Bilateral inguinoscrotal swelling: An uncommon presentation of omental cystic lymphangioma.

Abdominal cystic lymphangioma is a rare benign tumour in children. It is often difficult to diagnosis pre-operatively due to a varied spectrum of symptoms. We report a case of a male infant who presented with gross bilateral inguinoscrotal swelling. Provisional diagnosis of congenital communicating hydrocele was made and investigation revealed a large abdominal cyst. Patient underwent explorative laparotomy and the cyst arising from greater omentum, extending into bilateral scrotum, was excised and bilateral herniotomy done. Mass was confirmed to be lymphangioma on biopsy. This case is unique as an abdominal lymphangioma presented solely as inguinoscrotal swelling, with no abdominal symptom. To our knowledge, this is the first case of omental cystic lymphangioma involving both inguinoscrotal regions. Our case suggests that abdominal cystic lymphangioma should be a part of the differential diagnosis in any child with gross inguinoscrotal swelling in whom initial impression is of communicating hydrocele.

Postoperative intussusception in children operated for primary intussusception - A very rare entity.

Postoperative intussusception (POI) after abdominal and non-abdominal operations is a rare but recognized condition discussed several times in literature. There are scarce reports regarding POI in children operated primarily for intussusception. We discuss three such cases that were seen in our institution in the last two years. The patients showed symptoms of atypical ileus that failed to resolve two to eight days following primary surgery. Ultrasound reported intussusception and surgical intervention was sought. All patients had ileoileal intussusception. Manual reduction was successful in two cases. One had intestinal necrosis and underwent resection and anastomosis. Recovery was satisfactory without recurrence. POI should be suspected in patients who show signs of intestinal obstruction in early postoperative period. A second POI should be kept in mind after surgical reduction of the first intussusception. Ultrasound should be performed to aid diagnosis followed by urgent surgical intervention.

Seroprevalence of SARS-CoV-2 antibodies in pediatric hospital surgical unit: a lower-middle-income country perspective.

BACKGROUND: The objective of our study was to measure and give insight into the seropositivity of anti-SARS-CoV-2 antibodies in the patients in our pediatric hospital surgical unit in Pakistan. METHODS: A prospective cohort study was conducted at a tertiary care pediatric hospital surgical unit in Pakistan between 1 January 2021 and 1 June 2021 on the enrolled neonates and children aged 1 day to 13 years. All patients from three different pediatric strata [neonates (<1 month), infants (1 to 12 months) and children (>1 year)] were enrolled in the study. RESULTS: Six-hundred patients were enrolled, and 426 patients were included in the study. Among 426 patients, 234 (54.9%) were male, and 192 (45.1%) were female. Overall only 118 (27.7%) patients developed symptoms. The other 308 (72.3%) were asymptomatic of which 28 (9.1%) had fever, 28 (9.1%) had cough, 38 (12.33%) had body aches, 292 (94.8%) had vomiting/diarrhea, and only 28 (9.1%) developed loss of smell and taste. Our results showed seropositivity of 27.7% (n = 118), while 72.3% (n = 308) had negative antibody titers. CONCLUSION: A much higher pediatric SARS-CoV-2 burden of 27.7% was found in our pediatric surgical unit than has previously been reported in the literature of 6.8% for children in pediatric hospitals or pediatric surgical units. Contrary to reporting early in the COVID-19 pandemic, this study determined that children experience a significant burden of COVID-19 infection. Thus, children appear very important in SARS-CoV-2 pandemic, from harboring the virus and further studies need to be done to find if they are transmitting the disease silently.

Trichotillomania, Trichophagia and Trichobezoar in a Male Paediatric Patient: A Case Report and Literature Review.

INTRODUCTION AND IMPORTANCE: Trichotillomania and tricophagia, characterized by compulsive hair-pulling and subsequent ingestion which results in a compact mass of hair called trichobezoar. It represents an uncommon psychiatric disorder, especially in young children. CASE PRESENTATION: This case report describes a distinctive and rare occurrence of trichotillomania, tricophagia and trichobezoar in a 11-year-old male child. Concerns raised by the parents regarding noticeable hair loss, who initially presented to medical outdoor patient with complaints of abdominal pain on and off from the last one year. He had a history of pica and weight-loss. He was then diagnosed with a gastric trichobezoar for which he was operated upon and a giant trichobezoar was retrieved from his stomach. Post-operatively patient remained admitted in ward and was discharged home on fifth post-operative day and sent for psychiatry evaluation. CLINICAL DISCUSSION: Trichotillomania and tricophagia often have roots in psychosocial stressors, anxiety, and depression. Children may engage in hair-pulling as a coping mechanism, especially in response to familial or environmental stressors. The literature emphasizes the importance of understanding the psychosocial context to tailor interventions effectively. CONCLUSION: Trichotillomania and tricophagia is very rare in paediatric population and if presents a multidisciplinary team comprising of a paediatrition, paediatric surgeon and paediatric psychiatrist should be involved and if diagnosed with a gastric trichobezoar should be removed surgically in order to prevent complications.

A uretheral stone causing urinary obstruction in a paediatric patient.

Urinary retention in pediatric patients is an uncommon presentation, particularly when attributed to urethral stones. We present the case of an 8 year old child who experienced acute urinary retention due to a urethral stone, an infrequent occurrence in this age group. Initial assessment revealed signs of obstructive voiding, prompting further investigation. Imaging studies confirmed the presence of a urethral stone causing complete obstruction. Management involved a multidisciplinary approach, incorporating surgical intervention. This case report underlines the need for awareness about the rare occurrence of urethral stones in pediatric age group which must be kept in mind while treating children.

Surgical Smoke Inhalation, Its Hazards And Prevention Among Paediatric Surgery Residents In Pakistan.

BACKGROUND: For thousands of years human beings have been using heat as a source of ligature and to treat the wound either it's from the trauma or fought in the wars. In 1854 an imminent surgeon Albrecht Theodor Middendorf published a paper on the application of electrocautery in surgical operations. The objective of the present study was to analyze the hazards of surgical smoke inhalation in Paediatric Surgery residents and to create awareness of its signs and symptoms, risk factors and utilizing preventive measures. METHODS: A Cross-sectional study was conducted involving all the Paediatric Surgery residents enrolled on a supervised training program in Pakistan between 1st July 2022 to 30th June 2023 at all the tertiary care hospitals in Pakistan. Their socio-demographic, academic data, signs and symptoms and risk factors were calculated. Data was analyzed with descriptive and comparative analysis using SPSS. A Pearson contingency coefficient is used to determine the association between categorical variables. RESULTS: Our study included all the Paediatric Surgery residents in Pakistan n=155 over one year starting from July 1st 2022 to June 30th 2023. N=75 (48.4%) were males and n=80 (52.6%) were female residents. Their mean age was 29.5 years±4 (SD). 41% of the residents were from Khyber Teaching Hospital Peshawar, 32% from The Children's Hospital Lahore, 14% from National Institute of Child Health Karachi, 9.8% from The Children's Hospital Islamabad (PIMS) and 5.2% from Lady Reading Hospital Peshawar. N=135 (87.1%) of the residents used electrocautery while performing the surgery (p=0.006). N=121 (78.1%) were aware of its hazards (p=0.341). 90% think they are at an increased risk (p=0.032). Most of them (84.6%) wear a surgical mask while only (64%) wear protective equipment (p=0.321). Think they are at an increased risk of cancers (83.9%) (p=0.002) and should be screened (93.7%) (p=0.343). CONCLUSIONS: Paediatric Surgery residents are at an increased risk of surgical smoke inhalation, pointing to the emerging need to adopt protective measures by creating awareness, and utilizing health safety checklists and smoke evacuation mechanisms in operation rooms. All residents should seek knowledge on the subject and use personal protective equipment for less harmful effects on their health.

Characteristics And Outcomes Of Aerodigestive Foreign Bodies In Children.

Background: Aerodigestive foreign bodies are common in children of pre-school-going age. It is one of the leading cause of morbidity and mortality in the paediatric population and a global health burden. Methods: We present here data of 108 patients who presented to Children hospital's Emergency with a suspicion of foreign body ingestion/aspiration over 2 years from July 1st 2021 to 30th June 2023. Their descriptive analysis including, socio-demographics, type of foreign body, age of presentation, and mode of presentation were calculated and correlation was done using the Pearson Chi square test. Results: We observed different types & characteristics of foreign bodies, patients were predominantly male with 62.26%. The mean age of presentation was 40.97 months. The majority of patients were of pre-school age, younger than 4 years (44.44%) followed by the infant population (19.44%) p=0.002. Foreign bodies were mainly located in the upper oesophagus for ingested FBs (60.8%). Most of the population presented within the first 5 hours (52.88%) followed by the first 12 hours (11.11%). Coin ingestion was by far the most common (54%) followed by button battery (19%) and the whistle was the most common aspirated object (33%). Conclusion: All patients with a suspicion of foreign body ingestion/inhalation should be evaluated. Early recognition and treatment are imperative because the complications are serious and can be life-threatening and once confirmed should undergo endoscopic removal.

A very rare case of diphallia with anorectal malformation.

INTRODUCTION AND IMPORTANCE: Diphallia is extremely rare urological anomaly with reported incidence of 1 in 5-6 million live births. It can present as complete or incomplete diphallia. In most of the cases it is associated with complex urological, gastrointestinal or anorectal malformations. CASE PRESENTATION: We report here case of a newborn who was presented to us at 1st day of life with diphallia and anorectal malformation. He had true diphallia with two separate uretheral orifices. Both phalluses were uncircumcised, phallus 1 was 2.5 cm in length while phallus 2 was 1.5 cm. Both phalluses had normal shaped glans with uretheral opening located at the normal place He had a single scrotum with two midline raphe and well-formed rouge. He was passing urine from both orifices. His ultrasonography of urological system showed two ureters and a single hemi bladder. He was admitted and operated upon and a sigmoid divided colostomy was constructed. Per-operatively congenital pouch colon (type 4) was identified. His post-operative recovery was uneventful. The patient was discharged on second post-operative day and called for follow up. CLINICAL DISCUSSION: Diphallia is a rare congenital anomaly, which means two structurally and anatomically separate phalluses. Complete Duplication in Diphallia presents the kind of Diphallia in which both the phalluses have two corpus cavernosum and only one corpus spongiosum. As diphallia presents with a spectrum of diseases; therefore, it requires a multidisciplinary approach. A case of Diphallia may well present with complex urogenital, gastrointestinal or anorectal malformations. As in our case the patient had Diphallia with anorectal malformation. Hence he was operated upon and a sigmoid colostomy was constructed. CONCLUSION: Diphallia is a very rare congenital anomaly which can occur in association with anorectal malformations. Management of such cases should be individualized depending upon the spectrum of disease.

A case of double appendix and cecum in an infant - case report.

The duplication of the cecum and appendix is a rare congenital anomaly found incidentally on exploration for another indication. We present here a case of a female child at 18 months of life, who was a diagnosed case of anorectal malformation with a persistent cloaca and at the time of the surgery, duplication of the appendix and cecum was found. Both the appendices were attached to the cecum with a separate base. Thus, appendectomies and a sigmoid divided colostomy were performed.

Gastric Trichobezoars in paediatric population- A series of six cases and literature review.

Background: Trichobezoar is a rare gastrointestinal pathology in paediatric population. Patients present with a range of symptoms from being asymptomatic to abdominal pain with a palpable abdominal mass. Once diagnosed it warrants urgent retrieval as delayed diagnosis may lead to serious complications. Methods: We present a series of six cases between March 2021 and March 2022 who presented to Children's Hospital and were diagnosed as a case of Gastric Trichobezoars. Patients were optimized and prepared for surgery. All patients underwent Surgical exploration and a tuft of hair were removed. They were followed up throughout the course of treatment and three of the patients underwent psychiatric evaluation. Discussion and conclusion: Trichobezoar is a rare but important surgical case that is a manifestation of underlying psychiatric ailment. Presentation varies from asymptomatic masses to life threatening complications with delayed presentations. A multi-disciplinary approach including Psychiatric, Paediatrician and Paediatric surgeon should be undertaken. Follow-up is the mainstay of treatment and recurrence may be seen due to non-compliance or inadequate management.

Hyponatremia As A Marker Of Complicated Appendicitis.

Background: The most frequent cause of paediatric acute abdomen is acute appendicitis. If acute appendicitis is not treated promptly, one third of cases progress to complicated appendicitis. Complicated appendicitis is associated with significant morbidity and its management protocol differs significantly from that of uncomplicated appendicitis. In this study, we assessed the relationship between serum sodium levels and complicated appendicitis. Methods: We conducted a prospective observational study from July to December 2020 at the Department of Neonatal and Paediatric Surgery, The Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, on a sample size of 140 patients who met inclusion and exclusion criteria. For this study, we divided the patients into two groups. Group 1 had uncomplicated appendicitis and Group 2 had complicated appendicitis. These findings were then compared to preoperative serum sodium (Na) levels. Results: The median serum sodium level in group 1 (uncomplicated appendicitis) was 137.81 mg/dl, while in group 2 it was 131.35 mg/dl (Complicated Appendicitis). The sensitivity and specificity of serum sodium levels at a cut-off point of less than 135 mg/dl were 84.80% and 89.40%, respectively. Conclusion: Hyponatremia is currently thought to be a new marker for differentiating between complicated and uncomplicated appendicitis. It is a low-cost, high efficiency predictive marker for diagnosing and differentiating complicated appendicitis in children.

Manual separation of labial synechiae: A cost-effective method in prepubertal girls.

BACKGROUND: Labial synechiae is a fairly common gynaecological problem that occurs as a result of inflammation leading to fusion between the labia minora. Being in a developing country with limited resources and poor compliance of patients to prolonged treatments, we are faced with immense challenges in the management of these girls. AIMS: We wanted to evaluate the efficacy and the cost-effectiveness of manual separation and topical antibiotics with perineal hygiene in the management of pre-pubertal girls with labial synechiae. MATERIALS AND METHODS: Design.Prospective, non-randomised interventional study. Participant: Pre-pubertal girls presenting with the diagnosis of labial synechiae in the period from September 2015 to January 2018. Interventions: Manual separation followed by topical antibiotic ointment application for 1 week with local hygiene. Outcomes measure: Complete release of the synechiae and no recurrence up to 6 months. RESULTS: Out of the total 55 patients, only 48 patients were included, their age ranged from 3 months to 7 years (mean 2.8 years). Almost half of our patients were asymptomatic, and other half had symptoms (urinary tract infection, dripping of urine and itching). Majority of our patients belong to low middle class status. We had 100% complete release of synechiae and no recurrence on 6 months follow-up. CONCLUSION: Manual separation followed by topical antibiotics is a cost-effective method of the treatment of labial synechiae with immediate response and low recurrence rate.

Determinants Of Bowel Resection In Childhood Intussusception.

BACKGROUND: Intussusception is an acute surgical emergency and one of the most common causes of acute abdomen in early paediatric age group with peak incidence between 3 months to 3 years. It is considered the most common cause of intestinal obstruction in first two years of life. Early diagnosis and management may prevent major complications of bowel ischemia and necrosis thus avoiding morbidity and mortality. Our objective was to evaluate the risk factors or determinants of bowel resection in childhood intussusception. METHODS: It is a prospective, descriptive and cross-sectional study in which 102 consecutive cases of intussusception presenting to The Children's Hospital PIMS, from January 2018 to May 2019, were included. RESULTS: Total 102 patients were included in the study. Seventy-three (71.6%) were male and 29 (28.4%) were female. Mean age at presentation was 16.30 months (ranged from 1 day to 9 years). Mean duration of symptoms was 3.1 days. 52.9% (53/102) patients had mass palpable on abdominal examination while 22.5% (23/102) had palpable mass on digital rectal examination (DRE). Mean haemoglobin at presentation was 10.2 g/dL (min 4g/dL, max 26g/dL) and mean haematocrit was 32.6%. The most common type of intussusception was ileo-colic (57.8%) followed by ileo-ileal (21.6%). 36.3% (37/102) patients had to undergo bowel resection due to bowel gangrene/necrosis while in 66 (64.7%) patients had manual reduction. Statistically significant relationship was found between resection and duration of symptoms more than 24 hours (p=0.01, CI=95% OR= 6.24), haemoglobin less than 10g/dL (p=0.022, CI=95% OR=2.78) and haematocrit less than 30% (p=0.028, CI=95% OR=2.63). CONCLUSIONS: Prevention of anaemia and early presentation to a facility where trained paediatric surgeons are available can reduce the chances of bowel resection in childhood intussusception.