Adhesive small bowel obstruction (ASBO) in children--role of conservative management.

Adhesive small bowel obstruction (ASBO) is an annoying postoperative complication. Though the diagnosis can be made easily, the role of conservative management in children is controversial. Hence a study was conducted to determine the role of conservative management, and to identify the factors that can predict / influence the outcome of conservative treatment in children with ASBO. Children admitted with ASBO from 1980 to 2002 (22 year period) formed the material for this study. The data was analyzed with respect to the influence of age at the time of presentation, primary disease for which original laparotomy was done, time interval between the primary surgery and the development of ASBO and the number of laparotomies prior to the development of ASBO on the outcome of conservative management. There were 74 episodes of ASBO in 69 children (Five children had two episodes). Out of 74 episodes, 5 episodes (6.75%) needed immediate laparotomy for suspected gangrene. All others were managed conservatively. Of the 69 episodes managed conservatively, 36 responded to conservative treatment (2-5 days) while 33 required subsequent surgical intervention, with 11 of them requiring bowel resection (two for gangrene and 9 for bowel damage during adhesiolysis) and in the rest 22 cases adhesiolysis. A substantial number of children with ASBO respond well to conservative treatment. Majority of the children developed ASBO within three months after the primary laparotomy. Children below the age of one year (at the time of presentation with ASBO) responded poorly to the conservative management. Children who had primary surgery for Hirschsprung's disease and intussusception also appeared to have responded poorly to conservative management, but statistically not significant. Time interval between the primary surgery and the number of laparotomies before the child developed ASBO did not influence the outcome of conservative management.

Low anorectal malformation associated with 'ano-urethro-cutaneous' fistula.

Anorectal malformations are one of the common congenital anomalies encountered in the newborn period. The plethora of anomalies described makes it a complex subject for embryological explanations. Fistulous communications between the blind rectum and the urinary tract are common in boys with high/intermediate anomalies, but it is uncommon in children with low anorectal malformations, more so a double fistula. We are reporting a case of 'ano-uerthro-cutaneous fistula' associated with a low ano rectal malformation.

Anterior abdominal wall--an unusual site for ectopic testis.

Testicular descent can be described in two phases, the transabdominal and the inguinoscrotal. During the inguinoscrotal phase, the testis may deviate from the normal path of descent and "migrate" to an abnormal location; this is called ectopic testis and is a relatively uncommon condition. The common sites for ectopic testes include the superficial inguinal pouch, the perineum, the opposite side of the scrotum, the femoral canal, and the pubopenile region. In addition to these well-recognized sites, preperitoneal and extracorporeal ectopic testes, which are extremely rare, have been reported. We report yet another rare site for ectopic testis, the anterior abdominal wall, probably the first of its nature to be reported in the English literature.

Waugh's Syndrome.

A case of Waugh's Syndrome, association of malrotation and intussusception, is being reported. It is suggested that this possibility must be kept in mind and looked for, when a case of intussusception is being treated either by surgery or by hydrostatic reduction. If not when the child develops intestinal problems like obstruction, secondary to malrotation, in the post operative period, it could be misdiagnosed as recurrent intussusception.

Duodenojejunal obstruction by a hemangioma.

Gastrointestinal obstruction by hemangiomas is exceedingly rare. We report a case of a duodenojejunal obstruction caused by a large hemangioma. The patient underwent a gastrojejunostomy for relief of the obstruction and has been symptom-free, although the hemangioma persists.

Unilateral inguinal ectopic scrotum with covered exstrophy.

A case of ectopic scrotum located in the right inguinal area and associated with covered exstrophy and ipsilateral renal agenesis is described. Initially, repair of the exstrophy was performed. Scrotal reconstruction was carried out after 1 year, during which time the patient developed an inguinal hernia in the ectopic scrotum. The literature is reviewed and the scrotal reconstruction procedure is discussed.

Pyriform sinus fistula.

Pyriform sinus fistulae/sinuses are rare causes of recurrent cervical abscess, especially on the left side. They can also present as acute thyroiditis. Treatment in the form of simple incision and drainage is invariably unsuccessful, and the entity may be confused with the residual tract of a second branchial arch anomaly. We report a case of pyriform sinus fistula, and believe that this is only the second case report in India. We feel that greater awareness can lead to proper and appropriate diagnosis of this anomaly.

Spontaneous Bleeding, Cornu Cutaneum, Nevus Flammeus in Angiokeratoma Circumscriptum.

A case of angiokeratoma circumscriprum of the upper limb with extensive lesions spontaneous bleeding during episodes of fever, cornu cutaneum and nevus flammeus is reported.