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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 18 | Issue 2
Page Nos. 73-126

Online since Thursday, February 18, 2021

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ORIGINAL ARTICLES  

Association between the computed tomography findings and operative time for interval appendectomy in children p. 73
Takahiro Hosokawa, Yutaka Tanami, Yumiko Sato, Tetsuya Ishimaru, Hiroshi Kawashima, Eiji Oguma
DOI:10.4103/ajps.AJPS_94_20  PMID:33642402
Purpose: The purpose was to evaluate the association between operative time and findings noted on computed tomography (CT) immediately before interval appendectomy. Materials and Methods: Forty-two children who underwent CT before interval appendectomy were included. We evaluated the association between operative time and these image findings: (1) appendicolith, (2) increased intra-abdominal fat density around the appendix, (3) location of the appendix, (4) ascites, (5) abscess formation and (6) maximum appendix outer wall diameter. Appendix location was classified as (#1) just below the anterior abdominal wall; (#2) retrocaecal or retro-ascending colon and (#3) pelvic. Results were analysed using Pearson's correlation coefficient or Mann–Whitney U test. Results: The mean patient age and operative time were 116.24 ± 38.66 months (range, 31–195) and 67.76 ± 31.23 min (range, 30–179), respectively. Ascites was detected in only one case, and no abscess occurred in any patient; therefore, these findings were not analysed. Factors that significantly prolonged the operative time included increased intra-abdominal fat density around the appendix (absent, 59.43 ± 22.14 [range, 30–108] vs. present, 84.43 ± 40.13 [range, 32–179] min; P = 0.03) and retrocaecal or retro-ascending colon appendix (location 1, 40.83 ± 8.35 [range, 30–50]; location 2, 99.25 ± 18.56 [range, 74–135]; location 3, 64.54 ± 30.22 [range, 30–179] min; P < 0.01). There was a weak but significant association between maximum appendix outer wall diameter and operative time (R = 0.353; P = 0.02). Conclusion: These pre-operative CT findings are important predictors of operative time for interval appendectomy. Radiologists and surgeons should use these specific image findings to predict the operative time and need for additional procedures during an interval appendectomy.
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Compared outcomes of femoral shaft fracture treatment in school-age children in Sub-Saharan Africa: Primary open reduction and intramedullary K-wire fixation versus traction followed by spica cast Highly accessed article p. 79
Jean Baptiste Yaokreh, Moufidath Sounkéré-Soro, Samba Tembely, Yapo Guy-Serge Kouamé, Audrey Helen Thomas, Thierry-Hervé Odéhouri-Koudou, Bertin Dibi Kouamé, Ossénou Ouattara
DOI:10.4103/ajps.AJPS_35_20  PMID:33642403
Background: Elastic stable intramedullary nailing has become the treatment of choice for femur shaft fractures in school-age children in developed world. However, in the sub-Saharan Africa, this management is still challenging because of the lack of fluoroscopy in more hospitals. We performed either primary open reduction and intramedullary K-wire fixation (PORIKF) or conservative treatment. The aim of this study was to compare the clinical and functional outcomes of these two procedures employed. Patients and Methods: This retrospective study included 62 children with 64 fractures (10 years on an average; range: 6–15 years) treating for femoral shaft fractures either by PORIKF (n = 21; 23 fractures) or skin traction followed by spica cast (n = 41) between 2008 and 2017. Outcomes were assessed using Flynn criteria. Comparisons were made by Fisher and Student's t-test with a significant P < 5%. Results: Outcomes were satisfactory in 21 cases (91%) in the PORIKF group compared with 32 (78%) in the conservative group (P = 0.3012). The average hospital stay was 18.6 days in the PORIKF group, whereas it was 20 in the conservative group (P = 0.0601). The mean time for bone union was 13.9 weeks in the PORIKF group and 13.2 weeks in the conservative group, (P = 0.4346). There was a statistically significant difference between the two groups in terms of major complications (P = 0.0177). One patient had osteomyelitis in the PORIKF group. Unacceptable shortening >2 cm was observed only in the conservative group. The average time to return to daily activities was 30 days shorter in the PORIKF group when compared to conservative group (P < 0.05). Conclusion: PORIKF provides better results than conservative treatment. Open reduction did not increase the rate of infectious complication.
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Health literacy of parents/caregivers of paediatric surgical patients: A study on 1000 individuals p. 85
Georgios Kampouroglou, Venetia-Sofia Velonaki, Ioanna D Pavlopoulou, Marinos Kosmopoulos, Nikos Kouvas, Eleni Drakou, Nikolaos Skoutelis, Dimitrios Spinos, Stavros Tsagkaris, Konstantinos Tsoumakas
DOI:10.4103/ajps.AJPS_42_20  PMID:33642404
Purpose: There is a paucity of studies concerning health literacy (HL) of parents/guardians of patients in paediatric surgery. The purpose of our study is to measure HL levels of parents/guardians of paediatric surgery patients and to explore the determinants of low HL levels in this population. Materials and Methods: We conducted a cross-sectional study from December 2016 to July 2018 through in-person interviews of parents/guardians of paediatric surgical patients. Sociodemographic and clinical data were recorded, and HL levels were calculated using a validated tool (HLS-EU-Q16). In order to examine the impact of various sociodemographic variables and clinical data on HL, a multivariate regression model was run. Results: A total of 1000 participants were recruited (recruitment rate 93.5%). Slightly less than half (44.2%) presented problematic or inadequate HL levels. The results of the regression analysis showed that nationality other than Greek (β = −2.180, P < 0.001) and lower health insurance status (β = −0.461, P < 0.05) were associated with lower HL levels. HL was found positively associated with the educational level of the parent (β = −0.775, P < 0.001) and being a health professional (β = 1.791, P < 0.001). Conclusion: The prevalence of low HL levels in the parents/guardians of paediatric surgical patients is high and should not be neglected both in the pre-operative and post-operative setting. Communication should be tailored to the specific needs of each individual to achieve better engagement and quality of care.
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Evaluation of tunica vaginalis free graft as a better alternative to tunica vaginalis pedicled flap for providing waterproof cover in Stage II hypospadias repair Highly accessed article p. 90
Charu Tiwari, Nitinkumar Borkar
DOI:10.4103/ajps.AJPS_93_20  PMID:33642405
Background: Tunica vaginalis (TV) flap has been used by many surgeons as a waterproof layer to cover neourethra. We present our experience in using free TV graft as an alternative to TV flap for providing waterproof cover in second-stage hypospadias repair. Materials and Methods: A retrospective review of ten patients with severe hypospadias who underwent Stage II hypospadias repair over a period of 15 months was carried out. Free TV graft was used to cover neourethra in all the patients. Results: The median age of patients was 3.5 years. Six patients had proximal hypospadias with severe chordee and four patients had peno-scrotal hypospadias. Eight patients had undergone Byars procedure and two patients had undergone Bracka's procedure during the first stage repair in the same institute. The mean operative time for Stage II repair using free TV graft was 150 min (standard deviation ± 15 min). All patients passed urine in good stream following stent/feeding tube removal. The average duration of hospital stay was 11 days. None of our patients developed urethrocutaneous fistula. Only one patient had superficial surgical site infection. All patients are well on follow-up after 6 months. Conclusion: Free TV graft could be used in place of TV flap as an intermediate waterproof cover to reduce the incidence of urethrocutaneous fistula in staged II hypospadias repair; however, studies involving a larger number of patients would be required to draw conclusions.
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CASE REPORTS Top

Conservative management of iatrogenic tracheal rupture in a 19-month-old child p. 94
Tugba Acer-Demir, Esra Elif Arslan
DOI:10.4103/ajps.AJPS_13_20  PMID:33642406
Up to date, only five cases of iatrogenic tracheal rupture during rigid bronchoscopy have been reported in children. Herein, we report the first case who has recovered with spontaneous respiration without intubation. Rigid bronchoscopy of a 19-month-old girl revealed a foreign body at the right main bronchus. While the bronchoscope was being withdrawn, we identified a 0.5-cm longitudinal mucosal laceration along the right wall of the membranous trachea. As her spontaneous respiration was adequate, she was treated conservatively. For the treatment of tracheal lacerations, while early surgical repair has traditionally been acceptable, evidence supporting conservative treatment is increasing, particularly in paediatric cases. If spontaneous respiration is sufficient, bridging the laceration with an endotracheal tube may not be required.
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Bladder exstrophy with exstrophic rectal duplication in an infant: An extremely rare case p. 97
Levent Duman, Özkan Cesur, Mustafa Çagri Savas
DOI:10.4103/ajps.AJPS_89_20  PMID:33642407
Exstrophic rectal duplication and its association with bladder exstrophy and anorectal malformation is an extremely rare clinical entity. This is a report of the second case of an exstrophic rectal duplication associated with bladder exstrophy in English literature. However, it is the first case, where all these anomalies were accompanied by an anorectal malformation.
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Congenital lateral facial teratoma: A case report and review of literature p. 99
Enono Yhoshu, Gyanendra Chaudhary, Intezar Ahmed, Manish Kumar Gupta
DOI:10.4103/ajps.AJPS_77_20  PMID:33642408
Facial teratomas are uncommon tumours in children that distort the face and may be associated with functional problems. They are less common than cervical teratomas though they are often grouped together and considered an emergency due to their tendency to cause respiratory compromise. They tend to be large and cause cosmetic issues; hence usually noticed early and medical help sought promptly by parents. The close proximity of facial teratomas to structures like eyes, parotid gland, facial nerve, vessels and brain makes them challenging and requires a patient and meticulous exploration during surgery. We present a case of an 11 month old girl with left sided temporal teratoma. Well planning of the incision and complete excision of the tumour with careful sparing of the facial nerves and parotid gland yielded good result.
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Spontaneous rupture of sac in bochdalek hernia leading to acute intestinal obstruction p. 104
Vidyanand P Deshpande, Rajgopal J Totla, Arjun A Pawar, Pravin R Suryawanshi
DOI:10.4103/ajps.AJPS_79_20  PMID:33642409
Bochdalek hernia usually presents in neonates in the form of respiratory distress. Presentation as acute intestinal obstruction is extremely rare. We report a 6-month-old male infant with spontaneous rupture of the sac in a Bochdalek hernia leading to acute gastrointestinal obstruction. Diaphragmatic hernia can rarely present as acute intestinal obstruction due to spontaneous rupture of sac.
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A rare case of congenital ranula p. 106
Nitinkumar Bhajandas Borkar, Debajyoti Mohanty, Nighat Hussain, Rashmi Dubey, Sunita Singh, Abhimanyu Varshney
DOI:10.4103/ajps.AJPS_36_20  PMID:33642410
Simple ranula is a cystic swelling confined to the floor of mouth while plunging ranula presents with extension to the neck. Congenital ranula presenting with symptoms of feeding difficulties is a very rare occurrence. There is paucity of literature regarding the management of large congenital ranula. Varied treatment options are described for the management of ranula with variable recurrence rate. In paediatric and adult patients, ranula is considered as a type of extravasation cyst and removal of sublingual gland is advocated to remove the sources of extravasation. Congenital ranula is usually a variant of retention cyst and should be treated with marsupialisation or simple excision of cyst while cyst excision with sublingual sialadenectomy should be reserved for recurrent cases.
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Ruptured duplication cyst of transverse colon p. 109
Laraib Rasul, Navira Javed, Naeem Liaqat, Shoaib Tarrar, Jawad Abbasi
DOI:10.4103/ajps.AJPS_81_20  PMID:33642411
Duplication cysts of gastrointestinal tract are rare congenital abnormalities found in 0.2% of children. We report a rare case of a ruptured duplication cyst of transverse colon in a 7-year-old female child who presented with abdominal pain and mass in the right iliac fossa. We assumed it as an appendicular mass; however, it turned out to be a ruptured duplication cyst of transverse colon. Only two cases of duplication cyst of transverse colon have been reported yet in the literature.
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Surgical management of garre's osteomyelitis in an 8-year-old child p. 111
Lida Mary Nidhin Philip, Francis Akkara, Tahura Khwaja, Taradevi Narayan, Akshata G Kamath, Nidhin Philip Jose
DOI:10.4103/ajps.AJPS_66_20  PMID:33642412
Chronic non-suppurative osteomyelitis, also known as Garre's osteomyelitis is a well-described pathologic entity in dental literature. We present here a case report of a unilateral hard bony swelling of the lower jaw associated with infection. Radiograph revealed the pathognomic feature of 'onion skin' appearance. Surgical recontouring of the lower jaw was performed since there was no evidence of bone remodelling after removal of the infected tooth.
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Internal hernia through hepatic falciform ligament iatrogenic defect in a neonate: A case report and review of the literature p. 114
Guoxiu Han, Fengchun Cheng, Lianmeng Cao, Lei Geng, Xijie Liu, Guojian Ding, Tingliang Fu
DOI:10.4103/ajps.AJPS_14_20  PMID:33642413
Internal hernia through an iatrogenic defect in the hepatic falciform ligament and acquired jejunal atresia in a 8-day-old neonate was reported. The PubMed, MEDLINE, CNKI, Wanfang and Weipu databases were searched The literature about the hepatic falciform ligament iatrogenic defect causing internal hernia was analysed. Ten other cases were collected from the world literature. Herniated intestinal necrosis was found in four cases. All cases were recovered uneventfully after operation. Internal herniation through an iatrogenic defect in the hepatic falciform ligament is extremely rare. However, the case reports are increasing, especially in the era of laparoscopic surgery. Adequate closure or open the defect is essential to prevent internal hernia occurrence.
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Isolated central sterna clefts: A rare congenital malformation p. 117
Rachida Laamiri, Nahla Kechiche, Nahla Hmidi, Lassaad Sahnoun, Mongi Mekki, Mohsen Belghith, Amine Ksia, Abdellatif Nouri
DOI:10.4103/ajps.AJPS_47_20  PMID:33642414
Sternal cleft is a rare congenital anomaly which is generally observed at birth. The aetiology remains obscure. Superior clefts are more frequent than inferior ones, and isolated central clefts are extremely rare. Surgery is recommended to protect the heart and other mediastinal contents from trauma and also to improve respiratory dynamics. We present the case of a newborn with isolated central clefts and we will give a review of the literature.
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A report of a novel approach for the management of paediatric mandibular fracture using a prefabricated adaptable surgical splint p. 119
Puttaraj T Kattimani, Banibrata Lahiri, T Kishore Babu, N Koteswara Rao, Divakar Thiruvenkatakrishnan, Tejal R Patil, C Swarnalatha, J Suresh Babu, Abhishek Singh Nayyar
DOI:10.4103/ajps.AJPS_2_20  PMID:33642415
Paediatric facial fractures are relatively rare. The inherent elasticity of the bones with more of the cartilage than that of the mineralised bone accounts for this. The principles involved in the management of facial fractures are the same irrespective of the age of the patient; however, in children, the techniques used are necessarily modified by certain anatomical, physiological, psychological and feeding factors related to childhood and the parents. In an attempt to keep the treatment and fixation technique simple, the case, presented here, describes the management of a mandibular parasymphyseal fracture in a 16-month-old child with the use of a prefabricated adaptable surgical splint.
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HOW I DO IT Top

Simplified preformed silo bag crafted from standard equipment in African Hospitals p. 123
Ayman Elhosny, Behrouz Banieghbal
DOI:10.4103/ajps.AJPS_62_20  PMID:33642416
Silo bags are synthetic, flexible silicone bags used to cover and protect the bowel of neonates born with gastroschisis. They are transparent, which enables clinicians to visualise bowel colour and allows for gentle reduction until closure. Silo bags are expensive, and different sizes are needed depending on the gastroschisis size. Currently, tertiary hospitals in low-income countries experience great difficulty in purchasing these bags. Therefore, in this article, we present a method for creating a preformed silo bag by utilising readily available disposable equipment in secondary or tertiary hospitals. The disposable equipment required includes a 200- or 500-ml saline or blood bag, 16- or 18-Fr silicone/latex Foley catheter, Opsite® and 2-0 silk suture. The saline bag is cut and opened transversely. The Foley catheter is cut corresponding to the diameter of the saline bag opening, and both ends of the catheter piece are connected to each other to create a 'circle', which is used as the base for the opening. The edge of the saline bag is turned inside out around the catheter and then securely closed with a continuous suture, which fixes the folded part of the bag to the catheter. These silo bags are cheap and easily and quickly prepared at any centre in Africa and very similar to manufactured silo bags, which are comparatively costly and difficult to procure in limited-resource environments.
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