Ashish Wakhlu | King George's Medical University (original) (raw)

Papers by Ashish Wakhlu

Research paper thumbnail of Duodenal Obstruction in Infants and Children

Archives of Surgery, 1953

OBSTRUCTION of the duodenum occurring in infants and children is almost invariably the result of ... more OBSTRUCTION of the duodenum occurring in infants and children is almost invariably the result of congenital maldevelopment. The origin of the obstruction may be intrinsic or extrinsic. Intrinsic obstruction is usually caused by atresia and is therefore complete. However, incomplete intrinsic obstruction due to stenosis may also occur. Extrinsic obstruction is usually incomplete and is frequently accompanied by other anomalies. These accompanying anomalies may be malrotation of the colon, midgut volvulus, or both. Abnormalities in the second stage of intestinal rotation may account for the extrinsic duodenal obstruction, the malrotation of the colon, and the midgut volvulus. The embryologic aspects of the conditions resulting in duodenal obstruction have been thoroughly and completely presented in the publications of Dott,1Ladd,2Wakefield and Mayo,3Gardner and Hart,4Webb and Wangensteen,5Haymond and Dragstedt,6and others. Further elaboration on this phase of the problem would be unnecessarily

Research paper thumbnail of Scleredema in a 6-week-old baby

Research paper thumbnail of Forme fruste choledochal cyst

PubMed, Nov 1, 2005

Two girls presenting with features of pancreatitis were diagnosed to have minimal dilatation of e... more Two girls presenting with features of pancreatitis were diagnosed to have minimal dilatation of extra hepatic biliary duct (EHBD) associated with pancreatico-biliary maljunction (PBMJ). A high degree of suspicion is required to diagnose this condition that has been termed Forme fruste choledochal cyst (FFCC). Both did well with pancreatico-biliary disconnection procedure and reconstruction of biliary channel using enteric conduit.

Research paper thumbnail of The wandering ventriculoperitoneal shunt and the scope of its salvage

Childs Nervous System, May 8, 2021

Distal shunt tube migration following ventriculoperitoneal (VP) shunt placement in children is mo... more Distal shunt tube migration following ventriculoperitoneal (VP) shunt placement in children is mostly managed by an initial shunt diversion/removal and subsequent replacement. Lately, shunt salvage is being used as an alternative in certain conditions. We have focused on the situations where one can consider or disregard shunt salvage in such cases. A retrospective study of children treated for distal shunt migration following VP shunt placement between January 2013 and December 2019. Seventeen children were managed for over 7 years. These included cutaneous extrusions (n = 4), hollow viscus perforation (n = 6), inguinal hernias (n = 5), and umbilical extrusion (n = 2). The surgical treatment varied from a cutaneous wound closure (with a tube in situ), temporary external shunt diversion, and laparotomy with shunt reposition into the peritoneal cavity. Shunt salvage was possible in three cases, whereas in 2 cases even though shunt salvage was possible, it was not feasible due to a short residual shunt length. VP shunt salvage is possible in certain cases of distal shunt migration with a functional uninfected shunt. Small cutaneous extrusions can be covered by a local skin flap. Also, one should consider the residual intraperitoneal shunt length before its salvage in small children.

Research paper thumbnail of Massive paraganglioma in an infant Massive paraganglioma in an infant

Research paper thumbnail of Paediatric Gastric Teratoma

European Journal of Pediatric Surgery, Dec 1, 2002

This paper reviews our experience with patients presenting with gastric teratoma treated over an ... more This paper reviews our experience with patients presenting with gastric teratoma treated over an eighteen-year period. This rare paediatric tumour has an excellent prognosis after curative resection. There were seven patients, all males. Investigations included a haematological profile, plain radiography and ultrasound of the abdomen. All patients were operated and the specimens subjected to histopathological examination. The age at presentation ranged from 1 month to 7 years. Two patients presented with melaena and the rest with progressively increasing abdominal mass. Our oldest patient had a massive tumour occupying nearly the whole abdomen. None of the children had metastases and none of the lesions had invaded adjacent structures. The tumours could be completely resected and all patients had an uneventful recovery. Histology of the tumours showed mature elements arising from the three germ layers in 6 children, one child had an immature teratoma. The average follow-up was 3 years (range 2 - 6 years). None of the patients has had a recurrence or any other problem. Gastric teratoma is a rare tumour but amenable to curative resection with an excellent prognosis.

Research paper thumbnail of Massive paraganglioma in an infant

Journal of Indian Association of Pediatric Surgeons, 2005

We report here a 7-month-old baby presenting with a large paraganglioma arising from the right si... more We report here a 7-month-old baby presenting with a large paraganglioma arising from the right side of neck and extending to the scalp. Catecholamine screening was within normal limits. Ultrasound of the abdomen, CT-scan, and whole body MRI excluded any other coexisting neuroendocrine tumor. The tumor was treated by radical excision, and the resultant soft tissue defect was resurfaced using a pectoralis major muscle flap with split skin grafting. There has been no recurrence or metastasis during the 2-year follow up. To the best of our knowledge, this is the youngest reported patient with paraganglioma of the neck. Surgical excision of paraganglioma is feasible and curative in the absence of metastasis.

Research paper thumbnail of An unusual presentation of pulmonary echinococcosis

PubMed, Oct 17, 1998

A case of pulmonary hydatid disease presenting with right supraclavicular cystic swelling is bein... more A case of pulmonary hydatid disease presenting with right supraclavicular cystic swelling is being reported. Radiologically, the cyst had an extension into the chest wall with bony involvement in the form of destruction and thinning of the first and second ribs on the right side. The patient responded to albendazole therapy.

Research paper thumbnail of Unique presentation of meckel's diverticulum

Journal of Indian Association of Pediatric Surgeons, Apr 1, 2002

ABSTRACT: This report describes an unusual presentation of Meckel's diverticulum in a 2-day o... more ABSTRACT: This report describes an unusual presentation of Meckel's diverticulum in a 2-day old male neonate. The clinical presentation was small bowel obstruction. Plain abdominal X-ray was suggestive of segmental small bowel dilatation. Laparotomy revealed a greatly distended Meckel's diverticulum; the intestine immediately distal to the diverticulum was kinked and trapped in its own anomalous artery. Resection of the distended diverticulum and restoration of bowel continuity was curative. This is a unique presentation of massive dilatation of Meckel's diverticulum in a neonate.

Research paper thumbnail of Isolated penile injury in boys: Accident, negligence, or abuse?

Journal of Indian Association of Pediatric Surgeons, 2021

Aim: The aim of the study was to highlight the etiology, spectrum of presentation, and management... more Aim: The aim of the study was to highlight the etiology, spectrum of presentation, and management of isolated penile trauma in boys. Methods: A retrospective review of boys treated for isolated penile trauma between January 2015 and June 2019 at a tertiary-level hospital. Results: Nine children were admitted over 4½ years. Etiology: The mechanism of penile injury (PI) was penile hair tourniquet (n = 5), postcircumcision (n = 2), dog bite (n = 1), and scald injury (n = 1). Extent of injury includes complete urethral transection at corona (n = 4); loss of urethral plate in a case of hypospadias (n = 1); complete loss of glans (n = 1); penile transection at corona (n = 1); total penile amputation (n = 1); and deep partial-thickness burns of penile shaft and adjacent suprapubic skin (n = 1). Management: One patient absconded. The remaining patients were managed as follows: calibration of urethral meatus (n = 1); penile burn was managed with dressing and antibiotics; coring of glans with urethral end–end anastomoses (n = 4); Bettocchi's quadrangular lower abdominal flap phalloplasty (n = 1); and Bracka's staged urethroplasty (n = 1). Complications include wound infection following trauma (n = 4), postsurgical infection (n = 3), urethrocutaneous fistula (n = 2), and reapplication of penile hair tourniquet (n = 1). Conclusion: Isolated PI in boys is not uncommon. Most are preventable if the parents are apprized and watchful. The clinician should also be vigilant regarding child maltreatment. A staged approach tailored to the type of injury provides a satisfactory outcome.

Research paper thumbnail of Case Report - Isolated cleft sternum: Neonatal surgical treatment

Isolated cleft sternum is a rare congenital defect of the anterior chest wall and is the result o... more Isolated cleft sternum is a rare congenital defect of the anterior chest wall and is the result of failed ventral midline fusion of sternal bands. We present two cases operated 18 and 24 days after birth with satisfactory results. Surgery is indicated to protect the heart and mediastinal contents.

Research paper thumbnail of Role of Bishop–Koop Procedure for Jejunal and Proximal Ileal Atresia

Journal of Neonatal Surgery, 2020

Background: This study was undertaken to review the Bishop–Koop procedure as a treatment option w... more Background: This study was undertaken to review the Bishop–Koop procedure as a treatment option with a grossly dilated proximal segment in jejunal and proximal ileal atresia.Materials and Methods: This was a retrospective cohort study conducted from January 2012 to June 2018 in the Department of Pediatric Surgery at King George's Medical University, Lucknow, India. The outcome, complication rate, and the follow-up study for postoperative adverse outcomes were assessed.Results: Thirty-two neonates underwent Bishop–Koop procedure. The mean age at presentation was 4.37  2.3 days. The male (n=22) to female (n=10) ratio was 2.2:1. Sixteeen had jejunal (type II-9, type III- 7), and 16 (type II-6, type III-10) had proximal ileal atresia. The mean duration of the hospital stay was 13.03  5.7 days. Oral feeds were initiated by the 7th postoperative day. In our study, the complication rate was 31.25% (n=10) and mortality rate was 37.5% (n=12).Conclusions: Bishop–Koop procedure appears t...

Research paper thumbnail of Window Colostomy as a Preliminary Diversion Procedure in Cases of Congenital Short Colon-Lessons Learnt in 10 Years

New Indian Journal of Surgery, 2015

Research paper thumbnail of Management Issues in Paediatric Liver Abscesses

New Frontiers in Medicine and Medical Research Vol. 4, 2021

Background: With evidence of increasing incidence, Liver abscesses remain an important cause of ... more Background: With evidence of increasing incidence, Liver abscesses remain an important cause of morbidity in children. Evaluation of the clinical profile and management outcomes of pediatric liver abscess would guide evidence-based management. Objectives: To determine how physical characteristics of Paediatric liver abscesses guide intervention and eventual treatment outcome. Methods: A retrospective, observational, cohort study was conducted on all LA patients managed from February 2011 to August 2016. Data regarding symptoms, possible predisposing factors, method of diagnosis, any interventions, and duration of stay were collected and analyzed. Sonographic characteristics of the lesion guided management in the study. Results: Thirty two patients with a mean age of 5.52 years were managed during this period. The clinical features were fever (25, 78%), pain in right hypochondrium (19, 59%), abdominal distension (4, 12.5%), subacute intestinal obstruction (2, 6.25%), and peritonitis (2, 6.25%). Three patients experienced abscess rupture. In three patients, conservative treatment was successful. In five individuals with a size of less than 100ml, USG guided needle aspiration was effective. In 21 patients with bigger lesions, pigtail insertion was required. In three individuals, a laparotomy was performed. One patient died as a result of severe sepsis and coagulopathy. All of the other patients were released. Conclusions: LA is an important cause for morbidity in children. It could lead to rupture and death if it isn't treated. High suspicion, early screening, and proper intervention in form-tailored management may yield positive outcomes.

Research paper thumbnail of Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals

BMC Pediatrics, 2020

Background India introduced rotavirus vaccines (RVV, monovalent, Rotavac™ and pentavalent, Rotasi... more Background India introduced rotavirus vaccines (RVV, monovalent, Rotavac™ and pentavalent, Rotasiil™) in April 2016 with 6, 10 and 14 weeks schedule and expanded countrywide in phases. We describe the epidemiology of intussusception among children aged 2–23 months in India. Methods The prospective surveillance at 19 nationally representative sentinel hospitals from four regions recruited children with intussusception from April 2016 to September 2017. Data on sociodemography, immunization, clinical, treatment and outcome were collected. Along with descriptive analysis, key parameters between four regions were compared using Chi-Square/Fisher’s exact/Mann–Whitney U/Kruskal-Wallis tests. The pre- and post-RVV periods were compared to estimate the risk ratios. Results Six hundred twenty-one children with intussusception from South (n = 262), East (n = 190), North (n = 136) and West (n = 33) regions were recruited. Majority (n = 465, 74.8%) were infants (40.0% aged 4–7 months) with medi...

Research paper thumbnail of Giant occipital encephalocele – Challenges in management

Journal of Indian Association of Pediatric Surgeons, 2020

Introduction: Giant occipital encephalocele (GOE) is a term used when the size of the OE is great... more Introduction: Giant occipital encephalocele (GOE) is a term used when the size of the OE is greater than or equal to the size of the head. It has been limited to case reports, with only sporadic exclusive series. This is a series of GOE managed at our center over time with emphasis on practical problems faced in management. Materials and Methods: This was a retrospective observational study. The patients were evaluated for the age of presentation, sex, and head size. Any associated neural tube defect was also looked for. Imaging was used for associated brain anomalies and to plan the surgical procedure. The requirement of ventriculoperitoneal (VP) shunt was also assessed. Results: During the study period of 7 years, 11 patients of GOE were admitted. Apart from one, all other patients were <1 year of age. Nine patients underwent surgical intervention, which included excision and repair of swelling with or without VP shunt placement. The content of the sac was only cerebrospinal fluid (CSF) in six patients and CSF and gliotic brain tissue in remaining patients. The attendants of two patients did not give consent for surgery and left against medical advice. Conclusion: GOE is an uncommon entity with limited information about management. Careful evaluation, proper imaging of patient, and care during intraoperative and postoperative periods with emphasis of factors determining the prognosis may provide satisfactory results.

Research paper thumbnail of Evaluation of nebulized N-acetyl cysteine in outcome of esophageal atresia with tracheoesophegeal fistula

Journal of Pediatric Surgery, 2020

To evaluate the role of nebulized N-acetyl cysteine (NAC) in liquefying the airway secretions and... more To evaluate the role of nebulized N-acetyl cysteine (NAC) in liquefying the airway secretions and improving the outcome of patients of esophageal atresia with tracheoesophageal fistula (EA + TEF). Methods: It was a non-randomized interventional study. Two milliliters of 10% NAC was given in a nebulized form (2:5 dilution, every six hourly) to patients of ET + TEF, along with regular suction of upper esophageal pouch. The group was compared with control, which comprised patients of EA + TEF receiving only saline nebulization. The consistency of the secretions was compared by hand held consistometer in unit of time (seconds) required to cross a predetermined distance along with gravity. Results: Sixty patients were assessed. Of these, 30 patients were present in both groups. The study group showed significant (p = 0.01-0.0001) decrease in consistency of secretions from the control group after day 2 of NAC nebulization. Patients' discharge was significantly (p = 0.01) earlier in cases. There was no significant (p = 0.41) difference in mortality between the groups. No specific adverse effects were observed in the study group. Conclusion: It appears that nebulized NAC decreases the consistency of secretions in EA + TEF patients. It is interesting to note that the group of patients that received NAC was discharged earlier than the control group and had a higher survival rate than the control group. Whether this is directly attributable to the use of NAC is unknown. A prospective double-blinded randomized clinical trial is warranted to confirm these results. Level of evidence: Level II, prospective comparative study (non-randomized).

Research paper thumbnail of Evaluation of effect of propranolol on serum vascular endothelial growth factor and tissue inhibitor of metalloproteinase-2 levels in infantile hemangioma

Journal of Indian Association of Pediatric Surgeons, 2020

Background: Infantile hemangioma is the most common tumor of infancy. Currently, propranolol is a... more Background: Infantile hemangioma is the most common tumor of infancy. Currently, propranolol is a preferred drug for treating hemangioma. The exact mechanism of action of propranolol is not known. In this study, we attempted to assess whether propranolol has any effect on vascular endothelial growth factor (VEGF) and tissue inhibitor of metalloproteinase-2 (TIMP-2) over a period of time, and if it is there, how long it affects it. Materials and Methods: Propranolol was administered in the dosage of 2–3 mg/kg. The first serum sample was collected before starting the propranolol treatment. Thereafter, samples were collected at monthly intervals up to a total of six samples. The samples were assessed for TIMP-2 and VEGF using enzyme-linked immunosorbent assay kit. Results: The duration of this study was from June 2016 to November 2017. The total number of patients in this study was 15. Thirteen patients responded to treatment. The mean age of patients was 7.1 months. The mean value of baseline VEGF was 0.234 ± 0.059 and that of TIMP-2 was 1.338 ± 0.679. As compared to baseline value, the P value was statistically not significant in any of sequential values. In category-wise analysis, apart from statistically significant value in the 6th month in excellent category and good response category in the 1st month, all other values did not reveal any significant change in VEGF analysis. The analysis of TIMP-2 revealed a significant change in the levels from Sample 2 to Sample 6 in the excellent response group; however, the levels did not show a specific trend either increasing or decreasing. Conclusion: Despite its beneficial action in regression of hemangioma, the exact mechanism is yet to be identified. The exact duration of treatment needs further evaluation.

Research paper thumbnail of Atresia of the Colon: Etiological Aberrations, Clinical Observations, and Challenges in Management

Journal of Neonatal Surgery, 2018

Objective: The objective of this study is to review the clinicoradiological profile, scheme of ma... more Objective: The objective of this study is to review the clinicoradiological profile, scheme of management and the outcome in cases of colonic atresia (CA), and ascertain an optimal approach for the treatment of CA to minimize morbidity and mortality. Design and Setting: This was a retrospective observational study carried out at a tertiary health‑care center. Duration: Total of 6 years duration (January 2011–December 2016).Materials and Methods: A retrospective analysis of 10 patients of CA managed over a 6- year period. Data related to demographics, clinical presentation, associated anomalies, radiologic, intraoperative findings, postoperative stay, complications, and outcome were analyzed.Results: There were three cases of Type II atresia involving terminal ileum, cecum, and adjacent colon. Three cases had proximal ascending colon atresia (Type IIIa [n = 2]; Type I [n = 1]) Type I [n=1], and two cases of type IIIa atresia of the hepatic flexure. Two babies had atresia involving th...

Research paper thumbnail of Evaluation of Clinical and Radiological Factors Determining the Need of Post-operative Ventilator Requirement in Patients of Esophageal Atresia

Journal of Neonatal Surgery, 2018

Objective: Ventilator requirement is an important constituent of post-operative care of patients ... more Objective: Ventilator requirement is an important constituent of post-operative care of patients of esophageal atresia (EA). In contrast to the developed world, the situation is very different in developing countries where the resources are limited, and ventilator may not be available to all patients of EA. This study was conducted to assess whether there are certain criteria, which may predict the possibility of non- requirement of ventilator for patients of EA in the post-operative period. Design: This study was a retrospective observational study. Setting: This study was conducted at a tertiary care teaching hospital. Duration: This study was conducted from 5 years and 6 months. Materials and Methods: We used certain parameters to assess the requirement of ventilators for the patients in the post-operative period. These included the presentation of patients before or after 3 days of life and birth weight (BW) of more or <2.5 kg. Presence of respiratory distress (RD) was analyz...

Research paper thumbnail of Duodenal Obstruction in Infants and Children

Archives of Surgery, 1953

OBSTRUCTION of the duodenum occurring in infants and children is almost invariably the result of ... more OBSTRUCTION of the duodenum occurring in infants and children is almost invariably the result of congenital maldevelopment. The origin of the obstruction may be intrinsic or extrinsic. Intrinsic obstruction is usually caused by atresia and is therefore complete. However, incomplete intrinsic obstruction due to stenosis may also occur. Extrinsic obstruction is usually incomplete and is frequently accompanied by other anomalies. These accompanying anomalies may be malrotation of the colon, midgut volvulus, or both. Abnormalities in the second stage of intestinal rotation may account for the extrinsic duodenal obstruction, the malrotation of the colon, and the midgut volvulus. The embryologic aspects of the conditions resulting in duodenal obstruction have been thoroughly and completely presented in the publications of Dott,1Ladd,2Wakefield and Mayo,3Gardner and Hart,4Webb and Wangensteen,5Haymond and Dragstedt,6and others. Further elaboration on this phase of the problem would be unnecessarily

Research paper thumbnail of Scleredema in a 6-week-old baby

Research paper thumbnail of Forme fruste choledochal cyst

PubMed, Nov 1, 2005

Two girls presenting with features of pancreatitis were diagnosed to have minimal dilatation of e... more Two girls presenting with features of pancreatitis were diagnosed to have minimal dilatation of extra hepatic biliary duct (EHBD) associated with pancreatico-biliary maljunction (PBMJ). A high degree of suspicion is required to diagnose this condition that has been termed Forme fruste choledochal cyst (FFCC). Both did well with pancreatico-biliary disconnection procedure and reconstruction of biliary channel using enteric conduit.

Research paper thumbnail of The wandering ventriculoperitoneal shunt and the scope of its salvage

Childs Nervous System, May 8, 2021

Distal shunt tube migration following ventriculoperitoneal (VP) shunt placement in children is mo... more Distal shunt tube migration following ventriculoperitoneal (VP) shunt placement in children is mostly managed by an initial shunt diversion/removal and subsequent replacement. Lately, shunt salvage is being used as an alternative in certain conditions. We have focused on the situations where one can consider or disregard shunt salvage in such cases. A retrospective study of children treated for distal shunt migration following VP shunt placement between January 2013 and December 2019. Seventeen children were managed for over 7 years. These included cutaneous extrusions (n = 4), hollow viscus perforation (n = 6), inguinal hernias (n = 5), and umbilical extrusion (n = 2). The surgical treatment varied from a cutaneous wound closure (with a tube in situ), temporary external shunt diversion, and laparotomy with shunt reposition into the peritoneal cavity. Shunt salvage was possible in three cases, whereas in 2 cases even though shunt salvage was possible, it was not feasible due to a short residual shunt length. VP shunt salvage is possible in certain cases of distal shunt migration with a functional uninfected shunt. Small cutaneous extrusions can be covered by a local skin flap. Also, one should consider the residual intraperitoneal shunt length before its salvage in small children.

Research paper thumbnail of Massive paraganglioma in an infant Massive paraganglioma in an infant

Research paper thumbnail of Paediatric Gastric Teratoma

European Journal of Pediatric Surgery, Dec 1, 2002

This paper reviews our experience with patients presenting with gastric teratoma treated over an ... more This paper reviews our experience with patients presenting with gastric teratoma treated over an eighteen-year period. This rare paediatric tumour has an excellent prognosis after curative resection. There were seven patients, all males. Investigations included a haematological profile, plain radiography and ultrasound of the abdomen. All patients were operated and the specimens subjected to histopathological examination. The age at presentation ranged from 1 month to 7 years. Two patients presented with melaena and the rest with progressively increasing abdominal mass. Our oldest patient had a massive tumour occupying nearly the whole abdomen. None of the children had metastases and none of the lesions had invaded adjacent structures. The tumours could be completely resected and all patients had an uneventful recovery. Histology of the tumours showed mature elements arising from the three germ layers in 6 children, one child had an immature teratoma. The average follow-up was 3 years (range 2 - 6 years). None of the patients has had a recurrence or any other problem. Gastric teratoma is a rare tumour but amenable to curative resection with an excellent prognosis.

Research paper thumbnail of Massive paraganglioma in an infant

Journal of Indian Association of Pediatric Surgeons, 2005

We report here a 7-month-old baby presenting with a large paraganglioma arising from the right si... more We report here a 7-month-old baby presenting with a large paraganglioma arising from the right side of neck and extending to the scalp. Catecholamine screening was within normal limits. Ultrasound of the abdomen, CT-scan, and whole body MRI excluded any other coexisting neuroendocrine tumor. The tumor was treated by radical excision, and the resultant soft tissue defect was resurfaced using a pectoralis major muscle flap with split skin grafting. There has been no recurrence or metastasis during the 2-year follow up. To the best of our knowledge, this is the youngest reported patient with paraganglioma of the neck. Surgical excision of paraganglioma is feasible and curative in the absence of metastasis.

Research paper thumbnail of An unusual presentation of pulmonary echinococcosis

PubMed, Oct 17, 1998

A case of pulmonary hydatid disease presenting with right supraclavicular cystic swelling is bein... more A case of pulmonary hydatid disease presenting with right supraclavicular cystic swelling is being reported. Radiologically, the cyst had an extension into the chest wall with bony involvement in the form of destruction and thinning of the first and second ribs on the right side. The patient responded to albendazole therapy.

Research paper thumbnail of Unique presentation of meckel's diverticulum

Journal of Indian Association of Pediatric Surgeons, Apr 1, 2002

ABSTRACT: This report describes an unusual presentation of Meckel's diverticulum in a 2-day o... more ABSTRACT: This report describes an unusual presentation of Meckel's diverticulum in a 2-day old male neonate. The clinical presentation was small bowel obstruction. Plain abdominal X-ray was suggestive of segmental small bowel dilatation. Laparotomy revealed a greatly distended Meckel's diverticulum; the intestine immediately distal to the diverticulum was kinked and trapped in its own anomalous artery. Resection of the distended diverticulum and restoration of bowel continuity was curative. This is a unique presentation of massive dilatation of Meckel's diverticulum in a neonate.

Research paper thumbnail of Isolated penile injury in boys: Accident, negligence, or abuse?

Journal of Indian Association of Pediatric Surgeons, 2021

Aim: The aim of the study was to highlight the etiology, spectrum of presentation, and management... more Aim: The aim of the study was to highlight the etiology, spectrum of presentation, and management of isolated penile trauma in boys. Methods: A retrospective review of boys treated for isolated penile trauma between January 2015 and June 2019 at a tertiary-level hospital. Results: Nine children were admitted over 4½ years. Etiology: The mechanism of penile injury (PI) was penile hair tourniquet (n = 5), postcircumcision (n = 2), dog bite (n = 1), and scald injury (n = 1). Extent of injury includes complete urethral transection at corona (n = 4); loss of urethral plate in a case of hypospadias (n = 1); complete loss of glans (n = 1); penile transection at corona (n = 1); total penile amputation (n = 1); and deep partial-thickness burns of penile shaft and adjacent suprapubic skin (n = 1). Management: One patient absconded. The remaining patients were managed as follows: calibration of urethral meatus (n = 1); penile burn was managed with dressing and antibiotics; coring of glans with urethral end–end anastomoses (n = 4); Bettocchi's quadrangular lower abdominal flap phalloplasty (n = 1); and Bracka's staged urethroplasty (n = 1). Complications include wound infection following trauma (n = 4), postsurgical infection (n = 3), urethrocutaneous fistula (n = 2), and reapplication of penile hair tourniquet (n = 1). Conclusion: Isolated PI in boys is not uncommon. Most are preventable if the parents are apprized and watchful. The clinician should also be vigilant regarding child maltreatment. A staged approach tailored to the type of injury provides a satisfactory outcome.

Research paper thumbnail of Case Report - Isolated cleft sternum: Neonatal surgical treatment

Isolated cleft sternum is a rare congenital defect of the anterior chest wall and is the result o... more Isolated cleft sternum is a rare congenital defect of the anterior chest wall and is the result of failed ventral midline fusion of sternal bands. We present two cases operated 18 and 24 days after birth with satisfactory results. Surgery is indicated to protect the heart and mediastinal contents.

Research paper thumbnail of Role of Bishop–Koop Procedure for Jejunal and Proximal Ileal Atresia

Journal of Neonatal Surgery, 2020

Background: This study was undertaken to review the Bishop–Koop procedure as a treatment option w... more Background: This study was undertaken to review the Bishop–Koop procedure as a treatment option with a grossly dilated proximal segment in jejunal and proximal ileal atresia.Materials and Methods: This was a retrospective cohort study conducted from January 2012 to June 2018 in the Department of Pediatric Surgery at King George's Medical University, Lucknow, India. The outcome, complication rate, and the follow-up study for postoperative adverse outcomes were assessed.Results: Thirty-two neonates underwent Bishop–Koop procedure. The mean age at presentation was 4.37  2.3 days. The male (n=22) to female (n=10) ratio was 2.2:1. Sixteeen had jejunal (type II-9, type III- 7), and 16 (type II-6, type III-10) had proximal ileal atresia. The mean duration of the hospital stay was 13.03  5.7 days. Oral feeds were initiated by the 7th postoperative day. In our study, the complication rate was 31.25% (n=10) and mortality rate was 37.5% (n=12).Conclusions: Bishop–Koop procedure appears t...

Research paper thumbnail of Window Colostomy as a Preliminary Diversion Procedure in Cases of Congenital Short Colon-Lessons Learnt in 10 Years

New Indian Journal of Surgery, 2015

Research paper thumbnail of Management Issues in Paediatric Liver Abscesses

New Frontiers in Medicine and Medical Research Vol. 4, 2021

Background: With evidence of increasing incidence, Liver abscesses remain an important cause of ... more Background: With evidence of increasing incidence, Liver abscesses remain an important cause of morbidity in children. Evaluation of the clinical profile and management outcomes of pediatric liver abscess would guide evidence-based management. Objectives: To determine how physical characteristics of Paediatric liver abscesses guide intervention and eventual treatment outcome. Methods: A retrospective, observational, cohort study was conducted on all LA patients managed from February 2011 to August 2016. Data regarding symptoms, possible predisposing factors, method of diagnosis, any interventions, and duration of stay were collected and analyzed. Sonographic characteristics of the lesion guided management in the study. Results: Thirty two patients with a mean age of 5.52 years were managed during this period. The clinical features were fever (25, 78%), pain in right hypochondrium (19, 59%), abdominal distension (4, 12.5%), subacute intestinal obstruction (2, 6.25%), and peritonitis (2, 6.25%). Three patients experienced abscess rupture. In three patients, conservative treatment was successful. In five individuals with a size of less than 100ml, USG guided needle aspiration was effective. In 21 patients with bigger lesions, pigtail insertion was required. In three individuals, a laparotomy was performed. One patient died as a result of severe sepsis and coagulopathy. All of the other patients were released. Conclusions: LA is an important cause for morbidity in children. It could lead to rupture and death if it isn't treated. High suspicion, early screening, and proper intervention in form-tailored management may yield positive outcomes.

Research paper thumbnail of Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals

BMC Pediatrics, 2020

Background India introduced rotavirus vaccines (RVV, monovalent, Rotavac™ and pentavalent, Rotasi... more Background India introduced rotavirus vaccines (RVV, monovalent, Rotavac™ and pentavalent, Rotasiil™) in April 2016 with 6, 10 and 14 weeks schedule and expanded countrywide in phases. We describe the epidemiology of intussusception among children aged 2–23 months in India. Methods The prospective surveillance at 19 nationally representative sentinel hospitals from four regions recruited children with intussusception from April 2016 to September 2017. Data on sociodemography, immunization, clinical, treatment and outcome were collected. Along with descriptive analysis, key parameters between four regions were compared using Chi-Square/Fisher’s exact/Mann–Whitney U/Kruskal-Wallis tests. The pre- and post-RVV periods were compared to estimate the risk ratios. Results Six hundred twenty-one children with intussusception from South (n = 262), East (n = 190), North (n = 136) and West (n = 33) regions were recruited. Majority (n = 465, 74.8%) were infants (40.0% aged 4–7 months) with medi...

Research paper thumbnail of Giant occipital encephalocele – Challenges in management

Journal of Indian Association of Pediatric Surgeons, 2020

Introduction: Giant occipital encephalocele (GOE) is a term used when the size of the OE is great... more Introduction: Giant occipital encephalocele (GOE) is a term used when the size of the OE is greater than or equal to the size of the head. It has been limited to case reports, with only sporadic exclusive series. This is a series of GOE managed at our center over time with emphasis on practical problems faced in management. Materials and Methods: This was a retrospective observational study. The patients were evaluated for the age of presentation, sex, and head size. Any associated neural tube defect was also looked for. Imaging was used for associated brain anomalies and to plan the surgical procedure. The requirement of ventriculoperitoneal (VP) shunt was also assessed. Results: During the study period of 7 years, 11 patients of GOE were admitted. Apart from one, all other patients were <1 year of age. Nine patients underwent surgical intervention, which included excision and repair of swelling with or without VP shunt placement. The content of the sac was only cerebrospinal fluid (CSF) in six patients and CSF and gliotic brain tissue in remaining patients. The attendants of two patients did not give consent for surgery and left against medical advice. Conclusion: GOE is an uncommon entity with limited information about management. Careful evaluation, proper imaging of patient, and care during intraoperative and postoperative periods with emphasis of factors determining the prognosis may provide satisfactory results.

Research paper thumbnail of Evaluation of nebulized N-acetyl cysteine in outcome of esophageal atresia with tracheoesophegeal fistula

Journal of Pediatric Surgery, 2020

To evaluate the role of nebulized N-acetyl cysteine (NAC) in liquefying the airway secretions and... more To evaluate the role of nebulized N-acetyl cysteine (NAC) in liquefying the airway secretions and improving the outcome of patients of esophageal atresia with tracheoesophageal fistula (EA + TEF). Methods: It was a non-randomized interventional study. Two milliliters of 10% NAC was given in a nebulized form (2:5 dilution, every six hourly) to patients of ET + TEF, along with regular suction of upper esophageal pouch. The group was compared with control, which comprised patients of EA + TEF receiving only saline nebulization. The consistency of the secretions was compared by hand held consistometer in unit of time (seconds) required to cross a predetermined distance along with gravity. Results: Sixty patients were assessed. Of these, 30 patients were present in both groups. The study group showed significant (p = 0.01-0.0001) decrease in consistency of secretions from the control group after day 2 of NAC nebulization. Patients' discharge was significantly (p = 0.01) earlier in cases. There was no significant (p = 0.41) difference in mortality between the groups. No specific adverse effects were observed in the study group. Conclusion: It appears that nebulized NAC decreases the consistency of secretions in EA + TEF patients. It is interesting to note that the group of patients that received NAC was discharged earlier than the control group and had a higher survival rate than the control group. Whether this is directly attributable to the use of NAC is unknown. A prospective double-blinded randomized clinical trial is warranted to confirm these results. Level of evidence: Level II, prospective comparative study (non-randomized).

Research paper thumbnail of Evaluation of effect of propranolol on serum vascular endothelial growth factor and tissue inhibitor of metalloproteinase-2 levels in infantile hemangioma

Journal of Indian Association of Pediatric Surgeons, 2020

Background: Infantile hemangioma is the most common tumor of infancy. Currently, propranolol is a... more Background: Infantile hemangioma is the most common tumor of infancy. Currently, propranolol is a preferred drug for treating hemangioma. The exact mechanism of action of propranolol is not known. In this study, we attempted to assess whether propranolol has any effect on vascular endothelial growth factor (VEGF) and tissue inhibitor of metalloproteinase-2 (TIMP-2) over a period of time, and if it is there, how long it affects it. Materials and Methods: Propranolol was administered in the dosage of 2–3 mg/kg. The first serum sample was collected before starting the propranolol treatment. Thereafter, samples were collected at monthly intervals up to a total of six samples. The samples were assessed for TIMP-2 and VEGF using enzyme-linked immunosorbent assay kit. Results: The duration of this study was from June 2016 to November 2017. The total number of patients in this study was 15. Thirteen patients responded to treatment. The mean age of patients was 7.1 months. The mean value of baseline VEGF was 0.234 ± 0.059 and that of TIMP-2 was 1.338 ± 0.679. As compared to baseline value, the P value was statistically not significant in any of sequential values. In category-wise analysis, apart from statistically significant value in the 6th month in excellent category and good response category in the 1st month, all other values did not reveal any significant change in VEGF analysis. The analysis of TIMP-2 revealed a significant change in the levels from Sample 2 to Sample 6 in the excellent response group; however, the levels did not show a specific trend either increasing or decreasing. Conclusion: Despite its beneficial action in regression of hemangioma, the exact mechanism is yet to be identified. The exact duration of treatment needs further evaluation.

Research paper thumbnail of Atresia of the Colon: Etiological Aberrations, Clinical Observations, and Challenges in Management

Journal of Neonatal Surgery, 2018

Objective: The objective of this study is to review the clinicoradiological profile, scheme of ma... more Objective: The objective of this study is to review the clinicoradiological profile, scheme of management and the outcome in cases of colonic atresia (CA), and ascertain an optimal approach for the treatment of CA to minimize morbidity and mortality. Design and Setting: This was a retrospective observational study carried out at a tertiary health‑care center. Duration: Total of 6 years duration (January 2011–December 2016).Materials and Methods: A retrospective analysis of 10 patients of CA managed over a 6- year period. Data related to demographics, clinical presentation, associated anomalies, radiologic, intraoperative findings, postoperative stay, complications, and outcome were analyzed.Results: There were three cases of Type II atresia involving terminal ileum, cecum, and adjacent colon. Three cases had proximal ascending colon atresia (Type IIIa [n = 2]; Type I [n = 1]) Type I [n=1], and two cases of type IIIa atresia of the hepatic flexure. Two babies had atresia involving th...

Research paper thumbnail of Evaluation of Clinical and Radiological Factors Determining the Need of Post-operative Ventilator Requirement in Patients of Esophageal Atresia

Journal of Neonatal Surgery, 2018

Objective: Ventilator requirement is an important constituent of post-operative care of patients ... more Objective: Ventilator requirement is an important constituent of post-operative care of patients of esophageal atresia (EA). In contrast to the developed world, the situation is very different in developing countries where the resources are limited, and ventilator may not be available to all patients of EA. This study was conducted to assess whether there are certain criteria, which may predict the possibility of non- requirement of ventilator for patients of EA in the post-operative period. Design: This study was a retrospective observational study. Setting: This study was conducted at a tertiary care teaching hospital. Duration: This study was conducted from 5 years and 6 months. Materials and Methods: We used certain parameters to assess the requirement of ventilators for the patients in the post-operative period. These included the presentation of patients before or after 3 days of life and birth weight (BW) of more or <2.5 kg. Presence of respiratory distress (RD) was analyz...