Coronal urethrocutaneous fistula in an uncircumcised child with penile hair tourniquet syndrome: A case report

Hair tourniquet syndrome is characterized by circumferential strangulation of an appendages or genitalia by human hairs or fibres. Here we are reporting a rare case and its successful management of coronal urethrocutaneous fistula developed due to penile hair tourniquet syndrome (PHTS) in a 5 years old child

Esophageal replacement by gastric tube: is three-stage surgery justified?

Background Long gap esophageal atresia with or without  tracheoesophageal fistula is a challenging problem. We present our  experience with the three-stage surgery technique.Materials and methods All patients with long gap esophageal atresia were operated by gastric tube esophagostomy in the second stage and esophagostomy closure in the third stage. The patients were then  evaluated for intraoperative and postoperative complications, need for a ventilator, and follow-up.Results There were a total of eight patients. There were no intraoperative complications. There was no anastomotic leak in any patient. One patient died in the postoperative period because of respiratory distress.  Follow-up of the remaining patients was satisfactory.Conclusion Three-stage surgery may avoid respiratory complications  because of the short operative time and less intervention. Anastomotic leak and stenosis in the long esophageal suture line may also be avoided. This may be a useful alternative under a resource-limited condition, with optimal outcome. Keywords: esophageal replacement, gastric tube, long gap esophageal atresia, pure esophageal atresi

A simple technique to create spur in loop colostomy

A colostomy is one of the most popular techniques used as a protective maneuver for a distal anastomosis and/or temporary fecal diversion loop colostomy is used mainly for fecal diversion so as to protect the distal bowel. We report a new simple technique for the creation of mucosal spur in between the proximal and distal stoma without using either a tube or skin flap. The essence of this technique is the creation of mucosal spur by placing two additional sutures in the bridge in between the proximal and distal stoma. The placement of sutures creates the spur and helps in defunctioning of distal stoma. Seventeen patients were operated by this technique over a period of 1 year. The creation of the mucosal spur was excellent. There was no requirement of a tube or skin flap in any of the patients in the follow-up. There was no problem of loss of spur over a period. This is a simple technique, which needs few additional sutures apart from the necessary sutures needed for maturation of colostomy

Bladder exstrophy: Comparison of anatomical bladder neck repair with innervation preserving sphincteroplasty versus Young-Dees-Leadbetter bladder neck reconstruction

Aim: To evaluate the outcome of innervation preserving sphincteroplasty along with anatomical bladder neck reconstruction (IPS-ABNR) compared to classic Young-Dees-Leadbetter (YDL) bladder neck reconstruction in exstrophy with insufficient bladder capacity requiring detubularized-ileocystoplasty. Materials and Methods: Sixteen male patients of exstrophy bladder who required ileocystoplasty from 2004 to 2010 were randomized into group A (n = 7) and group B (n = 9). After detubularized-ileocystoplasty with Mitrofanoff stoma and ureteric reimplantation in all, group A received YDL bladder neck repair while group B received IPS-ABNR repair through a midline scrotoperineal approach. Outcome measurement included operative and postoperative problems, continence, and upper tract status. Results: In group A, two had incompetent bladder neck with gross incontinence, while four had a dry interval of more than 3 h without the ability of voiding per urethra. In group B, seven patients had dry interval of more than 3 h with an ability of urethral voiding and midstream holding in five. Conclusions: Exstrophy patients requiring augmentation cystoplasty and repaired with IPS-ABNR can achieve dynamic bladder outlet resistance with adequate leak point pressure and ability to void voluntarily with midstream holding capability. The children had the satisfaction of voiding per urethra with ability to stop in midstream similar to that in normal children

Congenital anterior urethral valves and diverticula: Diagnosis and management in six cases

<b>Background:</b> Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. Although they are referred to as valves, these obstructive structures often occur in the form of a diverticulum. The urethra in these cases shows saccular or bulbar dilatation known as anterior urethral diverticulum (AUD). They typically occur where there is a defect in the corpus spongiosum, leaving a thin-walled urethra. This segment of the urethra balloons out during voiding, simulating a mass that is sometimes visible along the ventral wall of the penis. The swelling is fluctuant and urine dribbles from the meatus on compression. The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula.<b> Materials and Methods: </b> We have studied children with congenital anterior urethral valves and diverticula. Six patients of AUVs with diverticula were admitted during the period of 2000-2007 and were prospectively evaluated. The mean age of presentation was 16 months (15 days to 4 years). Straining at micturition and a palpable penile swelling were the most common presenting features. The diagnosis was established by voiding cystourethrogram (VCUG) and supported by ultrasonography (USG). All patients were treated with single-stage open surgical excision except one who died preoperatively due to urosepsis. Initial lay opening of the penoscrotal urethra and delayed repair were done in one patient. <b> Results: </b> The surgical outcome was successful in all but one patient, who died of delayed presentation with severe back pressure changes, urinary ascitis and urosepsis. On long-term follow-up, all patients demonstrated good stream of urine. The renal functions were normal and the patients had no evidence of urinary infections. <b> Conclusion: </b> We propose that, the patients of AUVs, if not excessively delayed for treatment are otherwise well in terms of general condition as opposed to patients of posterior urethral valves. The diagnosis is easily established by VCUG and the severity is revealed by a sonogram. Open surgical excision is the method of choice for patients with a urethral diverticulum; however, cystoscopic fulguration is also feasible in selected patients. The outcome is excellent with minimal morbidity and mortality

Six-year retrospective analysis of colonic perforation in neonates and infants: Single centre experience

Background: Developing countries at tertiary referral centre. This study analysed the aetiology of colonic perforation (CP) in neonates and infants. Materials and Methods: Retrospective analyses of 60 CP cases (presented from May 2005 to May 2011) were done. Results: The mean age at presentation was 8.33 ± 0.11 days (range, 2-110 days). The aetiology were Hirschsprung′s disease (HD), necrotising enterocolitis (NEC) and idiopathic perforation in 78.33% (47/60), 6.67% (4/60) and 15% (9/60), respectively. There were 210 patients with histopathologically proven HD; 22.38% (47/210) cases of HD had CP. Most common site of perforation was mid-transverse colon (74%, 35/47) in HD patients. All HD-associated mid-transverse colonic, caecal, appendicular and ascending colon perforations (except one caecal perforation) had aganglionic recto-sigmoid region and ganglionic perforation site. Features of enterocolitis were not found in any HD patients. Two patients (3.33%) died due to sepsis. Conclusions: There was a high rate of primary HD-associated colonic perforation in this study. Colonic perforation may the initial presenting condition in HD disease. We advocate colonic biopsy to rule out HD in any neonate presenting with primary colonic perforation

IschioPubic osteotomy, A simple and effective technique for pelvic ring closure in repair of classic exstrophy bladder

Aim: The aim of this study is to report the technique and outcome of ischiopubic (IP) osteotomy for pelvic ring closure in classic exstrophy bladder. Methods: A total of 85 male classic exstrophies were selected based on trapezoid-shaped space between IP ramus on three-dimensional computed tomography pelvis. Using midline scroto-perineal approach, after bladder plate mobilization and radical corporal detachment; the pelvic surface of superior pubic ramus (SPR) was exposed. Above the obturator canal, H-shaped incision was made on periosteum of the SPR. The horizontal line of H was placed above the obturator canal. Rectangular periosteal flaps above and below the horizontal line was raised. In the subperiosteal plane, curved hemostats encircled the SPR that were divided using a bone drill. On the medial aspect of ischial tuberosity, a notch was created as hinge using a bone drill. Forks of bone holding forceps hooked the pubic bone and tightened for its midline approximation, lengthening of the SPR and inward rotation of IP ramus. Linea alba and pubic bones were approximated with interrupted Polygalactin sutures. Results: Midline approximation of pubic bone and linea alba was possible in all. There was no injury to obturator nerve, vessels, or other structures . Conclusions: IP osteotomy is the safe and effective technique of pelvic ring closure in patients with specific pelvic configuration

A Pilot Study on Histopathology of the Jejunoileal Atresia—Can it Be Used as a Guide to Determine the Length of Adequate Resection?

Introduction: Some studies reported that there is abnormality in the histopathology of atretic bowel in jejunoileal atresia (JIA). We have made an attempt to assess sequential histopathologic changes in the resected atretic segment. Material and methods: The histopathology of the resected segment was evaluated at 1, 3, 5, 7, 9, and 11 cm from atretic end (Sections A to F, respectively). The ratio of inner and outer muscle layer (measured by NIS-Element D software) was calculated at every section. Immunohistochemistry for α-smooth muscle actin (α-SMA) was also done. The findings were compared with control. Results: In control set (n = 5), the ratio of inner and outer muscle layer was 1.03. In patients with JIA, the ratio was 0.68 to 0.9 at section A. This ratio varied at various sections in all specimens. In section F, this ratio was 0.95 to 1.09, which is close to control ratio. There were no specific findings related to α-SMA staining. Conclusions: It appears that the bowel proximal to the atresia is abnormal for a varied length. It may be a possibility that this abnormality is present at least up to about 10 cm proximal to atresia. Adequate resection is important for optimal outcome