ED can present with a wide spectrum of symptomatology. It can present as mass abdomen, intestinal obstruction or even can mimic as hydrocoele. High index of suspicion is therefore required. Ultimate aim of treatment is excision of cyst with preservation of vascularity of native gut.

BackgroundAcute postoperative pain control in children is an essential component of postoperative care, particularly in daycare procedures. Giving patients continuous narcotic analgesics can be risky; however, a single dose may be sufficient.MethodsThis study used a prospective, randomized controlled design and was conducted at the Pediatric Surgery Unit, Services Hospital, Lahore. In total, 150 patients who underwent inguinal herniotomy (age range: 1–12 years) were randomly assigned to two groups: group A (nalbuphine) and group B (tramadol). Patients were given a single dose of either nalbuphine (0.2 mg/kg) or tramadol (2 mg/kg) immediately after surgery and pain was measured at 0, 1, 2, 4, and 8 h.ResultsThe demographic characteristics were similar between the two groups. The mean pain score was lower in group A than in group B at 0 and 1 h (P < 0.05). However, at 4 h and 8 h, the pain scores in group A were still lower, but not significantly. In all, 9 patients (12.0%) required rescue analgesics in group A compared to 16 patients (21.3%) in group B (P = 0.051). The mean time for requirement of rescue analgesics was 6.5 ± 0.5 h in group A and 5.3 ± 1.7 h in group B (P = 0.06).ConclusionsA single dose of nalbuphine is sufficient, and superior to tramadol, for postoperative pain management in children who have undergone daycare procedures.

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Background Perforation of Meckel Diverticulum (MD) is a rare cause of pneumoperitoneum in neonates. We hereby report six cases of perforation of MD in neonates, with addition of 53 cases from systematic review of the literature. A systematic review was performed using Mesh terms “Neonate, Meckel Diverticulum, Perforation, Pneumoperitoneum.” All reports of perforated MD in the English literature were identified. Details of our 6 cases were analyzed in similar fashion. Results A total of 3027 manuscripts were screened and 59 cases including 6 of our own were identified. The vast majority (78%) were female. Fifty patients (84.7%) presented in the newborn period. Half of the cases (52.5%) had associated anomalies and 13 neonates (22%) required oxygen supplementation including CPAP or ventilatory support before surgery. In 73% of the cases, a resection of gut was undertaken. Histopathological assessment in 44 cases (74.6%) revealed no ectopic gastric mucosa. Three cases demised prior to treatment. The outcome in the vast majority was excellent with 84.7% surviving and discharged well. Conclusion Perforated MD is an unusual cause of a pneumoperitoneum in the newborns. Diagnosis is established at laparotomy and it rare to find ectopic mucosa histopathologically. The overall outcome is excellent.

IntroductionAmong patients with cholelithiasis, choledocholithiasis may also be present in about 18% of cases. They can be treated through various endoscopic, laparoscopic, and open surgical procedures.ObjectiveThe objective of this study was to determine the outcome of patients with choledocholithiasis being treated in our setup.MethodsThis descriptive case series was conducted at Holy Family Hospital, Rawalpindi, Pakistan over two years from January 2015 to December 2016. All patients with choledocholithiasis admitted to Surgical Unit 1 were included in this study. All patients underwent elective endoscopic retrograde cholangiopancreatography (ERCP). In patients with successful ERCP, laparoscopic or open cholecystectomy was performed at a later date. In patients in whom ERCP failed, open surgical clearance of the common bile duct (CBD), along with cholecystectomy, was done.ResultsA total of 200 cases of choledocholithiasis were admitted during the study period. Most of the participants (73%) in this study were female. Liver function tests were found to be deranged in 88 patients (44%) and normal in 112 patients (56%). At presentation, 3.5% (n=7) had concomitant acute biliary pancreatitis and 8% (n=16) had cholangitis. Successful ERCP followed by cholecystectomy was performed in 88.5% of cases. On the other hand, 11.5% (n=23) patients had failed ERCP due to impacted stones. They underwent open surgical procedures, i.e. 43.48% (n=10) had choledochotomies, 47.82% (n=11) had choledochoduodenostomies and 8.69% (n=2) had hepaticojejunostomies. No postoperative mortality was observed. However, anastomotic leaking occurred in 8.69% cases (n=2).ConclusionA two-staged procedure consisting of ERCP, followed by laparoscopic cholecystectomy, should be the first line of treatment for common bile duct (CBD) stones. In cases where ERCP fails, open surgical procedures still remain a relevant and a definitive option in resource-constrained setups.

Background: Generally, the healthcare workers have a stressful job and it includes both physical and mental stress. We conducted this study to determine the burnout among postgraduate residents (PGR’s). Methods: This cross-sectional study was conducted at The Children’s Hospital and The Institute of Child’s Health, Lahore over a period of 3 months. A total of 113 PGR’s participated in this study. Burnout was measured using Copenhagen Burnout Inventory (CBI). Questionnaire was filled by participants on paper. Results were analyzed through SPSS–26. Results: In this study, most of the participants (n=70) were females. Mean age of the participants was 28.6±2.035 years. More than 50% participants suffer from moderate to severe burnout. Nine percent of participants had high personal and client related burnout. The highest mean score was for personal burnout scale. When burnout scores were categorized according to demographic details, personal burnout was significantly higher among those who considered that they are burnout (p=0.000) and work burnout was significantly higher among those who travelled to the workplace by their cars (p=0.025). Burnout was higher among females, those who have long duration to travel from their homes to the hospital and whose parents were doctors; however, the difference was not significant. The scale showed a good overall internal reliability (Cronbach’s alpha=0.697). Conclusion: This study showed a high rate of burnout among PGR’s that needs to be addressed and adequate measures should be taken to reduce it.

Introduction Jejunoileal atresia (JIA) among neonates is still a condition which has huge morbidity and mortality, particularly in the developing world. We share a case series of JIA in context of their presentation, management, and outcome. Materials and methods This study was conducted at Children’s Hospital and Institute of Child Health, Lahore, over 1 year. We included all patients presenting with JIA, and their demographic details, presentation, investigations, treatment strategies, and the outcome were noted at a pre-designed proforma. All data were analyzed using SPSS version 26. Results A total of 63 neonates with JIA were included. Most of them (79.4%) presented after 48 h of life, and the mean age at presentation was 5.68 ± 4.75 days. There were 37 male patients (58.7%), and 51 (81%) were full-term. The most common presenting complaint was not being able to pass meconium (88.9%). Type III atresia was the most common subtype (41.3%). Most of them underwent resection without tapering. The mean hospital stay was 12.81 ± 6.53, and it was significantly longer among those who underwent re-exploration (P = 0.034). Twenty-three patients (36.5%) expired within 6 months of follow-up. The only significant factor for mortality was the presence of short bowel syndrome (P = 0.030). All other demographic and management factors did not alter the mortality rate. Conclusion Management of surgical neonates is a difficult job in developing countries with limited resources. There is a high mortality rate of neonates following JIA surgeries, and surgeons in these countries must fight on many fronts to improve the outcome.

Haemangioma is the most common benign neoplasm of infantile age. It is most commonly located in head and neck region, trunk and extremities but very rarely it can be located at clitoris. However, it is very important to differentiate clitoral haemangioma from enlargement of the clitoris secondary to androgen excess. Only four cases of clitoromegaly caused by cavernous haemangioma have been reported in the literature so far. Herein, we report our experience with a 10-year-old girl who presented with clitoromegaly and normal hormonal assay that turned out to be clitoral cavernous haemangioma after histopathological examination of the clitoral mass.