Corrosive tracheo-esophageal fistula following button battery ingestion.

We describe a case of corrosive tracheo-esophageal fistula following button battery ingestion in a 1-year old nonverbal pediatric patient. The delay in diagnosis was caused by failure to obtain correct history and failure to detect opacity of the battery in the neck at the first visit. The large fistula was successfully treated with division and repair with non absorbable sutures, with interposition of strap muscles between separated trachea and esophagus.

Congenital segmental dilatation of jejunoileal region in a newborn: Unusual clinical and radiologic presentation.

Segmental dilatation of the ileum is one of the uncommon causes of intestinal obstruction in neonates. We present a case of slow transit of bowel contents leading to suspicion of functional bowel obstruction in a new born, which on exploration turned out to be a case of segmental dilatation of the jejuno-ileal region. The clinical and radiological evaluation was suggestive of hypomotility disorder of gut, resulting in diagnostic dilemma and delayed surgical intervention.

Foot Protective System : A Boon to Demining Soldiers.

BACKGROUND: A significant number of soldiers suffer serious injuries or die in the process of demining and a protective device is necessary in such operations. METHODS: All the patients involved in demining operations using the foot protection devices in last one year were analysed. RESULTS: We received 35 patients, of which only five had limb injuries and 30 had eye injuries. Of the five, three had closed calcaneal fractures and two contusion of foot. No fatality, amputation or compound fracture occured. CONCLUSION: Early results after the use of this device during demining operations are encouraging.

Management of Combat Related Vascular Injuries in a Zonal Hospital.

BACKGROUND: The extremity gunshot wound (GSW) and penetrating splinter injuries from mine blast present a surgical challenge in the treatment of arterial trauma especially at non-vascular surgery centre. Adherence to specific principles of management is required for optimal limb salvage. METHODS: Fourteen vascular injuries in patients of GSW and mine explosions were managed at a zonal military hospital with successful outcome in two years. The diagnosis of arterial injury was done clinically. RESULTS: The commonest site of vascular injury was femoral. The methods of choice for repair were autogenous vein interposition or end-to-end anastomosis. All except for two patients retained a functional limb. CONCLUSION: All surgeons in peripheral hospitals should be trained in vascular injury repair to save life and limb. Our series shows that right timing and prompt treatment of vascular injuries in a peripheral hospital, can give satisfactory results.

A Prospective Randomized Controlled Study of Lichtenstein's Tension Free versus Modified Bassini Repair in the Management of Groin Hernias.

BACKGROUND: Bassini's repair and the Lichtenstein's tension free mesh hernioplasty are commonly used hernia repair techniques. A prospective randomized controlled study of Lichtenstein's tension free versus modified Bassini repair in the management of groin hernias was undertaken to compare the technique and postoperative course in the two procedures. METHODS: A prospective study was conducted on patients reporting to Command Hospital (SC) Pune with inguinal hernia. One hundred and ninety six patients were included in the study, operated upon by either of technique and followed up. RESULTS: Study involved 196 patients with 216 primary inguinal hernias, studied over a period of 24 months. A total of 118 Bassini repair and 98 Lichtenstein's repair were done. Of the 196 patients, four were females. Bassini Repair took more time than Lichtenstein's repair, though the difference was not statistically significant (p>0.05). Direct hernias took lesser time to operate than the indirect hernias. Pain on the operative day, in the evening, was similar in both the groups. The commonest complication in both the groups was scar tenderness followed by erythema, scrotal swelling, neuralgia, superficial wound infection, funiculitis and seroma formation in the order of frequency. The average hospital stay was 5.74 days for Bassini's repair as compared to 4.97 days for Lichtenstein's repair. Patients undergoing Bassini's repair took longer (mean 28.4 days) to return to work as compared to those who underwent Lichtenstein's repair (mean 21.4 days) and the difference was statistically significant (p < 0.05). The recurrence rate was similar in Bassini's (6.78%) and Lichtenstein's repair (5.10%). CONCLUSION: The Lichtenstein's tension free mesh hernioplasty was comparatively better than modified Bassini's repair due to its simplicity, less dissection and early ambulation in the postoperative period. Surgeons in training found the technique easier to master than the Bassini's repair.

Congenital prepubic sinus: a case report

Congenital prepubic sinus is an exceptional disorder of uncertain origin. These sinuses may represent a variant of epispadiac duplication or dorsal urethral duplication of the urethra.We present a case of isolated blind ending prepubic congenital sinus in a 5-year-old male child; which revealed transitional epithelium lining proximally; and squamous epithelium distally. This entity presents with either an opening in the prepubic region and/or persistent mucoid discharge. Excision leads to a permanent cure

Hydatid cyst of the renal pelvis.

Hydatid disease is fairly common and is prevalent worldwide. The principal organs involved are the liver and lungs. Kidney involvement also occurs but usually with involvement of other viscera. Isolated hydatid cyst of the kidney is extremely uncommon. In the kidney, the hydatid cyst usually occurs in the renal parenchyma. We present a rare occurrence of a hydatid cyst of the renal pelvis in a 4-year-old child and discuss measures to decrease surgical morbidity.

Laparoscopic orchiopexy: is closure of the internal ring necessary?

BACKGROUND: Narrowing of the internal ring around the pulled through spermatic cord in cases of laparoscopic orchiopexy is the norm. AIM: To carry out a prospective study to see if closure of the internal ring is really necessary, hypothesis being that mobilization of the impalpable testis leaves a raw surface, which, coupled with the presence of the spermatic cord results in effective closure of the internal ring. METHODS AND MATERIALS: 51 patients with 65 impalpable testes underwent laparoscopic orchiopexy between July 1998 and June 2003. An impalpable testis was present in 21 cases on the left, 16 cases on the right and bilateral in 14 cases. Following complete mobilization required for orchiopexy, all testes with adequate length of spermatic cord were pulled down into the scrotum through the inguinal canal. No suture was applied to narrow the internal ring around the pulled through spermatic cord. Five testes were pulled down by an opening in the medial end of the inguinal canal due to inadequate length of the spermatic cord. In these cases the internal ring was closed by a suture. RESULTS: Follow up of all cases ranged between 1.5 years to 6.5 years. Not a single case has reported with recurrence of a hernia. CONCLUSION: The results suggest that narrowing of the internal ring around the pulled through spermatic cord may not be necessary.

Mine Blast Injuries - Our Experience.

BACKGROUND: The sudden increase in incidence and magnitude of mine blast injuries prompted us to highlight the problem and its management. METHODS: The cases of mine blast injuries occurring during mining and demining in a particular geographical area were analysed. Total 27 cases of mine blast injuries occurred during mining or demining operations in a period of 13 months. RESULTS: Various body regions were involved in the mine blast injuries but the main brunt was borne by feet and legs followed by multiple body regions due to splinters. 14 patients underwent below knee (BK) amputation while 4 patients required through knee (TK) amputations. The effect of blast was so severe that most of the cases required 2 to 5 times wound debridements. The initial aggressive debridement / open stump amputation saved the limb and life of all patients. CONCLUSION: A mine blast causes extensive injuries and psychological trauma. Management is needed urgently, surgery is difficult, and amputation is often inevitable. Maximum lives and limbs can be saved with aggressive debridement, repeated inspections and dressings under anaesthesia and definitive closure at optimum time.