Journal of Pediatric and Adolescent Surgery 2021-07-26T07:45:20+00:00 Prof. Dr. Muhammad Saleem Open Journal Systems <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 insufflated baloon 2021-01-26T13:28:50+00:00 Abdul Lateef Leghari Muhammad Bilal Mirza Nabila Talat 2021-03-13T00:00:00+00:00 Copyright (c) 2021 Abdul Lateef Leghari, Muhammad Bilal Mirza, Nabila Talat Postoperative gastric outlet obstruction following hiatal hernia repair in an infant: A case report 2020-11-16T17:20:28+00:00 Muhammad Jawad Afzal Shabbir Ahmad Farrakh Mehmood Satar Sajid Iqbal Nayyer Muhammad Bilal Mirza Nabila Talat <p>Background: Infantile hypertrophic pyloric stenosis (IHPS) is an exceedingly rare cause of postoperative emesis in a case of hiatal hernia. Occasionally it may simulate other etiology of gastric outlet obstruction.</p> <p>Case Presentation: A 32-day-old male baby presented with respiratory distress and vomiting since birth. Diagnosis of eventration of left hemi diaphragm was made on CT Chest. At surgery, hiatal hernia with an intrathoracic stomach was found, which was repaired. On 5th postoperative day, the baby developed vomiting after feeding which gradually turned to be projectile in nature over a week. Contrast meal performed showed malpositioned stomach with delayed emptying. At re-operation, a well-formed olive of pylorus was encountered; Ramstedt pyloromyotomy was done. Postoperative course remained uneventful.</p> <p>Conclusion: IHPS is a rarely described association with hiatal hernia. Pyloric stenosis should be considered in differential diagnoses of postoperative emesis in infants with hiatal hernia.</p> 2021-01-20T00:00:00+00:00 Copyright (c) 2021 Dr Muhammad Jawad Afzal, Shabbir Ahmad, Farrakh Mehmood Satar, Sajid Iqbal Nayyer, Muhammad Bilal Mirza, Nabila Talat Inflammatory myofibroblastic tumor of caecum presenting as recurrent intussusception: A case report 2021-01-18T06:35:37+00:00 Dinesh Kumar Barolia Aditya Pratap Singh Harsha Vinod Bathia Vipal H Parmar Bhavana Asit Mehta Shraddha Mehta <p><strong>Background: </strong>Inflammatory myofibroblastic tumor is an uncommon tumor. It commonly affects the lung but it can be found anywhere in the body. </p> <p><strong>Case Report: </strong>We are reporting a case of caecal mass presenting as recurrent intussusceptions. Histopathology and immunohistochemistry confirmed it to be an inflammatory myofibroblastic tumor of caecum. Immunohistochemistry of tumor cells were positive for vimentin, smooth muscle actin, MIB 1, and CD 45 in lymphoid cells in the stroma of the tumor.</p> <p><strong>Conclusion: </strong>Recurrent intussusception should be kept as one of the differential diagnosis in patient with caecal mass with recurrent abdominal pain. Inflammatory myofibroblastic tumor of the caecum is unusual in paediatric patients and may present as recurrent intussusception.</p> 2021-06-01T00:00:00+00:00 Copyright (c) 2021 Dr.Dinesh Kumar Barolia, Aditya Pratap Singh, Dr. Harsha Vinod Bathia, Vipal H Parmar, Bhavana Asit Mehta, Shraddha Mehta A rare case of simultaneous bilateral testicular torsion in inguinal canal: A case report 2021-04-23T04:06:57+00:00 Dilip Kumar Pal ASHUTOSH KUMAR TIWARI Sunirmal Choudhury <p><strong>Background: </strong>Simultaneous bilateral testicular torsion in inguinal canal is a very rare condition which mandates prompt surgical intervention. </p> <p><strong>Case Report: </strong>We report a case of an adolescent male presenting with complaint of severe pain in left inguinal region. Diagnosis of bilateral testicular torsion with bilateral undescended testes was made clinically and supported by Doppler study. This was followed by emergent surgical exploration requiring left orchiectomy and right orchiopexy.</p> <p><strong>Conclusion: </strong>A high index of suspicion is required in any patient presenting with lower abdominal or groin pain and an empty scrotum to clinch the diagnosis and act promptly in an effort to salvage the testes. We believe, irrespective of the time elapsed since the onset of symptoms, surgical intervention should be undertaken as spontaneous torsion and detorsion might be happening, enabling testicular salvage.</p> 2021-06-15T00:00:00+00:00 Copyright (c) 2021 dilip kumar pal, ASHUTOSH KUMAR TIWARI, SUNIRMAL CHOUDHURY Rectal duplication cyst mimicking rectal prolapse: A case report 2020-07-03T06:38:59+00:00 Asrar Ahmad Eelaf Karar Irum saleem Nisar Ahmad <p><strong>Background:</strong> Gastrointestinal tract duplications are rare congenital malformations that are benign, presenting usually in childhood. Most common sites include the distal ileum and esophagus. Rectal presentation is quite uncommon and is usually cystic.</p> <p><strong>Case Presentation:</strong> This is a case of a 3-year-old boy who came with rectal prolapse. On further examination and imaging investigations, a presacral cyst was located and a diagnosis of rectal duplication was made. The cyst was completely excised by a posterior sagittal approach.</p> <p><strong>Conclusion:</strong> Rectal duplication is a rare entity that may simulate a rectal prolapse.</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Asrar Ahmad, Eelaf Karar, Irum saleem, Nisar Ahmad Solitary intrascrotal neurofibroma in a child: A case report 2021-02-08T04:03:32+00:00 Ghadir Jaber Vipul Gupta Usman Javaid Diary Mohammed Mamoun AlMarzouqi <p><strong>Background: </strong>Neurofibroma (NF) remains a rare entity among various scrotal masses in the pediatric age group. We report a case of solitary intrascrotal extra testicular plexiform neurofibroma in a 6-year-old child with the clinical management of this rare entity and review of the literature. </p> <p><strong>Case Summary: </strong>A 6-year-old male presented with incidentally noticed intrascrotal swelling. Clinical examination confirmed the presence of solitary intrascrotal swelling with normal testis. Radiological imaging showed the presence of a hypoechoic mass in the left hemiscrotum with normal both testes. Surgical exploration showed the presence of unencapsulated soft tissue mass and histopathological examination (HPE) confirmed the diagnosis of plexiform neurofibroma. Thorough evaluation ruled out features of neurofibromatosis 1 thus confirming the diagnosis of solitary intrascrotal extratesticular plexiform neurofibroma. Complete surgical excision resulted in satisfactory recovery with no recurrence on follow-up</p> <p><strong>Conclusion: </strong>Neurofibroma although rare should be considered as a differential in the diagnosis of an intrascrotal mass in the pediatric age group. The benign nature of the lesion and extratesticular origin usually makes testis sparing surgical excision feasible which remains the treatment of choice with excellent prognosis and minimal chances of recurrence. A thorough histopathological examination is mandatory to rule out neurofibromatosis.</p> 2021-03-25T00:00:00+00:00 Copyright (c) 2021 Ghadir Jaber, Vipul Gupta, Usman Javaid, Diary Mohammed, Mamoun AlMarzouqi Spontaneous enterocutaneous fistula in an infant: A case report 2021-01-24T14:02:26+00:00 Gali Divya Pinaki R Debnath Vijay Kumar Kundal Anil kumar Arnab Kumar Amita Sen <p>Background: Enterocutaneous fistulae (ECF) most commonly occurs following intestinal surgery. Spontaneous ECF is a rare entity in infants. Early presentation to the hospital decreases complications.</p> <p>Case Presentation: A 2.5-month-old infant developed spontaneous ECF below the umbilicus following abdominal wall erythema and abdominal wall abscess. The bowel mucosa prolapsed out on straining efforts. Work-up was uneventful. At operation, the fistula was mobilized, and intestinal continuity was restored. Postoperative recovery was uneventful.</p> <p>Conclusion: Spontaneous development of ECF is a rare entity in children. Every effort should be made to identify the etiology before labeling it as spontaneous. </p> <p>Keywords: Enterocutaneous fistula, Necrotizing fasciitis, Primary closure.</p> 2021-03-31T00:00:00+00:00 Copyright (c) 2021 GALI DIVYA, Pinaki R Debnath, Vijay Kumar Kundal, Anil kumar, Arnab Kumar, Amita Sen Spontaneous caecal perforation secondary to abdominal wall abscess or vice versa - case report and review of literature 2021-06-09T17:32:12+00:00 Dinesh Kumar Barolia Aditya Pratap singh . Harsha Vinod Bathia Vipal H Parmar Bhavana Asit Mehta Shraddha Mehta <p>Background: Spontaneous caecal perforation secondary to abdominal wall abscess is a rare entity. There may be abdominal wall abscess due to spontaneous caecal perforation. Small and large bowel perforation in neonatal period is common secondary to necrotizing enterocolitis. But beyond neonatal caecal perforation is unusual.</p> <p>Case presentation: We are reporting an interesting case of spontaneous caecal perforation in two year old female child without any sign and symptoms of peritonitis or abdominal discomfort secondary to abdominal wall abscess. Or it may be vice versa, abdominal wall abscess develops secondary to caecal perforation.</p> <p>Conclusion: Caecal perforation in children beyond to neonatal period is extremely rare. To the best of our knowledge, I have never seen in English literature of spontaneous caecal perforation secondary to abdominal wall abscess or vice versa.</p> 2021-07-17T00:00:00+00:00 Copyright (c) 2021 Dr.Dinesh Kumar Barolia, Aditya Pratap singh , . Harsha Vinod Bathia, Vipal H Parmar, Bhavana Asit Mehta, Shraddha Mehta Percutaneous cystolithotripsy in the reconstructed bladder of cloacal exstrophy: A case report 2020-07-26T01:03:03+00:00 Eiji Hisamatsu Kanae Koyama Kaoru Yoshino <p>Background: Bladder stones are common after bladder augmentation. The management of bladder stones is challenging, especially in patients who underwent complex urinary tract reconstruction.</p> <p>Case Presentation: We report our experience of percutaneous cystolithotripsy after bladder neck closure, creation of a catheterizable channel, and ileal bladder augmentation in a girl with cloacal exstrophy.</p> <p>Conclusion: Percutaneous cystolithotripsy is a safe, effective, and minimally invasive treatment option for bladder stones after bladder neck closure and the creation of a continent catheterizable channel.</p> 2021-01-19T00:00:00+00:00 Copyright (c) 2021 Eiji Hisamatsu, Kanae Koyama, Kaoru Yoshino A newborn with anterolateral diaphragmatic defect: An unusual anomaly? 2020-08-26T22:27:29+00:00 A. Mohamed Shankar S Abid Qazi <p><strong>Background:</strong> Anterolateral defect of diaphragm is unusual and has been reported less than 5 times in literature.</p> <p><strong>Case Presentation:</strong> We are reporting a case with typical initial presentation of a congenital diaphragmatic hernia. A chest x-ray raised suspicion of a cystic lesion or diaphragmatic eventration which was excluded by chest ultrasound. At operation he was found to have a localised and large anterolateral defect with a very thick sac which was plicated to bridge the diaphragmatic defect.</p> <p><strong>Conclusion: </strong>A rare variant and should be differentiated from other variants using imaging.</p> 2021-01-21T00:00:00+00:00 Copyright (c) 2021 A. Mohamed, Shankar S, Abid Qazi Congenital epulis: Report of two cases 2021-06-24T05:11:44+00:00 Ali Chaudhry Rumaisaa Saman Muhammad Umar Nisar Khawar Abbas Samer Sikander <p><strong>Background: </strong>Congenital epulis is a rare benign, smooth, sessile, or pedunculated, solitary mass of varying sizes commonly occurring at the anterior alveolar ridge of the maxilla. It can occur as a solitary as well as a multifocal lesion.</p> <p><strong>Case Presentation: </strong>Case 1: A two-day-old female newborn presented with a single round, smooth, pedunculated mass measuring 3x2x2cm on the anterior alveolar ridge of the maxilla. Complete excision of the mass was done under general anesthesia. Histopathology confirms congenital epulis. No recurrence was found till one year of follow-up. Case 2: A one-day-old female newborn presented with a 3x4x3cm soft to firm mass arising from the right upper alveolar margin attached with a stalk and extending into the mouth without any respiratory difficulty. Complete excision of the mass was done under general anesthesia. Follow-up for one year showed no recurrence.</p> <p> </p> 2021-07-28T00:00:00+00:00 Copyright (c) 2021 Ali Chaudhry, Rumaisaa Saman, Muhammad Umar Nisar, Khawar Abbas, Samer Sikander Congenital laryngeal cyst causing repeated airway obstruction in a six-year-old girl 2020-11-18T03:40:56+00:00 Abdolhamid Amooee Farzan Safi Dahaj Shokouh Taghipour zahir Arezoo Alamdar yazdi 2021-01-18T00:00:00+00:00 Copyright (c) 2021 Dr. Abdolhamid Amooee, Dr. Farzan Safi Dahaj, Prof. Shokouh Taghipour zahir, Dr. Arezoo Alamdar yazdi Factors affecting the outcome of neonates with anorectal malformation in a developing country 2020-08-03T14:30:53+00:00 Muhammad Umar Nisar Asad Iqbal Noshela Javed Samer Sikander Sadia Asmat Burki Muhammad Amjad Chaudhry <p><strong>Background: </strong>The survival and outcome of neonates with anorectal malformations (ARM) have much improved in the developed countries due to optimal perioperative and postoperative care but in developing countries, sepsis, low birth weight, delayed presentation, and lack of intensive care for neonates are still important in affecting the outcome. This study was carried out to evaluate factors of poor outcome (mortality) in neonates with ARM.</p> <p><strong>Method: </strong>This is a prospective analytical study. A total of 44 consecutive neonates with Anorectal malformations (ARM) presenting to the Department of Pediatric Surgery, The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, were included. Variables studied included age at presentation, gender, birth weight, type of malformation, sepsis at presentation, type of surgery performed, postoperative complications, and their relationship to the outcome. The statistical analysis was performed using SPSS version 21.</p> <p><strong>Results:</strong> A total of 44 neonates with ARM were included in the study. In the study population, 56.8 % (25) were males and 43.2% (19) were females. The mean age at presentation was 2.1 ± 0.5 days. The mean birth weight was 2.5 ± 0.6 kg. Overall mortality was 29.5% (13) with 13.63% (6) patients died pre-operatively. The most common cause of death in postoperative patients was sepsis (40%). There was a statistically significant relationship between low birth weight (P= &lt;0.01) and sepsis at presentation (P=0.001) with mortality. No statistically significant association was found when the outcome was compared with age at presentation (P=0.21) and postoperative complications (P=0.16).</p> <p><strong>Conclusion:</strong> In developing countries, the lack of resources, lack of trained midwives/LHVs, intensive care are contributing factors to sepsis and delayed presentation, and ultimately mortality. Good antenatal care, awareness of the midwives/Lady Health Visitors to refer such patients in time, and provision of adequate intensive care can improve the outcome of surgery in ARMs.</p> 2021-03-08T00:00:00+00:00 Copyright (c) 2021 Muhammad Umar Nisar, Asad Iqbal, Noshela Javed, Samer Sikander, Sadia Asmat Burki, Muhammad Amjad Chaudhry Abdominal tuberculosis requiring surgical intervention: A 10-year single-center experience 2020-07-07T02:51:32+00:00 Hana Arbab Nawal Khan Farhana Amanullah Lubna Samad <p><strong>Background: </strong>Although uncommon in children, abdominal tuberculosis (ATB) can be a life-threatening condition with a subset requiring emergency surgical intervention. This study aims to determine the presentation, surgical procedures performed, and outcomes in children affected by abdominal tuberculosis.</p> <p><strong>Methods: </strong>A retrospective chart review of all children undergoing surgical intervention for ATB from July 2007 to December 2018 was conducted. Data were analyzed using SPSS version 22.</p> <p><strong>Results: </strong>Of 340 children with a diagnosis of ATB seen at the Indus Hospital’s TB clinic, 14 (4%) underwent laparotomy. Females were affected more commonly (57%), with a mean age at presentation of 11 years (range 8-14). Nine children required laparotomy for documented perforation, while 5 had an intestinal obstruction. Most children (n=10) had an established diagnosis of ATB before the surgical intervention; 2 children had completed 6–9 months anti-tuberculous treatment (ATT) courses, while 8 children had been on ATT for a mean period of 2.5 months at the time of developing acute surgical symptoms. Diversion ileostomy was made in 64%. Postoperative complications included sepsis (n=4), wound infection (n=3), abdominal collection (n=2), enterocutaneous fistula (n=2), and abdominal wound dehiscence requiring formal closure (n=2). There were 4 mortalities (29%); 10 patients were discharged after a median in-hospital stay of 12 days (range 6-35) of which 6 with ileostomies underwent reversal after completion of the ATT course.</p> <p><strong>Conclusion: </strong>ATB has high morbidity and mortality. Perforation and obstruction can occur during or after the completion of ATT. Management requires early recognition and surgical intervention as indicated.</p> 2021-02-15T00:00:00+00:00 Copyright (c) 2021 Hana Arbab, Nawal Khan, Farhana Amanullah, Lubna Samad The spectrum of congenital malformations of the lung at a rural hospital 2020-12-24T18:49:02+00:00 Dr. Pooja Bhole Dr. Vivek Gharpure <p>ABSTRACT</p> <p><strong>Background: </strong>Congenital malformations of lung, such as congenital lobar emphysema, cystic adenomatoid malformation, bronchial cyst, pulmonary sequestration are of rare occurrence. However, our hospital being in a rural area attracts a large number of patients with complex malformations.</p> <p><strong>Method: </strong>This retrospective analysis is done to evaluate diagnostic accuracy, safety and efficacy and outcomes of open lung resections at a rural hospital.</p> <p><strong>Results:</strong> 16 children with congenital lung malformation underwent open resection in a rural hospital, with no mortality and minimal morbidity, no complications and more than 24 months follow-up.</p> <p><strong>Conclusion:</strong> Open lung resections are found to be safe, effective in a rural setting also.</p> 2021-03-03T00:00:00+00:00 Copyright (c) 2021 Dr. pooja, Dr. Vivek Congenital lobar emphysema in children: Institutional experience and errors to be avoided in the management 2020-11-20T22:43:17+00:00 Asif Iqbal Naeem Liaqat Muhammad Saleem Nabila Talat Arsalan Raza Wasti Muhammad Ammar Imran Hashim <p>Background: Congenital Lobar emphysema (CLE) is one of the rarest cystic lesions in the thoracic cavity among children. It is often misdiagnosed and managed incorrectly. We are reporting our institutional experience and recommendations regarding the prevention of common errors in the management of this condition.</p> <p>Methods: This study was conducted at the Paediatric Surgery Department, The Children’s Hospital &amp; the University of Child Health Sciences Lahore from January 2015 to December 2018. All the patients who underwent thoracotomy for congenital lobar emphysema at our center were included in the study and their charts were reviewed. </p> <p>Results: A total of 19 patients had been treated at our center in this duration. The mean age of patients was 2.85 ± 2.11 months. Thirteen of them (68%) were male and the most common presenting complaint (94.7%) was respiratory distress. Chest X-ray was done in all of the patients while a CT scan was needed in 11 patients (57.9%). The most involved lobe was left upper (n=15). Lobectomy was done in all patients. Post-operative ventilation was required in 2 patients (10.5%) and pneumonia developed in 2 patients (10.5%). The most significant complication was wound infection (9/19, p=&lt;0.01).</p> <p>Conclusion: Our results about perioperative management are consistent, however, we received cases with misdiagnosis. We have proposed recommendations to address this issue.</p> 2021-08-20T00:00:00+00:00 Copyright (c) 2021 Asif Iqbal, Naeem Liaqat , Muhammad Saleem, Nabila Talat , Arsalan Raza Wasti, Muhammad Ammar, Imran Hashim Single-center experience of managing childhood intussusception 2021-07-26T07:45:20+00:00 Wajeeh Uddin Vipul Gupta Ghadeer Jabir Diary Abdulrahman Mohd Mamoun Muhamed Rafea <p><strong>Background: </strong>Intussusception is one of the emergencies encountered in early childhood requiring emergent interventions. The purpose of the study is to determine the outcomes and prognosis of our methods and management strategies employed in children who developed intussusception.</p> <p><strong>Methods: </strong>This is a retrospective case series performed by reviewing the patient medical records, sonographic and radiological reports, and surgical notes of the patients managed for intussusception at our hospital from 2009–2018.</p> <p><strong>Results:</strong> A total of 355 cases of intussusception were managed during the study tenure. The etiology was idiopathic in 97.4% whereas the remaining patients had Meckel’s diverticulum, lymphoma, and intestinal polyp as pathological lead point (PLP). Ultrasound was used for the diagnosis as the primary investigation tool in all the patients, with 100% diagnostic accuracy in the current study. Non-operative management by hydrostatic reduction was performed successfully in 79.43% of the patients. Total episodes with recurrence were 23 (6%); 30% had recurrence within 48 hours. Recurrence occurred by an average of 7.68 months after the successful reduction.</p> <p><strong>Conclusions: </strong>The majority has idiopathic etiology, but secondary cause with some pathological lead point is also not uncommon. Profound attention is required for prompt identification and treatment to avoid bowel ischemia. Ultrasound remains the preferred diagnostic modality in our patients. Even with recurring episodes of intussusception, the primary treatment remains hydrostatic reduction. </p> 2021-08-20T00:00:00+00:00 Copyright (c) 2021 Wajeeh Uddin, Vipul Gupta, Ghadeer Jabir, Diary Abdulrahman Mohd, Mamoun Muhamed Rafea Automatic planning of paediatric craniofacial deformities: new virtual facial-symmetry operative detection 2020-12-30T10:12:20+00:00 Giuditta Mannelli Antonio Marzola Francesco Buonamici Yari Volpe Francesca Uccheddu Giuseppe Spinelli <p><strong>Background:</strong> The correction of craniofacial deformities is an ongoing challenge in maxillofacial surgery. However, conventional measurement methods for treatment planning are not appropriate for craniofacial surgery. Computer-assisted approaches can improve surgical outcomes. A new, non-invasive, patient-specific automatic method, proposed here, has been tested for assisting the surgeon in preoperative planning.</p> <p><strong>Case Presentation:</strong> In the case reported, the described method allows effective surgery planning that led to a significant decrease in asymmetries in the orbital region.</p> <p class="Didefault"><strong>Conclusion:</strong> The multidisciplinary collaborative approach is a central element for the construction of effective personalized procedures and for the conception of new surgical approaches. The here proposed technology offers a good level of feasibility and has an achievable potential for breakthroughs in the improvement of facial deformities surgical treatment, thus representing an overwhelmingly useful tool in a clinical setting. </p> 2021-03-31T00:00:00+00:00 Copyright (c) 2021 Giuditta Giuditta Mannelli, Antonio Marzola, Francesco Buonamici, Yari Volpe, Francesca Uccheddu, Giuseppe Spinelli