Neonatal intestinal obstruction due to double jejunal web causing Windsock deformity.

Windsock deformity (WD) is a rare anomaly. A case of double jejunal web with WD causing neonatal intestinal obstruction is being reported.

Mechanical small bowel obstruction in children at a tertiary care centre in Kashmir.

BACKGROUND: Small bowel obstruction is the commonest surgical emergency encountered in childhood. We observed that intestinal obstruction caused by ascariasis is one of the leading causes of death in our children and consumes a major portion of our hospital resources. Other causes include intussusception, adhesions, volvulus, hernias, and worm obstruction. The aim of this study was to analyze the presentation, diagnosis, management of mechanical bowel and complication of obstruction in children. PATIENTS AND METHODS: The study was conducted from Jan 2005 to Dec 2007 in the Department of Pediatric Surgery at Sheri-Kashmir Institute of Medical Sciences, Srinagar, Kashmir. All patients who presented in the emergency department with the diagnosis of intestinal obstruction were recruited. Patients with a dynamic obstruction were excluded from the study. Diagnosis was based on history and radiological findings. Data regarding the type of management, operative findings, operative procedure and post-operative complications were collected. RESULTS: There were 207 patients admitted for intestinal obstruction. Males and females were equally affected. Most of the children (55%) were aged 3-5 years. The causes of obstruction included ascariasis 131 (63.2%), adhesion 23 (11.1%), intussusception 21 (10.1%), obstructed hernia 17 (8.2%), and volvulus 11 (5.3%). One hundred twenty-six patients needed an operative intervention and 81 were treated conservatively. The operative procedures performed included enterotomy in 37 (29.3%), milking of worms in 18 (14.2%), resection anastomosis in 31 (24.6%) and adhesiolysis in 13 (10.3%). Appendicular perforation was seen in 4 (1.9%) and worm in gall bladder in 1 (0.5%) patients. Surgical complications were wound infection in 18 (14.2%), burst abdomen in 5 (3.9%) and fecal fistula in 3 (2.3%) patients. CONCLUSION: Intestinal obstruction is associated with considerable morbidity and mortality in children. Obstruction by ascariasis constituted the majority of intestinal obstruction in this study. Efforts should be made to eradicate ascariasis in endemic areas through proper sanitation, hygiene and use of antihelminthics.

Comparative study of various forms of urinary diversion after radical cystectomy in muscle invasive carcinoma urinary bladder.

OBJECTIVE: To compare the three types of urinary diversion namely Ileal Conduit, MAINZ Pouch II and Ileal Neobladder in terms of patient preference, post-operative hospital stay, early and late complications, continence rates, quality of life and patient satisfaction. METHOD: From January 2003 to October 2007, 30 patients (28 males and 2 females) of muscle invasive carcinoma urinary bladder (mean age 57.7 years) were operated upon by radical cysto- prostatectomy or anterior pelvic exenteration and urinary diversion was performed by Ileal conduit, Mainz pouch II or Ileal neobladder. The patient preference for the type of diversion was determined pre-operatively after discussing all the three types of urinary diversions. Post-operative hospital stay, early and late complications, continence rates, quality of life and patient satisfaction with the type of diversion were evaluated on follow up. RESULTS: 60% of the patient's preferred Ileal neobladder, 10% preferred Ileal conduit and 10% preferred Mainz pouch II as their 1st choice diversion; 20% left the decision to the operating surgeon. The mean post-operative hospital stay was 15.0 days in Ileal conduit group, 17.8 days in Mainz pouch II group and 19.7 days in Ileal neobladder group. The mean follow up was 27.7 months. Early complications (within 1 month of surgery) were observed in 46.2% of patients in Ileal conduit group, 38.5% in Mainz pouch II group and 50.0% in Ileal neobladder group. Late complications (after 1 month of surgery) were seen in 61.5% of patients in Ileal conduit group, 46.2% in Mainz pouch II group and 50.0% in Ileal neobladder group. In Mainz pouch II group 92.3% of the patients achieved daytime continence and 84.6% achieved night time continence 3 to 6 months after surgery. In Ileal neobladder group, 75.0% patients achieved day time continence and 50.0% achieved night time continence 3 to 6 months after surgery. Patient satisfaction and overall quality of life was described 'Good' by majority of patients in Ileal conduit group and 'Very Good' by majority of patients in Mainz pouch II group and Ileal neobladder group. CONCLUSION: There are inherited advantages and disadvantages to each form of urinary diversion and patient selection is important to identify the most appropriate method of diversion for an individual.