An extremely rare case of classic complete caudal duplication: Dipygus.

Dipygus is a complete caudal duplication deformity in its severest form. The structures derived from the embryonic cloaca and notochords are duplicated to various extent. We report a male baby who presented to us with complete somatic and visceral duplication below the umbilical level associated with gastroschisis and imperforated anus. Staged surgical corrections were suggested and three out of the four stages were performed successfully.

Preservation of glanular cleft in the configuration of a vertical slit neomeatus in modified mathieu hypospadias repair.

BACKGROUND: The aim of this study is to review the results of modified Mathieu's repair in a single surgeon's series. The technique involved preserving the apical part of the glanular cleft including the lips, part of the un-formed glanular meatus in the reconstruction of a vertical slit neomeatus. The achievement of a vertical slit neomeatus was critically assessed. MATERIALS AND METHODS: A retrospective analysis was carried out for all cases of Mathieu's repair done by a single surgeon over the past 22 years (1995-2017). Inclusion criteria included all cases of coronal, subcoronal and distal penile hypospadias. Cases done as redo secondary Mathieu's procedure were also included irrespective of the type of primary procedure. RESULTS: A total of 97 cases fulfilled the inclusion criteria. 91 patients had a primary Mathieu's procedure. Six patients had a Mathieu's repair as a secondary operation. The complications included 4 fistulas (4.12%), 3 meatal retractions (3.09%) and 2 mild stenosis (2.06%). There were no breakdowns of the repair Ninety-four patients (96.90%) had a glanular vertical slit neomeatus. This included patients with a fistula and both patients with mild stenosis. All fistulas were successfully closed in a single attempt. Four patients (4.12%) had a slight splaying of the lower end of the meatus and three circular neomeatus (3.09%). Both cases of stenosis responded well to dilatation. CONCLUSION: Mathieu's repair is an old and time-tested technique used in surgery of distal hypospadias. With modification aiming to preserve the apical part of the glanular cleft adopted, a vertical slit neomeatus can be achieved readily as shown by our series and major complications appear rather uncommon.

Scrotal abscess with a rare cause.

A 4-year-old boy presented with a short history of right-sided acute scrotal pain and swelling. At exploration, pus was found in the hemiscrotum but no local cause could be found. Further exploration showed the pus coming through a patent processus vaginalis from a collection in the right iliac fossa secondary to acute appendicitis.

Rare case of pediatric cecal volvulus.

An 11-year-old female child presented with abdominal pain, vomiting and constipation. An exploratory laparotomy revealed a cecal volvulus due to a congenital band and malfixation of the cecum. This was treated by excision of the band, derotation and decompression of cecum though an appendiceal stump suction.

'Screw'--appendicitis.

We report a rare case of appendicitis due to screw in the appendix in a 4-year old boy. An appendicectomy was done. Foreign body appendicitis should be treated with early surgical intervention.

Separation of xiphi-omphalo-ischiopagus tetrapus twins with favorable internal anatomy.

Conjoined twinning is a rare occurrence, and ischiopagus variety is even more rare. So far, only 20 cases have been reported. The incidence is 1 in 500,000. Because of its rarity and variable anatomy, no definite line of treatment can be adapted. Time of operation and mode of treatment have to be tailored according to the local circumstances and organ sharing in each individual pair. The twins in this report were xi phi-omphalo-ischiopagus tetrapus conjoined twins. Although several internal organs were fused and shared, they were complete mirror image sets for each twin. In this case report, details of anatomy and more importantly, preoperative investigations, preparations, and organizational aspects that were designed to suit local conditions are described. Operative details, postoperative care, and short and long-term progress also has been highlighted.