Background Management of bowel dysfunction in children is expensive. Pharmacological measures (PM) are the most commonly used treatment option which has shown to have varying outcomes. The next option after failed PM involves invasive surgical procedures like the Malone Antegrade Continence Enema (MACE). Trans Anal Irrigation (TAI) is an efficacious treatment modality between failed medical therapy and invasive surgeries. As no cost analysis of TAI in children has been conducted, this study evaluated the direct costs involved with TAI in comparison to PM from the health care provider perspective. Methods Children >4 years with persistent bowel dysfunction despite PM, were divided into three groups: Constipation, Pseudoincontinence and Incontinence group. The costs of existing PM and number of diapers used daily were noted for each patient. In all patients, PM was stopped and TAI was initiated. Improvement in symptoms and reduction in daily diaper usage over six months was recorded. The direct costs of TAI versus the costs that would be involved had PM been continued, were compared using paired ‘t’ test. Results 34 patients (20 male, 14 female) with an average age of 76.7 months were divided into three groups: Constipation:12, Pseudoincontinence:15 and Incontinence:7. In all groups, there was a significant reduction in direct costs with TAI in comparison to PM. Conclusion In children with bowel dysfunction, TAI is an effective and significantly economical treatment modality in comparison to PM and should be considered early on in the management therapy.

Objective: Rectal prolapse is common in children below the age of 4 years.A significant number of children undergo spontaneous resolution over time, hence upfront surgical treatment is not commonly offered to these patients, resulting in prolonged sufferring in symptomatic children while hoping for a spontaneous resolution.Abdominal rectopexy involves extensive mobilization of the rectum followed by its fixation to the presacral fascia(1) thereby increasing the risk of damage to the nervi erigentes, with resultant postoperative constipation, bladder and sexual dysfunction.The present study was done on the premise that the pathophysiology of prolapse begins with intussusception and hence can be prevented by pexing the start point that is the rectosigmoid instead of the rectum.Methods: Our study included patients over a period of six years who underwent upfront surgery for full thickness rectal prolapse.The surgery performed was a modification of the Well's procedure, by avoiding rectal mobilisation completely and by fixing the rectosigmoid to the presacral fascia using an absorbable mesh.Results: 17 patients (mean age -7 years) underwent surgery.Early recurrence occurred in one patient.There was no prolonged constipation, bladder dysfunction or mesh related complications.Conclusion: Upfront surgery for complete rectal prolapse stops the suffering a child has to undergo each time the child passes stools, while the parents are hoping for a spontaneous resolution with some form of conservative management.The surgical technique we followed is effective and avoids complications arising due to denervation of the rectum during mobilization.

Background Intussusception is the one of the commonest causes of intestinal obstruction requiring urgent attention in early childhood. There is no gold standard of non-operative reduction. We report our 6 years’ experience in non-operative reduction using our “RIGHT” (Reduction of Intussusception under General anesthesia using Hydrostatic Technique) technique, emphasizing the need to perform the procedure in the operating room (OR) under general anesthesia. This prospective observational study covering the period from July 2014 till May 2020 included patients diagnosed with intussusception. Hydrostatic reduction was performed in the OR under general anesthesia by infusing a saline enema and the reduction was confirmed by ultrasound. Results Forty-eight patients underwent reduction using the RIGHT technique. Successful reduction was achieved in 44 (91.6%) patients. Four (8.3%) patients needed surgery, three (6.2%) due to failed reduction and one (2.0%) due to perforation. One (2.2%) patient developed a recurrence. Conclusions The “RIGHT” technique is a combination of the best available techniques of reduction of intussusception. It ensures patient safety by being performed in the OR, being pain free, avoiding radiation, avoiding the risk of aspiration associated with sedation, and also being able to immediately address a failure of reduction or a complication by surgical exploration.

Background: Duplications of the alimentary tract are rare congenital malformations, out of which, true pyloric duplications constitute only 2.2%. They present with non-bilious vomiting and mimic hypertrophic pyloric stenosis (HPS). Pyloric duplications that are intraluminal are not separately visible at laparotomy, making their diagnosis difficult. Case presentation: Our case is a neonate with an intraluminal pyloric duplication cyst who presented with recurrent vomiting. The radiological evaluation suggested a duplication cyst medial to the second part of the duodenum towards the stomach’s lesser curvature with features of gastric outlet obstruction. Intraoperatively, a cystic mass of 1 x 2 cm intraluminally was found on opening the pylorus which was excised and pyloroplasty was done. Postoperatively the baby was discharged in a stable condition. Conclusion: Intraluminal pyloric duplication cysts are rare and the clinical presentation mimics HPS. They should be considered as a differential diagnosis in a neonate presenting with features of gastric outlet obstruction.

Esophageal dilatation is the modality of choice for managing anastomotic stricture after primary repair of esophageal atresia (EA). Balloon dilatation over guide wire is the preferred technique with minimal chances of mucosal erosion. In some cases of tight strictures, safe antegrade dilatation becomes impossible if the guidewire cannot be negotiated across the stricture. In such situations, retrograde dilatation is a safer alternative to avoid another thoracotomy for stricture resection and anastomosis.

Background: Phytobezoars are concretions of non-digestible vegetative matter in the gastroin­testinal tract and are a rare cause of intestinal obstruction in children. Case presentation: We report a case of intestinal obstruction in a 2-day-old neonate with no specific radiological features pointing to any common etiology. On exploratory laparotomy, a swollen raisin was found impacted in the ileum causing intestinal obstruction. The history taken in retrospect revealed that the elder sibling had witnessed her father perform a traditional ritual of putting a drop of honey into the mouth of the newborn and she imitated the same with a raisin, which led to the obstruction. Conclusion: A careful detailed history of local traditional rituals is at times, the most important pointer towards the etiology of a clinical condition. The basic clinical skill of history taking is still very important, despite the availability of advanced radiological investigations.

Purpose: To study the varied presentations and the outcomes in children with Type 2 Abernethy malformation following shunt ligation. Material and methods: Children with Type 2 Abernethy who had had been operated between 2013 and 2017 were included in the study. The diagnosis had been confirmed on ultrasonography, CECT or angiography. All patients underwent laparotomy. The shunt was identified, clamped and the bowel congestion was noted. The shunt was ligated if the bowel congestion was not significant or had improved. Relevant follow-up investigations were done to document the resolution or amelioration of symptoms and the patency of the shunt. Results: Five patients were included in the study with a median age of 6 years. Hepatopulmonary syndrome was the presentation in 4 patients while one patient presented with liver tumor. Ultrasonography and CECT were able to diagnose Type 2 malformation in 4 patients whereas in 1 patient the distal portal vein was not seen. The postoperative period was complicated in 3 patients. At the median follow up at 14 months, good intrahepatic portal flow in all patients. All patients demonstrated improvement/resolution of symptoms. Conclusion: Abernethy is rare malformation which can have a varied presentation. Additional investigations may be needed to confirm the diagnosis of Type 2 variety. Most patients have gradual improvement of symptoms. (C) 2018 Elsevier Inc. All rights reserved.