Vijayendra Kumar - Academia.edu (original) (raw)

Papers by Vijayendra Kumar

Introduction: Anorectal malformation [ARM] can be treated either by staged procedures or by a sin... more Introduction: Anorectal malformation [ARM] can be treated either by staged procedures or by a single stage procedure. In the present study we have performed single stage surgery of ARM in male neonates. Materials and Methods: Retrospective review of cases of ARM operated over 4 years at Indira Gandhi Institute of Medical Sciences, Patna, and Bihar from January 2015 to December 2018 were undertaken. In this study we have compared the results of single stage repair of Anorectal malformation with that of staged procedures performed earlier. Fifty four patients of Anorectal malformation were operated by single stage procedure (category 1) this was compared with staged procedures (category 2). Forty three patients underwent primary PSARP (posterior sagittal anorectoplasty) and the remaining 11 primary APP (abdomino-perineal pull through) procedure. The result of these single stage procedures were compared with that of staged procedures (category 2) in which a total of 39 cases were opera...

Malrotation with midgut volvulus often results in gangrene of midgut with relative sparing of duo... more Malrotation with midgut volvulus often results in gangrene of midgut with relative sparing of duodenum. An extremely unusual case of Malrotation with isolated necrosis of distal duodenum is described with brief review of literature. Isolated duodenal necrosis in association with malrotation is very rare; it increases the complexity of surgery and prolongs hospital stay.

APSP Journal of Case Reports, 2018

Background: With increasing survival of patients suffering from necrotizing enterocolitis (NEC) c... more Background: With increasing survival of patients suffering from necrotizing enterocolitis (NEC) colonic strictures, as its late sequelae, is increasingly being seen and most of these patients present with chronic constipation. Case Series: Five patients of acquired colonic stricture presenting with abdominal distension and constipation are being reported here. All five patients varied in clinical features, age at presentation and surgical manage-ment. Three of them had abdominal distension and constipation with poor nutritional status. Primary resection with anastomosis could be done in only one while stoma was made initially in other patients. One patient pre-sented with sealed perforation and fistula between jejunum and colon. All, except one patient, had stricture at splenic flexure. Histopathology of colon reported normal ganglion cells in all patients. Conclusion: All survivors of necrotizing enterocolitis, should be followed for the development of colonic stricture; It should ...

Journal of Advances in Medicine and Medical Research, 2020

Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing ... more Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing a case of Paediatric gastrointestinal perforation to Typhoid would be of help in reaching a proper diagnosis to guide appropriate management. Aims and Objectives: To review all cases of Typhoid perforation for their clinical, pathologic and intra-operative findings. Materials and Methods: A retrospective study was conducted on all cases of typhoid perforation (gastrointestinal perforation with positive Widal test) operated at a tertiary care centre from September 2015 to September 2018. Data regarding their clinical findings, investigation results, intraoperative findings, nature of the surgical intervention, postoperative results and histopathological findings were collected from their records and analysed. Results: A total of 13 patients were operated during this period with positive Widal’s test at presentation. 6/13 had single ileal perforation; two patients had multiple ileal perfor...

IOSR Journal of Dental and Medical Sciences, 2014

Congenital ureteric obstruction caused by a ureteric valve is an extremely rare entity. Our patie... more Congenital ureteric obstruction caused by a ureteric valve is an extremely rare entity. Our patient, a 6-year-old male, had undergone evaluation for recurrent pain in the left lower part of abdomen and was diagnosed as a case of left hydrouretronehrosis on ultrasound abdomen. Intravenous urography revealed left hydronephrosis and hydroureter with a cutoff in mid-ureteric region. Micturating cysto-urethrogram (MCUG) and cystoscopy were normal. Laparotomy with excision of valve with end to end uretro-uretrostomy was performed. Histopathology revealed Type II ureteric valve. A high index of suspicion is required to make a correct preoperative diagnosis.

Current Urology, 2011

Background: To assess two different operative techniques in hypospadias with special emphasis on ... more Background: To assess two different operative techniques in hypospadias with special emphasis on urinary flow with the help of uroflowmetry. Material and Methods: In this prospective study, all patients underwent either Snodgrass or Mathieu urethroplasty. Preoperative uroflowmetry was done in every patient. Postoperative uroflowmetry was done 2 weeks after stitch removal only in those patients who were not having urethral fistula. Postoperative dilation was done only in those patients who had decreased urinary flow as compared to preoperative values. Results: Fifty patients were included in this 2-year study. Uroflowmetry was performed in 37 patients. Twenty-two patients underwent Snodgrass urethroplasty and the other 15 had Mathieu urethroplasty. Pre-and postoperative Q max values were 6.57 ± 2.67 and 7.36 ± 3.90 ml/s, respectively. Q avg values were 4.16 ± 1.87 and 4.52 ± 2.50 ml/s, respectively. Although statistically insignificant, the Snodgrass technique appeared to be relatively better than Mathieu's technique. Conclusion: Uroflowmetry can predict the need for dilation in hypospadias. The Snodgrass technique appears to be functionally better than Mathieu's technique. With avoidance of unnecessary trauma due to dilation, the cooperation of pediatric patients can be achieved.

Annals of Pediatric Surgery, 2012

Background The aim of this study was to decrease complication rates in proximal hypospadias surge... more Background The aim of this study was to decrease complication rates in proximal hypospadias surgery. Methods A simple method of stenting using a polypropylene stent has been developed for the most severe form of hypospadias during the period from January 2008 to January 2011 in the Department of Pediatric Surgery. The total number of patients was 46. The patients were classified into group 1 (n = 23), in which a polypropylene stent was used, and group 2 (n = 23), in which a polypropylene stent was not used. Results In group 1, complications occurred in three patients (13.04%), whereas in group 2 it occurred in 12 patients (52.2%). The difference in the total number of complications between groups was highly significant (P < 0.001). In group 1, no patient needed redo surgery, and in group 2 four patients (17.39%) needed redo surgery (P < 0.05). All other patients responded to repeated dilatation in the follow-up. Conclusion Although the sample size was small, this simple modification can decrease the complication rate significantly in the most severe form of hypospadias. Ann

World Journal of Pediatrics, 2008

Background: Achalasia cardia is an uncommon disease in children particularly in infants. We prese... more Background: Achalasia cardia is an uncommon disease in children particularly in infants. We present 8 cases of achalasia who were encountered over a 12-year period. In infantile achalasia, respiratory symptoms predominate and vomiting may easily be mistaken for gastroesophageal reflux (GER). Vomiting of uncurdled milk is characteristic of achalasia. Methods: In this retrospective study, the data were obtained from records of the Department of Pediatric Surgery IMS, BHU Varanasi, India. The patients were diagnosed by clinical examination and barium study. Any other associated anomalies were noted in these patients. The patients underwent esophagocardiomyotomy with antireflux procedure via the abdominal route. Results: In the present series, 7 patients survived. The follow-up study after operation showed remarkable relief of symptoms with satisfactory weight gain. No post-operative death occurred in the patients. Achalasia associated with alacrimia was noted in one infant who was lost to follow up. One infant was initially diagnosed as having gastric volvulus, but exploration revealed achalasia cardia. Conclusions: Esophageal achalasia is a rare disease in children and its origin is generally indeterminable. Achalasia cardia should be emphasized in the differential diagnosis of an infant presenting with signs and symptoms of esophageal obstruction.

Journal of Pediatric Surgery, 2009

Duplications of the alimentary tract are spherical or tubular structures lined by epithelium simi... more Duplications of the alimentary tract are spherical or tubular structures lined by epithelium similar to intestine that are firmly attached to or share the wall of the alimentary tract and have a common blood supply with the adjacent segment of the bowel. Completely isolated duplication cysts are an extremely rare variety of gastrointestinal duplications with their own exclusive blood supply and do not communicate with the intestine. There are only 4 cases reported in the English literature-3 in childhood and 1 in an adult, and all are male. We report a case of noncommunicating isolated ileal duplication cyst in a 3-year-old female child that presented as a mass in the right iliac fossa, mimicking an intussusception. The duplication had its own blood supply arising from the terminal ileal mesentery. This report describes the first female patient with this condition and reviews the English literature.

Journal of Medical Case Reports, 2010

Introduction Anorectal malformation, one of the most common congenital defects, may present with ... more Introduction Anorectal malformation, one of the most common congenital defects, may present with a wide spectrum of defects. Almost all male patients present within first few days of life. Case presentation A five-month-old baby boy of Indian origin and nationality presented with anal atresia and associated rectourethral prostatic fistula. The anatomy of the malformation and our patient's good condition permitted a primary definitive repair of the anomaly. A brief review of the relevant literature is included. Conclusion Delayed presentation of a patient with high anorectal malformation is rare. The appropriate treatment can be rewarding.

Journal of Medical Case Reports, 2010

Introduction: Fetus in fetu is an extremely rare condition wherein a malformed fetus is found in ... more Introduction: Fetus in fetu is an extremely rare condition wherein a malformed fetus is found in the abdomen of its twin. This entity is differentiated from teratoma by its embryological origin, its unusual location in the retroperitoneal space, and the presence of vertebral organization with limb buds and well-developed organ systems. The literature cites less than 100 cases worldwide of twin fetus in fetu. Case presentation: A two-and-a-half-month-old Asian Indian baby boy had two malformed fetuses in his abdomen. The pre-operative diagnosis was made by performing an ultrasound and a 64-slice computer tomography scan of the baby's abdomen. Two fetoid-like masses were successfully excised from the retroperitoneal area of his abdomen. A macroscopic examination, an X-ray of the specimen after operation, and the histological features observed were suggestive of twin fetus in fetu. Conclusion: Fetus in fetu is an extremely rare condition. Before any operation is carried out on a patient, imaging studies should first be conducted to differentiate this condition from teratoma. Surgical excision is a curative procedure, and a macroscopic examination of the sac should be done after twin or multiple fetus in fetu are excised.

Journal of Indian Association of Pediatric Surgeons, 2009

laparotomy, small bowel was distended with terminal ileocecal segment atresia, absent appendix an... more laparotomy, small bowel was distended with terminal ileocecal segment atresia, absent appendix and distal microcolon with V-shaped mesenteric defect [Figure 1]. The dilated part of ileal segment was excised and an end to end anastomosis was made. The post operative period was uneventful. He was discharged on 14th post operative day in a satisfactory condition. The baby was thriving on follow-up. Case 2 A three-month-old baby presented with a prolapsing stoma in left iliac fossa, suggestive of sigmoid loop colostomy. He passed urine normally and mucous was discharged per rectum with adequate stoma function. He was earlier operated elsewhere and no previous operative records were available. The baby weighed 3.2 kg. Clinically, a atresia of recto-sigmoid region was suspected. Contrast enema showed contrast passing through normal recto sigmoid and colon and suggestive of micro colon. Contrast instilled into the stoma suggested dilated tapering loop towards right iliac fossa distally. There was diagnostic dilemma as the stoma in the left iliac fossa was loop ileostomy proximal to dilated atretic ileac segment, instead of sigmoid loop colostomy. At laparotomy, the ileum was dilated up to ileocecal junction with collapsed cecum without mesenteric defect. There was micro colon in continuity up to the

Journal of Indian Association of Pediatric Surgeons, 2008

Aim: Report of a series of 12 cases of juvenile polyposis coli. Methods: The study period was fro... more Aim: Report of a series of 12 cases of juvenile polyposis coli. Methods: The study period was from 1995 to 2005. All the patients were treated by total colectomy with rectal mucosectomy and endorectal ileoanal pullthrough with or without ileal pouch formation. Covering ileostomy was avoided in all the cases. Time taken for the surgery, postoperative complications and continence were documented. Results: The mean operating time was 4.2 h (range: 4-5 h). The mean duration of hospital stay was 16.3 days (range: 15-18 days). The most common postoperative complication was pouchitis and perianal excoriation. Initially, all the patients were passing stools at an interval of 2 h, and after 3 weeks, the frequency has reduced to 6-8 stools per day. In the follow-up after 3 months, the frequency was 3-5 per day with minimal soiling. Conclusions: Single-stage total colectomy with rectal mucosectomy and endorectal ileoanal pull-through without covering ileostomy and pouch formation is a safe and definitive treatment for juvenile polyposis coli if the patient selection is appropriate.

Journal of Indian Association of Pediatric Surgeons, 2007

The purpose of this study was to inquire into the clinical features and methods for the diagnosis... more The purpose of this study was to inquire into the clinical features and methods for the diagnosis and management of single-system ectopic ureters associated with renal dysplasia. Materials and Methods: A total of 13 female patients were studied. Main stay of diagnosis was ultrasonography of KUB region and intravenous urography and renal scan was used to confirm the diagnosis. Histopathological evaluation was done in all cases for documentation of renal dysplasia. Result: In eight cases ectopic ureter with dysplastic kidney was seen on left side and in five it was on right side. All the patients were treated with nephroureterectomy of the affected side because of poor functioning of ipsilateral dysplastic kidney. Conclusion: Continuous urinary incontinence in females with a normal voiding pattern should prompt an evaluation for ureteric ectopia and when initial evaluation yields diagnosis of solitary kidney the clinician should be aware of the possibility of a hypoplastic and/or dysplastic on one side and normally functioning kidney on opposite side. Nephroureterectomy is the treatment of choice for unilateral single system ectopic ureter with renal dysplasia of affected side.

Indian Journal of Medical and Paediatric Oncology, 2013

Background: There is minimal literature on the use of intralesional chemotherapy in the pediatric... more Background: There is minimal literature on the use of intralesional chemotherapy in the pediatric age group. We undertook this present study to evaluate the two modalities (intratumoral and intravenous) of giving chemotherapy in terms of toxicity of chemotherapy, hematological parameters, efficacy of chemotherapy in reduction in volume of the tumor as well as resectability of tumor with special emphasis on immunological parameters. Materials and Methods: Advanced cases of Wilms′ tumor and Neuroblastoma were included in the study. Intratumoral chemotherapy was given through 25 G spinal needle under aseptic precautions and ultrasound guidance in the same dose as in systemic chemotherapy. Intravenous group was given chemotherapy in the usual way. Reassessment was carried out after every course of chemotherapy. Results: Group A included 16 cases of Wilms′ tumor and 6 cases of neuroblastoma. In group B, there were 14 cases of Wilms′ tumor and 8 of neuroblastoma. Vomiting, diarrhea, mucos...

Indian Journal of Cancer, 2008

BACKGROUND: Primary gastrointestinal system malignancies constitute approximately 2% of pediatric... more BACKGROUND: Primary gastrointestinal system malignancies constitute approximately 2% of pediatric neoplasm and of these; colorectal carcinoma is the second most common malignancy. This is one of the rarer diseases in children. AIM: We reviewed our records to study the clinical features, outcome and the follow-up of this condition with evaluation of the prognostic factors. SETTINGS AND DESIGN: Tertiary care Pediatric Surgery centre. Retrospective study. MATERIALS AND METHODS: The data of all patients with diagnosis of colorectal carcinoma from January 1986 to January 2006 were reviewed. The confi rmation of the diagnosis was by biopsy from the lesion. The age, sex, family history, clinical features, response to the treatment and follow-up were studied. RESULTS: There were four male patients. All had bleeding per rectum as the presenting complaint. Three patients had advanced disease at presentation. All the patients had signet cell adenocarcinoma. The two patients expired and one was lost to follow-up. One patient is alive after one year of follow up and is receiving treatment. CONCLUSION: Colorectal cancer in children though rare can be a reality, hence any children presenting with pain in abdomen along with doubtful history of constipation and rectal bleeding should be examined carefully with special emphasis on digital rectal examination.

Cases Journal, 2009

Introduction: The congenital constriction ring of lower extremity is very uncommon and rare condi... more Introduction: The congenital constriction ring of lower extremity is very uncommon and rare condition. The actual incidence in general population is not known. In English literature, very few cases are reported time to time as congenital constriction band syndrome associated with musculoskeletal disorder like congenital talipes equino varus. The lesion can involve skin only or goes to deeper structure up to bone, which can lead to gangrene of foot or auto amputation. Case presentation: We are presenting a case of bilateral congenital constriction ring in lower limb who presented at age of 4 year without any other associated congenital anomaly, simply managed by Z-plasty, which improves quality of life after physiotherapy. Conclusion: Congenital constriction ring of lower limb is extremely rare condition in children. Early diagnosis and management is mandatory, either in single stage or by stage procedure, to prevent auto-amputation of limb and to improve quality of life on feet.

Cases Journal, 2008

Acquired gastric outlet obstruction (GOO) during infancy beyond the neonatal period is a very rar... more Acquired gastric outlet obstruction (GOO) during infancy beyond the neonatal period is a very rare condition when other congenital causes like infantile hypertrophic pyloric stenosis, antral diaphragm, pyloric atresia etc are excluded. We report an unusual case of 6 month old male child who presented with recurrent episode of vomiting not relieved by medication. On gastrograffin study there was pre pyloric stricture of unknown etiology and was managed by stricturoplasty. We are reporting this case because of its rarity and with excellent outcome if diagnosed and managed properly. Even on extensive search of English literature we are not able to find a single report of this lesion in infants.

Cases Journal, 2008

Jejunoileal atresia is a congenital anomaly that is characterized clinically by bilious vomiting ... more Jejunoileal atresia is a congenital anomaly that is characterized clinically by bilious vomiting and abdominal distension. It has been associated with various congenital anomalies but its association with mesenteric cyst has only been reported sporadically. As this is a very rare entity, it is being reported with a brief review of literature.

Asian Journal of Surgery, 2008

OBJECTIVE: Advanced and inoperable solid tumours in children have high mortality despite aggressi... more OBJECTIVE: Advanced and inoperable solid tumours in children have high mortality despite aggressive multimodal treatment. Intravenous chemotherapy is abandoned at times because of systemic toxicity. This study investigated intratumoural chemotherapy and compared it with intravenous chemotherapy. METHODS: Forty children with advanced inoperable solid tumours (Wilms' tumour and neuroblastoma) were randomly allocated into two groups of 20. Group A was given intratumoural chemotherapy and group B was given intravenous chemotherapy. Both groups were compared for reduction in tumour size and volume, tumour resectability, histopathological changes and drug side effects. RESULTS: Intratumoural chemotherapy was superior to intravenous chemotherapy in terms of reducing tumour size and volume (63% in group A vs. 22% in group B). The resectability was 70% in the intratumoural group compared with 40% in the intravenous group. The overall good histopathological response was 71% in group A as opposed to 0% in group B. Moreover, the incidence and severity of drug side effects and morbidity were less with intratumoural chemotherapy. Mortality was also low in group A (5%) compared to group B (20%). CONCLUSION: Intratumoural chemotherapy can be offered as an effective and safe alternative treatment modality for advanced and inoperable Wilms' tumour and neuroblastoma.

Introduction: Anorectal malformation [ARM] can be treated either by staged procedures or by a sin... more Introduction: Anorectal malformation [ARM] can be treated either by staged procedures or by a single stage procedure. In the present study we have performed single stage surgery of ARM in male neonates. Materials and Methods: Retrospective review of cases of ARM operated over 4 years at Indira Gandhi Institute of Medical Sciences, Patna, and Bihar from January 2015 to December 2018 were undertaken. In this study we have compared the results of single stage repair of Anorectal malformation with that of staged procedures performed earlier. Fifty four patients of Anorectal malformation were operated by single stage procedure (category 1) this was compared with staged procedures (category 2). Forty three patients underwent primary PSARP (posterior sagittal anorectoplasty) and the remaining 11 primary APP (abdomino-perineal pull through) procedure. The result of these single stage procedures were compared with that of staged procedures (category 2) in which a total of 39 cases were opera...

Malrotation with midgut volvulus often results in gangrene of midgut with relative sparing of duo... more Malrotation with midgut volvulus often results in gangrene of midgut with relative sparing of duodenum. An extremely unusual case of Malrotation with isolated necrosis of distal duodenum is described with brief review of literature. Isolated duodenal necrosis in association with malrotation is very rare; it increases the complexity of surgery and prolongs hospital stay.

APSP Journal of Case Reports, 2018

Background: With increasing survival of patients suffering from necrotizing enterocolitis (NEC) c... more Background: With increasing survival of patients suffering from necrotizing enterocolitis (NEC) colonic strictures, as its late sequelae, is increasingly being seen and most of these patients present with chronic constipation. Case Series: Five patients of acquired colonic stricture presenting with abdominal distension and constipation are being reported here. All five patients varied in clinical features, age at presentation and surgical manage-ment. Three of them had abdominal distension and constipation with poor nutritional status. Primary resection with anastomosis could be done in only one while stoma was made initially in other patients. One patient pre-sented with sealed perforation and fistula between jejunum and colon. All, except one patient, had stricture at splenic flexure. Histopathology of colon reported normal ganglion cells in all patients. Conclusion: All survivors of necrotizing enterocolitis, should be followed for the development of colonic stricture; It should ...

Journal of Advances in Medicine and Medical Research, 2020

Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing ... more Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing a case of Paediatric gastrointestinal perforation to Typhoid would be of help in reaching a proper diagnosis to guide appropriate management. Aims and Objectives: To review all cases of Typhoid perforation for their clinical, pathologic and intra-operative findings. Materials and Methods: A retrospective study was conducted on all cases of typhoid perforation (gastrointestinal perforation with positive Widal test) operated at a tertiary care centre from September 2015 to September 2018. Data regarding their clinical findings, investigation results, intraoperative findings, nature of the surgical intervention, postoperative results and histopathological findings were collected from their records and analysed. Results: A total of 13 patients were operated during this period with positive Widal’s test at presentation. 6/13 had single ileal perforation; two patients had multiple ileal perfor...

IOSR Journal of Dental and Medical Sciences, 2014

Congenital ureteric obstruction caused by a ureteric valve is an extremely rare entity. Our patie... more Congenital ureteric obstruction caused by a ureteric valve is an extremely rare entity. Our patient, a 6-year-old male, had undergone evaluation for recurrent pain in the left lower part of abdomen and was diagnosed as a case of left hydrouretronehrosis on ultrasound abdomen. Intravenous urography revealed left hydronephrosis and hydroureter with a cutoff in mid-ureteric region. Micturating cysto-urethrogram (MCUG) and cystoscopy were normal. Laparotomy with excision of valve with end to end uretro-uretrostomy was performed. Histopathology revealed Type II ureteric valve. A high index of suspicion is required to make a correct preoperative diagnosis.

Current Urology, 2011

Background: To assess two different operative techniques in hypospadias with special emphasis on ... more Background: To assess two different operative techniques in hypospadias with special emphasis on urinary flow with the help of uroflowmetry. Material and Methods: In this prospective study, all patients underwent either Snodgrass or Mathieu urethroplasty. Preoperative uroflowmetry was done in every patient. Postoperative uroflowmetry was done 2 weeks after stitch removal only in those patients who were not having urethral fistula. Postoperative dilation was done only in those patients who had decreased urinary flow as compared to preoperative values. Results: Fifty patients were included in this 2-year study. Uroflowmetry was performed in 37 patients. Twenty-two patients underwent Snodgrass urethroplasty and the other 15 had Mathieu urethroplasty. Pre-and postoperative Q max values were 6.57 ± 2.67 and 7.36 ± 3.90 ml/s, respectively. Q avg values were 4.16 ± 1.87 and 4.52 ± 2.50 ml/s, respectively. Although statistically insignificant, the Snodgrass technique appeared to be relatively better than Mathieu's technique. Conclusion: Uroflowmetry can predict the need for dilation in hypospadias. The Snodgrass technique appears to be functionally better than Mathieu's technique. With avoidance of unnecessary trauma due to dilation, the cooperation of pediatric patients can be achieved.

Annals of Pediatric Surgery, 2012

Background The aim of this study was to decrease complication rates in proximal hypospadias surge... more Background The aim of this study was to decrease complication rates in proximal hypospadias surgery. Methods A simple method of stenting using a polypropylene stent has been developed for the most severe form of hypospadias during the period from January 2008 to January 2011 in the Department of Pediatric Surgery. The total number of patients was 46. The patients were classified into group 1 (n = 23), in which a polypropylene stent was used, and group 2 (n = 23), in which a polypropylene stent was not used. Results In group 1, complications occurred in three patients (13.04%), whereas in group 2 it occurred in 12 patients (52.2%). The difference in the total number of complications between groups was highly significant (P < 0.001). In group 1, no patient needed redo surgery, and in group 2 four patients (17.39%) needed redo surgery (P < 0.05). All other patients responded to repeated dilatation in the follow-up. Conclusion Although the sample size was small, this simple modification can decrease the complication rate significantly in the most severe form of hypospadias. Ann

World Journal of Pediatrics, 2008

Background: Achalasia cardia is an uncommon disease in children particularly in infants. We prese... more Background: Achalasia cardia is an uncommon disease in children particularly in infants. We present 8 cases of achalasia who were encountered over a 12-year period. In infantile achalasia, respiratory symptoms predominate and vomiting may easily be mistaken for gastroesophageal reflux (GER). Vomiting of uncurdled milk is characteristic of achalasia. Methods: In this retrospective study, the data were obtained from records of the Department of Pediatric Surgery IMS, BHU Varanasi, India. The patients were diagnosed by clinical examination and barium study. Any other associated anomalies were noted in these patients. The patients underwent esophagocardiomyotomy with antireflux procedure via the abdominal route. Results: In the present series, 7 patients survived. The follow-up study after operation showed remarkable relief of symptoms with satisfactory weight gain. No post-operative death occurred in the patients. Achalasia associated with alacrimia was noted in one infant who was lost to follow up. One infant was initially diagnosed as having gastric volvulus, but exploration revealed achalasia cardia. Conclusions: Esophageal achalasia is a rare disease in children and its origin is generally indeterminable. Achalasia cardia should be emphasized in the differential diagnosis of an infant presenting with signs and symptoms of esophageal obstruction.

Journal of Pediatric Surgery, 2009

Duplications of the alimentary tract are spherical or tubular structures lined by epithelium simi... more Duplications of the alimentary tract are spherical or tubular structures lined by epithelium similar to intestine that are firmly attached to or share the wall of the alimentary tract and have a common blood supply with the adjacent segment of the bowel. Completely isolated duplication cysts are an extremely rare variety of gastrointestinal duplications with their own exclusive blood supply and do not communicate with the intestine. There are only 4 cases reported in the English literature-3 in childhood and 1 in an adult, and all are male. We report a case of noncommunicating isolated ileal duplication cyst in a 3-year-old female child that presented as a mass in the right iliac fossa, mimicking an intussusception. The duplication had its own blood supply arising from the terminal ileal mesentery. This report describes the first female patient with this condition and reviews the English literature.

Journal of Medical Case Reports, 2010

Introduction Anorectal malformation, one of the most common congenital defects, may present with ... more Introduction Anorectal malformation, one of the most common congenital defects, may present with a wide spectrum of defects. Almost all male patients present within first few days of life. Case presentation A five-month-old baby boy of Indian origin and nationality presented with anal atresia and associated rectourethral prostatic fistula. The anatomy of the malformation and our patient's good condition permitted a primary definitive repair of the anomaly. A brief review of the relevant literature is included. Conclusion Delayed presentation of a patient with high anorectal malformation is rare. The appropriate treatment can be rewarding.

Journal of Medical Case Reports, 2010

Introduction: Fetus in fetu is an extremely rare condition wherein a malformed fetus is found in ... more Introduction: Fetus in fetu is an extremely rare condition wherein a malformed fetus is found in the abdomen of its twin. This entity is differentiated from teratoma by its embryological origin, its unusual location in the retroperitoneal space, and the presence of vertebral organization with limb buds and well-developed organ systems. The literature cites less than 100 cases worldwide of twin fetus in fetu. Case presentation: A two-and-a-half-month-old Asian Indian baby boy had two malformed fetuses in his abdomen. The pre-operative diagnosis was made by performing an ultrasound and a 64-slice computer tomography scan of the baby's abdomen. Two fetoid-like masses were successfully excised from the retroperitoneal area of his abdomen. A macroscopic examination, an X-ray of the specimen after operation, and the histological features observed were suggestive of twin fetus in fetu. Conclusion: Fetus in fetu is an extremely rare condition. Before any operation is carried out on a patient, imaging studies should first be conducted to differentiate this condition from teratoma. Surgical excision is a curative procedure, and a macroscopic examination of the sac should be done after twin or multiple fetus in fetu are excised.

Journal of Indian Association of Pediatric Surgeons, 2009

laparotomy, small bowel was distended with terminal ileocecal segment atresia, absent appendix an... more laparotomy, small bowel was distended with terminal ileocecal segment atresia, absent appendix and distal microcolon with V-shaped mesenteric defect [Figure 1]. The dilated part of ileal segment was excised and an end to end anastomosis was made. The post operative period was uneventful. He was discharged on 14th post operative day in a satisfactory condition. The baby was thriving on follow-up. Case 2 A three-month-old baby presented with a prolapsing stoma in left iliac fossa, suggestive of sigmoid loop colostomy. He passed urine normally and mucous was discharged per rectum with adequate stoma function. He was earlier operated elsewhere and no previous operative records were available. The baby weighed 3.2 kg. Clinically, a atresia of recto-sigmoid region was suspected. Contrast enema showed contrast passing through normal recto sigmoid and colon and suggestive of micro colon. Contrast instilled into the stoma suggested dilated tapering loop towards right iliac fossa distally. There was diagnostic dilemma as the stoma in the left iliac fossa was loop ileostomy proximal to dilated atretic ileac segment, instead of sigmoid loop colostomy. At laparotomy, the ileum was dilated up to ileocecal junction with collapsed cecum without mesenteric defect. There was micro colon in continuity up to the

Journal of Indian Association of Pediatric Surgeons, 2008

Aim: Report of a series of 12 cases of juvenile polyposis coli. Methods: The study period was fro... more Aim: Report of a series of 12 cases of juvenile polyposis coli. Methods: The study period was from 1995 to 2005. All the patients were treated by total colectomy with rectal mucosectomy and endorectal ileoanal pullthrough with or without ileal pouch formation. Covering ileostomy was avoided in all the cases. Time taken for the surgery, postoperative complications and continence were documented. Results: The mean operating time was 4.2 h (range: 4-5 h). The mean duration of hospital stay was 16.3 days (range: 15-18 days). The most common postoperative complication was pouchitis and perianal excoriation. Initially, all the patients were passing stools at an interval of 2 h, and after 3 weeks, the frequency has reduced to 6-8 stools per day. In the follow-up after 3 months, the frequency was 3-5 per day with minimal soiling. Conclusions: Single-stage total colectomy with rectal mucosectomy and endorectal ileoanal pull-through without covering ileostomy and pouch formation is a safe and definitive treatment for juvenile polyposis coli if the patient selection is appropriate.

Journal of Indian Association of Pediatric Surgeons, 2007

The purpose of this study was to inquire into the clinical features and methods for the diagnosis... more The purpose of this study was to inquire into the clinical features and methods for the diagnosis and management of single-system ectopic ureters associated with renal dysplasia. Materials and Methods: A total of 13 female patients were studied. Main stay of diagnosis was ultrasonography of KUB region and intravenous urography and renal scan was used to confirm the diagnosis. Histopathological evaluation was done in all cases for documentation of renal dysplasia. Result: In eight cases ectopic ureter with dysplastic kidney was seen on left side and in five it was on right side. All the patients were treated with nephroureterectomy of the affected side because of poor functioning of ipsilateral dysplastic kidney. Conclusion: Continuous urinary incontinence in females with a normal voiding pattern should prompt an evaluation for ureteric ectopia and when initial evaluation yields diagnosis of solitary kidney the clinician should be aware of the possibility of a hypoplastic and/or dysplastic on one side and normally functioning kidney on opposite side. Nephroureterectomy is the treatment of choice for unilateral single system ectopic ureter with renal dysplasia of affected side.

Indian Journal of Medical and Paediatric Oncology, 2013

Background: There is minimal literature on the use of intralesional chemotherapy in the pediatric... more Background: There is minimal literature on the use of intralesional chemotherapy in the pediatric age group. We undertook this present study to evaluate the two modalities (intratumoral and intravenous) of giving chemotherapy in terms of toxicity of chemotherapy, hematological parameters, efficacy of chemotherapy in reduction in volume of the tumor as well as resectability of tumor with special emphasis on immunological parameters. Materials and Methods: Advanced cases of Wilms′ tumor and Neuroblastoma were included in the study. Intratumoral chemotherapy was given through 25 G spinal needle under aseptic precautions and ultrasound guidance in the same dose as in systemic chemotherapy. Intravenous group was given chemotherapy in the usual way. Reassessment was carried out after every course of chemotherapy. Results: Group A included 16 cases of Wilms′ tumor and 6 cases of neuroblastoma. In group B, there were 14 cases of Wilms′ tumor and 8 of neuroblastoma. Vomiting, diarrhea, mucos...

Indian Journal of Cancer, 2008

BACKGROUND: Primary gastrointestinal system malignancies constitute approximately 2% of pediatric... more BACKGROUND: Primary gastrointestinal system malignancies constitute approximately 2% of pediatric neoplasm and of these; colorectal carcinoma is the second most common malignancy. This is one of the rarer diseases in children. AIM: We reviewed our records to study the clinical features, outcome and the follow-up of this condition with evaluation of the prognostic factors. SETTINGS AND DESIGN: Tertiary care Pediatric Surgery centre. Retrospective study. MATERIALS AND METHODS: The data of all patients with diagnosis of colorectal carcinoma from January 1986 to January 2006 were reviewed. The confi rmation of the diagnosis was by biopsy from the lesion. The age, sex, family history, clinical features, response to the treatment and follow-up were studied. RESULTS: There were four male patients. All had bleeding per rectum as the presenting complaint. Three patients had advanced disease at presentation. All the patients had signet cell adenocarcinoma. The two patients expired and one was lost to follow-up. One patient is alive after one year of follow up and is receiving treatment. CONCLUSION: Colorectal cancer in children though rare can be a reality, hence any children presenting with pain in abdomen along with doubtful history of constipation and rectal bleeding should be examined carefully with special emphasis on digital rectal examination.

Cases Journal, 2009

Introduction: The congenital constriction ring of lower extremity is very uncommon and rare condi... more Introduction: The congenital constriction ring of lower extremity is very uncommon and rare condition. The actual incidence in general population is not known. In English literature, very few cases are reported time to time as congenital constriction band syndrome associated with musculoskeletal disorder like congenital talipes equino varus. The lesion can involve skin only or goes to deeper structure up to bone, which can lead to gangrene of foot or auto amputation. Case presentation: We are presenting a case of bilateral congenital constriction ring in lower limb who presented at age of 4 year without any other associated congenital anomaly, simply managed by Z-plasty, which improves quality of life after physiotherapy. Conclusion: Congenital constriction ring of lower limb is extremely rare condition in children. Early diagnosis and management is mandatory, either in single stage or by stage procedure, to prevent auto-amputation of limb and to improve quality of life on feet.

Cases Journal, 2008

Acquired gastric outlet obstruction (GOO) during infancy beyond the neonatal period is a very rar... more Acquired gastric outlet obstruction (GOO) during infancy beyond the neonatal period is a very rare condition when other congenital causes like infantile hypertrophic pyloric stenosis, antral diaphragm, pyloric atresia etc are excluded. We report an unusual case of 6 month old male child who presented with recurrent episode of vomiting not relieved by medication. On gastrograffin study there was pre pyloric stricture of unknown etiology and was managed by stricturoplasty. We are reporting this case because of its rarity and with excellent outcome if diagnosed and managed properly. Even on extensive search of English literature we are not able to find a single report of this lesion in infants.

Cases Journal, 2008

Jejunoileal atresia is a congenital anomaly that is characterized clinically by bilious vomiting ... more Jejunoileal atresia is a congenital anomaly that is characterized clinically by bilious vomiting and abdominal distension. It has been associated with various congenital anomalies but its association with mesenteric cyst has only been reported sporadically. As this is a very rare entity, it is being reported with a brief review of literature.

Asian Journal of Surgery, 2008

OBJECTIVE: Advanced and inoperable solid tumours in children have high mortality despite aggressi... more OBJECTIVE: Advanced and inoperable solid tumours in children have high mortality despite aggressive multimodal treatment. Intravenous chemotherapy is abandoned at times because of systemic toxicity. This study investigated intratumoural chemotherapy and compared it with intravenous chemotherapy. METHODS: Forty children with advanced inoperable solid tumours (Wilms' tumour and neuroblastoma) were randomly allocated into two groups of 20. Group A was given intratumoural chemotherapy and group B was given intravenous chemotherapy. Both groups were compared for reduction in tumour size and volume, tumour resectability, histopathological changes and drug side effects. RESULTS: Intratumoural chemotherapy was superior to intravenous chemotherapy in terms of reducing tumour size and volume (63% in group A vs. 22% in group B). The resectability was 70% in the intratumoural group compared with 40% in the intravenous group. The overall good histopathological response was 71% in group A as opposed to 0% in group B. Moreover, the incidence and severity of drug side effects and morbidity were less with intratumoural chemotherapy. Mortality was also low in group A (5%) compared to group B (20%). CONCLUSION: Intratumoural chemotherapy can be offered as an effective and safe alternative treatment modality for advanced and inoperable Wilms' tumour and neuroblastoma.