Modified Ravitch procedure: A customized solution for iatrogenic unilateral pectus excavatum

Skeletal deformities in the form of pectus excavatum or scoliosis are unavoidable sequalae of large  diaphragmmatic defects irrespective of the technique of repair used at the time of primary procedure. These sequelae lead to cosmetic and functional issues in the rapidly growing skeleton of a young child. The crux of management is adequate correction of these deformities with minimal residual functional impairment. A customized case-based approach using the modified Ravitch procedure is an excellent technique to repair these pectus defects. We describe such a procedure in a 3-year-old girl.Keywords: congenital diaphragmmatic hernia, pectus excavatum,  Ravitchprocedur

Pseudoexstrophy associated with penile duplication and hypospadias: A case report and literature review

Bladder exstrophy is a rare developmental anomaly. Four principle variants of bladder exstrophy have been described and they themselves are rarer than the bladder exstrophy. Authors describe the management of a case of pseudoexstrophy type of variant in a 9 month old male child with penile duplication with torsion and coronal hypospadias. The rectal fascial defect was repaired without osteotomy as the distance between two pubic bones was <4 cm (3.1 cm). Genital reconstruction with excision of duplicate atrophic penile shaft and repair of coronal hypospadias with detorsion of the functional penile shaft could be accomplished. The patient had good outcome in terms of cosmesis and urinary stream. Total of 18 cases of the pseudoexstrophy have been described till date. Pseudoexstrophy of bladder is a very rare condition and can simultaneously present with other defects like omphalocele, anorectal malformations, pouch colon, multiple or solitary urogenital anomalies. The principles of correction though remain same with correction of abdominal wall defect with or without osteotomy depending upon severity of pubic diastasis. Other anomalies can undergo treatment as per standard protocol

Post traumatic urinary extravasation in occult urinary obstruction: Report of three cases

Urinary extravastion after blunt abdominal trauma is seen often and generally treated conservatively. However a blunt renal trauma causing huge amount of extravasations and symptoms disproportionate to the severity of trauma should alarm the surgeon towards an underlying occult renal pathology usually an obstruction. In this case series, we share three such experiences and their management

Congenital rectovaginal fistula with anorectal agenesis: A rare anorectal malformation

Background: Rectovaginal fistula is a rare type of anorectal malformation; the incidence being less than 1%. We describe five cases of rectovaginal fistula managed at our institution. Materials and methods: Case records of five female neonates with rectovaginal fistula managed at our institute between 2010 and 2016 were reviewed and analysed with respect to age at presentation, clinical presentations, physical findings, investigations, management and outcome. Results: The age at presentation varied from 1 day to 2 years of age. Three of them presented in the neonatal period, one presented at 1 month of age and one at two years of age with sigmoid loop colostomy done elsewhere. All had absent anal opening; two neonates passed small amounts of stools through vagina, but little in amounts. The one-month old patient had history of passing stools through vaginal orifice, but had presented to us with obstruction. All patients underwent high sigmoid loop colostomy followed by definitive procedure at a later date – Posterior Sagittal Anorectoplasty. One patient is awaiting definitive repair. Conclusion: Rectovaginal fistula is a rare anorectal malformation and needs thorough investigation and appropriate management for good outcome

Acquired tubercular bronchoesophageal fistula in a hemophiliac child

Acquired bronchoesophageal fistula in children is usually a late diagnosis, due to the rarity of the condition. The diagnosis was further complicated by presence of multiple co-morbid conditions. We would like to emphasize the importance of tackling the co-morbid factors strategically along with the surgical aspects in this case report

Acute acalculous cholecystitis causing gall bladder perforation in children

We report two cases of children who presented with acute abdomen due to gall bladder perforation and biliary peritonitis. Cholecystectomy with peritoneal lavage proved curative

Spontaneous Bowel Perforation in a Neonate with Anorectal Malformation

Gastrointestinal perforation in neonates with anorectal malformations is extremely uncommon. Delayed patient presentation is an important factor that demands special attention. We present a neonate with anorectal malformation and meconium peritonitis following spontaneous bowel perforation. A day 1 neonate was referred with features suggested of peritonitis. After adequate resuscitation and drainage under local anesthesia, patient was successfully operated for a sigmoid perforation and is now awaiting definitive surgery for the anorectal malformation

Outcome analysis of shunt surgery in hydrocephalus

<b>Aim:</b> To study the clinical outcome of shunt surgeries in children suffering from hydrocephalus. <b> Methods:</b> A prospective study of 50 children with hydrocephalus who underwent a ventriculo-peritoneal shunt insertion over a period of two years. These patients were then followed up for shunt related complications, shunt revisions and outcome. <b> Results</b> : Twenty six of the 50 patients (52&#x0025;) suffered from complications. The most common complications were shunt blockage (n=7) and shunt infection (n=6). These complications necessitated repeated shunt revisions. <b> Conclusions:</b> Infective complications of hydrocephalus are more likely to leave behind an adverse neurological outcome in the form of delayed milestones and mental retardation