Thoracoscopic resection of foregut duplication cyst in a neonate.

Foregut duplication is more common in girls, particularly if there is bronchopulmonary involvement. The incidence of oesophageal duplication cyst is estimated to be one in 8200 live births with male prevalence. Most duplications are benign, but the presence of ectopic gastric mucosa and the potential for malignant degeneration remain a concern. A newborn female, antenatally diagnosed with right-sided thoracic mass, was diagnosed with a foregut duplication cyst of size 4.1 cm × 3.7 cm × 8 cm in the posterior mediastinum. Thoracoscopic resection was done on day of life 14. The postoperative recovery was uneventful and histopathology confirmed the diagnosis. A literature search revealed only a few cases of an early thoracoscopic intervention, and ours is the earliest reported. Thoracoscopy in the neonatal period is safe and effective.

Our experience of laparoscopic pyloromyotomy with ultrasound-guided parameters.

Traditional management of infantile Hypertrophic Pyloric Stenosis is open pyloromyotomy after initial adequate resuscitation of the patient. From 1991, laparoscopic approach is considered feasible and safe. Today, diagnosis of hypertrophic pyloric stenosis is made most often made by ultrasound. With use of ultrasound-guided parameters (length of pyloric tumour and thickness of pyloric tumour), we could avoid 'incomplete pyloromyotomy' and 'mucosal perforation' (most common complications in laparoscopic approach) to achieve 100% adequacy and safety in laparoscopic pyloromyotomy.

Total laparoscopic repair of Spigelian hernia with undescended testis.

Spigelian hernia is very rare in the paediatric age group. We present the case of an 11-month-old male child who presented with left Spigelian hernia with the left undescended testis in its sac. Hernia repair with orchidopexy was done using total laparoscopic approach. It is the first reported case of total laparoscopic repair of Spigelian hernia with undescended testis in the paediatric age group.

Complete sternal cleft - A rare congenital malformation and its repair in a 3-month-old boy: A case report.

Complete midline sternal cleft is a rare congenital anomaly resulting from failed midline ventral fusion of the sternal bars. Very few cases of complete sternal cleft have been described in literature. We present a case of complete sternal cleft in a 3-month-old child. The patient underwent primary closure of the defect using stainless steel wires.

Congenital pulmonary airway malformation (CPAM) presenting as spontaneous pneumothorax in young boy.

Congenital pulmonary airway malformation (CPAM) is most common congenital lung anomaly of lower respiratory tract accounting for approximately 25% of all congenital pulmonary malformations. It is usually unilateral and involves single lobe of lung. It is usually diagnosed prenatally; rarely found in children and adults. We report a rare case of 14-year-old male presented with sudden onset breathlessness secondary to right sided pneumothorax associated with right lower lobe cystic lesion; successfully managed with multidisciplinary approach involving tube thoracostomy and non-anatomical wedge resection of right lower lobe cystic lesion (using VATS). Adults diagnosed with CPAM usually present with breathlessness, fever, recurrent pulmonary infection, pneumothorax, and haemoptysis. For definitive treatment of symptomatic CPAM cases, surgical resection at the time of diagnosis is recommended in view of possible risk of malignant transformation and recurrent respiratory tract infections. Considering the mild but definitive risk of malignancy, it is advocated to closely monitor the individuals with CPAM even after the surgical resection.

Twenty-Four Hour pH Study and Manometry in Gastric Esophageal Substitutes in Children.

PURPOSE: Studies on the physiology of the transposed stomach as an esophageal substitute in the form of a gastric pull-up or a gastric tube in children are limited. We conducted a study of motility and the pH of gastric esophageal substitutes using manometry and 24-hour pH measurements in 10 such patients. METHODS: Manometry and 24 hour pH studies were performed on 10 children aged 24 to 55 months who had undergone gastric esophageal replacement. RESULTS: Six gastric tubes (4, isoperistaltic; 2, reverse gastric tubes) and 4 gastric pull-ups were studied. Two gastric tubes and 4 gastric pull-ups were transhiatal. Four gastric tubes were retrosternal. The mean of the lowest pH at the midpoint of the substitute was 4.0 (range, 2.8-5.0) and in the stomach remaining below the diaphragm was 3.3 (range, 1.9-4.2). In both types of substitute, the difference between the peak and the nadir pH recorded in the intra-thoracic and the sub-diaphragmatic portion of the stomach was statistically significant (p<0.05), with the pH in the portion below the diaphragm being lower. The lowest pH values in the substitute and in the remnant stomach were noted mainly in the evening hours whereas the highest pH was noted mainly in the morning hours. All the cases showed a simultaneous rise in the intra-cavitatory pressure along the substitute while swallowing. CONCLUSION: The study suggested a normal gastric circadian rhythm in the gastric esophageal substitute. Mass contractions occurred in response to swallowing. The substitute may be able to effectively clear contents.

Unusual Presentation of Metanephric Stromal Tumor in a Neonate.

Metanephric stromal tumor (MST) of kidney is an under-reported benign stromal specific renal neoplasm with good prognosis. This tumor is to be differentiated from congenital mesoblastic nephroma and clear-cell sarcoma of the kidney. In this case report, we describe the imaging, gross, and microscopic features of MST with ischemic left kidney in a 1-month-old child and discuss treatment with relevant literature.

Congenital facial teratoma in a neonate: Surgical management and outcome.

Teratomas are among the most common tumors of childhood, but craniofacial teratomas are rare. They can be diagnosed antenatally. Craniofacial teratomas may cause airway obstruction in the newborn. We present a case of a newborn male child who was diagnosed to have a facial tumor in the 8(th) month of gestation. He was delivered normally and had no respiratory or feeding difficulties. He was also found to have a cleft palate. Serum alpha fetoprotein levels were normal. He underwent excision on day of life 9. At 11 months follow-up, he is well with no evidence of recurrence and good functional outcome.

Successful Separation of Omphalopagus Twins: A Case Report.

Omphalopagus twins are conjoined twins sharing part of gastrointestinal system and abdominal wall. These types of twins have best chances of survival if successfully separated. We report a case of successfully separated omphalopagus twins at day six of life.

Retroperitoneal Mature Cystic Teratoma in a Neonate: A Case Report.

We report a case of retroperitoneal mature cystic teratoma in a 2-day-old neonate. Diagnostic and surgical procedure including its complexity and relevant literature review has been discussed.

Cloacal Exstrophy with Mature Teratoma: A Rare Association in a Neonate.

Cloacal exstrophy is a very rare and complex malformation. We report a neonate of cloacal exstrophy with mature teratoma presenting as a component of exstrophy. To our knowledge this has not been reported in the literature.

Immediate and long-term outcome analysis of lipomeningomyelocele repair in asymptomatic infants in a tertiary care center.

OBJECTIVE: To analyze immediate and long-term results of lipomeningomyelocele (LMM) repair in asymptomatic patients. MATERIALS AND METHODS: Seventeen patients of LMM presented to Department of Paediatric Surgery over a period from 2011 to 2015 were evaluated preoperatively by magnetic resonance imaging of whole spine, and pre- and post-operative Ultrasound of kidney, ureter, bladder, and neurosonogram. Surgical procedure involved total excision of lipoma in 15 patients and near total excision in 2 patients. Division of filum terminale could be done in 15 out of 17 patients. Follow-up varied from 1 to 3.5 years (mean 1.9 years). RESULTS: This study included 10 (58.8%) patients of lumbosacral LMM, 5 (29.4%) patients of sacral, and 2 (11.7%) patients of thoracolumbar LMM. About 13 (76.4%) patients were operated before 3 months of age, 2 (23.5%) patients were operated between 3 and 6 months, and two patients were operated between 6 and 11 months. None of the patients had bladder/bowel dysfunction preoperatively. Preoperative lower limb power was normal in all patients. Objective improvement in lower limb motor function was observed in 3 (17.6%) patients and three patients had decreased lower limb power. Two patients developed altered sensations and weakness of lower limb about 2.5-3 years after initial LMM repair. They needed repeat detethering of cord. Two patients had fecal pseudoincontinence, whereas one patient developed constipation. Bowel dysfunction was managed by rectal washouts, and oral laxatives were added if required. One (5.8%) patient of lumbosacral LMM and 1 (5.8%) patient of sacral LMM had urinary incontinence postoperatively. This was managed by clean intermittent catheterization with continuous overnight drainage. Conservative management of bladder and bowel dysfunction was effective in all patients till the last follow-up. Two patients developed hydrocephalus after LMM repair for which low-pressure ventriculoperitoneal shunt was inserted. Wound infection occurred in 1 (5.8%) patient, whereas 7 (41.1%) patients developed seroma in wound which responded to repeated aspirations under aseptic precautions. CONCLUSION: With total excision of lipoma and division of filum terminale satisfactory outcome for asymptomatic patients of LMM can be achieved. Authors recommend early surgery for LMM even in asymptomatic patients. Patients with residual lipoma and undivided filum terminale should be observed closely for the development of progressive neurological changes.

Thoracoabdominal pseudocyst of pancreas: An rare location, managed by retrocolic retrogastric Roux-en-Y cystojejunostomy.

Pseudocyst formation is a common complication of acute and chronic pancreatitis. Most common site of pseudocyst is lesser sac; mediastinal extension of pseudocyst is rare. Other possibilities of posterior mediastinal cyst must be considered. This patient presented with computed tomography abdomen with thorax showing a large thoraco-abdominal pseudocyst with right sided pleural effusion. It was confirmed to be pancreatic pseudocyst by analyzing fluid for amylase and lipase during surgery. In our patient, the pseudocyst was accessible transabdominaly. Cystogastrostomy was not possible as it was causing twisting of cardio-esophageal junction; we did retrocolic and retrogastric Roux-en-Y cystojejunostomy. Only two such cases were reported in literature.

Use of composite mesh in gastroschisis: A unique approach.

Gastroschisis is a congenital defect of the abdominal wall involving evisceration of abdominal contents. Initial surgical treatment of this condition depends on the size of the defect, size of the abdominal cavity and amount of bowel exposed. Various techniques described are primary closure, use of the skin flap and silo bag application, followed by fascial closure. Here we present a case wherein even after 7 days of silo bag application, fascial closure was not possible, and a composite mesh was used to cover the bowel until further repair could be attempted.