Management of Spontaneous Perforation of the Bile Duct in an Infant in a Semi-Urban Setup: A Case Report

Spontaneous perforation of the extrahepatic bile duct leading to biliary peritonitis is a rare occurrence once other causes of biliary peritonitis, such as trauma, choledochal cyst, stone diseases, and distal atresia of the bile duct, are ruled out. A 7-month-old male infant was brought to the hospital in critical condition with distension of the abdomen. He had a history of vomiting and diarrhoea, low-grade fever, and refusal to feed for 2 days. Signs of peritonitis were found upon examination. Due to the poor general condition of the patient, the case was taken up for laparotomy, and a diagnosis of spontaneous extrahepatic bile duct perforation was made intra-operatively. In the present case, the cause was idiopathic. An external drain was placed near the site of the leak for 2 weeks. The patient recovered well and was discharged on post-operative day 16. Disease awareness for correct pre-operative diagnosis and interventional planning is required to reduce mortality, morbidity, and complications in spontaneous perforation of the common bile duct.

The role of epilepsy management guidelines in a developing country

India is home to about 10 million people with epilepsy (prevalence of about 1%). The number of Epilepsy Specialists and Neurologists being very small in India, most people with epilepsy are being diagnosed and treated by non-specialists at both primary and secondary care levels. It is obvious that epilepsy management in such situation can be sub-optimal. The Indian Epilepsy Society strongly felt for a need to have its own guidelines for management of epilepsy in India (GEMIND). The guidelines were developed based on a consensus arrived by a group of experts on the good practice parameters relevant to epilepsy treatment in India. The recommendations of the expert group were peer reviewed. The guidelines are parameters of practice and should be considered as guidelines only. The electronic version of GEMIND is now available on the Indian Epilepsy Society-Indian Epilepsy Association website (http://www.epilepsyindia.org) and the ILAE website (http://www.ilae-epilepsy.org).

Consanguinity and inherited epilepsies

As a working defi nition, unions contracted between persons biologically related as second cousins or closer are categorized as consanguineous. The offspring of consanguineous relationships are at greater risk of certain genetic disorders. Recent studies have shown a signifi cantly higher rate of consanguinity among parents of epilepsy patients and a signifi cantly higher rate of epilepsy among family members with consanguineous marriages for both cryptogenic and idiopathic epilepsies. Carrier detection and genetic counseling programmes have been very successful in reducing the incidence of inherited disorders in many populations. Models for prevention of hereditary diseases due to consanguinity should be multiaxial focusing on public education on genetic diseases and also deal with applicable preventive measures. These programmes are most successful when they are sensitive to the cultural backgrounds of populations in which they are applied.

Ethics in the genetics of epilepsy: What are the pros and cons?

Genetic data and tools offer enormous potential benefi ts to humankind but raise signifi cant societal concerns as well. As the impact of the new genetics grows, we can expect the society to be increasingly confronted with many novel, challenging, and sometimes disturbing issues. Genetic testing of complex disorders such as epilepsy raise even more concerns in regards to various social and ethical issues because of the associated stigma. Proper research involving all concerned should result in the formulations of guidelines for the clinicians, researchers, people with epilepsy and their families and health care planners.