Transverse testicular ectopia is a rare form of congenital urogenital anomalies. It is characterised by migration and descent of both testes through a single inguinal canal. Laparoscopy is useful for both diagnosis and management of transverse testicular ectopia. The surgical options for management are transseptal orchiopexy and transperitoneal orchiopexy. This article describes the case of a 2‑year‑old boy who had transseptal right orchiopexy for transverse testicular ectopia. Keywords: Cryptorchidism, transverse testicular ectopia, undescended testis

A BSTRACT The coexistence of bilateral multicystic dysplastic kidneys (MCDKs) and high anorectal malformation with pouch colon is exceptionally rare. The combination results in a nonsurvivable condition due to complete renal failure, posing complex diagnostic and management challenges. A full-term male neonate presented with absent anal opening, limb and auricular deformities, and progressive anuria since birth. Antenatal history was unavailable. Clinical examination revealed bilateral clubfoot and normal male genitalia. Laboratory evaluation showed steadily worsening renal function. Ultrasound demonstrated bilateral MCDK with multiple cysts and gross hydronephrosis. A high-divided sigmoid colostomy was performed, and intraoperatively, a Type IV pouch colon was identified. Despite supportive management, including percutaneous nephrostomy, no urine output was achieved. Given the confirmed diagnosis of bilateral nonfunctioning kidneys and poor prognosis, the family opted for termination of care and support. This case highlights the diagnostic and ethical challenges associated with managing rare, fatal congenital anomalies in neonates. Early antenatal detection, when available, may facilitate better parental counseling and decision-making.

Concomitant anterior urethral valves and posterior urethral valves (AUV and PUV) are extremely rare congenital causes of bladder outlet obstruction in boys and can lead to significant renal damage if undiagnosed. A 10-month-old male, antenatally detected with bilateral hydroureteronephrosis, presented with dribbling and a weak urinary stream since birth. Micturating cystosurethrogram (MCU) showed a trabeculated bladder with left vesicoureteric reflux and a pseudodiverticulum inside the anterior urethra, forming an obtuse angle with the ventral urethra, suggestive of an AUV. Cystoscopy confirmed both AUV and PUV, which were fulgurated in a single session with good postoperative recovery. A well-performed MCU and complete cystoscopic evaluation are essential to detect coexisting lesions, as missed AUVs may cause persistent obstruction even after PUV ablation. Awareness of this rare dual pathology facilitates early diagnosis and treatment, preventing progressive bladder and renal dysfunction.

Empyema of the gall bladder is a rare condition, especially in the paediatric age group. We report a case of a 12-year-old male with empyema of the gall bladder who was previously operated on for transposition of the great arteries with ASD at 2 months of age. After initial resuscitation, open cholecystectomy was done. But symptoms persisted. So, the patient was again operated on for retained calculus in CBD and ERCP with retrieval of calculus and stenting was done. Now the patient is asymptomatic.

Adrenocortical adenoma is a rare tumour in children and even rarer in infancy. Most of these tumours in the paediatric age group are hormonally active and predominantly present with virilisation. Cortisol hypersecretion, presenting as Cushing syndrome, is extremely rare and seen in older age groups. We are reporting two cases of adrenal adenoma with different clinical presentations. The first case was of a 9‑month‑old female who presented with isolated features of Cushing’s syndrome (CS). The second case was of a 3‑year‑old male who presented with features of CS, virilisation and dyselectrolytemia. The clinical, biochemical and histological features are discussed. These cases are being reported because of their rarity. Early diagnosis, proper peri‑operative management, complete excision of the tumour and close follow‑up are crucial to improve survival and quality of life. Keywords: Adenoma, adrenocortical tumour, Cushing’s syndrome, dyselectrolytemia, infant, paediatric, virilisation

INTRODUCTION:Hypospadias is a common congenital disorder of the male external genitalia which is repaired surgically. Platelet rich plasma (PRP) gel formed by centrifugation of autologous blood has been shown to promote wound healing and has previously been used as a covering layer in hypospadias repair. OBJECTIVE:Objective comparison of the occurrence of urethrocutaneous fistula and overall cosmetic appearance after PRP gel application on children with mid and distal penile hypospadias. STUDY DESIGN:A two arm parallel design randomised controlled trial was performed on 50 children (age <14 years) with distal or mid penile hypospadias at a tertiary care centre in India from July 2024 to July 2025. We compared the patients who underwent Tubularised Incised Plate urethroplasty with PRP gel application (Study Group) to those who underwent standard tubularised incised plate urethroplasty (Control Group). RESULTS:We noted a comparable preoperative Glans, Meatus and Shaft score between the groups (7.1 v/s 6.7, p = 0.25). Urethrocutaneous fistula had lower occurrence in the study group (8/25 v/s 12/25, p = 0.25). Post operative Hypospadias Objective Scoring Evaluation (HOSE) scores at 1 and 3 months were significantly different between the study and control groups respectively (14.4 v/s 12.6, p = 0.001; 14 v/s 11.7, p < 0.001) DISCUSSION & CONCLUSION: Utilization of platelet rich plasma gel in anterior hypospadias repair is safe and may have a role in reducing the occurrence of urethrocutaneous fistula and improving the overall cosmetic appearance. Its use may be extended to posterior hypospadias and compared to tissue flaps like tunica vaginalis in future studies.

The occurrence of infantile hypertrophic pyloric stenosis (IHPS) in twins offers significant insight into the interplay of genetic and environmental factors in the etiology of the condition. IHPS is characterized by hypertrophy and hyperplasia of the pyloric muscle, leading to gastric outlet obstruction. Studies have shown that the concordance rate of IHPS is higher among monozygotic twins (0.25–0.44) compared to dizygotic twins (0.05–0.10), suggesting a stronger genetic component in identical twins. However, cases in dizygotic twins, although rare, are clinically significant and underscore the possible influence of shared environmental or perinatal risk factors.

Painless midline neck swellings have been a challenging confrontation for any surgeon, mostly due to numerous diagnostic possibilities at this location. Common ones include thyroglossal cyst, epidermoid cyst, dermoid cyst, enlarged lymph nodes, vascular anomaly etc. Due to a different treatment modality for each entity, proper diagnosis is necessary. We are presenting two cases of midline epidermal inclusion cyst having unique clinical and radiological features, creating a diagnostic query.

Neonate with a perineal mass may rarely present with a rectal duplication cyst. The index case presented with a perineal located mass which on evaluation revealed an exstrophied variant of a duplication cyst neonate associated with supernumerary kidney. She was subsequently managed surgically with the resection of mass and a diversion colostomy. It is understood that these extrophic variants are neither cystic nor tubular and maybe attached to the rectum or vagina but do not communicate with it. Previous reports of such rectal cysts are less than ten in number with this being the only one reported with supernumerary kidney.

Lipofibromatosis is a rare and benign soft-tissue tumor predominantly affecting children. It commonly presents as a slow-growing, painless mass, often misdiagnosed due to its rarity and variable presentation. We report the unusual case of an 8-month-old male with a congenital upper thoracic mass initially suspected to be a lipomyelomeningocele. Clinical examination and ultrasound supported this diagnosis, but magnetic resonance imaging findings suggested a soft-tissue tumor. The child underwent excisional biopsy, and intraoperative findings revealed a highly vascular, well-defined mass without spinal cord involvement. Histopathological analysis confirmed lipofibromatosis. The postoperative course was uneventful, and no recurrence was observed after 1 year of follow-up. This case highlights the diagnostic challenges associated with lipofibromatosis and its potential for misdiagnosis, and the importance of histopathology in establishing a definitive diagnosis. Early complete surgical excision remains the preferred treatment to prevent recurrence.

Pelviureteric junction obstruction (PUJO) is typically diagnosed through ultrasound and dynamic renal scintigraphy. This report describes a 5-year-old boy with right flank pain diagnosed as PUJO. Imaging revealed a narrowing at the pelvi-ureteric junction, and a subsequent diuretic renal scan indicated obstructed drainage. During surgery, a second narrowing due to congenital mid-ureteral stenosis was discovered, necessitating an excision of the obstructed ureter segment and pyeloplasty. This report highlights the rarity of Congenital Midureteral Stenosis (CMUS) and the challenges in diagnosing it, especially when it coexists with PUJO. Literature search revealed limited previous reports of this dual obstruction, stressing the importance of careful surgical evaluation in suspected cases of urinary obstruction.

Enterocutaneous fistulas, abnormal connections between the intestinal tract and the skin, are rare but serious postoperative complications associated with significant morbidity. This case presents a one-year-old male with anorectal malformation who developed subcutaneous emphysema secondary to an enterocutaneous fistula after colostomy closure and concurrent ureteric reimplantation. The fistula was managed with surgical excision and end-to-end bowel anastomosis, leading to full recovery with no recurrence. This report highlights the importance of considering rare differentials like enterocutaneous fistula in cases of subcutaneous emphysema at the wound site. It also underscores the complexity of managing multiple surgical procedures in pediatric patients and the importance of considering staged surgeries when feasible to reduce postoperative complications and improve outcomes. Timely diagnostic measures such as lateral abdominal X-ray played a critical role in early recognition and successful management.

Closed neural tube defects are known to be associated with multiple syndromic anomalies. These defects add to the patient’s morbidity and have a deleterious effect on their life. After a thorough review of literature, we could not find and reported cases of bilateral duplicated renal collecting systems in association with a closed neural tube defect. We are reporting this case to bring to light its rare nature and promote discussion related to its further management.

Congenital paraesophageal hernia is a rare condition in the pediatric population, with giant hiatal hernia (HH) being even more uncommon. We report a case of a 3-year-old male who presented with epigastric pain after meals, recurrent respiratory symptoms, early satiety, and a history of pneumonia. Imaging studies, including a chest X-ray, upper gastrointestinal (UGI) contrast study, and contrast-enhanced computed tomography thorax, confirmed a sliding HH. The laparoscopic evaluation revealed 80% of the stomach herniating into the thoracic cavity through lax esophageal hiatus contained in a sac. The patient underwent UGI endoscopy and laparoscopic reduction of contents, sac excision, diaphragmatic crural repair, and Thal's anterior fundoplication. Postoperative recovery was uneventful, with the patient remaining asymptomatic on follow-up. Congenital paraesophageal hernias are believed to arise from embryologic abnormalities and often present with atypical symptoms, such as respiratory distress, making early diagnosis challenging. The etiology can be confirmed only after ruling out all the acquired causes of HH. Surgical intervention is the preferred treatment, particularly in cases of giant HH, to prevent complications such as volvulus and obstruction. Adhering to key surgical principles - including complete hernia reduction, crural repair, and an appropriate antireflux procedure - ensures optimal outcomes. This case highlights the rarity of congenital giant HH in children and its unusual presentation with predominant respiratory symptoms. Laparoscopic repair, following established surgical principles, proved to be an effective and minimally invasive approach, leading to a successful outcome.

Introduction: Gastroschisis is a rare congenital abdominal wall defect whose management in resource-limited settings poses significant challenges of hypothermia, severe fluid loss resulting in shock, infections, intestinal necrosis, and intestinal obstruction. Commercially available preformed silo bags are often unaffordable and/or inaccessible. Case presentations: We used self-made silo bags in four patients with gastroschisis. Case 1 was a 39-week male with a 4-cm defect, who achieved complete reduction of the eviscerated bowel by day of life 6, followed by successful abdominal closure. The silo became dislodged once during the reduction process, but it was replaced easily. His growth continues to be appropriate at six months of follow-up. Case 2 was a 40-week male with a 4 cm defect, who achieved full reduction of the eviscerated bowel by day of life 7. He continues to grow well at 2 months of follow up. Case 3 was a 38-week female with a large (9 cm) defect and extensive herniation, who had suffered hypothermia and fluid loss before arrival. the hand-made silo was placed without difficulties. Before the herniated bowel could be completely reduced, the family left against medical advice and the patient was lost to follow up. Case 4 was a 40-week male with a 5 cm defect. Like the previous patient, before the herniated bowel could be completely reduced, the family left against medical advice, and he was lost to follow up. Conclusion: In resource-limited environments, self-made silo bags offer a practical and cost-effective solution for managing gastroschisis.

BACKGROUND:Many urinary biomarkers like MCP1, EGF, KIM1, CCL5/RANTES, CA19.9, NAG, TTF and micro albumin have been used as indicators of renal damage in HDN patients. Urine albumin-to-creatinine ratio (ACR) is widely used to detect renal damage in systemic diseases like diabetes and hypertension. While extensively studied in medical renal diseases, its role as an intraoperative prognostic biomarker for renal damage remains unexplored. ACR offers advantages such as low cost, easy availability, and spot testing. AIMS:To determine the correlation between urinary ACR from obstructed pelvis in the prognostication of renal function of children with unilateral pelviureteric junction obstruction. METHODS:This prospective observational pilot study included 30 patients with unilateral PUJO, aged over six months, undergoing Anderson-Hynes pyeloplasty. Patients underwent a standardized diagnostic protocol, including USG-KUB and technetium-99m DTPA renal scans. Preoperative urinary ACR from voided urine was measured. During surgery, urine from the obstructed pelvis was aspirated for ACR analysis. Data analysis compared preoperative and postoperative variables and intra-operative urinary ACR levels were correlated with change in differential renal function on DTPA. DISCUSSION:Postoperative outcomes currently rely on dynamic nuclear renal scans and USG performed 3 months after surgery. Intraoperative urinary ACR from the obstructed renal pelvis shows promise as an early biomarker for predicting renal function outcomes after pyeloplasty. It provides immediate results, alleviating parental anxiety by eliminating the usual delay in postoperative assessments. CONCLUSION:This study highlights the potential role of urinary ACR for peri-operative prognostication in children with PUJO, though larger studies are required to confirm these findings. LEVEL OF EVIDENCE:Level 2B - Prospective observational study.

Duodenal perforation (DP) is a very rare entity in neonates. Although there can be several causes of retroperitoneal mass in a neonate, DP presenting as a retroperitoneal mass has not been described in the literature. We present a case of DP masquerading as a retroperitoneal mass in a 28-day-old neonate.

Aims: Pediatric intestinal atresia poses a significant challenge for pediatric surgeons, especially in our area, where it is often treated as an emergency. Numerous factors affect patient outcomes, making it essential to identify potential management pitfalls. This study seeks to assess the management and outcomes of neonatal intestinal atresia in our Institution, pinpointing challenges, pitfalls, and areas for enhancement to improve patient care and outcomes. Methods: This is a retrospective observational study conducted at a tertiary care pediatric surgical center in Eastern India. The study spans five years, from January 2020 to June 2025, and includes all neonates and children who underwent surgery for intestinal atresia during this time. Results: A total of 31 patients with intestinal atresia were included in this retrospective study conducted over five years. Most patients (87%) were in the neonatal age group, with only 13% presenting in the post-neonatal period. There was a male predominance, with 24 males (77.4%) and 7 females (22.6%). Two primary anatomical categories were identified: Jejunoileal atresia (JIA) was the predominant condition, observed in 24 patients (77.4%). Duodenal web or duodenal atresia was present in 7 patients (22.6%). Among the JIA cases, type 3a was the most prevalent, accounting for 22.6%. The average duration to start enteral feeding was 16 days. The mean total duration until discharge was 21.7 days. The overall mortality rate was 38.7%, with 12 out of 31 patients succumbing. Conclusion: Children with gastrointestinal atresia often present late in their illness, experiencing significant morbidity and mortality due to factors such as poor economic conditions, inadequate nutrition, surgical challenges, and potentially related anomalies, rather than solely surgical morbidity. The high mortality rate observed in our study indicates a need to enhance our management protocols, which may be linked to delayed presentation, insufficient preoperative care, or postoperative complications. Further research is necessary to pinpoint specific areas for improvement and optimise patient outcomes.

Enteric duplication has cystic and tubular varieties. A male infant presented with a large cystic, well-demarcated mass in the right flank. On exploratory laparotomy, multiple cystic and tubular lesions were present adjacent to the mesenteric border of the small bowel along with malrotation of the small bowel. The tubule-cystic structure was excised along with the involved normal bowel segment and Ladd’s procedure was performed. Histopathological evaluation revealed an intestinal duplication cyst. The occurrence of midgut malrotation and volvulus along with duplication is uncommon. The cyst’s substantial size could have been an aetiological factor for malrotation and volvulus. The child’s small bowel had adapted remarkably with time. This case highlights a new variant of duplication cysts.