case report <p><strong>Background: </strong>Foreign body (FB) ingestion is relatively common in the pediatric population. However, it is a rare occurrence in neonates and intestinal perforation due to ingested FB is once in a blue moon event.</p> <p><strong>Case Presentation: </strong>Here we present a case of accidental FB ingestion by a neonate leading to a rare complication. The patient was received in vitally unstable condition and exploratory laparotomy was performed after initial resuscitation. The intra-operative findings included perforation of the cecum, which was repaired with a covering stoma. The postoperative period was uneventful, and stoma was reversed later.</p> <p><strong>Conclusion: </strong>Foreign body ingestion is possible in neonates, though very rare, and can lead to fatal complications If not detected and treated in time.</p> Muhammad Kamran Saleem Ullah Khan Muhammad Saleem Asif Iqbal Imran Hashim Javed Iqbal Khan Zubair Shoukat Copyright (c) 2020 Muhammad Kamran, Saleem Ullah Khan, Muhammad Saleem, Asif Iqbal, Imran Hashim, Javed Iqbal Khan, Zubair Shoukat 2020-08-31 2020-08-31 1 1 10.46831/jpas.v1i1.11 COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C) simulating as acute appendicitis: A case report <p><strong>Background:</strong> As the COVID-19 pandemic continues to disrupt global affairs through a variety of manifestations, a severe presentation of some COVID-19 pediatric patients has emerged, presenting as multisystem inflammatory syndrome in children (MIS-C) that may mimic surgical conditions.</p> <p><strong>Case Presentation:</strong> We report the case of a 9-year-old boy who presented with acute, intermittent abdominal pain and fever. Further inquiry suggested a hyperinflammatory disorder affecting multiple organ systems. Upon COVID-19 PCR testing, the patient was reported as COVID-19 positive in the second test on the 2<sup>nd</sup> day of admission, after an initial negative test upon admission. We describe the course of this patient’s disease from presentation until discharge and discuss the emerging literature on this potentially fatal complication.</p> <p><strong>Conclusion: </strong>MIS-C should be a differential diagnosis in patients who may present with acute abdominal pain in the emergency room.</p> Zorays Moazzam Areej Salim Kiran Hilal Muhammad Arshad Copyright (c) 2020 Zorays Moazzam, Areej Salim, Kiran Hilal, Muhammad Arshad 2020-08-15 2020-08-15 1 1 10.46831/jpas.v1i1.31 Human tail- a rare anatomical mystery: A case report <p><strong>Background: </strong>Human tails are rare entities and can be classified as true tails and pseudotails. True tails are composed of adipose tissue, connective tissue, muscles, vessels, nerves and mechanoreceptors whereas pseudotails may be an anomalous prolongation of the coccygeal vertebra, lipoma, teratoma, chondrodystrophy or parasitic fetus.</p> <p><strong>Case Report: </strong>A 3-month-old male baby had a tail like appendage since birth which was gradually increasing in size. After complete workup, an elective resection was done under general anesthesia. Postoperative recovery was uneventful.</p> <p><strong>Conclusion: </strong>Surgical excision of the tail is the ultimate and may be the only surgical intervention required in these patients.</p> Asrar Ahmad Masooma Hasnain Bangash Irum Saleem Copyright (c) 2020 Masooma Hasnain Bangash, Asrar Ahmed, Irum Saleem 2020-07-10 2020-07-10 1 1 10.46831/jpas.v1i1.3 Peutz-Jeghers syndrome associated with eventration of left hemidiaphragm in a child: A case report <p><strong>Background: </strong>Peutz–Jeghers syndrome (PJS) is a rare genetic disorder. PJS with ileo-ileal intussusception and left-sided eventration of the diaphragm is an extremely rare presentation and not been reported so far.</p> <p><strong>Case Presentation: </strong>An 8-year-old child of PJS presented with acute intestinal obstruction. Examination and investigations of the child revealed intussusception with left side elevated hemidiaphragm. Surgical correction of both conditions was done.</p> <p style="text-align: justify;"><strong>Conclusion: </strong>PJS with intestinal obstruction due to intussusception needs surgical correction. Sometimes these cases may present with other associated surgical conditions that too need simultaneous surgical correction.</p> Jiledar Rawat Sudhir Singh Copyright (c) 2020 Jiledar Rawat, Sudhir Singh 2020-07-10 2020-07-10 1 1 10.46831/jpas.v1i1.22 Leadership role of pediatric surgeon during COVID-19 Pandemic Sameh Shehata Copyright (c) 2020 Sameh Shehata 2020-09-21 2020-09-21 1 1 1 1 10.46831/jpas.v1i1.15 The Association of Paediatric Surgeons of Pakistan (APSP): A platform for improving pediatric surgical services in Pakistan Inayat Ur Rehman Muhammad Saleem Sajjad Ali Copyright (c) 2020 Inayat Ur Rehman, Muhammad Saleem, Sajjad Ali 2020-09-21 2020-09-21 1 1 2 3 10.46831/jpas.v1i1.25 Journal of Pediatric and Adolescent Surgery: Why do we need another journal? Muhammad Bilal Mirza Nabila Talat Muhammad Saleem Copyright (c) 2020 Muhammad Bilal Mirza, Nabila Talat, Muhammad Saleem 2020-09-21 2020-09-21 1 1 4 4 10.46831/jpas.v1i1.16 Safe surgical practice in surgical wards during COVID-19 pandemic Imbesat Maheen Syed Copyright (c) 2020 Imbesat Maheen Syed 2020-08-18 2020-08-18 1 1 10.46831/jpas.v1i1.28 COVID-19 Pandemic: Advisory and Consensus Statement for the provision of surgical services from The Association of Paediatric Surgeons of Pakistan (APSP) <p>This is an advisory and consensus statement of the Association of Paediatric Surgeons of Pakistan (APSP) regarding guidelines for providing surgical services to the children. This can be implemented for other surgical services as well.</p> Muhammad Saleem Nabila Talat Imran Hashim Muhammad Javed Iqbal Khan Asif Iqbal Copyright (c) 2020 Muhammad Saleem, Nabila Talat, Imran Hashim, Muhammad Javed Khan, Asif Iqbal 2020-09-23 2020-09-23 1 1 5 12 10.46831/jpas.v1i1.26 Resuming elective surgeries in Corona pandemic from the perspective of a developing country <p>Since the COVID-19 pandemic, healthcare facilities have entered into a “crisis mode”. One of the measures used to allow hospitals to surge their capacity and serve the patient population with COVID-19 infection was the suspension of elective activity, most importantly elective surgery and other procedures. Now as the infection is fading, efforts are being made to resume elective surgical services keeping in mind the safety of the patient and health care workers. Resuming surgical services in developing countries is an uphill task.&nbsp;</p> Yogesh Kumar Sarin Copyright (c) 2020 Yogesh Kumar Sarin 2020-07-10 2020-07-10 1 1 19 21 10.46831/jpas.v1i1.27 Rapunzel Syndrome with a gastric ulcer Sajid Iqbal Nayyar Hamza Malik Allah Ditta Muhammad Bilal Mirza Nabila Talat Copyright (c) 2020 Sajid Iqbal Nayyar, Hamza Malik, Allah Ditta, Muhammad Bilal Mirza, Nabila Talat 2020-07-13 2020-07-13 1 1 10.46831/jpas.v1i1.6 Cecal volvulus in a child with Cornelia de Lange syndrome Dhanasekhar Kesavelu Prakash Agarwal Raj Kishore Bagdi Copyright (c) 2020 Dhanasekhar Kesavelu 2020-07-10 2020-07-10 1 1 10.46831/jpas.v1i1.12 Pediatric Anesthesia Advisory: What should we know as a pediatric anesthetist when a COVID-19 patient needs an operation? <p>We are living in a developing country with limited resources in the context of PCR testing, personal protective equipment, and negative pressure operating room availability; so facing a serious challenge for the continuation of surgical services especially in the context of anesthesia services and personnel safety during this COVID pandemic. As anesthesia provision is highly aerosol-generating thus predisposes both surgical and anesthesia teams to COVID. This demands a change in our anesthesia practice to provide a safe and comfortable atmosphere for the continuation of surgical services, as anesthesia is the backbone of surgery. We have developed this advisory for pediatric anesthetists especially relating to developing countries to guide them for providing safe anesthesia services keeping in mind the limited resources based on our practices and experiences gained during this pandemic along with reviewing national and international literature.</p> Saira Usman Muhammad Saleem Aima Zahid Azka Saleem Uzma Ather Muhammad Ali Copyright (c) 2020 Saira Usman, Saleem, Aima Zahid, Azka , Uzma Ather, Muhammad Ali 2020-07-10 2020-07-10 1 1 10.46831/jpas.v1i1.17 Changes in surgical practice by surgical residents and consultants during COVID-19 pandemic: A cross-sectional survey <p><strong>Background: </strong>During the COVID-19 pandemic, surgical practice is greatly changed as a strategy to prevent infection to the health care workers. This study was done to see what changes have been made in the surgical practice by the surgical consultants and residents in various surgical disciplines.</p> <p><strong>Methods: </strong>A Survey form was developed on the “Google Forms” application and distributed to surgical consultants and residents. The submission was received online during May 2020. The collected data were entered and analyzed using SPSS V.23. Qualitative data were presented as frequencies and percentages. Quantitative data were presented as mean and standard deviation.</p> <p><strong>Results: </strong>Overall, 272 consultants and residents from 45 teaching hospitals from Pakistan and around the world participated in the survey. Among the participants, 100 (36.8%) were surgical consultants and 172 (63.2%) were surgical residents. About 42% of participants were not performing elective surgeries during this pandemic of COVID-19 but almost all participants were performing emergency surgeries (93%). Over 60% of the respondents admitted that their practice is either reduced to more than 50% or completely shut down during this pandemic. Over 80% stated that their training activities were compromised due to the pandemic.</p> <p><strong>Conclusion</strong>: COVID-19 pandemic has greatly affected surgical practice both in the public and corporate sectors. Elective surgeries are affected the most in addition to the suspension of training activities of the residents.</p> Muhammad Kamran Muhammad Bilal Mirza Usama Aziz Warda Tahir Kashif Nawaz Nishant Singh Asad Ameer Muhammad Rehan Nabila Talat Copyright (c) 2020 M Kamran Azam, Muhammad Bilal Mirza, Usama Aziz, Warda Tahir, Nishant Singh, Asad Ameer, Muhammad Rehan, Kashif Nawaz, Nabila Talat 2020-09-07 2020-09-07 1 1 22 27 10.46831/jpas.v1i1.33 Lymph node biopsy in children: Indications and etiology <p><strong>Background: </strong>Peripheral lymphadenopathy manifests in a variety of benign and malignant conditions and is often challenging to distinguish pathologic from non-pathologic etiology based on clinical presentation alone. Therefore, lymph node biopsy is often required as an essential part of management. This study aimed to determine the causes of peripheral lymphadenopathy in children needing excision biopsy in our setting and establish a correlation with clinical features and laboratory findings.</p> <p><strong>Methods:</strong> A retrospective review of medical records of children aged 0-14 years undergoing lymph node biopsy at our institution, between January 2015 and June 2018, was conducted. Demographic, microbio­logical, and histopathological findings were reviewed.</p> <p><strong>Results:</strong> A total of 69 patients underwent lymph node biopsy, the majority of whom were male (n=40, 58%), with a mean age of 7.9 years. The histopathological findings confirmed lymphoma (n=27), tubercu­losis (n=24), benign reactive changes (n=14), and Langerhan Cell Histiocytosis (n=4). Cervical lymph nodes were most frequently involved (n=64). Associated symptoms included fever (n= 27), weight loss (n=2) and cough (n=7). Only one patient developed a postoperative complication (wound infection). A clini­cal diagnosis of tuberculosis (TB) had been presumed in 19 patients, but only 2 (11%) were confirmed to have TB, whereas10 were found to have histopathological findings of lymphoma.</p> <p><strong>Conclusion:</strong> Excisional biopsy is useful in the management of children with lymphadenopathy, allowing treatment to be initiated based on a histopathological diagnosis.</p> Maryam Aftab Maria Hasan Lubna Samad Copyright (c) 2020 Maryam Aftab, Maria Hasan, Lubna Samad 2020-08-07 2020-08-07 1 1 28 31 10.46831/jpas.v1i1.18 Transurethral fragmentation of bladder stone in children: Our experience <p><strong>Background: </strong>This study is performed to find the outcome of transurethral fragmentation and clearance of bladder stones in children as well as assessment of stone recurrence after the procedure.</p> <p><strong>Methods: </strong>It was a retrospective analysis of the medical record of 365 patients with bladder stones, treated with transurethral fragmentation at the Department of Pediatric Urology, The Children’s Hospital and the Institute of Child Health, Lahore, over a period of 5 years. Bladder stones were fragmented by using ureterorenoscope (URS) and pneumatic Lithotripsy under general anesthesia. Patients were asked to void next day for spontaneous passage of stone fragments. Duration of procedure, hospital stay, peroperative, and postoperative complications were recorded on a self-structured proforma. The collected data was analyzed with SPSS, version 22.</p> <p><strong>Results: </strong>The mean age of the patients was 4.7 ±2.31 years, and male to female ratio was 6:1. Clinical presentation was painful micturition with milking of penis (55%), followed by straining during micturition (17.5%), urinary retention (10%), increased frequency of urine (8%), febrile UTI (7.5%), and hematuria (2%). The mean stone size on ultrasound was 17.2 ±3.8 mm (Range 7-25 mm). The average operating time was 18 minutes (Range: 12-35 minutes). The transurethral fragmentation was successfully done in all (100%) patients. Average hospital stay was 24 hours. Most patients (98.5%) passed all stone fragments in urine &amp; were stone free at one week, confirmed by ultrasound and X-Ray Kidney, Ureter, and Bladder (KUB). Postoperative minor complications were found in (6%) patients including hematuria (3%), dysuria (2%), febrile UTI (1%), failure to void (0.5%). Stone recurrence was 0.27% and no urethral stricture was noted up to one year follow up.</p> <p><strong>Conclusion</strong>: Endoscopic treatment of bladder stone in children appears effective and safe by fragmenting the stone into multiple small pieces, which passed out spontaneously without any need for extraction of stone. The associated complications and recurrence rate are very negligible.</p> Ghulam Mujtaba Zafar Naseem Javed Fawad Humayun Asif Iqbal Copyright (c) 2020 Ghulam Mujtaba Zafar, Naseem Javed, Fawad Humayun, Asif Iqbal 2020-09-11 2020-09-11 1 1 32 36 10.46831/jpas.v1i1.24 Frequency and outcome of complicated appendicitis in toddlers and pre-schoolers <p><strong>Background: </strong>Acute appendicitis is a frequent indication of emergency abdominal surgery in the pediatric population. In younger children, especially toddlers, and preschoolers, the presentation is comparatively late resulting in complicated appendicitis. This study was done to determine the frequency and outcome of complicated appendicitis in toddlers and preschoolers.</p> <p><strong>Methods:</strong> This is a cross-sectional study done at the Department of Pediatric Surgery, Lady Reading Hospital Peshawar, during August 2018 and February 2019. The medical records of 144 toddlers and preschoolers who presented with acute appendicitis were reviewed for demography, clinical presentation, operative findings, and outcome. Frequency and types of complicated appendicitis were recorded.</p> <p><strong>Results:</strong> The mean age of study participants was 3 years (±2.84), including 46(32%) toddlers and 98(68%) preschoolers. Overall 62% of patients were male while 38% of patients were female. Complicated appendicitis was documented in 75% of patients. The common types of complicated appendicitis were perforation of the appendix with a localized abscess in 68 patients, gangrenous appendicitis in 4 patients, generalized peritonitis in 24 patients, and mass formation in 12 patients. All patients did well after surgery, except one who succumbed to complications of leukemia.</p> <p><strong>Conclusion:</strong> In our study, a great deal (75%) of toddlers and preschoolers had complicated appendicitis especially perforated appendicitis with localized peritonitis.</p> Naseem Khan Muhammad Ayub khan Jehangir Khan Sajjad Ali Imran Khattak Anwar Masood Copyright (c) 2020 Naseem Khan, Muhammad Ayub khan, Jehangir Khan; Sajjad Ali, Imran Khattak, Anwar Masood 2020-07-13 2020-07-13 1 1 10.46831/jpas.v1i1.5