Medical conditions mimicking the acute surgical abdomen in children

Background: We present our experience with children landing up in our pediatric surgery emergency with potentially confounding medical conditions that evade diagnosis. It is imperative to apply sound clinical judgement in the evaluation of these patients so that an unnecessary laparotomy can be avoided but, at the same time, a lifesaving intervention is not denied.Patients and methods: This is a retrospective descriptive analysis pertaining to all patients who were admitted in our department from 1 January 2014 to 31 July 2017. A total of 27 867 patients presented to our out-patient department of these, 3034 were admitted to our ward. A total of 1531 surgeries were performed, of which 288 were for various abdominal surgical conditions. A total of 16 patients, representing 0.5 % of the admissions, were eventually found to have an acute abdomen secondary to a medical cause.Results: Out of the above 16 patients, 10 had to undergo exploratory laparotomy (62.5%). Eight patients of the 10 operated had a negative laparotomy. Two of the 10 operated were found to have a surgically correctable cause, one with ovarian torsion and one with severe colonic edema secondary to Kawasaki’s disease causing intestinal obstruction.Conclusion: Although eight patients with negative laparotomy result constitute only 0.5% of all the surgeries and 2.7% of all the laparotomies, it still forms the bulk (i.e. 8/16=50%) of the patients with underlying medical cause of the surgical abdomen. There were two deaths, representing a mortality of 12.5% (2/16=12.5%), with one in the operated group and one in the nonoperated group. This is why we want to stress the importance of caution and sound clinical judgement in evaluating this subset of patients.Keywords: acute abdomen, medical conditions mimicking, surgical abdomen in childre

Traumatic diaphragmatic rupture, a diagnostic dilemma in the presence of eventration: a case report

Eventration of the diaphragm is the condition where the muscle is permanently elevated, but retains its continuity and attachments to the costal margins. Traumatic diaphragmatic rupture is a recognized consequence of high velocity blunt trauma to the abdomen usually a result of motor vehicle accident. Multi-slice CT and Magnetic Resonance Imaging in the pre-operative evaluation of trauma patients, diaphragmatic rupture can be still overlooked if not evaluated with the fair degree of clinical suspicion, more so if it is associated with an eventration of diaphragm - as was in our case

Molecular Characterization and Evaluation of Two Potential Mosquitocidal Lysinibacillus Strains from Himalayan Valley Kashmir

In an exertion to isolate natural non-harmful mosquitocidal bacteria, 158 samples of soil were collected from various habitats of Himalayan valley Kashmir. A total of 450 bacteria were screened for mosquitocidal activities against three epidemiological disease causing vectors: Aedes aegypti, Culex quinquefasciatus and Anopheles stephensi larvae/pupae. Out of 450 bacteria screened, none had shown pupicidal activity. However, two isolates KS2-15 and KS2-13 exhibited mosquito larvicidal activity against C. quinquefasciatus (LC50: 1.36 × 103 spores/mL; 1.41 × 103 spores/mL respectively) and A. stephensi (LC50: 2.14 × 103 spores/mL; 2.11 × 103 spores/mL correspondingly). These two isolates were identified, morphologically, biochemically and comparative investigation of 16S rRNA gene sequences, as Lysinibacillus sphaericus (previously Bacillus sphaericus). Sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis of spore crystal mixture of each strain revealed two major bands of around 51.4 kDa and 41.9 kDa. PCR of mosquitocidal toxin genes showed the presence of binA and binB genes in both the strains. Comparative amino acid sequence analysis revealed that the BinA (41.9 kDa) and BinB (51.4kDa) proteins of KS2-13 and L. sphaericus 2362 differ by 3 (K89E, E104A, Y176D) and 6 (A69S, K70N, I110T, N248H, H314L and L317F) amino acids respectively. Similarly BinA and BinB proteins of KS2-15 and L. sphaericus 2362 strains vary by 1(E104A) and 3 (H109P, N248H and P274S) amino acids respectively. The varied amino acid sequences could be reason for the difference in activity. These two strains can act as good candidates for insecticidal formulation. Moreover, we reported for the first time the isolation of mosquitocidal Lysinibacillus strains from Kashmir valley

Selective use of superficial temporal artery cannulation in infants undergoing cardiac surgery

Arterial cannulation is routinely performed in children undergoing cardiac surgery to aid the intraoperative and intensive care management. Most commonly cannulated peripheral site in children is radial artery, and alternatives include posterior tibial, dorsalis pedis, and rarely superficial temporal artery (STA). Two specific situations in cardiac surgery where STA cannulation and monitoring was useful during the surgical procedure are reported. To our knowledge, such selective use of STA pressure monitoring has not been reported in the literature previously. Our experience suggests that STA monitoring can be useful and reliable during repair of coarctation of aorta or administration of anterograde cerebral perfusion in patients having associated aberrant origin of the right subclavian artery