Aim: Neonatal gastric perforation (NGP) is a rare, perplexing, life-threatening entity affecting neonates. We share our experience of operating upon cases of NGP s and highlight important points observed which may aid in further improving care of neonates, diagnosed with this entity. Materials and Methods: A retrospective analysis of all consecutive patients with NGP operated by the author, at various centers between January 2015 and December 2018, was carried out. We analyzed different variables for these and reached logical conclusions. Results: Between January 2015 and December 2018, we treated ten patients with gastric perforation. All the neonates were preterm, except one. Mean birth weight in our series was 1745 g (range 1300–2400 g). Deterioration in activity, worsening of sepsis, metabolic acidosis, increased ventilator requirements, and abdominal distension were prominent clinical features identified in all patients. All patients subsequently had massive pneumoperitoneum before surgery. Six patients had perforation along the greater curvature, two had perforation at the posterior wall, and two had near total gastric necrosis. We had four mortalities out of ten patients operated. Conclusion: NGP is associated with high mortality, especially in premature and low birth weight neonates. Severity of contributing factors in a premature predisposed neonate determines the severity of gastric necrosis, which in turn is an important prognostic factor. Certain preoperative signs can be useful and can aid in initiating preventive measures to curtail severity of the pathology.

Presence of symptomatic mesonephric duct remnants is rare in pediatric age group. These can be present in dormant physiological or symptomatic pathological states. Pathologies can vary from benign cysts to malignant tumors. We here report a rare presentation in a 2-year-old female, of a mesonephric remnant in the form of a sinus above the iliac crest.

Purpose To describe innovative use of instruments from other specialities in pediatric laparoscopy. The usage was intended in some cases, and it was need of the hour in few cases because of unavailability of an instrument in resource-limited condition or because of troubleshooting. Methods We retrospectively collected data for all cases where we used instruments from other surgical specialties in pediatric surgical cases. These cases were operated at various centers from January 2016 to December 2018. Results We found seven such scenarios where we used instruments routinely used by urologists, gynecologists, general surgeons and plastic surgeons. In all these cases, we found the use of these alternative instruments advantageous. Conclusion A basic knowledge and working fundamentals of instruments of other speciality can be innovatively and fruitfully be utilized in making pediatric surgery easier and less invasive. This can avoid undue dissections, save few port placements and can avoid deferring of cases in situation of troubleshooting.

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