A two and half years old female child presented with recurrent episodes of colicky abdominal pain and bilious vomiting since 3 months. On clinical examination, a small mobile intra

Skip segment Hirschsprung's disease is a condition where an area of normally ganglionated intestine is interspersed proximally and distally by aganglionic segments. The occurrence of skip segment has no clear embryological explanation, contrary to the present concept of failure of cranio-caudal migration of neural crest-derived cells in Hirschsprung's disease. Only 25 case reports have been published in literature so far and this is possibly the first to be reported from Asia. We report one such case with novel surgical management.

Melioidosis, an endemic disease in South East Asia and Australia is emerging a potential infectious threat off late in India. Though not highly infectious it can be extremely fatal. It has various manifestations which can mimic a wide array of disease including tuberculosis, malignancy, etc., Though not an untreatable disease it can certainly worsen with treatment. An interesting fact is that the fast deteriorating and fatality has made Burkholderia pseudomaleii, the causative organism qualified for biological warfare.

Introduction: Hirschsprung’s disease (HD) is a developmental disorder caused by the migration failure of neural crest cells during intestinal development, resulting in an aganglionic colon and causing a functional obstruction in children. Duhamel’s procedure (DP) which involves excision of the aganglionic segment with retrorectal pull through, and anastomosis of the ganglionated bowel above dentate line, is one of the classical surgical procedures for HD. Materials and Methods: This retrospective study was conducted in a tertiary care center in South India. The medical records and follow-up details of 17 patients, who underwent DP for HD between January 2014 and December 2018, were obtained and evaluated. Outcomes evaluated included incidence of post-operative constipation, incontinence/soiling, enterocolitis, anastomotic stricture, and leak. Results: There were 17 patients with HD who underwent DP during the study period, among which 76.47% of patients had classical HD and 23.52% were long-segment HD. A total of 58.82% of patients presented at birth, with overall 76.47% of male predominance. Fecal soiling (29.41%), perianal excoriation (17.64%), wound infection (11.76%), post-operative enterocolitis (11.76%), stricture formation (11.76%), constipation (11.76%), and hypertension (11.76%), and adhesive bowel obstruction (5.88%) were some complications observed in this study. Most of these complications were successfully managed. Conclusion: Staged DP is safe and can address the entire spectrum of HD. Complications are less and comparable to other techniques, and with close follow-up to address the post-operative complications, good quality of life can be achieved for the children with HD.

Background: Children are vulnerable to a wide range of bicycle-related traumatic injuries. Bicycle handlebar injuries often cause diagnostic dilemma and delay in diagnosis due to trivial nature of the incident. Objectives: To study the bicycle handlebar injuries in children and their management. Materials and Methods: A retrospective review of all the children with blunt abdominal injuries secondary to bicycle handlebar injuries at our institution, between April 2011 and March 2015 was done. The patient medical records were examined, and all the data pertaining to the demographic information, clinical history, hematological investigations, imagingstudies, operative technique, post-operative recovery and complications, and duration of hospitalization were obtained. Results: During the study period of 48-month, 26 children with blunt abdominal injuries were treated at our institution. Among these patients, 7 children had bicycle handlebar abdominal injuries. All 7 patients were male. Mean age of the patients was 9.6 years (range 5-12 years). The average time gap between trauma and presentation to our institution was 46 h (range 22-96 h). All the 7 children had circular patternedabrasion of the bicycle handlebar over the abdominal wall. Mean duration of hospital stay was 16.1 (range: 9-28) days, and the average duration of follow-up was 35.6 months (range 7-55 months). Conclusion: “Ring sign” indicates a higher probability of associated intraabdominal injury, and these children should be thoroughly evaluated and managed with close observation, repeated clinical examination, appropriate imaging studies, and surgical or endoscopic intervention as required.

Heminasal aplasia is a rare congenital anomaly of nose that has rarely been reported in the English literature. The surgical management remains a challenge due to its rarity and lack of uniform management guidelines. We report a case of heminasal aplasia, managed successfully at our institute and systematic review of the available literature. Keywords: Heminasal aplasia, Hemi-arhinia, Aplasia nose, Arhinia, Absent nose, Half nose, Reconstruction, Anomaly of nose, Nasolabial flap, Folded nasolabial flap.

I n 1786, John Hunter was the first to observe that the testis was located in the abdomen of the fetus. Undescended testis (UDT) is a common congenital problem encountered in pediatric age group. Cryptorchid testis, literally meaning hidden or obscure testis, refers to the absence of testis in the scrotal position and is most commonly undescended or maldescended. Overall, up to 4% of full-term male newborns may present with UDT. The prevalence is around 33% in premature male newborns and it reaches 60-70% if the birth weight is <1500 g [1]. In majority, the testis descends within the subsequent 3 months, resulting in an incidence of 1% UDT at 1 year. The testis is unlikely to descend after this time. However, testicular descent after 3 months of age is also possible; especially, in preterm infants [4]. About 10% of the cases are bilateral and are commonly associated with complex syndromes or other congenital malformations such as abdominal wall defects or neural tube defects [2].Factors that predispose to UDT include prematurity, low birth weight, small for gestational age, twins, genetic predisposition, endocrine disorders (e.g. disruption of hypothalamic-pituitarygonadal axis), and environmental factors such as nicotine, alcohol, pesticides, and maternal exposure to estrogen during the first trimester [2]. Since 80-90% of a testis is composed of seminiferous tubules, the volume of the testis is significantly related to the semen profile and testicular function, hence testicular volume is an indicator of development of the testis [3]. Since boys with UDT may have an increased incidence of testicular hypoplasia, atrophy, infertility, torsion of testis, trauma, and testicular malignancy, there is a need for locating testis and placement in the scrotum at an early age.Principles of surgical management of palpable UDT are well established. Management of non-palpable testis is challenging and laparoscopy is an ideal tool for diagnosis and management in this scenario. There is a need for spreading the awareness regarding current concepts of management of UDT; especially, among pediatricians, general surgeons, and referral doctors. Children who undergo early orchiopexy need to be followed up, to evaluate outcomes of UDT with respect to growth potential [4].

BACKGROUNDEmergence agitation is usually common after nasal surgery. We underwent investigation to find the effects of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery in adult patients.