Congenital perineal grove: an unusual Anorectal anomaly in females-report of two cases and literature review.

Congenital perineal grove (CPG) is a rare anorectal anomaly; only 65 cases have been reported in literature. Two cases who were referred for evaluation of a lesion in the perineum are reported here. The patients were diagnosed clinically as CPG in neonatal period and were initially managed conservatively. Surgery was required in one case as the lesion was persistent and symptomatic. A high index of suspicion is required for diagnosis of CPG to avoid parental anxiety and unnecessary diagnostic work-up and surgery. Surgery is required only in cases where the lesion persists or there is infection, pain, and ulceration.

Assessment of pediatric surgical needs, health-seeking behaviors, and health systems in a rural district of Pakistan.

Surgical conditions are responsible for up to 15% of total Disability-Adjusted Life Years (DALY) lost globally. Approximately 4.8 billion people have no access to surgical care and this studies aim is to assess the surgical disease burden in children under the age of five years. We used Surgeons OverSeas Assessment of Surgical Need (SOSAS) and Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tools in Tando Mohammad Khan (TMK). A set of photographs of lesions were also taken for review by experts. All the data was recorded electronically via an android application. The current surgical need was defined as the caregiver's reported surgical problems in their children and the unmet surgical need was defined as a surgical problem for which the respondent did not access care. Descriptive analysis was performed. Information of 6,371 children was collected. The study identified 1,794 children with 3,072 surgical lesions. Categorization of the lesions by the six body regions suggested that head and neck accounted for the greatest number of lesions (55.2%) and the most significant unmet surgical need (16.6%). The chest region had the least unmet surgical need of 5.9%. A large percentage of the lesions were managed at a health care facility, but the treatment essentially consisted of mainly medical management (87%), and surgical treatment was provided for only 11% of lesions. The health facility assessment suggested that trained personnel including surgeons, anesthetic, or trained nurses were only available at one hospital. Basic procedures such as suturing and wound debridement were only performed frequently. This study suggests a high rate of unmet surgical need and a paucity of trained health staff and resources in this rural setting of Pakistan. The government needs to make policies and ensure funding so that proper trained staff and supplies can be ensured at district level.

Penile strangulation injury in children - Reconstructive procedure and outcome.

BACKGROUND: Penile strangulation injury (PSI) is rare and is usually reported in circumcised children. Damage to Corpus Spongiosum (encasing urethra) and Corpus Spongiosum by hidden constricting material (e.g. hair or thread) in penile groove can cause Urethral Fistula (UF) and near total glans amputation. We report varied grades of PSI in children with emphasis on surgical procedure and its outcome. PATIENTS AND METHODS: Fifteen children were treated from August 1991 to December 2018 for PSI inflicted by encircling hair (n = 4) and cotton or polyester thread (n = 11). Twelve patients with Grade 1 and 2 injury had a single stage reconstructive procedure. RESULTS: Age of patients ranged from 6 months to 11 years (mean 5.8 years). All the patients including two who have attained sexual maturity stated satisfactory outcomes, e.g., urinary stream on follow up (range: 1.1 to 13 years; mean 6.5 years). One patient developed urethrocutaneous fistula (UF) and had repair as a daycare procedure. CONCLUSION: One stage surgical repair is appropriate to manage varied damage to urethra and corpora associated with PSI. Immediate and long-term results are reasonable. LEVEL OF EVIDENCE: Level IV.