Journal of Pediatric and Adolescent Surgery

Transverse testicular ectopia

Muhammad Sharif, Samra Zahra, Ahmad Hassan — Sun, 20 Feb 2022 00:00:00 +0000

Omphalomesenteric duct cyst containing gastric mucosa presenting with periumbilical excoriation

Wed, 25 May 2022 00:00:00 +0000

A 2-year-old male child presented with umbilical discharge (for 1.5 years), red-brown swelling at the umbilicus (since birth), and severe excoriation around the umbilicus (for 1 year). He was taking medicine from a local practitioner for umbilical swelling for one year. But there was no improvement. Gradually periumbilical excoriation worsened. On examination, the excoriated skin became black. He was investigated for routine hemogram, USG whole abdomen, and pre-anesthetic checkup. Ultrasonography showed umbilical sinus. After optimization, surgery was performed that showed a cystic swelling beneath the umbilicus, opening at the umbilicus. The end of cystic swelling was connected with the distal ileum (site for Meckel's diverticulum) with a fibrous band. The cyst and the band were excised. Umbilicoplasty was done along with layered wound closure. The postoperative period was uneventful. Histopathology of the excised specimen showed a cystic lesion composed of ectopic gastric mucosa surrounded by muscle layer and fibroadipose tissue.

Is the Snodgrass technique suitable for different types of hypospadias? Single-center experience

Thu, 20 Jan 2022 00:00:00 +0000

Background: Hypospadias is a congenital penile defect and Tubularized Incised Plate (TIP) urethroplasty is a widely accepted option to repair this defect. Our experience about the outcome of hypospadias repair by this technique is discussed.

Methods: This is a retrospective analytical study consisting of 80 cases, conducted between May 2017 to December 2019 at the Department of Pediatric Surgery, Maternity, and Children’s Hospital Dammam. All the cases with anterior, middle, and posterior hypospadias, who underwent Snodgrass TIP urethroplasty, were included in the study. The same surgeon performed all the operations. The follow-up period lasted for 2 years, after surgery and the final outcome of the procedure was recorded, based on the observations.

Results: The age range of the patients varied between 1 to 9 years. Anterior hypospadias constituted 64 (80%) cases followed by middle hypospadias 13 (16.25%), and posterior hypospadias 3 (3.75%). By type, glanular hypospadias was the most common 30 (37.5%), followed by sub-coronal 19 (23.75%), coronal 15 (18.75%), mid-penile 11 (13.75%), proximal penile 2 (2.5%) and penoscrotal hypospadias 2(2.5%). Scrotal hypospadias was the least common type, 1 (1.25%). Overall complications that required re-intervention occurred in 16 (20%) cases. Urethrocutaneous fistula (UCF) which occurred in 7 (8.75) cases was the most common complication, followed by meatal stenosis in 4 (5%) and glans dehiscence and urethral stricture 2 in each (2.5% each). Total repair disruption was the least common complication that was noticed in 1 (1.25%) case. Functional and cosmetic results were judged as satisfactory.

Conclusion: For hypospadias repair, TIP urethroplasty is the procedure of choice for anterior hypospadias with excellent results. It is also quite suitable with middle hypospadias and acceptable for posterior hypospadias for selected cases. The overall complication rate is low and also offers very good functional and cosmetic results.

Foreign body ingestion and inhalation in pediatric age: Our experience at a tertiary care hospital

Mon, 20 Jun 2022 00:00:00 +0000

ABSTRACT

BACKGROUND: Foreign bodies in aero digestive tract is a common emergency in pediatric age group.

METHODS: This cross-sectional study included 156 patients of foreign bodies in aero digestive tract over a period of 2 years from January 2016 to December 2017.

RESULTS: Out of 156 patients, foreign body in esophagus was found in 111 patients with age range from 6 months to 12 years. Fifty-six patients (50%) belonged to 3-5 years age group. Coin was found in most of the patients which constitutes 61(55%) patients. Majority of the foreign bodies got impacted in cricopharynx. Of all the patients, 45 had foreign body in airway with age ranging from 6 months to 12 years. Peanuts were found in majority of cases, constituting 20% and right bronchus was mostly affected. One patient of foreign body ingestion expired.

CONCLUSION: Early detection and referral to a well-equipped center can prevent mortality and morbidity.

Management of chronic empyema thoracis in children, a single center retrospective observational study

Sudhir Singh, Nitin Pant , Survesh Kumar Gupta, Jiledar Rawat — Sun, 20 Feb 2022 00:00:00 +0000

^Abstract:

Background: Chronic empyema thoracis (CET) is common in developing and developed countries despite advancement in diagnostic and therapeutic technologies. Some of the cases of CET can be managed with antibiotics and tube drainage alone, some of them managed with less extensive surgical procedure like video-assisted thoracoscopic surgery (VATS) or open decortication alone, while some of the complicated cases need extensive decortication and debridement of necrotic lung tissue or lobectomy. Our aim is to present our experience of management of cases of chronic empyema thoracis in children.

Methods and Material: This is a retrospective observational study of cases, managed at tertiary care center with chronic empyema thoracis. Records of cases of CET admitted, referred or transferred to department of pediatric surgery at our center over last three years were studied. Demographic data, clinical, radiological profile, surgical/ non-surgical intervention, hospital stay, aetiology, outcome was analysed. Follow up was up to the last recorded outpatient visit. This study is a retrospective observational study with small number of cases statistical tool are not used to draw any statistical interference.

Results: Twenty-nine cases with median age 3 years, male to female ratio was 25:4 were admitted over three years. Pre-operative bronchopleural fistula was seen in four. Five cases were managed conservatively, twenty underwent decortication alone while four cases required decortication along with lobectomy. Tuberculosis was detected in three cases. A pyogenic organism was identified in ten cases only. Post-operative ventilation was required in three patients. There was no mortality. All thrived well at 12-18 months follow up.

Conclusions: Management of chronic empyema should be case based. Cases of CET in children can managed with conservative (with appropriate drainage of cavity, proper antibiotics, and nutritional build-up of child), thoracotomy and decortications alone or some time removal of disease lung also required depending on clinical and radiological finding of cases.

The predictive value of neutrophil-to-lymphocyte ratio to diagnose acute appendicitis and grade its severity

Fri, 17 Jun 2022 00:00:00 +0000

ABSTRACT

Background: Acute appendicitis (AA) is one of the most common acute abdominal emergencies in the pediatric population, occurring commonly between the ages of 7-15 years. The diagnosis mostly depends upon typical presentation and clinical findings. Laboratory investigations and imaging techniques aid the diagnosis. Neutrophil to lymphocyte ratio (NLR) is a valuable indicator of diagnosis in questionable cases.

Methods: This is a retrospective study consisting of 260 pediatric patients who underwent appendicectomy. The study was conducted at the Department of Pediatric Surgery, Maternity and Children’s Hospital Dammam, Saudi Arabia. The duration of the study was May 2018 to March 2021. The clinical features and initial preoperative total leukocyte count (TLC), with neutrophil and lymphocyte values, were collected. The neutrophil to lymphocyte ratio (NLR) was preoperatively calculated by dividing the values obtained. The patients were categorized in group 1 as non-appendicitis and group 2 as appendicitis. On the basis of histopathological findings, group 2 was further divided into catarrhal, phlegmonous, and gangrenous/perforated as groups A, B, and C respectively. The value of NLR was compared between the groups.

Results: The children with acute appendicitis had a higher NLR than healthy children. Acute appendicitis was ruled out at 2 cut-off-value of NLR with 94% sensitivity and 100% specificity. An NLR of 3.5 was an accurate marker for acute appendicitis. Significant differences in NLR values were also observed in the severity of appendicitis. Phlegmonous appendicitis had 78% sensitivity and 82% specificity at a cut-off value of 6.0 while NLR of > 8.0 was the cut-off point for gangreneous/perforated appendicitis with 80 % sensitivity and 87% specificity.

Conclusion: The NLR is a reliable biomarker to exclude, diagnose, and grade the severity of acute appendicitis. It is a valuable indicator of atypically presented cases or cases lacking adequate clinical findings. The yield of the test is increased in conjunction with other laboratory parameters.

Itinerary of children in the management of intussusception: the true reasons of delayed medical care in a west African country

Wed, 26 Jan 2022 00:00:00 +0000

Background: The delayed medical care of intussusception is still the reason for morbidity and mortality in many developing countries. The objective of this study is to take stock of the itinerary of children treated for intussusception, in order to to reduce the delay of the treatment.

Methods: This is a cross-sectional study, carried over three years (from 1^st June 2016 to 31 May 2019), at a Paediatric Surgery department of Campus Teaching Hospital in Lomé (Togo). The medical record of 23 children whose median age was 12 months, were included. Symptoms, the average time before the first consultation, different health centres consulted and treatment received, and the average time before the admission in the specialised department were studied.

Results: In three years, 23 children were managed for intussusception. The average time before the first consultation from home in a health centre was 1.87 days. No patient was admitted to the Paediatric Surgery department directly from home. Twelve patients consulted one centre, eight patients 2 centres, and one patient 3 centres before admission. Before referral, these patients were misdiagnosis as gastro-enteritis in 8 cases (38.10%), malaria in 8 cases (38.10%), and digestive salmonellosis in 3 cases (14.29%). The time elapsed between the beginning of the disease and the admission in specialised service was on average 5.39 days and 3.52 days elapsed then between the first consultation from home and the admission to the Paediatric Surgery service.

Conclusion: Valuable time to manage intussusceptions is lost in other medical health services before admission to specialised services. Action on this route will have to be taken through an effective counter-referral system.

Penile hypoplasia associated with anorectal malformation: What should we call this condition?

Chikako Nakata, Eiji Hisamatsu, Atsunori Muraki, Motofumi Tajima, Kaoru Yoshino — Tue, 01 Mar 2022 00:00:00 +0000

Background: Urogenital abnormalities are common in patients with anorectal malformations (ARM). The wide spectrum of urogenital abnormalities and ARM sometimes make it difficult to name the conditions simply.

Case Presentation: We experienced a case of penile hypoplasia associated with the urethrorectal communication.

Conclusion: From the viewpoint of urogenital anomalies, we might call this condition “aphallia variant” or “absent penis spectrum”. On the other hand, from the viewpoint of ARM, we might call this condition “male posterior cloaca” or “partial urorectal septum malformation sequence”. More important than naming them is understanding the clinical conditions precisely.

A complex pancreaticobiliary malunion causing recurrent pancreatitis in a boy: A case report

Amen Zafar, Anwar Ul Haq, Dawood Shehzad, Mohammad Salih, Gulrez Umar — Tue, 19 Apr 2022 00:00:00 +0000

Background

Pancreaticobiliary malunion (PBM) is a distinct malformation of the pancreatic and biliary ductal system, in which the junction of the pancreatic and biliary ducts occurs above the duodenal wall. PBM has varied presentations that prompt early diagnosis and management.

Case Presentation

A 9-year-old male, a known case of chronic pancreatitis, presented with sudden intense abdominal pain and vomiting. After evaluation, the diagnosis of acute on chronic pancreatitis secondary to PBM was made and the patient underwent Roux-en y hepaticojejunostomy, along with cholecystectomy and common bile duct excision.

Conclusion

The purpose of this report is to add to the literature the unique presentation of PBM in the pediatric population in order to aid in prompt diagnosis and management. This will be the first report on PBM in the pediatric population of Pakistan

Corrosive ingestion in a 4 days old newborn

Ahmad Hassan, Asad Munir, Fatima Naumeri, Bilal Qayyum, Muhammad Sharif — Wed, 19 Jan 2022 00:00:00 +0000

Background: Corrosive ingestion in children is very important and sensitive issue which result in lot of morbidity and mortality corrosive ingestion is mostly in form of acid or alkali chemical. 5000 to 15000 caustic ingestion cases are reported annually in United States. Majority of cases are accidental and can occur in any age of children but in new born it occur very rarely.

Case Presentation: we are presenting a case of corrosive ingestion in 04 days old new born who was given a liquid bleed mixed with formula milk by mother considering the liquid bleed as water for the dilution of milk.

Conclusion: We conclude that legislation should be done for authorizes sale of corrosive chemical and awareness campaign should be lounge through social, print and electronic media about hazards of corrosive ingestion.

Rectal atresia with pouch colon without fistula in a female newborn– a rare association: A case report

Tue, 15 Mar 2022 00:00:00 +0000

Background: Rectal atresia is a rare variant of anorectal malformation (ARM). Pouch colon is an abnormal dilation of the colon distally connected by the fistula. Pouch colon without fistula is extremely rare.

Case Presentation: We report a case of unusual association of rectal atresia with pouch colon without fistula in a female newborn. At surgery, a type IV pouch colon was found which was resected and colostomy was done as the initial procedure.

Conclusion: Rectal atresia with congenital pouch colon without genitourinary fistula in a female child is an extremely rare association.

Every tangle has a story - Rapunzel Syndrome: A case report

Yousuf Aziz Khan, Zainab Zaib, Fizza Tufail, Kashif Rafiq, Khyal Muhammad — Wed, 09 Feb 2022 00:00:00 +0000

Background: Rapunzel syndrome is the rarest form of trichobezoar; a condition in which trichobezoar extends beyond the stomach into the small intestine. It is common among children and young girls with a history of psychiatric illnesses.

Case Presentation: A 10-year-old girl without any history of psychiatric illness, presented with abdominal pain and non-bilious vomiting for 6 months. Clinically she had a non-tender upper abdominal mass which, later at workup, was found to be a trichobezoar. She was surgically managed successfully.

Conclusion: Though uncommon, Rapunzel syndrome should be kept in the differential diagnoses especially in a young female patient with features of an upper GI obstruction and a non-tender, palpable epigastric mass.

Laparoscopic management of a giant challenging ovarian dermoid cyst: A case report

Sangam Jha, Akanksha Singh, Upasna Sinha, Jayanti Sinha — Sat, 26 Feb 2022 00:00:00 +0000

Background: Dermoid cyst accounts for 10-20 % of all ovarian tumors. Traditionally giant ovarian cysts have been removed through a midline laparotomy. Here we report a case of laparoscopy-assisted removal of a giant dermoid cyst in an adolescent girl.

Case Presentation: A 17-year-old girl presented with a complaint of abdominal distension for 7 months. Abdominal examination revealed a well-defined tense cystic mass arising from the pelvis and extending up to the epigastric region. CT scan of abdomen and pelvis reported a mature teratoma of size 25.5x19.9x35cm of the right ovary. Laparoscopic excision of the cyst was performed following extracorporeal drainage of the cyst.

Conclusion: Laparoscopy-assisted of a giant ovarian dermoid cyst is a feasible mode of treatment irrespective of its size provided malignancy has been ruled out.

Acute exogenous lipoid pneumonia due to foreign body aspiration in a child- an unusual and sinister presentation: A case report

Tue, 15 Mar 2022 00:00:00 +0000

Background: Acute exogenous lipoid pneumonia is an extremely rare pathology in children and occurs because of aspiration of oil or lipid-containing material. The presentation and radiological findings vary widely and the exact mechanism of injury to the lungs is not clear.

Case Presentation: An 18-month-old girl presented with gradually increasing swelling and subcutaneous emphysema over the chest wall, neck, and face. The investigation revealed pneumomediastinum, pneumorachis, and soft tissue density in the left bronchus. The child underwent rigid bronchoscopy and retrieval of an organic foreign body.

Conclusion: Acute exogenous lipoid pneumonia can occur in children because of aspiration of oil-secreting organic foreign body. The presentation can be atypical, clinical suspicion and early diagnosis with timely intervention are crucial for the appropriate management.

Galectin 3 Binding Protein as a biomarker of choledochal cyst in children: A pilot study

Mon, 11 Apr 2022 00:00:00 +0000

A choledochal cyst (CDC) is a rare congenital, single, or multiple cystic dilatations of the biliary tract encountered most commonly in infants and children. A sensitive and specific serological marker, if available, may add to its early recognition thereby avoiding the risk of complications frequently seen in these patients. We analyzed serum galectin-3-binding protein (Gal-3BP) levels in 21 children with CDC and 14 age-matched controls by the ELISA method. Serum Gal-3-BP levels were significantly raised in the patient group (36.6 ±25.2 ng/ml versus 7.0 ±4.3 ng/ml in controls; p <0.0001) and 95.2% of patients had Gal-3BP levels higher than the mean value in controls. Almost 67% of patients showed values ≥3 times of mean Gal-3BP level in controls (p <0.0001). Equal to 5 times or greater levels were seen in 43% of the patients (p = 0.0051). The study, therefore, suggests further evaluation of Gal-3BP as a potential biomarker for CDC and other biliary disorders.