Toxocariasis is an extensive helminthic infection that leads to visceral larva migrans in humans. A 2.5-year-old girl referred for abdominal mass. She had history of pharyngitis for two weeks. There were no other symptoms. Abdominal examination revealed an irregular solid mass in right lower quadrant (RLQ). Abdominal ultrasonography revealed an echohetrogenic large mass in RLQ, liver, and retroperitoneal area. Abdominal CT scan showed a huge mass. At laparotomy a large retroperitoneal mass that involved right liver lobe, bladder, ileocecal valve, small and large intestines was found. At histopathology diagnosis of toxocariasis was made.
Thoracoschisis is a rare condition. A female newborn presented with right-sided thoracoschisis, associated with diaphragmatic hernia and protrusion of an accessory liver lobe through the chest wall defect along with deformity of the right forearm and hand duplication. Diagnosed as part of the limb-body wall complex (LBWC), management included resection of the exteriorized liver lobe followed by right hemidiaphragm and thoracic wall reconstruction.
Recurrent intussusception is a management dilemma and have many causes. We report a 22-month old boy who presented multiple times for recurrent intussusception. At diagnostic work-up he was found to be suffering from non-IgE food allergy. The child did not develop further episodes of intussusception after removal of allergenic diet.
Hemi-truncus arteriosus is a rare congenital cardiovascular malformation. It usually presents in infancy and leads to development of progressive pulmonary vascular disease, heart failure, and death. We report a case of hemi truncus arteriosus in a 12-day-old neonate who was successfully managed at our institute.
Bilateral congenital cystic adrenal neuroblastoma (NB) with cystic liver metastasis is a very rare condition and only few cases have been reported in the literature. Herein we report a case of a congenital bilateral cystic adrenal NB with cystic liver metastasis and briefly discuss characteristic imaging features of cystic NB.
Ovarian torsion is a surgical emergency demanding timely diagnosis and treatment to prevent loss of the ovaries which if happens may result in functional and emotional consequences. Simple (less than 5cm in size) ovarian cysts require follow-up for potential self-resolution. We describe a case of antenatally detected bilateral ovarian cysts that developed bilateral ovarian torsions on follow-up, postnatally.
Most ingested foreign bodies usually pass uneventfully through the gastrointestinal tract. Few may cause complications and require surgical interventions. We report a 1.5-year-old child who ingested hair clip and presented with vomiting and obstruction. At operation, we found duodenal and colonic perforations. Hair clip was removed with repair of perforations.
Laparoscopic procedures in children are technically demanding because of reduced working space with careful monitoring of pneumoperitoneum pressure. We report a case of laparoscopic cholecystectomy performed in a 9-year-old boy using slender forceps which addressed all the above mentioned concerns. This shows a possibility of needlescopic surgery in children.
A term 3 kg hospital born neonate presented on day 9 of life with continuous high grade fever since day 2 of life. Baby developed progressive erythema and swelling of scalp, face and periorbital area with small scattered black patches for 5 days (Fig.1A). Complete blood count showed haemoglobin of 13.5 g/dL, total leukocyte count of 26,200/mm3 and platelet count of 71,000/mm3. Coagulogram, cerebrospinal fluid (CSF) analysis, HIV ELISA, blood culture, immunoglobulin profile, T and B-lymphocyte subsets and nitro-blue tetrazolium tests were in normal range. Contrast CT scan showed diffuse skin and subcutaneous thickening of face and neck. Baby was managed with vancomycin, meropenem and clindamycin. He developed clinical deterioration and multiple areas of gangrenous spots surrounded by inflamed edematous skin over right half of face and scalp. Ultrasonography of neck was suggestive of pyomyositis and NF. Figure 1: A) Showing cellulitis of face, scalp and neck with areas of cutaneous skin necrosis of case 1. B) showed areas of granulation tissue over the scalp and neck after antibiotic therapy.
Although animal bites are common, genital trauma caused by animal bites is rare. Here we report a case of bilateral testicular loss in an infant due to a dog bite. The patient was bitten by a friend's dog while his mother was intoxicated and, therefore, did not receive immediate medical attention. Although initial treatment with subsequent genital reconstruction and hormone replacement is important for children with genital trauma, it is too important to make home safe for them.
An 18-month-old male infant presented with intermittent non-bilious vomiting with pain abdomen for last six months. There was history of localized abdominal distension which gets relieved partially, with vomiting. Patient was born at full term and had no previous medical or surgical history. On examination, patient’s weight was 8.8 kg. Biochemical profile was normal. X-ray abdomen revealed gastric distension with paucity of gas in rest of abdomen. In upper GI study, stomach and duodenum were distended with narrowing of the 2rd part of the duodenum with passage of the contrast distally, suggestive of the perforated duodenal web (Fig.1). At laparotomy, duodenotomy revealed a web with a pin point hole in the center. Multiple FBs were present in the duodenum. The web was excised and the foreign bodies were retrieved (Fig.2). The foreign bodies were mostly buttons, seeds and diamonds. Postoperative period was uneventful.
A 10-month-old male baby presented with irritability and inconsolable cry for last two weeks which increased on touching the chest. There was no history of fever, respiratory symptoms, or any accident. On examination, an indurated tender nodule over right lower chest was present. Chest x-rays showed a metallic foreign body at right lower chest extending from skin to pleural cavity (Fig.1A,1B). Foreign body was removed under anesthesia. It was a two inches long sewing needle. Child was discharged on day three of hospitalization after information to authority for further action.
Isolated female epispadias without bladder exstrophy is a rare congenital anomaly affecting 1 in 484,000 females. The presenting features of female epispadias are urinary incontinence and abnormal anatomical features. A 6-year-old girl presented with primary urinary incontinence who on physical examination had a bifid clitoris and labia minora. The vagina and hymen were normal. Voiding cystourethrogram showed no reflux and a funnel shaped proximal urethra. With the diagnosis of isolated female epispadias, one-stage reconstruction of the urethra, bladder neck, labia minora and clitoris was performed.
Trichobezoar is less common in boys. We are reporting a case of isolated ileal trichobezoars in a 4-year old boy causing intestinal obstruction and gut ischemia with perforation and peritonitis. The case was managed surgically with ileal resection and anastomosis. Postoperative period was uneventful.
A baby girl was born, on the 35th week of gestation via cesarean section, to an 18-year old mother. Apgar score at the 1st and 5th minute was 8 and 9, respectively. Antenatal scan at 20th gestational week found microcephaly, edema in both lower extremities and the dilation of the proximal intestinal loops. No pathology was found on FISH examination in relation to chromosome 13, 18, 21, X and Y during amniocentesis. At birth baby had weight of 1890 gram (10-50 percentile), the height of 40cm (<10 percentile) and head circumference of 26cm (<10 percentile). Examination of the head revealed microcephaly, micrognathia and a high-bridged nose (Fig. 1). Edema was seen in both lower extremities (Fig. 1). CBC showed thrombocytopenia (86.000/mm3). Liver and kidney function tests, and albumin level were in normal range. Serologic tests for TORCH and Parvovirus were negative. Abdominal ultrasonography (USG) showed bilateral renal hypodysplasia. Ventricular septal defect was found on Echocardiography. Ophthalmologic examination showed microphthalmia, microcornea, and sclerocornea.
Intussusception is relatively common in infants but occurs only 0.3% of cases during the first month of life.[1] Majority of neonatal intussusceptions occur in full term babies and it is rare in the premature newborns. Poynter suggested intrauterine intussusception as a cause of intestinal atresia in 1922. Less than 100 cases of intrauterine intussusception in association with ileal atresia have been reported in the literature.[2,3] We are adding another case with similar anomaly.
Patent vitellointestinal duct (PVID) is a benign congrnital anomaly ususally presenting with fecal discharge from the umbilicus. In this report, we describe two cases of PVID presented with massive bowel prolapse through the PVID and signs of intestinal obstruction. Surgery revealed prolapse of the ileal intussusceptum through the PVID. Both of the babies were sucssesfully managed with surgery.
We read with great interest the contribution of Gupta et al on the lumbo-costo-vertebral syndrome (LCVS).[1] We encountered this rare anomaly in a 39 week-of-gestation female patient, who after an uncomplicated birth underwent investigation because of a left lumbar hernia, and vertebral anomalies. Imaging assay with plain radiography, revealed the presence of tenth and eleventh thoracic hemivertebrae, and intervertebral cleft of the twelfth thoracic vertebra. These anomalies resulted in clockwise thoracic and counterclockwise lumbar scoliosis. Magnetic resonance imaging revealed syringomyelia at the level of the three lower thoracic dysplastic vertebrae, and low termination of the spinal cord at the level of the fourth lumbar vertebra.
Concurrent spinal dural arteriovenous fistula (AVF) and cecal arteriovenous malformation (AVM) are very rare. A 6-year old boy presented with lower limb paresis after trauma. On imaging work-up spinal dural AVF was found. It was managed with endovascular glue embolization. After two years, the boy presented with severe anemia and occult gastrointestinal tract (GIT) bleed. Cecal AVM was diagnosed and managed with embolization.
Foreign body ingestion is very common in childhood especially under 3 year of age. Pica syndrome is characterized by an appetite for substances that are largely non-nutritive. We present a 3-year old girl who presented to ER with symptoms and signs of intestinal obstruction.
