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   2009| July-December  | Volume 6 | Issue 2  
    Online since July 29, 2009

 
 
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EDUCATION
Childhood cancers: Challenges and strategies for management in developing countries
Lohfa B Chirdan, Fidelia Bode-Thomas, Oluwabunmi O Chirdan
July-December 2009, 6(2):126-130
DOI:10.4103/0189-6725.54783  PMID:19661650
The developing countries bear the greatest burden of childhood cancers as over 90% of the world's children live in these countries. Childhood cancer in most instances is curable, but many children die from cancer because most children live in developing countries without access to adequate treatment due to high cost of treatment and poor organization in these countries. Initiatives to increase cancer care in developing countries would therefore include establishment of standard cancer care centres, manpower training, establishment of standardized management protocols, procurements of standard drugs and collaboration with international organizations.
  8 6,480 386
CASE REPORTS
Meckel's diverticulum strangulated in an umbilical hernia
Akakpo-Numado Gamedzi Komlatse, Gnassingbe Komla, Attipou Komla, Boume Missoki Azanledji, Sakiye Kodjo Abossisso, Tekou Hubert
July-December 2009, 6(2):118-119
DOI:10.4103/0189-6725.54779  PMID:19661646
Background: Strangulated Meckel's diverticulum (MD) in an umbilical hernia (UH) is a rare event. We present herein a case of strangulated MD in UH in a child. Case Report: An 18-month girl was admitted with clinical features suggesting upper intestinal strangulation since seven days. Many attempts of reduction were done before admission. She was resuscitated and had exploratory laparotomy, which revealed the hernia sac containing a completely gangrenous MD. She had bowel resection and had an uneventful postoperative period. Conclusion: An MD may be the content of a strangulated UH. Bowel resection of the segment bearing the diverticulum is advisable if the latter is gangrenous.
  7 4,578 228
Duodenal atresia with 'apple-peel configuration' of the ileum and absent superior mesenteric artery: A rare presentation
Ashraf Ahmad, Dinesh Sarda, Prashant Joshi, Paras Kothari
July-December 2009, 6(2):120-121
DOI:10.4103/0189-6725.54780  PMID:19661647
According to the current understanding, duodenal atresia is considered to be a primary malformation resulting from the errors in recanalisation in early gestation. We report a rare case of duodenal atresia with apple-peel configuration of remaining small bowel with absent superior mesenteric artery in a preterm child, which indicates that in rare circumstances vascular accidents may be the underlying cause for duodenal atresia, and jejuno-ileal atresia; only second such case to be reported in the English literature.
  6 5,170 296
ORIGINAL ARTICLES
Congenital anterior urethral valves and diverticula: Diagnosis and management in six cases
Jiledar Rawat, Tanvir Roshan Khan, Sarita Singh, Madhukar Maletha, Shivnarain Kureel
July-December 2009, 6(2):102-105
DOI:10.4103/0189-6725.54773  PMID:19661640
Background: Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. Although they are referred to as valves, these obstructive structures often occur in the form of a diverticulum. The urethra in these cases shows saccular or bulbar dilatation known as anterior urethral diverticulum (AUD). They typically occur where there is a defect in the corpus spongiosum, leaving a thin-walled urethra. This segment of the urethra balloons out during voiding, simulating a mass that is sometimes visible along the ventral wall of the penis. The swelling is fluctuant and urine dribbles from the meatus on compression. The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula. Materials and Methods: We have studied children with congenital anterior urethral valves and diverticula. Six patients of AUVs with diverticula were admitted during the period of 2000-2007 and were prospectively evaluated. The mean age of presentation was 16 months (15 days to 4 years). Straining at micturition and a palpable penile swelling were the most common presenting features. The diagnosis was established by voiding cystourethrogram (VCUG) and supported by ultrasonography (USG). All patients were treated with single-stage open surgical excision except one who died preoperatively due to urosepsis. Initial lay opening of the penoscrotal urethra and delayed repair were done in one patient. Results: The surgical outcome was successful in all but one patient, who died of delayed presentation with severe back pressure changes, urinary ascitis and urosepsis. On long-term follow-up, all patients demonstrated good stream of urine. The renal functions were normal and the patients had no evidence of urinary infections. Conclusion: We propose that, the patients of AUVs, if not excessively delayed for treatment are otherwise well in terms of general condition as opposed to patients of posterior urethral valves. The diagnosis is easily established by VCUG and the severity is revealed by a sonogram. Open surgical excision is the method of choice for patients with a urethral diverticulum; however, cystoscopic fulguration is also feasible in selected patients. The outcome is excellent with minimal morbidity and mortality.
  6 6,633 499
CASE REPORTS
Patent processus vaginalis: A window to the abdomen
N Rahman, K Lakhoo
July-December 2009, 6(2):116-117
DOI:10.4103/0189-6725.54778  PMID:19661645
A patent processus vaginalis (PPV) allows a communication between the peritoneum and scrotum. Hydrocoele is the usual presentation of a PPV in children. However, with intraabdominal pathology the patent PPV may provide the first clue to the mischief within the abdomen. We present here two unusual cases associated with a PPV and migration of intraabdominal contents from the abdomen to the scrotum.
  5 32,529 323
ORIGINAL ARTICLES
Versatility of tubularized incised plate urethroplasty in the management of different types of hypospadias: 5-year experience
Gamal Al-Saied, Ahmed Gamal
July-December 2009, 6(2):88-92
DOI:10.4103/0189-6725.54770  PMID:19661637
Background: The outcomes of urethroplasty in the management of different types of hypospadias have continued to improve since the introduction of the tubularized incised plate (TIP) urethroplasty (Snodgrass method). The aim of this study was to evaluate the feasibility and applicability of TIP urethroplasty in the management of different types of hypospadias. Materials and Methods: This work was carried out at Al-Azhar University Hospital, Cairo, Egypt in the period from January 2002 to December 2002 and King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia; in the period from January 2003 to January 2007 by the same authors. The medical records of 175 boys with different types of hypospadias, who underwent TIP urethroplasty, were critically reviewed. Their age ranged from 9 to 36 months (mean age; 22.72 7.75 months).The period of follow-up was ranged from 7 to 60 months (mean 34.42 15.41). Results: All families were happy with penile aesthetic appearance. The total number of boys with different types of hypospadias was 175 (145 1ry and 30 2ry). Out of 175 cases, the overall urethrocutaneous fistula rate was 11 (6.29%), and the overall rates for glanular dehiscence, urethral stricture, meatal stenosis and meatal regression were 4 (2.29%), 5 (2.86%), 17 (9.71%), and 10 (5.71%), respectively. All cases of urethral stricture and most cases of meatal stenosis 12 (6.86%) responded well to regular urethral dilatation. Meatoplasty was performed in only 5 (2.85%) cases (1 of 1ry and 4 of 2ry cases). Secondary surgery for fistula repair and glans closure was successful in all patients. All children void with a single straight urinary stream in a forward direction, and have a rounded glans with vertical slit- like terminal glanular meatus. The mean hospital stay was 4.6 days. Conclusion: TIP urethroplasty with neourethral coverage using a vascularized pedicle of dartos flap is versatile and simple operation in management of different types of hypospadias. It has a good functional and cosmetic outcome.
  5 4,734 519
CASE REPORTS
Splenic abscess in children: A report of three patients
Kamal N Rattan, Yogender S Kadian, Vikas Saroha, Nipun Jindal
July-December 2009, 6(2):106-109
DOI:10.4103/0189-6725.54774  PMID:19661641
Splenic abscess is uncommon in paediatric age group. It usually occurs in conditions of disseminated infective focus. Conventional treatment of abscess is incision and drainage, although splenectomy or splenic conservation is alternative. In this report, we are presenting case summaries of three patients suffering from splenic abscess. A retrospective review of three children was managed for eplenic abscess in our institution.All three patients presented with pyrexia, weight loss, and recurrent abdominal pain for more than six weeks. Human immunodeficiency virus (HIV) antibody detection test (ELISA) was nonreactive in all of them. The first patient was managed by splenectomy because of multiple splenic abscesses involving the entire spleen; the second one had exploratory laparotomy and drainage of splenic abscess with preservation of the spleen; and the third patient had successful ultrasonic guided aspiration of abscess. The follow-up ultrasonography done after three and six months in two patients, with splenic conservation, did not reveal any recurrence of abscess. In children with splenic abscess, ultrasound guided aspiration of abscess should be the first line of treatment, when this fails either because of multiple abscesses or dense adhesions around the spleen then splenectomy or open drainage may become necessary.
  4 4,965 296
ORIGINAL ARTICLES
Bowel resection in Nigerian children
LO Abdur-Rahman, JO Adeniran, JO Taiwo, AA Nasir, T Odi
July-December 2009, 6(2):85-87
DOI:10.4103/0189-6725.54769  PMID:19661636
Background : Although bowel resections are commonly done for congenital malformations in children in developed countries, they usually follow neglected and preventable acquired diseases of the intestine in developing countries. Objectives : To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital. Materials and Methods: Data of the patients operated (from birth to 15 years) was retrospectively collected over eight years (January 1999 to December 2006). The biodata of children included the following: Indications for operation, type of operations, duration of admission, and outcome of treatment including complications. Patients with Hirschsprung's disease were excluded from the study because bowel resection forms part of their definitive surgical management. Results : There were 70 patients (38 boys and 32 girls). The age ranged between four hours to 15 years (median, five months). There were 16 (22.9%) neonates, 26 (37.1%) infants, and 28 (40%) grown children. The indications were congenital anomalies in the 16 neonates. Also, 23 (88.5%) infants had intussusception, 2 (7.7%) had midgut vovulusm and 1 (3.8%) had congenital small intestine band. Among the grown children, typhoid ileal perforation (TIP) was seen in 14 (50.0%), intussusception in 5 (17.9%), and other causes in nine patients. Overall, intussusception was the most common indication for bowel resection, followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8% and anastomotic leak in 42.8%. The duration of admission ranged between 4-35 days (median, 15 days). The overall mortality was 17.1% -; which was highest among neonates (56.3%), followed by the infants (26.9% -). Conclusion : Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation, preexisting malnutrition, and nonavailability of parenteral nutrition contributed to unacceptable morbidity and mortality.
  4 3,405 464
Neonatal intestinal obstruction in Benin, Nigeria
Osarumwense David Osifo, Jonathan Chukwunalu Okolo
July-December 2009, 6(2):98-101
DOI:10.4103/0189-6725.54772  PMID:19661639
Background: Intestinal obstruction is a life threatening condition in the newborn, with attendant high mortality rate especially in underserved subregion. This study reports the aetiology, presentation, and outcome of intestinal obstruction management in neonates. Materials and Methods: A prospective study of neonatal intestinal obstruction at the University of Benin Teaching Hospital, Benin, Nigeria, between January 2006-June 2008. Data were collated on a structured proforma and analysed for age, sex, weight, presentation, type/date of gestation/delivery, aetiology, clinical presentation, associated anomaly, treatment, and outcome. Results: There were 71 neonates, 52 were males and 19 were females (2.7:1). Their age range was between 12 hours and 28 days (mean, 7.9 2.7 days) and they weighed between 1.8 and 5.2 kg (average, 3.2 kg). The causes of intestinal obstruction were: Anorectal anomaly, 28 (39.4%); Hirschsprung's disease, 8 (11.3%)' prematurity, 3 (4.2%); meconeum plug, 2 (2.8%); malrotation, 6 (8.5%); intestinal atresia, 8 (11.3%); necrotising enterocolitis (NEC), 4 (5.6%); obstructed hernia, 4 (5.6%); and spontaneous gut perforation, 3 (4.2%). Also, 27 (38%) children had colostomy, 24 (33.8%) had laparotomy, 9 (12.8%) had anoplasty, while 11 (15.4%) were managed nonoperatively. A total of 41 (57.7%) neonates required incubator, 26 (36.6%) needed total parenteral nutrition, while 15 (21.1%) require d paediatric ventilator. Financial constraint, late presentation, presence of multiple anomalies, aspiration, sepsis, gut perforation, and bowel gangrene were the main contributors to death. Neonates with lower obstructions had a better outcome compared to those having upper intestinal obstruction ( P < 0.0001). Conclusion: Outcomes of intestinal obstruction are still poor in our setting; late presentation, financial constraints, poor parental motivation and lack of basic facilities were the major determinants of mortality.
  4 4,545 311
Minimal access surgery in children: An initial experience of 28 months
Abhaya R Gupta, Rahul Gupta, Vinay Jadhav, Beejal Sanghvi, Hemanshi S Shah, SV Parelkar
July-December 2009, 6(2):93-97
DOI:10.4103/0189-6725.54771  PMID:19661638
Background : This study reports our 28 months experience with minimal access surgery (MAS) in children. Materials and Methods : This was a review of all children who underwent MAS between December 2004 and March 2007 at the Departments of Paediatric Surgery, Seth Gordhandas Sunderdas Medical College (GSMC) and King Edward the VII Memorial (KEM) Hospital, India. Results and observations were tabulated and analysed, comparing with observations by various other authors regarding variety of indications such as, operative time, hospital stay, conversion rate, complications, safety, and feasibilty of MAS in neonates, in the appropriate operative groups. Results : A total of 199 procedures were performed in 193 children aged between 10 days and 12 years (average age: 5.7 years). One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH) repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical difficulty. The overall conversion rate was 3%. Morbidity and mortality were very minimal and the procedures were well tolerated in majority of cases. Conclusion : We concluded that MAS procedures appear to be safe for a wide range of indications in neonates and children. Further development and expansion of its indications in neonatal and paediatric surgery requires further multi-institutional studies and larger cohort of patients, to compare with standards of open surgery.
  3 6,676 240
GABBY: An ex vivo model for learning and refining the technique of preformed silo application in the management of gastroschisis
Natalie Dabbas, Zahid Muktar, Niyi Ade-Ajayi
July-December 2009, 6(2):73-76
DOI:10.4103/0189-6725.54766  PMID:19661633
Background: Gastroschisis (GS) is a congenital full-thickness defect of the anterior abdominal wall, whose incidence is increasing. Traditional postnatal management options include primary reduction and closure under general anaesthetic or operative silo construction for defects judged to be unsuitable for immediate repair. The cot-side application of the preformed silo (PFS) with delayed abdominal wall closure has recently been advocated as the management method of choice for infants with GS. We report a novel trainer designed to facilitate acquisition and refinement of the skills to apply the PFS. Materials and Methods: A model of an infant with GS was constructed to allow application of a PFS. Each step of the clinical application of a PFS could be simulated. Paediatric surgeons at a regional meeting participated in evaluating the model. This cohort was surveyed with regards to previous clinical experience applying the PFS, invited to apply the silo on the model and then resurveyed with regard to the technique, ease of the application of the PFS on the model, its robustness and potential use as a training tool. Results: Seventeen paediatric surgeons completed the surveys and applications of the PFS on the model. Under supervision, each step of the procedure was completed by all participants. Feedback was enthusiastic and positive and participants judged the model to be realistic and potentially very useful as a training tool (median score 8 out of 10). Conclusions: We have developed and evaluated a reproducible, low-cost model of an infant with GS. This ex vivo trainer may be a useful adjunct in the acquisition and refinement of the skills of surgeons who manage GS using a PFS.
  3 4,235 463
PRACTITIONERS SECTION
Complications of neonatal circumcision: Avoiding common pitfalls in a common procedure
AO Ademuyiwa, CO Bode
July-December 2009, 6(2):134-136
DOI:10.4103/0189-6725.54786  PMID:19661653
  3 3,793 350
7TH APSON ANNUAL GUEST LECTURE
Paediatric surgery in Nigeria: Past, present and future
Paul T.N Madu
July-December 2009, 6(2):137-142
DOI:10.4103/0189-6725.54787  PMID:19661654
  2 5,028 207
CASE REPORTS
Cystic adenomatoid malformation of the lung: A diagnostic dilemma
Anup Mohta, Ravi P Kanojia, Sapna Bathla, Nita Khurana
July-December 2009, 6(2):112-113
DOI:10.4103/0189-6725.54776  PMID:19661643
Congenital cystic adenomatoid malformation (CCAM) of the lung is an uncommon anomaly that arises from excessive disorganised proliferation of tubular bronchial structures excluding the alveoli. These are believed to represent focal pulmonary dysplasia because skeletal muscle may be identified from within the cyst wall. This report describes a case of an infant operated for presumed diagnosis of congenital diaphragmatic hernia. Diaphragm was found to be normal and further investigations revealed cystic mass in the lower lobe of the left lung. Thoracotomy was done to resect the lesion that revealed a type II CCAM on histopathological examination. The case stresses the need for better clinical examination and advanced radiological investigations in doubtful cases.
  2 4,786 361
LETTERS TO THE EDITOR
Acute intussusception due to intestinal Kaposi's sarcoma in an infant
R Bankole Sanni, R Nandiolo, Mouafo Tambo F Coulibaly Diaoudia, L Vodi, ML Mobiot
July-December 2009, 6(2):131-131
DOI:10.4103/0189-6725.54784  PMID:19661651
  2 2,375 160
ORIGINAL ARTICLES
Transfer of surgical competences in the treatment of intersex disorders in Togo
K Gnassingbe, S da Silva-Anoma, GK Akakpo-Numado, AH Tekou, B Kouame, C Aguehounde, L Coupris, RB Galifer, D Aubert, Y Revillon
July-December 2009, 6(2):82-84
DOI:10.4103/0189-6725.54768  PMID:19661635
Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo. Results: There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French- speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. Conclusion: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities.
  2 5,905 451
CASE REPORTS
An unusual cause of caecal perforation in a child
VL Simpkin, K Lakhoo
July-December 2009, 6(2):114-115
DOI:10.4103/0189-6725.54777  PMID:19661644
Faecolith impaction leading to caecal perforation is a rare cause of acute abdominal pain in children. We present a case of an 11-year-old boy who was admitted to our department with a perforated caecum caused by faecolith impaction. Histology demonstrated a normal appendix with ganglion cells present. No mechanism of action could be detected for the faecolith impaction. This is a previously unreported cause of caecal perforation in children.
  1 3,263 198
Haemorrhage in a scrotal lymphangioma in a child: A rarity
Kamal N Rattan, Pradeep Kajal, Yoginder S Kadian, Ruchi Gupta
July-December 2009, 6(2):110-111
DOI:10.4103/0189-6725.54775  PMID:19661642
We report here a case of cystic lymphangioma of scrotum presenting as acute scrotum due to haemorrhage. The diagnosis was confirmed on ultrasonography and magnetic resonance imaging and managed successfully by surgical excision. There was past history of bilateral congenital cataract for which the patient had undergone surgery with complete visual recovery. Scrotal cystic lymphangioma complicated by haemorrhage is rare; hence, the case is being reported with a review of literature.
  1 3,218 186
Double dumb-bell calculus in childhood
Prashant Joshi, Dinesh Sarda, Ashraf Ahmad, Gursev , Paras Kothari
July-December 2009, 6(2):122-123
DOI:10.4103/0189-6725.54781  PMID:19661648
An eight-year old male was admitted with complaints of right scrotal swelling, dysuria and intermittent retention of urine for 10 days. On per-rectal examination, a hard mass was palpable in the posterior urethra. An X-ray (KUB) of the abdomen revealed a double dumb-bell calculus at the base of bladder, extending into the posterior urethra. A cystolithotomy via the suprapubic approach was successfully curative.
  1 2,817 181
Paediatric laryngeal granular cell tumour
Ayuba M Dauda, F.K.R Iseh
July-December 2009, 6(2):124-125
DOI:10.4103/0189-6725.54782  PMID:19661649
Granular cell tumour (GCT) affecting the larynx is not common, especially in children. Most cases are apt to be confused with respiratory papilloma and may even be mistaken for a malignant neoplasia. We present a case of laryngeal GCT in a 12-year-old child to emphasize that the tumour should be regarded in the differential of growths affecting the larynx in children.
  1 2,911 185
LETTERS TO THE EDITOR
Mature cystic teratoma in falciform ligament of the liver in an infant
AN Gangopadhyay, Punit Srivastava, Vijai D Upadhyaya, Zaheer Hasan, KR Vijayendra, SP Sharma
July-December 2009, 6(2):132-133
DOI:10.4103/0189-6725.54785  PMID:19661652
  1 3,445 153
ABSTRACTS
APSON 2008 Abstracts

July-December 2009, 6(2):144-153
  - 3,557 218
BOOK REVIEW
Surgical principles and problem-based learning in surgery: A revision guide
Uba A Francis
July-December 2009, 6(2):143-143
  - 1,753 119
ORIGINAL ARTICLES
Protocol for managing acute cancrum oris in children: An experience in five cases
DS Adeola, AC Obiadazie
July-December 2009, 6(2):77-81
DOI:10.4103/0189-6725.54767  PMID:19661634
Background: Acute cancrum oris (NOMA) is a major health concern in most parts of northern Nigeria, affecting children aged 2-9 years. The management of the acute phase/condition poses a great clinical challenge. We present our protocol for the management of acute NOMA in a referral health facility in northern Nigeria. Materials and Methods: The management of five consecutive children with acute NOMA managed at the maxillo-facial department of Ahamdu Bello University Teaching Hospital, Kaduna, is presented. The initial management is conservative, followed later by multiple reconstructions. Results: NOMA thrives in children with poor nutritional status and/or compromised immune status. Aggressive wound debridement, antibiotic therapy and nutritional rehabilitation limited the spread of the orofacial tissue destruction and produced rapid wound healing. Conclusion : The management of acute NOMA should be nonoperative; surgery is only indicated to debride the ulcer. Efforts to boost patient's immune and nutritional status limit further tissue destruction and produced satisfactory wound healing.
  - 6,244 486
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