Tracheal Diverticulum: Rare Presentation of Known Entity: A Case Report.

Paratracheal air cyst encompasses conditions including tracheoceles, bronchogenic cysts, lymphoepithelial cysts, and tracheal diverticula. The occurrence of tracheal diverticulum is rare and usually does not manifest clinically or may cause symptoms like chronic cough. However, it may have a rare presentation-like in our case-where rupture of tracheal diverticulum post-intubation and assisted ventilation for elective surgery led to pneumothorax, pneumopericardium, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum. It may pose diagnostic dilemmas in such cases. An understanding of the underlying mechanism helps in the management, which in majority of cases is conservative.

Pediatric Meningoencephaloceles Endoscopic Endonasal Repair: Our Experience.

BACKGROUND: Pediatric patients presenting with a nasal mass is uncommon and a high index of suspicion for it to be a meningoencephalocele is essential. Majority of these are congenital and require early intervention owing to the risk of meningitis. Surgery in these cases is very challenging because of the risk of anesthesia and limited space. OBJECTIVE: This study aimed to describe our technique and experience in managing pediatric meningoencephaloceles. METHODS: A retrospective study of 19 pediatric patients (age ranging from 40-day-old infants to 11.5-year-old children) was conducted at our tertiary care center from January 2012 to February 2017. Patients presenting with an intranasal meningoencephalocele were treated by endoscopic approach, using otological microinstruments. After detailed imaging and clinical evaluation, a tailored repair, using fat/fascia/cartilage, a multilayer closure, was carried out in all cases. RESULTS: All patients had a successful repair and recovery, except for one death following an episode of convulsion. There was a minor circumferential narrowing of the nasal vestibule and synechia formation in 2 of our cases. CONCLUSION: Transnasal endoscopic repair of meningoencephalocele is minimally invasive. It avoids permanent anosmia and is cosmetic. A combination of miniaturized instruments and a 4-mm 0° nasal endoscope gives excellent visual field and an adequate working space. Owing to the larger defects in congenital meningoencephaloceles, a multilayer repair provides excellent outcomes.