Journal of Pediatric and Adolescent Surgery

A rare occurrence of primary obstructive megaureter with secondary ureteric stones: A case report

Muhammad Nadeem Sajjad — Sat, 06 Jun 2026 00:00:00 -0400

Background

Primary obstructed megaureter (POM) is a congenital functional obstruction caused by an adynamic distal ureteric segment. Although it commonly presents with urinary tract infection, flank pain, or impaired renal function, its association with urolithiasis is rare in children and may cause diagnostic difficulty.

Case Presentation
We report a 10-year-old boy who presented with intermittent left flank pain for one year. Imaging revealed a unilateral left obstructed megaureter with multiple mobile ureteric stones and a renal calculus, along with a contralateral renal duplex system. Ultrasonography demonstrated hydroureteronephrosis, while micturating cystourethrogram excluded vesicoureteric reflux. MAG-3 renography showed impaired drainage and reduced differential renal function. Intravenous urography confirmed distal functional obstruction consistent with POM rather than obstruction secondary to stones. Surgical management included excision of the adynamic distal ureteric segment, removal of all stones, and ureteric reimplantation using an extravesical (modified Lich–Gregoir) technique. Histopathology confirmed the diagnosis. The postoperative course was uneventful.

Conclusion
POM complicated by urolithiasis in children is rare and can be misdiagnosed as secondary hydroureteronephrosis. A high index of suspicion and detailed evaluation are required. IVP and CT urography are crucial for diagnosis, and surgical management is essential to prevent recurrent infection and renal impairment.

Congenital Tail Gut Cyst Presenting as a Gluteal Swelling in a Toddler: A Case Report

Sat, 06 Jun 2026 00:00:00 -0400

Background: In infants and young children, tailgut cysts often present as an incidental finding or as a progressively enlarging mass in the sacrococcygeal or gluteal region. Due to their rarity, they are frequently misdiagnosed as other congenital or neoplastic lesions, leading to delays in diagnosis and management.

Case presentation: A 1.5-year-old male was referred for a left buttock swelling. Ultrasound suggested a fluid collection. Subsequent MRI revealed a 75 x 54 x 57 mm peripherally enhanced lesion in the pelvis, posterior to the rectum, extending into the right ischiorectal fossa and perineum. Incision and drainage revealed a straw-colored fluid within a cystic cavity with a white glossy surface. A wall biopsy confirmed a tailgut cyst, with no malignancy. The cyst was completely excised, and histopathology showed fibroadipose tissue lined by cuboidal epithelium and smooth muscle bundles without neural plexi.

Conclusion: Tailgut cysts are rare congenital lesions and may simulate other lesions. The case emphasizes the need for awareness of tailgut cysts as a differential in cases with gluteal collection without classical stigmata of abscess.

A flame burn caused by hand sanitizer

Muhammad Sharif, sadaf — Mon, 08 Jun 2026 00:00:00 -0400

Background:

During COVID-19 pandemic, use of alcohol-based hand sanitizers increased.

The Centers for Disease Control and Prevention (CDC) recommends 60% alcohol concentration in sanitizers for their effectiveness against microorganisms. This high concentration of alcohol makes them inflammable. They can cause burn injuries if precautions are not taken during storage and use.

Case presentation:

We report a case of flame burn in a ten-year-old boy due to accidental spillage of hand sanitizer.

Conclusion:

We emphasize that public awareness should be made regarding proper storage and use of sanitizers to prevent burn injuries. They should be kept away from children and older children should be supervised while using them.

Key words: Hand Sanitizer, COVID-19 pandemic, flame Burn

Annular pancreas presenting as duodenal obstruction in a neonate: Report of successful management of 2 cases of a rare anomaly

Pradeep Kajal, Bhaswati Bharadwaj, Neha Yadav — Sat, 06 Jun 2026 00:00:00 -0400

Background

Annular pancreas is an uncommon inborn error that unequivocally leads to duodenal obstruction. The ventral lobe of the pancreas develops in a manner that encircles the duodenum, resulting in a significant blockage.

Case presentation

Two cases presented to the department of Paediatric surgery at different time intervals, with complaints of non-acceptance of feed and non-bilious vomiting. They were diagnosed by double bubble signs on a plain X-ray of the abdomen. One of the cases was associated with malrotation of the gut as well. Duodenoduodenostomy was performed on both the cases along with Ladd’s procedure in the second one.

Keyword

Annular pancreas; duodenal obstruction; duodenoduodenostomy; neonate

Outcome of complicated hernia in a tertiary care hospital

Thu, 04 Jun 2026 00:00:00 -0400

Background: Complications of hernias, particularly strangulation and incarceration, are relatively frequent and constitute diagnostic and therapeutic emergencies. This study aimed to describe the diagnostic and prognostic aspects of complicated hernias in children.

Methods: This was a retrospective study conducted over a 5-year period (January 2015–December 2019). All cases of complicated hernias managed during this period were included.

Results: During the study period, 1,446 patients were hospitalized, including 93 cases of complicated hernias, representing a hospital frequency of 6.43%. The mean age was 23.79 months, with a male-to-female ratio of 2.72. Infants accounted for 61.29% (n = 57) of cases. The main reason for consultation was painful umbilical swelling in 74% (n = 71) and inguinal swelling in 21.88% (n = 21). The mean duration of symptoms before presentation was 28.16 hours. The swelling was irreducible in 59.13% (n = 55) of patients. The average time to treatment was 16 hours. Surgical management was performed in all cases. Exploration revealed viable hernia contents in 91% (n = 85), with a mean neck diameter of 1.5 cm. Necrosis was observed in 9% of cases (n = 8), two-thirds of which (n = 5) involved inguinal hernias. Simple reduction with closure of the hernia defect was performed in 95.6% (n = 89) of patients, while resection with anastomosis was required in 4.3%. After a mean follow-up of 15 months, no recurrence or mortality was reported.

Conclusion: Strangulation remains a frequent complication of hernias in children. In this study, the type of hernia and patient sex were identified as prognostic factors.