Background: Hypospadias is common congenital condition. First attempted hypospadias surgery was done during first century A.D. Since then more than 300 techniques have been explained in the surgery for Hypospadias. The goal of surgery is focused on functional and cosmetic outcomes. In 1994 Snodgrass popularized the technique of urethral plate incision, tubularization and secondary dorsal healing for hypospadias repair. Aim of the study was to evaluate the short term outcomes of Snodgrass urethroplasty.Methods: This was a retrospective study conducted by the department of Pediatric Surgery, Kempegowda Institute of medical sciences (KIMS) hospital, Bangalore from 2014 to 2017. Children with mid penile and distal hypospadias who had undergone Snodgrass urethroplasty were enrolled in the study. Children with previous surgery were excluded. The demographic data, duration of surgery, post operative requirement of anticholinergics, duration of catheterization and post operative stay were tabulated. Children were followed up for duration of 6 months to 3 years. Post operative complications were tabulated. Results: 40 children were included in the study. Age ranges of children were between 9 months to 14 years. In most of the children hypospadias was diagnosed at birth. The mean duration of surgery was 97.25 minutes. The mean duration of hospitalization was12.2 day. The overall complications rate was 20%. The most common complication was urethrocutaneous fistula. Out of the 40 children included in the study 4(10%) children required resurgery (urethrocutaneous fistula closure).Conclusions: Snodgrass urethroplasty is a simple and effective technique. It is easy to learn and can be applied as a single stage procedure. The most common complications are urethrocutaneous fistula and meatal stenosis.
Background: Meckel’s diverticulum (MD) is one of the most prevalent congenital abnormalities of the small intestine. Due to its wide-ranging presentations, it often becomes a challenge to diagnose it. Objective: The objective of the study is to analyze varied clinical manifestations of MD in children and their outcomes. Materials and Methods: This was a retrospective study of children diagnosed with MD in the Department of Pediatric Surgery, Medical College of Karnataka from January 2015 to January 2019. A total of 13 patients (10 male and 3 female) aged 1 month–15 years with a diagnosis of MD were included in the study. Their demographic and clinical parameters, investigation, and histopathological findings along with the surgical interventions were collected and analyzed. Results: Patients were presented with varied clinical features such as intestinal obstruction (30.76%), perforated MD (15.38%), diverticulitis (15.38%), gastrointestinal bleed (7.69%), patent vitellointestinal duct (7.69%), and incidental (23.07%). All the cases were investigated and underwent treatment. The most common post-operative complication was wound infection in 2 children which were treated conservatively. Conclusion: A pre-operative diagnosis of complicated MD may be challenging because of the overlapping clinical and imaging features of the other acute surgical and inflammatory conditions of the abdomen. Therefore it is necessary to maintain a high incidence of suspicious in the pediatric age group.
Most common ovarian mass in children is benign functional cyst. Epithelial tumors account for 8-10% of ovarian tumors. Most common epithelial tumor is cystadenoma. Mucinous cystadenoma occurs in 3 rd-6 th decade of life. We report a case of 10 years old premenarchal girl presenting with abdominal distension and discomfort. On examination the entire abdomen was occupied by a firm mass. CT imaging showed a large multiloculated cystic lesion arising from the right ovary. The child underwent right salphingo-oophrectomy. The biopsy of the mass was suggestive of benign mucinous cystadenoma. The child was on regular follow up. After 1 year of follow up child is doing well.
Self-insertion of foreign body in lower urinary tract is rare in children. It is commonly seen in adults. The reason for self-insertion may be accidental, due to psychiatric illness, curiosity, sexual stimulation or therapeutic in cases of stricture. Most of the cases reported are in adults. Here we present a 12-year-old child presenting with self-insertion of metallic hair pin into the lower urinary tract with symptoms of dysuria and retention of urine. X-ray and ultrasonography were diagnostic modalities which aided in the diagnosis. The child underwent successful cystoscopic removal of foreign body after thorough investigation. Post removal child underwent psychiatric evaluation. He was not suffering from any psychiatric condition. He admitted having inserted the hair pin out of curiosity. Child was passing urine in good stream at time of discharge. At six months follow up child remains asymptomatic.
Ovarian tumors are commonly seen in adults and rare in children. Incidence in children is about 2.6 cases per 1,00,000 girls. Most common ovarian mass in children is benign functional cyst. Epithelial tumors account for 8-10% of ovarian tumors. Most common epithelial tumor is Cystadenoma. Mucinous cystadenoma occurs in 3rd -6th decade of life. We report a 10-year-old Premenarchal girl presenting with abdominal distension and discomfort. On examination the entire abdomen was occupied by a firm mass. CT imaging showed a large multiloculated cystic lesion arising from the right ovary. The child underwent right salphingo-oophrectomy. The biopsy of mass was suggestive of benign mucinous cystadenoma. The child is on regular follow up. At 1 year follow up child is doing well.
Microgastria is a rare congenital anamoly. It was first reported in 1800s. It occurs in association with other anamolies. Common associated anomalies include asplenia, malrotation of intestine, upper limb anomalies, situs inversus. Isolated cases of Microgastria are very few in literature. Most cases of microgastria present during infancy. This is a report of a four year old child, eldest in litreature presenting with isolated microgastria. Child presented with vomiting, failure to thrive. Child underwent excision of stomach and oesophago-jejunostomy with pouch after initial stabilization. The child had an uneventful post-operative recovery.
Background: Pelvi-ureteric junction obstruction (PUJO) is defined as anatomical or functional obstruction to the flow of urine from the pelvis to the upper ureter. With the advent of ultrasonography most of the cases of PUJO are identified in antenatal period. The treatment protocol for antenatal diagnosed PUJO is standardized. Few children present later in life. Present study was done to evaluate clinical profile and outcome of children presenting with PUJO above 1 year.Methods: A retrospective observational study conducted by the department of Paediatric Surgery, KIMS hospital Bangalore. All children with PUJO above 1 year of age from January 2015 to January 2018 were included. Clinical, biochemical and imaging findings of these children were tabulated. A diuretic renogram was done to confirm the diagnosis. The children underwent either pyeloplasty or nephrectomy, depending on the function of the kidney. In children with calculi, pyelolithotomy with pyeloplasty was done. The children were followed up post-surgery.Results: Twenty-six children were included in the study. Mean age of presentation was 6.86±4.13years. Most common presentation was pain abdomen. Left kidney was commonly involved. The mean anteroposterior pelvic dimension (APPD) of involved kidney was 38.96±17.7 mm. 5 children presented with poorly functioning kidney with split renal function less than 10%. In three children PUJO was associated with pelvic calculi. Out of the 26 children simple nephrectomy was required in 4 (15%) children. The remaining 22 children underwent pyeloplasty. Mean duration of stay was 6.19±1.8 days. Post-pyeloplasty diuretic renogram showed improved drainage with improved function.Conclusions: PUJO is common cause of urinary obstruction in children. Delay in diagnosis or presentation leads to increased chances of renal damage and loss. Hence it is important to diagnose PUJ obstruction at the earliest and receive prompt treatment.
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