African Journal Of Paediatric Surgery[JOURNAL]
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200 papers
Complex pediatric "Spin Dryer" injuries - An uncommon mechanism and pattern of synchronous upper limb fractures.
Mencia MM, Goalan R
Afr J Paediatr Surg · 2022 · PMID 36018211 · Full text
Ipsilateral humerus and forearm fractures, or 'floating elbow,' are high-energy injuries, uncommon in children and usually due to falls or motor vehicle accidents. Early models of washing machines were associated with va...
Ipsilateral humerus and forearm fractures, or 'floating elbow,' are high-energy injuries, uncommon in children and usually due to falls or motor vehicle accidents. Early models of washing machines were associated with various reports of upper extremity injuries in children, mostly occurring when the child attempted to remove clothes from a spinning machine. Some of these accidents resulted in serious injuries, including amputation, but have become considerably less common with the introduction of improved safety features in modern appliances. We describe the successful management of a child with multiple complex upper limb fractures caused by a modern washing machine.
Isolated duodenal duplication cyst in a neonate.
Hakda RY, Makwana DV, Shukla R … +2 more , Parikh U, Chandna SB
Afr J Paediatr Surg · 2022 · PMID 36018210 · Full text
Duodenal duplication cysts are a rare subtype of alimentary tract duplications cysts, consisting of 7% of all the duplications. We report a rare case of neonatal duodenal duplication cyst presenting as a palpable abdomin...
Duodenal duplication cysts are a rare subtype of alimentary tract duplications cysts, consisting of 7% of all the duplications. We report a rare case of neonatal duodenal duplication cyst presenting as a palpable abdominal mass and features of gastric outlet obstruction. A 27-day-old male child presented with complaints of icterus, non-bilious vomiting after every feed and right-sided abdominal lump for the last 15 days. A computed tomography scan of the abdomen revealed well-defined peripherally enhancing cystic lesion noted in the subhepatic region extending up to the right lumbar region. On surgical exploration, a cystic mass was found attached to the pyloric part of the stomach along the mesenteric border of the first, second and third part of the duodenum, which was marsupialised, and no communication was found with the duodenum. On histopathological analysis, a duodenal duplication cyst was diagnosed without any heterotopic mucosa. The literature was reviewed and the approach to duodenal duplication cyst in neonates is discussed.
A case of ovarian fibromatosis as an incidental finding in an acute ovarian torsion: Differential diagnosis and management.
Costoya CPR, La Torre FV, Jiménez Salinas LK … +2 more , Farpón ÁG, Muñoz VÁ
Afr J Paediatr Surg · 2022 · PMID 36018209 · Full text
Ovarian fibromatosis (OF) is a rare non-neoplastic condition, more frequent in young females and characterised by ovarian enlargement with proliferation of collagen-producing spindle cells in the stroma. It usually prese...
Ovarian fibromatosis (OF) is a rare non-neoplastic condition, more frequent in young females and characterised by ovarian enlargement with proliferation of collagen-producing spindle cells in the stroma. It usually presents with abdominal pain, menstrual disorders or as a solid mass. Hirsutism and virilisation are possible. The relevance of this subject remains in the usual misdiagnosis as a malignant tumour, which may lead to unnecessary oophorectomies. We report the case of a 17-year-old female who presented with acute intense pain in the right iliac fossa and vomits. On examination, she complained of intense pain without any signs of peritonism. An abdominal ultrasound was performed, finding an enlarged right adnexal containing a heterogenic cyst without flow to the ovary. A Pfannenstiel laparotomy showed a right ovarian torsion. The haemorrhagic cyst was drained and the ovary was detorsed. Bilateral ovarian biopsies were performed as both ovaries showed an indurated and cerebroid surface, suggestive of malignancy. Tumoural markers were negative. Histological examination confirmed OF. After 3 months, the magnetic resonance imaging showed an enlarged right ovary with a fibrous capsule surrounding both ovaries. In conclusion, OF can also be found incidentally in the context of an ovarian torsion. Since its appearance may be dismissed as malignant, it is important to recognise it and remain conservative. Biopsies can be taken to make the differential diagnosis.
Congenital sacrococcygeal rhabdomyosarcoma.
Inuganti RV, Boddapati A, Mathi A … +1 more , Shaik R
Afr J Paediatr Surg · 2022 · PMID 36018208 · Full text
Rhabdomyosarcoma (RMS) is one of the common malignant soft-tissue sarcomas affecting children. It originates from the embryonic mesenchyme precursor of striated muscle and is frequently seen in the head-and-neck region,...
Rhabdomyosarcoma (RMS) is one of the common malignant soft-tissue sarcomas affecting children. It originates from the embryonic mesenchyme precursor of striated muscle and is frequently seen in the head-and-neck region, genitourinary system and extremities. Occasionally, it arises from the retroperitoneum, biliary tract and abdomen and is rarely seen in the sacrococcygeal area. A 4-month-male child presented with a nodule over the sacrum. Based on histopathology and immunohistochemical marker studies, a final diagnosis of RMS was rendered. There was no evidence of any teratomatous elements.
Time between onset of symptoms and definitive treatment in children with acute appendicitis: How it affects length of hospital stay?
Dimopoulou A, Yfanti A, Argyropoulos T … +6 more , Evaggelou E, Dimopoulou D, Dimopoulou K, Iakomidis E, Feizidou P, Zavras N
Afr J Paediatr Surg · 2022 · PMID 36018207 · Full text
PURPOSE: Any delay in treatment of acute appendicitis (AA) could lead to complications increasing morbidity and length of hospital stay (LHS). The aim of this study was to determine the time interval between onset of sym...
PURPOSE: Any delay in treatment of acute appendicitis (AA) could lead to complications increasing morbidity and length of hospital stay (LHS). The aim of this study was to determine the time interval between onset of symptoms and seeking medical attention and definitive treatment in children with AA and its impact on LHS. MATERIALS AND METHODS: A prospective study was conducted from December 2017 to March 2018. All patients diagnosed with AA and who underwent surgical procedure were enrolled. A questionnaire leaflet completed by parents was used to collect clinical data and information about seeking medical attention and children's management. Time was divided into six different intervals (1-2 h, 3-6 h, 7-12 h, 13-24 h, >24 h and >48 h) to estimate the time between onset of symptoms and seeking medical attention and time between hospital admission and surgical procedure. LHS was recorded. RESULTS: During the study period, 125 children were enrolled. Over half of the patients sought for medical assistance relatively soon (3-12 h) after the onset of symptoms, whereas 17.6% sought late healthcare (>24 h). The time between the medical examination and surgical procedure was <24 h in approximately 80% of the children. LHS was affected by time between onset of symptoms and seeking medical attention and time between medical examination and surgical procedure (P = 0.001 and P = 0.017, respectively). CONCLUSIONS: The majority of the children with AA admitted to hospital were treated relatively soon after the onset of symptoms. However, a significant proportion of children delayed to seek medical advice and undergo appendectomy, increasing LHS.
Peritoneal lavage during laparoscopic appendectomy for complex appendicitis is associated with increased post-operative morbidity.
Puttock D, Kumbhar V, Dagash H … +1 more , Patwardhan N
Afr J Paediatr Surg · 2022 · PMID 36018206 · Full text
AIM: Appendicitis is one of the most common paediatric surgical pathologies seen by paediatric surgeons worldwide. Laparoscopic appendectomy is undertaken for all cases of appendicitis in our institute. Intraperitoneal l...
AIM: Appendicitis is one of the most common paediatric surgical pathologies seen by paediatric surgeons worldwide. Laparoscopic appendectomy is undertaken for all cases of appendicitis in our institute. Intraperitoneal lavage following appendectomy is the conventional way of managing complicated appendicitis; however, some surgeons debate the efficacy of this practice. The aim of this study was to compare outcomes of intraperitoneal lavage versus suction only in children with complicated appendicitis. METHODS: Data were collected retrospectively between January 2018 and January 2019. All patients undergoing laparoscopic appendectomy for complex appendicitis were included and divided into two groups, patients who had suction only and those who had lavage and suction. Outcome parameters studied were the length of stay (LOS), number of temperature spikes > 37.7 (TS), operative times (OT) and readmission for intra-abdominal collections. Comparison between the two groups was performed using two sample t-test with unequal variance, significance was set at P < 0.05. RESULTS: A total of 115 patients were included (lavage n = 52, Suction n = 63). The LOS (P = 0.0054), TS (0.0109), OT (P < 0.0001) were significantly higher in the lavage group compared to the suction-only group. Overall rates of readmission were similar between groups, however, readmission for the confirmed intra-abdominal collection was more common in the lavage group. CONCLUSION: Based on our study, it appears that there is no advantage in performing an intraperitoneal lavage for complex appendicitis. It resulted in a prolonged stay, more post-operative TS and longer operative duration. The likelihood of being readmitted with an intra-abdominal collection following a lavage was higher compared to suction only.
Mastitis and breast abscess in newborns and infants.
Jean Bertrand KA, Rose NK, Franck LG … +3 more , Célestin BA, Ibrahim T, N'gouan Constance BU
Afr J Paediatr Surg · 2022 · PMID 36018205 · Full text
INTRODUCTION: Mastitis and abscess of the newborn breast are serious infections. The objective of our study was to describe the epidemiological and therapeutic aspects of these infections in our context. MATERIALS AND ME...
INTRODUCTION: Mastitis and abscess of the newborn breast are serious infections. The objective of our study was to describe the epidemiological and therapeutic aspects of these infections in our context. MATERIALS AND METHODS: This was a retrospective study from January 2017 to December 2019. We included all children aged ≤2 months admitted for mastitis or breast abscess. The variables studied were epidemiological and therapeutic. RESULTS: We collected 34 files, i.e., 11.3 cases/year. The sex ratio was 0.5. The mean age was 16.3 ± 6.6 days. The mean time to the consultation was 3.7 ± 2.4 days. The parents had undertaken a massage in 79.4% of cases. It was mastitis in 12 cases and abscess in 21 cases. Treatment was surgical in 26 cases. CONCLUSION: This affection is frequent with a female predominance. Its management must be early. The proscription of breast massage would reduce its frequency.
A prospective observational study to evaluate the change in inhibin-B as a marker of sertoli cell function in children subjected to surgical correction for undescended testes.
Raman VS, Khanna S, Verma V
Afr J Paediatr Surg · 2022 · PMID 36018204 · Full text
BACKGROUND AND OBJECTIVES: Undescended testes (UDT) or cryptorchidism is a common congenital disability characterised by the absence of at least one testicle from the scrotum. The primary aim of surgical correction is to...
BACKGROUND AND OBJECTIVES: Undescended testes (UDT) or cryptorchidism is a common congenital disability characterised by the absence of at least one testicle from the scrotum. The primary aim of surgical correction is to preserve fertility potential and prevent complications including trauma, malignancy, hernia and torsion. Often, children, especially in developing countries, present late with UDT. The effect of surgical correction in the recovery of Sertoli cell function in children aged more than 2 years is not apparent. The present study was conducted to study the change in inhibin-B level as a marker of Sertoli cell function in surgically corrected UDT in a heterogeneous population. MATERIALS AND METHODS: A prospective observational study conducted over a 3-year period at a tertiary care paediatric surgery centre recruited 76 children with UDT undergoing surgical correction. Inhibin-B as a marker for Sertoli cell function was studied preoperatively and postoperatively. Continuous variables were summarised by calculating mean, standard deviation, median and interquartile range (IQR). Quantile versus quantile plotting was done to assess the distribution of the data. Data were analysed in two groups, with participants aged <2 years (Group A) and more than 2 years (Group B). Wilcoxon signed-rank test was used to compare the pre-operative and post-operative value. RESULTS: In Group A (n = 39), the median (IQR) of pre-operative inhibin-B was 181 pg/ml (148-254) and post-operative inhibin-B was 230 pg/ml (176-296). In Group B, the median (IQR) of pre-operative inhibin was 70 pg/ml (44-104) and post-operative inhibin was 102 pg/ml (46-176). There was a significant increase in post-operative inhibin when compared to the pre-operative inhibin (P = 0.015 and 0.012, respectively, in Group A and B). Luteinizing hormone (LH) showed a significant decrease (P = 0.002) in Group A following surgery but bordering on significance in Group B (P = 0.43). On the other hand, follicle-stimulating hormone showed a significant decrease (P < 0.01) in Group B following surgery but not in Group A (P = 0.87). CONCLUSION: The mean post-operative inhibin-B levels were increased significantly as compared to the pre-operative levels indicating either a successful orchiopexy/adequate germ cell number or both. The benefit of orchiopexy may extend even to children presenting late for evaluation.
Surgical neonates with coronavirus infectious disease-19 infection: An experience with five cases at high-volume tertiary care centre of India.
Kadian YS, Ali M, Kumar C … +1 more , Kajal P
Afr J Paediatr Surg · 2022 · PMID 36018203 · Full text
Coronavirus infectious disease-19 (COVID-19) has caused serious threat to global health. With progression of time, more and more cases are being reported in paediatric age group. Management of COVID-19-positive neonates...
Coronavirus infectious disease-19 (COVID-19) has caused serious threat to global health. With progression of time, more and more cases are being reported in paediatric age group. Management of COVID-19-positive neonates with surgical condition is challenging as apart from medical management of COVID-19-induced morbidities, they also require surgical intervention. Various guidelines have been proposed for the management of neonates with coronavirus infection and surgical pathologies. In this original article, we are sharing our experience in managing such neonates. We managed five neonates with different surgical pathologies who were positive for the coronavirus at the time of admission. They received medical management initially. Three of these five neonates were operated after they were negative for the virus. The remaining two patients were operated in positive state due to their condition requiring urgent surgical intervention. All the recommendations as per the COVID-19 protocol were followed. Four of these babies survived. One neonate with the diagnosis of gastroschisis expired during stay in designated COVID-19 neonatal intensive care unit. Authors conclude that COVID-19-positive status of neonates should not scare the health-care workers. COVID-19 positivity in neonates does not alter the outcome.
External and internal parasitic conjoined twinning: Diverse presentation and different surgical challenges.
Menon P, Solanki S, Samujh R … +4 more , Kakkar N, Bhatia A, Mohanty S, N Rao KL
Afr J Paediatr Surg · 2022 · PMID 36018202 · Full text
BACKGROUND: Parasitic conjoined twin is a rare but well-known entity with unclear embryopathogenesis. Abnormal conjoined twinning can result in an externally attached parasitic twin (PT), an enclosed foetus in foetu, or...
BACKGROUND: Parasitic conjoined twin is a rare but well-known entity with unclear embryopathogenesis. Abnormal conjoined twinning can result in an externally attached parasitic twin (PT), an enclosed foetus in foetu, or a mature teratoma. The treatment requires complete excision and reconstruction of local anatomy which is not always straightforward. MATERIALS AND METHODS: PT cases presenting over 12 years were analysed. Patients with complete data, histopathological diagnosis and follow-up were included in the study. During follow-up, specific complications and related investigations were considered. RESULTS: A total of five patients at four different sites were identified: two retroperitoneal foetus in foetu and three externally attached PTs which were located in the lumbar region, sacrococcygeal area and on the lower anterior abdominal wall. All patients underwent complete surgical excision. In foetus in foetu cases, the blood supply was directly from the aorta with a short stump while the three externally located ones required meticulous and careful dissection with the reconstruction of local anatomy. CONCLUSION: Parasitic conjoined twinning can present at different sites and surgical challenges vary accordingly. For surface lesions, reconstruction may be as complicated as excision. Prognosis can be affected by the excellence of anatomical restoration. Long-term follow-up is essential to address problems specific to the site of lesion and method of surgical reconstruction.
Complicated duodenal perforation in children: Role of T-tube.
Keshri R, Chaubey D, Yadav R … +4 more , Kumar V, Thakur VK, Ranjana R, Rahul SK
Afr J Paediatr Surg · 2022 · PMID 36018201 · Full text
BACKGROUND: Diagnosis of duodenal perforation (DP) in children is often delayed. This worsens the clinical condition and complicates simple closure. OBJECTIVES: To explore the advantages of using T-tube in surgeries for...
BACKGROUND: Diagnosis of duodenal perforation (DP) in children is often delayed. This worsens the clinical condition and complicates simple closure. OBJECTIVES: To explore the advantages of using T-tube in surgeries for DP in children. PATIENTS AND METHODS: A retrospective study was conducted on all patients of DP managed in the Department of Paediatric surgery at a tertiary centre from January 2016 to December 2020. Clinical, operative and post-operative data were collected. Patients, with closure over a T-tube to ensure tension-free healing, were critically analysed. RESULTS: A total of nine DP patients with ages ranging from 2 years to 9 years were managed. Five (55.6%) patients had blunt abdominal trauma; a 2-year-old male had perforation following accidental ingestion of lollypop-stick while a 3-year-old male had DP during endoscopic evaluation (iatrogenic) of bleeding duodenal ulcers; cause could not be found in other 2 (22.2%) patients. Of the five patients with blunt abdominal trauma, 4 (80%) had large perforation with oedematous bowel, necessitating repair over T-tube. Both patients with unknown causes had uneventful outcomes following primary repair with Graham's patch. Patients with lollypop-stick ingestion and iatrogenic perforation did well with repair over T-tube. The only trauma patient with primary repair leaked but subsequently had successful repair over a T-tube. One patient with complete transection of the third part of the duodenum and pancreatic injury who had repair over T-tube died due to secondary haemorrhage on the 10 post-operative day. CONCLUSION: Closure over a T-tube in DP, presenting late with oedematous bowel, ensures low pressure at the perforation site, forms a controlled fistula and promotes healing, thereby lessening post-operative complications.
Religious circumcision (Khatna) and circumcision mishaps in Kashmiri children.
Hassan Y, Rasool H, Rather AA … +2 more , Ahmad Y, Rasool I
Afr J Paediatr Surg · 2022 · PMID 36018200 · Full text
BACKGROUND: Male circumcision is recommended practice in Muslim tradition and one of the oldest operations performed all over the world. Male circumcision is universal in our Muslim-dominated valley of Kashmir for religi...
BACKGROUND: Male circumcision is recommended practice in Muslim tradition and one of the oldest operations performed all over the world. Male circumcision is universal in our Muslim-dominated valley of Kashmir for religious reasons. It can be performed by different techniques such as the conventional open methods, the device methods and sutureless methods. The objective of this study was to report our practice of male circumcision amongst children and compare the different common surgical techniques and highlight the circumcision mishaps conducted by quacks in the Kashmir Valley. MATERIALS AND METHODS: This was a comparative observational study conducted at SKIMS Medical College and Hospital, from 2017 to 2021. Children who presented for primary circumcision were subjected to one of two different surgical techniques; the dorsal slit or Guillotine method. The prospective analysis of children managed for circumcision mishaps conducted by non-professionals was also included in the study. Circumcisions done after 2 years of age were defined as delayed. The data were collected analysed using SPSS software (SPSS version 22, IBM, Armonk, NY, USA). RESULTS: Total of 689 Kashmiri Muslim male children between 1 day and 10 years of age over a period of 5 years were studied. Six hundred and fifty-five children for primary circumcision and 34 children managed for circumcision mishaps were included in the study. Amongst the subjects for primary circumcision, the most number of children were between 1 and 2 years of age (33.28%). One hundred and fourteen (25.73%) hospital-delivered babies and 201 (94.81%) home-delivered babies had delayed circumcision that is after 2 years of age (P = 0.00001). Religious requirement was the only indication for circumcision in this study. Three hundred and ninety-six (60.46%) children were circumcised with dorsal slit and 259 (39.54%) with guillotine method using computer-generated random numbers. Complications were found 8.08% of subjects in dorsal slit method as compared to 16.60% in guillotine technique (P = 0.008). Out of 34 children managed for circumcision mishaps, 11 (32.35%) presented with massive bleeding after primary circumcision by half doctors, 18 (52.94%) had incomplete circumcision, 3 (8.82%) had multiple skin bridges and 2 (5.88%) had incomplete circumcision with glans injury. All the patients with circumcision mishaps were treated with good outcome. There was no mortality. CONCLUSION: Circumcision occurs at a wide range of ages and male circumcision is universal in our Muslim-dominated valley for religious reasons. Circumcision by quacks and the associated complications are still prevalent in our society. The procedure is safe and free of any major complications when conducted by trained medical personnel under aseptic conditions of the operation theatre and hence should be encouraged.
Are online discussion forums useful platforms for paediatric surgeons to seek advice regarding patient management? A review of the queries posted on the world federation of association of pediatric surgeons facebook group (The Pediatric Surgeon's Lounge).
Anand S, Sharma S, Shehata S
Afr J Paediatr Surg · 2022 · PMID 36018199 · Full text
BACKGROUND: Social media platforms are popular places for discussing difficult cases amongst the surgeons. Paediatric Surgeon's Lounge (PSL) is a closed Facebook group for the interaction of paediatric surgeons from diff...
BACKGROUND: Social media platforms are popular places for discussing difficult cases amongst the surgeons. Paediatric Surgeon's Lounge (PSL) is a closed Facebook group for the interaction of paediatric surgeons from different parts of the world. We aim to assess the safety and utility of the responses given by the members of the PSL group to the queries about the management of paediatric surgical cases. METHODS: All posts on PSL between January and July 2021 were retrospectively screened to select the patient management-related queries. For each included query, all the responses were scrutinised for their utility and safety. The utility was categorised as helpful or not helpful, and the safety of these responses was categorised as safe or unsafe. A note was also made whether any unsafe response was rectified in the subsequent responses or not. The proportion of each response category was calculated. RESULTS: Twenty-two queries with a total of 353 responses were assessed. The median (range) number of responses per query was 10 (2-45). The proportion of helpful, safe and rectified unsafe responses was 91.5% (307/353), 96.8% (342/353) and 36% (4/11), respectively. CONCLUSIONS: PSL is a safe and helpful platform for taking advice regarding the management of paediatric surgical cases.
Age-of-cessation of lumbar lordosis development as an assessment parameter.
Okpala FO
Afr J Paediatr Surg · 2022 · PMID 36018198 · Full text
BACKGROUND: In managing paediatric spinal deformities, the currently-in-use growth maturity assessment parameters (clinical or radiological) are based mostly on Caucasian populations. They may be adequate for general tre...
BACKGROUND: In managing paediatric spinal deformities, the currently-in-use growth maturity assessment parameters (clinical or radiological) are based mostly on Caucasian populations. They may be adequate for general treatment planning but may not accurately predict the remaining growth potential. Some therapies (e.g. growing rod distractions or growth modulation surgeries) require more accurate predictions of remaining growth potential and race-specific values. Lumbar lordosis (LL) development ceases at spinal bone maturity. The age-of-cessation seems a more accurate predictor of remaining spinal bone growth potential, compared to currently-in-use growth maturity assessment parameters, but is rarely included in the growth maturity assessment parameters. AIMS AND OBJECTIVES: As a predictor of remaining spinal growth potential, age-of-cessation of LL development (Race-specific of Black populations) was quantified. MATERIALS AND METHODS: In archival normal lateral lumbosacral radiographs of patients of a tertiary hospital in South-East Nigeria, LL development across five age groups (Birth- 9, 10-15, 16-20, 21-25 and 26-30 years) was quantified with lumbosacral joint angle (LSJA) in 215 (110 males, 105 females), and lumbosacral angle (LSA) in 238 (119 males, 119 females). Data were analysed with IBM SPSS Statistics 23.0 (NY, USA). P ≤ 0.05 was considered statistically significant. RESULTS: Both LSJA and LSA age groups' mean values progressively increased with age, and plateaued at 21-25 years range, with LSJA mean of 23.4 ± 1.3 years, and LSA mean 23.5 ± 1.3 years; the means difference was insignificant (P = 0.680). CONCLUSION: With ageing, there is progressive increment, and later, cessation of LL. Age-of-cessation indirectly infers spinal-maturity-age, and could indirectly be an assessment parameter of spinal-maturity-status.
Phimosis - Are we on right track?
Manekar AA, Janjala N, Sahoo SK … +2 more , Tripathy BB, Mohanty MK
Afr J Paediatr Surg · 2022 · PMID 36018197 · Full text
BACKGROUND: Phimosis, a common paediatric condition, is defined as the inability to retract the preputial skin behind the glans. Current practice shows there is some confusion among the paediatricians towards this common...
BACKGROUND: Phimosis, a common paediatric condition, is defined as the inability to retract the preputial skin behind the glans. Current practice shows there is some confusion among the paediatricians towards this common condition and in differentiating it from the more common physiological preputial adhesion; leading to frequent referrals to a paediatric surgeon or a general surgeon, which can be addressed by the parents and the child physicians themselves. AIM: To find out the awareness towards the management of phimosis among the paediatricians. MATERIALS AND METHODS: A questionnaire on this topic was generated using 'Google Forms' and was circulated among junior and senior residents, faculty in various medical colleges and consultants in private practice all over India and their response was collected and analysed. RESULTS: We received a total of 221 responses from all over India from paediatric medicine trainees and consultants. Among them, majority (48%) were senior residents. According to the survey participants, the most (46%) find inability to retract the prepuce as the major presenting complaint. A straight away reference to a paediatric surgeon was preferred by majority of paediatricians (62.9%), though most of them were aware of them were aware of physiological adhesions and conservative management (94.2%). There was a belief among 43% about counselling each and every patient presenting with phimosis for circumcision. Among the respondents, 60.2% advised ultrasound of kidneys, ureter, and bladder to their patients and believed that backpressure changes alter the management of the child. A urine routine examination was advised by 70.1% of participants, with 46.6% believing that the presence of urinary tract infection changes the management of phimosis. Waiting up to 1 year of age before going for surgery was advocated by 71.5%. A major proportion of respondents (76%) believed all cases of phimosis should be referred to a surgeon, only 58.8% would voluntarily follow them up. There is still a belief among 69.7% of participants that all cases of phimosis should be referred to a paediatric surgeon and only few of them, 5.4% feel referring only indicated cases. CONCLUSION: Physiological phimosis is a common condition which can be addressed by the paediatricians themselves. Awareness is to be increased among them, especially during the training period regarding the proper management of this common condition, avoiding unnecessary circumcisions.
Internal fat prolapse from ischiorectal fossa masquerading as currarino syndrome.
Ali MM, Kumar A, Rashi R … +2 more , Sinha AK, Kumar B
Afr J Paediatr Surg · 2022 · PMID 35775527 · Full text
Pelvic magnetic resonance imaging (MRI) is the latest addition to already existing tools for evaluation of anorectal malformation (ARM). It provides detailed information about pelvic floor musculature as well as position...
Pelvic magnetic resonance imaging (MRI) is the latest addition to already existing tools for evaluation of anorectal malformation (ARM). It provides detailed information about pelvic floor musculature as well as position of rectal pouch. However, lack of knowledge about normal pelvic floor anatomy can lead to misinterpretation of pelvic MRI which can create confusion and change in approach for surgery. A 14-month-old male child with diagnosis of ARM was evaluated with pelvic MRI. There was finding of abnormal protrusion of fat through the ischiorectal fossa which was misinterpreted as Currarino syndrome which created confusion immediately before posterior sagittal anorectoplasty. Pelvic MRI is highly informative while evaluating a case of ARM. However, a detailed knowledge of pelvic floor anatomy is mandatory to avoid wrong interpretation and misdiagnosis.
Management of chylous ascites with surgery and frusemide in a new born.
Wabada S, Ibrahim HA, Dada BJ … +3 more , Zanna AU, Muhammed A, Mustapha B
Afr J Paediatr Surg · 2022 · PMID 35775526 · Full text
Chylous ascites is the accumulation of milky fat-rich chyle in the peritoneal cavity. It is a rare condition in children. Congenital malformations of the lymphatic vascular channel are the predominant cause in children....
Chylous ascites is the accumulation of milky fat-rich chyle in the peritoneal cavity. It is a rare condition in children. Congenital malformations of the lymphatic vascular channel are the predominant cause in children. Diagnosis is often confirmed by paracentesis of the chylous ascitic fluid. Treatment is generally conservative except in rare refractory cases that surgery is required for closure of the leak site or excision of the lymphatic cyst. Here is a report on the management of chylous ascites in a 6-h-old girl presenting in acute respiratory distress with acute abdominal distention due rapid increase in chylous ascitic fluid volume that was managed with surgery and frusemide.
Brachial Plexus' Schwannoma in a Child.
Mbaye PA, Seye C, A Zeng FT … +1 more , Ngom G
Afr J Paediatr Surg · 2022 · PMID 35775525 · Full text
Children's schwannoma is a rare condition, generally occurring in a sporadic way. Its aetiology is still not fully understood. We report the case of a 10-year old girl who presented a left shoulder mass, along motility r...
Children's schwannoma is a rare condition, generally occurring in a sporadic way. Its aetiology is still not fully understood. We report the case of a 10-year old girl who presented a left shoulder mass, along motility reduction of the left upper limb for 24 months before presentation at our service. A biopsy resection of the mass gave the diagnosis and 6 months after surgical resection, no complication occurred.
Alternate management of an anterior maxillary dentigerous cyst in a paediatric patient.
Philip L, D'Silva J, Martis E … +1 more , Malathi S
Afr J Paediatr Surg · 2022 · PMID 35775524 · Full text
The purpose of this article is to show alternate management of an anterior maxillary dentigerous cyst in a paediatric patient. An 8-year-old male child reported to the Department of Oral and Maxillofacial surgery with th...
The purpose of this article is to show alternate management of an anterior maxillary dentigerous cyst in a paediatric patient. An 8-year-old male child reported to the Department of Oral and Maxillofacial surgery with the chief complaint of swelling in the upper left side of the face for 2 months. Based on the clinical and radiological findings of cystic cavity along with impacted tooth, lesion was diagnosed as dentigerous cyst and surgical enucleation was planned under general anaesthesia. Dentigerous cysts mostly occur in the mandible and are prevalent between the second to fourth decades of life. The incidence of this cyst in children is less. We present here a case report of a paediatric patient with a rare occurrence of a large cyst in the maxillary anterior region, and the treatment outcome by surgical enucleation and preservation of the permanent tooth bud are discussed. The line of treatment for dentigerous cyst is enucleation and extraction of involved tooth. We recommend the alternative treatment option, which involves enucleation of cyst, and consider the conservation of the affected tooth bud in the view of making its eruption viable in future.
Partial epididymal rupture and spermatic cord haematoma with an associated secondary testicular torsion due to blunt scrotal injury, in a 12-year-old boy.
Anastasiadis K, Godosis D, Kepertis C … +5 more , Mouravas V, Lampropoulos V, Demiri C, Tsopozidi M, Spyridakis I
Afr J Paediatr Surg · 2022 · PMID 35775523 · Full text
Scrotal injuries are not very common in children and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. Traumatic testicular torsion in children has been also infrequently repo...
Scrotal injuries are not very common in children and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. Traumatic testicular torsion in children has been also infrequently reported in the literature. To ensure testicular salvage, an urgent and specialised diagnosis and management are necessary. We present a case of a partial epididymal rupture and spermatic cord haematoma with an associated secondary testicular torsion due to blunt scrotal injury, in a 12-year-old boy.
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