Journal of Indian Association of Pediatric Surgeons最新文献

The penis should ideally be straight. Chordee is most commonly associated with hypospadias and epispadias; ventral chordee with hypospadias and dorsal chordee with epispadias, although they can also be seen in orthotopic meatus. One reason for a dorsal curvature of the penis might be improper saddling of the fundiform ligament on the dorsal shaft of the penis. The study documented the surgical treatment of a 6-year-old boy with isolated dorsal tilt of the penis.

The author reports a rare case of umbilical cord hernia with the accessory lobe of the liver entrapped in the amniotic sac with radial limb anomaly with malrotation. The accessory lobe of the liver is a rare anatomical variant of the liver that is often asymptomatic. The accessory lobe of the liver causing nonclosure of the umbilical ring is also very rare. The accessory lobe of the liver was formed during the development of embryonic body wall folds and disturbed the complete closure of the umbilical ring. If a clear-cut diagnosis of the accessory lobe is made, then it should be resected. In case of doubt, it should be fixed to the abdominal wall and regularly followed to look for signs and symptoms of torsion of the accessory lobe of the liver.

Background: Hypospadias repair has traditionally involved tubularized incised plate urethroplasty, often necessitating circumcision or preputial sacrifice due to dartos flap usage for waterproofing. However, many parents prefer preputial preservation for cultural and aesthetic reasons. No standardized technique currently exists for preputial reconstruction in distal and mid-penile hypospadias. We describe the hypospadias penile skin landmarks (HPS landmarks) technique based on ventral raphe classification and dorsal skin landmarks, a refined surgical approach leveraging natural penile skin creases to facilitate effective preputial reconstruction while maintaining functional and cosmetic outcomes.

Methods: This prospective study, conducted at two centers in India (January 2021-June 2024), included 67 patients (6 months-18 years) with distal and mid-penile hypospadias. A new classification system for ventral raphe and dorsal skin landmarks was proposed to guide preputial reconstruction. Surgical principles involved three key steps: (1) identifying and marking anatomical skin landmarks, (2) selective tissue dissection and preservation, and (3) midline approximation for symmetrical preputial restoration. Functional and cosmetic outcomes, including urethral patency, urinary stream, preputial symmetry, and complications, were assessed postoperatively.

Results: Among 67 cases (52 distal, 15 mid-penile hypospadias), the median age was 14 months, and the mean operative time was 110 ± 18 min. Urethrocutaneous fistula occurred in two patients (2.98%), preputial dehiscence in two (2.98%), and three (4.48%) exhibited persistent dorsal hooding. No cases of glans dehiscence, metal stenosis, or residual chordee were noted. Parental satisfaction was high, with favorable functional and aesthetic outcomes.

Conclusion: The HPS landmarks technique provides a refined surgical approach to preputial reconstruction in distal and mid-penile hypospadias, preserving prepuce integrity while ensuring functional and cosmetic success. By leveraging anatomical skin creases using the described classification, this technique minimizes preputial complications and offers a culturally acceptable alternative for patients desiring preputial preservation. Further long-term studies are warranted to validate its widespread applicability.

Aims: The primary objective was to evaluate the efficacy of a 2-week course of topical corticosteroids and outpatient adhesiolysis in managing preputial adhesions. Secondary objectives included assessing adhesion recurrence rates and monitoring adverse effects related to corticosteroid application and adhesiolysis.

Materials and methods: This prospective observational study was conducted at a tertiary care hospital. Boys presenting with symptoms such as inability to retract the prepuce, ballooning, penile swelling/smegma, urinary symptoms, or history of balanitis were enrolled. Preputial retractability was assessed using the KIKIROS scale. Symptomatic boys with lower KIKIROS grades underwent adhesiolysis during the first visit. Others were advised to apply topical steroids twice daily for 2 weeks, followed by adhesiolysis.

Results: In the 0-<5 years group, the inability to retract prepuce with other symptoms (31%) and ballooning (26%) were common. In the 5-<10 years group, 43.8% had inability to retract the prepuce with associated conditions. In the 10-<17 years group, 64% had inability to retract the prepuce. Post-ointment KIKIROS grading was predominantly 3 in all age groups. After the fifth follow-up, 79.55% of boys who underwent adhesiolysis without ointment achieved KIKIROS 0, compared to 55.39% of those who used ointment.

Conclusion: Topical steroids are helpful, but adhesiolysis alone shows higher efficacy, especially for those with lower initial KIKIROS grades. Reassurance is appropriate for asymptomatic boys under five, while older boys often benefit from intervention. Post-procedure hygiene education and regular follow-up are crucial to minimize recurrence.

Introduction: An appendicolith is a hard fecal concretion that can obstruct the appendix, leading to acute appendicitis. This study aimed to determine the prevalence of appendicoliths in pediatric patients with acute and complicated appendicitis. Secondarily, we aimed to evaluate its association with appendicular perforation peritonitis in pediatric patients.

Materials and methods: This ambispective observational study was conducted from 2018 to 2023 in a pediatric surgery tertiary care teaching institute. The selected patients (n = 181) were those operated on by the author only. Patients were assigned to the appendicolith (n = 80) and no appendicolith groups (n = 101), and clinical features, laboratory data, ultrasound findings, and final diagnosis were compared. Student's t-test and z-score analyses were used to establish statistical significance.

Results: Out of 181 patients, there were 129 males and 52 females (M: F = 2.48:1). The average age of the patients was 7.75 ± 3.35 years. The mean duration of symptoms was 3.62 ± 2.44 days. The mean leukocyte count was 14.24 ± 6.01 × 10³/μL, and the mean neutrophil% age was 78.18 ± 9.95. The mean maximal diameter of the appendix was 9.16 ± 2.69 mm. The ultrasound evaluation was highly suggestive of appendicitis in 168 (92.82%) patients. There were 80 (44.2%) patients with appendicolith(s). When appendicolith group and the no appendicolith group were compared, statistically significant differences were present in the age at presentation (6.82 ± 3.39 vs. 8.49 ± 3.15), mean duration of symptoms (4.09 ± 2.9 days vs. 3.25 ± 1.94 days), diarrhea (9, 11.25% vs. 2, 1.98%), anemia (30, 37.5% vs. 18, 17.82%), mean maximal diameter of the appendix (9.99 ± 2.82 mm vs. 8.49 ± 2.38 mm), acute (uncomplicated) appendicitis (13, 16.25% vs. 36, 35.64), and complicated appendicitis (67, 83.75% vs. 65, 64.36%). There was no statistically significant difference in the mean leukocyte count and mean neutrophil% age between the two groups. The maximal diameter of appendicolith ≥5 mm (73) in comparison to the maximal diameter of appendicolith <5 mm (7) was significantly associated with a larger percentage of patients with perforated appendicitis (60, 82.19%) than nonperforated appendicitis (3, 42.86%).

Conclusion: The presence of an appendicolith is associated with prolonged abdominal pain and higher rates of appendicular perforation in pediatric patients with acute appendicitis. The size of the largest appendicolith ≥5 mm is an exacerbating factor for appendicular perforation peritonitis.

Introduction: Primary hyperparathyroidism (PHPT) is a rare disorder in children, predominantly caused by parathyroid adenoma, often leading to delayed diagnosis and significant morbidity.

Subjects and methods: A prospective analysis of children with PHPT secondary to parathyroid adenoma, study period from 2015 to 2024 at a single institution. Data evaluated included demographics, clinical manifestations, biochemical and radiological features, surgical interventions, and postoperative care.

Results: Six children (4 males, and 2 females) with a mean age of 13.8 years (range 7-17) were evaluated. The mean duration from symptom onset to diagnosis was 3 years. All children presented with musculoskeletal deformities and exhibited elevated serum calcium (mean 12.48 mg/dL) and serum parathyroid hormone levels (1789-2500 picograms per milliliter (pg/mL)). Imaging with ultrasonogram and Isotope scan was successful in confirming the location of parathyroid adenoma with 100% sensitivity. Surgical excision was successful, and all patients developed hungry bone syndrome, requiring calcium supplementation. The mean serum calcium at discharge was 8.68 mg/dL, with no recurrence noted during an average follow-up of 9 years.

Discussion: Pediatric PHPT necessitates a high index of suspicion for timely diagnosis and intervention to prevent development of permanent disabilities. Effective surgical management and postoperative care can significantly enhance patient outcomes.

Congenital extrarenal rhabdoid tumor is a rare soft-tissue tumor, with the most common sites of origin in the genitourinary tract, head and neck regions, and extremities are less commonly involved. Malignant rhabdoid tumors are highly aggressive tumors, and when they develop in utero, the prognosis is even worse, with almost no reports of survival beyond the neonatal period. We present a rare case of congenital extrarenal extracranial rhabdoid tumor on the right shoulder reported at birth and later died after excision due to recurrence of the tumor with distant metastasis.