Childhood sacrococcygeal teratoma: a clinicopathological study

Background: Sacrococcygeal teratoma (SCT) is a relatively uncommon tumor affecting neonates, infants, and children with a female preponderance. Age is an important predictor of malignancy in SCT. Early antenatal diagnosis influences the management and provides a better outcome. Aim: The present study was carried out to describe in detail various clinicopathological features and outcome of SCT patients; as many reports are available from the West, there is a paucity of literature on this entity from the Eastern region, especially India, which has a unique socioeconomic and demographic background. Materials and methods: The study included 52 patients of SCT operated for 16 years from 2000 to 2015. A retrospective review of various parameters was done from the medical case records available in the Department of Pediatric Surgery (PGIMS, Rohtak, Haryana, India). Result: There were 40 females and 12 males with age ranging from newborn to 13 years. Thirty-three children (63%) presented in the neonatal age group. There were 40 cases of benign (mature), 7 immature and 5 malignant teratomas. Four cases had a recurrence on follow-up. Out of 52 patients, 7 died while the others are doing well on follow-up. Conclusion: A prenatal diagnosis of SCT is essential for reducing morbidity and mortality. Delayed presentation and the presence of malignant changes continue to be poor prognostic factors. Strict follow-up by clinical examination, ultrasound and tumor markers is mandatory to look for any recurrence

Hairpin impacted in the duodenum of a 4-month-old child - a rarity

Foreign body ingestion is common in children. The accidental ingestion is usually seen in children due to lingual curiosity. Most of the foreign body passes spontaneously through gastrointestinal (GI) tract; hence, requiring no removal. This is a case of impacted hairpin in the duodenum of a 4-month-old female child who accidentally ingested hairpin and was asymptomatic initially for 1 month and later presented with melena requiring surgical removal of hairpin. We failed to find in literature impacted hairpin in the duodenum associated with GI bleeding

Immunohistochemical evaluation of neuronal dysfunction in paediatric patients with Hirschsprung’s disease and allied disorder

Background: Neonatal bowel obstruction may result due to defect in the intestine wall which may be classified as neuropathic, myopathic or idiopathic types according to the pathological changes observed. The present study was conducted between September 2014 to December 2015 with the aim to study histomorphological changes and evaluate the role of various IHC markers (calretinin, S-100, CD117) in Hirschsprung’s disease (HD) to assess neuronal dysfunction in these patients.Methods: Thirty cases with clinical suspicion of HD were included in our study. The tissue sections were processed and wax blocks were prepared. Histopathological diagnosis was established on routine H and E. Representative sections were further subjected to IHC staining with calretinin, CD117 and S-100 protein. A descriptive study was carried out. Chi-square was used with P-value less than 0.05 accepted as statistically significant.Results: Out of 30 cases with clinical suspicion of HD, 13 cases were diagnosed as HD, 10 as Non-HD motility disorder whereas 7 were without any definitive diagnosis. All the cases were subjected to IHC staining using calretinin. Out of 13 cases diagnosed as HD, 1 case showed presence of ganglion cell using calretinin. All 7 equivocal cases were accurately diagnosed by calretinin. Thus 12 cases were confirmed HD while 18 were diagnosed as Non HD motility disorder. On statistical analysis, sensitivity (92.3%) of calretinin was lower than specificity (100%). Nerve bundle hypertrophy was observed in 11 cases of HD and 9 cases of Non-HD motility disorder using S-100 as an IHC marker. CD117 was used to demonstrate altered density and distribution of ICCs was statistically significant in cases of Non-HD motility disorder.Conclusions: IHC is being widely used as a reliable adjunctive test in evaluation of motility disorders of bowel. In view of its ease and reproducibility, it can be routinely used, avoiding need for repeated biopsies, and delay in treatment

The surged faradic stimulation to the pelvic floor muscles as an adjunct to the medical management in children with rectal prolapse

<p>Abstract</p> <p>Background</p> <p>To assess the role of the surged faradic stimulation to the pelvic floor muscles as an adjunct to the conservative management in the children of idiopathic rectal prolapse</p> <p>Methods</p> <p><it>Study design</it>: Prospective</p> <p><it>Setting</it>: Pediatric Surgery Department, Pt BD Sharma, Post Graduate Institute of Medical Sciences, Rohtak</p> <p><it>Subjects</it>: 47 consecutive children with idiopathic rectal prolapse attending the Pediatric Surgery out patient department from July 2005 to June 2006</p> <p><it>Methodology</it>: The information pertaining to duration and the extent of rectal prolapse, predisposing or associated medical conditions, results of local clinical examination were noted. Surged faradic stimulation using modified intraluminal rectal probe, was given on the alternate days. The conventional conservative medical management was also continued. The extent of relief and the number of the sittings of faradic stimulation required were noted at various stages of follow-ups</p> <p><it>Statistical Methods</it>: Mean values between those completely cured and others; poor responders and others were compared with t-test and proportions were compared with Chi square test. The p-value < 0.05 was considered statistically significant.</p> <p>Results</p> <p>The mean number of sittings in the completely cured group (n = <b>28</b>(64%)) was (12.4 ± 7.8) and was comparable with very poor responder (n = 6(13%). There was higher percentage of relief (76%) at the first follow up (at 15 days) in completely cured Vs other (37%) and also the poor responders showed (20%) Vs other (68%) and was statistically significant.</p> <p>Conclusion</p> <p>With use of faradic stimulation, even the long-standing rectal prolapse can be fully cured. The follow up visit at 2 weeks is very important to gauge the likely success of this modality in treatment of the patients with rectal prolapse. Those showing poor response at this stage may require alternative treatment or take a long time to get cured</p

Mediastinal neurenteric cysts in children: A case series

Introduction: Foregut duplication cysts along with vertebral anomalies are called neurenteric cyst. About 30 cases have been reported in the literature so far. Posterior mediastinal neurenteric cysts are very rare and few studies could be found in the literature even after extensive search. Due to this rarity we are prompted to present 7 cases of posterior mediastinal neurenteric cysts to further add on to the literature.Material and Methods: All details regarding patients with neurenteric cysts who underwent surgery, in the department of paediatric surgery from 2010 to 2015 were gathered from patient case files.Results: There were 7 patients with neurenteric cyst including 3 males and 4 females with an age range of 4 months to 8 years. The most common presentation was recurrent respiratory infection. In two cases, patients also suffered from dysphasia. In 5 cases there were right sided cysts while two had cyst on left side in posterior mediastinum. In 2 cases the cysts extended to the abdomen while one patient had separate ileal duplication cyst. Another case had mediastinal cyst which had a communication with ileum. All the mediastinal cysts were excised through posterior thoracotomy and subsequently confirmed on histopathology.Conclusion: When considering the differential diagnosis of mediastinal cysts in children, neurenteric cysts should be in mind

Meckel's diverticulum in children: Our 12-year experience

Background: Meckel's diverticulum (MD) is the one of the most common congenital malformation of gastrointestinal tract and has varied clinical presentations. We are presenting here our 12-year experiences with MD in children at tertiary care hospital in North India. It highlights the fact that isolated gangrene of MD can occur, and it is associated with increased morbidity. Materials and Methods: This retrospective study is conducted by analysing the medical records of the patients who were operated for MD in the last 12 years in paediatric surgery department at our hospital. Results: Sixty-five patients were operated for MD in study period; in this 52 were males and 13 were females with mean age of presentation 3.2 years. The most common presentation was intestinal obstruction seen in 86.1% (56 cases). Intestinal haemorrhage was seen in 4.6% (3 cases) and diverticulitis in 3% (2 cases). Perforation of the gut with peritonitis was present in 6.1% (four cases). Cause of obstruction was intussusception in 21.4% (12 cases), fibrous band connected to umbilicus in 17.8% (10 cases), volvulus in 17.8% (10 cases), kinking in 16.0% (9 cases), knotting in 14.2% (8 cases) and herniation of gut below in 12.5% (7 cases). Isolated gangrene of MD was present in ten cases with intestinal obstruction. The ectopic gastric mucosa was seen in three and pancreatic mucosa in two cases. Mortality and morbidity during the study were one and three cases, respectively. Conclusion: MD may remain clinically silent for lifetime, or it may have life-threatening complications. In our series, intestinal obstruction and not the haemorrhage was the most common presentation. Isolated gangrene of MD with obstruction was present in significant numbers, which we failed to find in literature

Spontaneous external rupture of hydrocephalus in the occipital region in an infant: A rare case report

With the availability of advanced diagnostic and therapeutic modalities, late presentation of hydrocephalus is a very uncommon occurrence in the present era. Here, we report an 11-months infant with late presenting hydrocephalus with spontaneous rupture at the occipital region. Keywords: Hydrocephalus, Infant, Rupture, Occipita

Ectopic cutaneous umbilical gastric mucosa

A 2‑year‑old male child presented with a complaint of bleeding from umbilicus every 15 days since birth on and off. Child was managed successfully by exploratory laparotomy and local umbilectomy. Histopathology showed gastric mucosa from the excised tissue.Key words: Gastric, mucosa, umbilicu

Childhood Morgagni hernia: report of two cases

Morgagni diaphragmatic hernia is a rare congenital anomaly to be seen in the pediatric age group. We are reporting two cases of Morgagni hernia, which presented with non-specific symptoms and posed a diagnostic dilemma. One of the patients was 10 years old and associated with asplenia and Down’s syndrome; the second case presented as isolated Morgagni hernia in an 8 month baby. The diagnosis was confirmed with radiography and computed chest tomography. Both cases were managed successfully with surgical repair of the diaphragmatic defect through trans-abdominal approach

Delayed presentation of congenital intrinsic duodenal obstruction in children with non-bilious vomiting: a diagnostic dilemma

The duodenum is described as the most common site of intestinal obstruction, classically presenting with bilious vomiting. Of the various categories described, congenital duodenal webs are reported as a rare cause of duodenal obstruction. The clinical features may vary depending on the size and location of the duodenal web. We are reporting 5 pediatric patients with delayed presentation of congenital intrinsic (type 1) duodenal obstruction. All patients presented with recurrent non-bilious vomiting and were misdiagnosed as gastroenteritis in other centers. The diagnosis was confirmed with upper gastrointestinal tract contrast studies. The patients were managed successfully with surgical intervention