Raashid Hamid

Introduction: Lymphatic malformations of abdomen include mesenteric, omental and retroperitoneal cysts. These are benign malformations with variable presentation. These malformations may present as abdominal distension, abdominal pain, features of intestinal obstruction and rarely acute abdomen. Ultrasonography, CT scan and MRI provide characteristics of malformations like size, composition and may at times help in determining the origin of the lesion. Surgical exploration confirms the diagnosis besides being therapeutic. The mesenteric and omental cysts are either enucleated or need bowel resection or sometimes, partial cyst excision with marsupliazation. Intraoperative injection of the sclerosing agent is an option in instances when excision is not possible or feasible. We analysed the clinical characteristics, management and follow-up of these cases in our study. Methods: We analysed 26 cases of abdominal lymphatic malformations. The data regarding epidemiological and clinical ch...

ABSTRACT Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH) cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India) during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients) to non-specific gastrointestinal complaints (5 patients). In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 14 patients chest, X-ray revealed the diagnosis of CDH and in remaining five patients (including the two patients with misdiagnosis) further investigations were undertaken to establish the diagnosis. Age ranged from 45 days to 17 years with an average age of 58.9 months. There were 12 male and 8 female patients. In all the 20 patients, surgical procedures were undertaken with the retrieval of herniated contents from the thoracic cavity and repair of the diaphragmatic defect. There was no mortality in our series. All the 20 patients were followed-up for a period ranging from 6 months to 5 years (median 3.1 years). Conclusions: Late-presenting CDH can have diverse clinical presentation. Late diagnosis and misdiagnosis can result in significant morbidity and potential mortality if these cases are not managed properly at an appropriate stage. Outcome is favourable if these patients are expeditiously identified and surgically repaired.

W e present our experience of sutureless and bloodless elective circumcision in neonates and infants with Gomco clamp. From March 2008 to May 2011, 200 babies with age ranging from 2 weeks to 7 months underwent Gomco circumcision. All patients were given chlorohydrate 50 mg/kg, paracetamol suppository 15 mg/kg, and local anesthesia. Procedure was done in minor operation theatre (OT) and babies were observed for 1 h in recovery room before discharging them home. Two of our patients (1%) required immediate suturing on table after Gomco clamp was removed, five patients (2.5%) were shifted back from the recovery room to minor OT for suture repair and eight patients (4%) required reinforcement of primary dressing to control the minor ooze. There was no other complication. Cosmesis was to the satisfaction of the surgeon as well as the parents. Gomco clamp is a bloodless, sutureless, simple, and safe method of circumcision in newborns and infants. It is cost-effective and can be performed under local anesthesia and sedation with excellent cosmetic results.

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Aims. To study the outcome of surgical treatment (STSG and multiple Z-plasties) in postburn contractures of groin and perineum.Material and Methods. We conducted a study of 49 patients, with postburn groin and perineal contractures. Release of contracture with split thickness skin grafting (STSG) was done in 44 (89.79%) patients and release of contracture and closure by multiple Z-plasties was done in 5 (10.21%) patients. Results. Satisfactory functional and cosmetic outcome was seen in 44 (89.79%) patients. Minor secondary contractures of the graft were seen in 3 (6.81%) patients who were manag...

Copyright © 2015 Raashid Hamid et al.This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Congenital midureteric stricture (MUS) is a rare malformation. We report our experience with five cases seen over a period of 4 years from 2010 to 2014. Materials and Methods. The study was based on the retrospective analysis of five patients diagnosed as having MUS. Diagnosis was suspected after fetal ultrasonography (USG) in one patient and magnetic resonance urography (MRU) in four patients. Retrograde pyelography (RGP) was performed on three patients. The final diagnosis was confirmed during surgical exploration in all the patients. Results. MRU was found to be a good investigation method. It showed the site of obstruction in the ureter in all instances. Intravenous urography detected proximal ureteric dilatation presen...

Aim: To evaluate the feasibility of one-stitch herniotomy in the management of inguinal hernia in infants. Materials and methods: Between January 2011 and June 2014, 100 children in the age group 0–14 months with unilateral inguinal hernia were prospectively enrolled for hernia repair and herniotomy was performed by one-stitch technique. The primary outcomes were the time in the operating room and cosmesis. The secondary outcomes were postoperative pain and surgical complications. Results: Of the 100 children who were included in the study, 88 were males (male/female ratio 7.3:1). The mean operating time was 14.99 ± 2.69 min with a total mean time in the operating room was 38.23 ± 9.84 min. Postoperative analgesia was required in 16% infants with only 6% requiring two or more doses over 24 h period. There were no recurrent hernias with minimal postoperative complications on follow-up. Contralateral metachronous inguinal hernia was seen in 10% children on follow-up. Cosmesis was exce...

Background: This study was conducted to characterize the clinical features, associated anomalies, operative management, and operative findings in babies with omphalocele minor. Material and Methods: This was a prospective study conducted over a period of 2 years, from 2011 to 2013. The clinical, radiological, and operative findings of all the babies diagnosed with omphalocele minor were recorded and analyzed. Results: A total of 12 patients of omphalocele minor were admitted to our department. Ten babies required immediate exploration within first 5 days of life. The main indication of exploration was mechanical intestinal obstruction due to either associated atresia (five patients) or obstruction caused by mechanical compression of the gut by the small abdominal wall defect in remaining seven patients. Atretic segment was seen within the sac in two patients, distal ileal atresia in one, atresia at the neck of the abdominal wall defect in one, and ascending and transverse colonic at...

Background: Non-operative management in majority of paediatric blunt abdominal trauma injuries is routine. The need for pediatric intensive care unit (PICU) admission, length of hospital stay pre and post discharge imaging, duration of activity restriction varies from country to country and center to centre. The purpose of this study was to characterize the pattern of practice in a developing state health institution and formulate safe and effective care plan for managing children with isolated blunt splenic injuries. Method: A retrospective study between 2009-2015 with isolated blunt splenic trauma at our hospital in paediatric population. Result: A total of 40 children (30 male and 10 female) with isolated blunt trauma spleen were included in this study. Age group was between 2.5–16 years (mean 9.5 ± 0.17 years). Fifteen patients were hemodynamically unstable and were resuscitated at reception. Average grade of splenic injury was 2.9. All the patients were admitted in general ward...

Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH) cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India) during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients) to non-specific gastrointestinal complaints (5 patients). In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 1...

In patients with hydrocephalus, the abdominal cavity has been used for absorption of cerebrospinal fluid (CSF) since 1905. Ventriculoperitoneal (VP) shunt operation is followed by abdominal complications in about 5-47% cases. Abdominal CSF pseudo cyst is an uncommon, but well described complication. This survey was conducted to study the clinical profile and management of this entity. We present our experience with cases of CSF pseudo cyst in children. Retrospective analysis of 4 cases diagnosed to have abdominal pseudo cyst following VP shunt between 2008 and 2013. All the four cases were suspected clinically and diagnosis was confirmed by abdominal ultrasonography. In three patients, the cyst was multilocular and of varying size. Fourth one had a unilocular cyst at the lower end of VP shunt. All the four patients had features of varying degree raised intracranial pressure and a two patients had abdominal signs also. All the patients needed open exploration. Cyst fluid was drained and partial to complete excision of the cyst was done along with the repositioning of the shunt in abdominal cavity in three patients and exteriorization of shunt in one patient. Patients were followed for any further complication over a period of 1-year. Abdominal pseudo cyst is a rare complication after VP Shunt and could result in shunt malfunction or abdominal symptoms and signs. Whenever suspected it should be confirmed by imaging, followed by open exploration and repositioning of the shunt.

Objective. Present study was undertaken to compare the results of two single stage hypospadias repairs, namely, Tubularized Incised Plate (TIP) repair and Mathieu’s repair.Methods. The study included 100 patients of distal penile hypospadias, from January, 2008 to January, 2013. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee. TIP repair was performed in 52 patients and Mathieu’s repair in 48 patients. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethrocutaneous fistula, and stricture formation.Results. The mean age of presentation was 6.2 ± 3.2 years (range 1.5–15years). The mean operative time was 63.7 ± 14.3 (45–90) minutes and 95.0 ± 19.1 (70–125) minutes in TIP and Mathieu’s repair, respectively.Complications after surgery were urethero cutaneous fistula in 3(5.76%) and 7 (14.5%), meatal stenosis in 3(5.33%) and 4(8.33%), wound infect...

Colonic atresia and stenosis are rare causes of intestinal obstruction in the infant. Only 10 cases have been reported in Literature since 1966 and only one late-onset case has been reported in Literature until now. We describe the case of a 3 day old baby presenting with abdominal distension, failure to pass meconium and vomiting. X-ray of the abdomen showed dilated gut loops. Exploratory laparotomy was performed. At the junction of descending and sigmoid colon a stenosis was found, laparotomy also revealed a perforation of transverse colon. Transverse colostomy and a mucous fistula of sigmoid colon was performed after resecting stenosing segment and colon distal to perforation site upto stenosing site. Diagnosis was confirmed on histopathology. Colostomy was close after six weaks with uneventful recovery. Considering both the Literature and our case, congenital colonic stenosis should be considered one of the rare differential diagnoses in a neonate presenting as complete or parti...

Background: Neonatal intestinal obstruction (NIO) continues to be a life-threatening condition with high mortality rates especially in developing countries. Highly skilled specialized care and facilities are required for survival. This study was conducted to assess various factors responsible for outcome in such neonates, so that extra attention is paid to the ones at high risk, with the idea to bring down the mortality rates in neonates admitted with intestinal obstruction.Materials and Methods: This study was a prospective observational study conducted on all neonates admitted with features of intestinal obstruction in our hospital from February 2014 to August 2016. The patients were followed up for a minimum of 1 month. Data was collected on prescribed proforma and analyzed for age, sex, prematurity, birth weight, clinical features, duration of symptoms, diagnosis, lab investigations, surgical procedure performed, complications etc. using the Statistical Package for Social Scienc...

Ascaris-induced small bowel obstruction (SBO) is a common sequel of Ascaris lumbricoides (AL) infestation. Most cases respond to conservative treatment practiced in different centers worldwide. We conceived a prospective randomized trial to compare the conservative treatment with gastrografin administered in addition to the conservative treatment. This prospective randomized study was conducted between January 2011 and June 2014 at Department of Paediatric and Neonatal Surgery, a tertiary-care hospital. Patients were divided into two groups, one group received conservative treatment and the other received gastrografin in addition to conservative treatment. Forty patients having uncomplicated AL-induced SBO were included in each group. Gastrografin was administered through nasogastric tube and serial clinical and radiological monitoring was performed. The duration of hospital stay, time between admission and first oral feed, passage of worms/flatus were compared in the two groups. Student's t test was used for comparing these variables. Average time for passage of flatus or worms and resolution of abdominal signs and was shorter in gastrografin group as compared to the conservative group. This difference was found to be statistically significant. The average duration of hospital stay in gastrografin group was 25.20 ± 8.01 h whereas it was 61.12 ± 14.64 h in the conservative group (P < 0.001). The difference in the operation rate was statistically insignificant (2 in gastrografin group and 3 in the conservative group).No serious adverse reaction was noted after gastrografin administration. Use of gastrografin resulted in faster relief of signs and symptoms of AL-induced SBO, early passage of worms/flatus and return to oral feeds. However, the role of gastrografin role in reducing the likelihood of laparotomy remains inconclusive. Adverse effects of gastrografin can be prevented if it is used in well-hydrated patients.

Introduction: Surgery for hypospadias has been continuously evolving, implying thereby that no single technique is perfect and suitable for all types of hypospadias. Snodgrass technique is presently the most common surgical procedure performed for hypospadias. Materials and Methods: We analysed the results of tunica vaginalis flap (TVF) as an additional cover to the tubularised incised plate (TIP) repair. Results: A total of 35 patients of hypospadias were repaired using TIP urethroplasty and TVF as a second layer. Mean age at the time of presentation was 6.63 ± 3.4 years. Post-operative complications namely wound infection, flap necrosis, scrotal haematoma, scrotal abscess, urethral fistula, meatal stenosis were recorded and analysed during follow-up period. Need for re-do surgery was considered as failure of the operative procedure. Out of 35 patients, 8 (22.85%) patients had proximal penile hypospadias and 27 (77.14%) patients had distal penile hypospadias. Mean post-operative fo...

Background. Congenital midureteric stricture (MUS) is a rare malformation. We report our experience with five cases seen over a period of 4 years from 2010 to 2014.Materials and Methods. The study was based on the retrospective analysis of five patients diagnosed as having MUS. Diagnosis was suspected after fetal ultrasonography (USG) in one patient and magnetic resonance urography (MRU) in four patients. Retrograde pyelography (RGP) was performed on three patients. The final diagnosis was confirmed during surgical exploration in all the patients.Results. MRU was found to be a good investigation method. It showed the site of obstruction in the ureter in all instances. Intravenous urography detected proximal ureteric dilatation present in two of the patients. RGP delineates the level of stricture and the course of ureter, as shown in our cases. All patients had significant obstruction on the affected side. Four patients underwent ureteroureterostomy, all of whom had satisfactory resu...

Hydatid disease is a common health problem in developing countries and liver and lungs are the most commonly involved organs. Hydatid cyst in inguinal canal is very rare and no case in children has been reported in literature. We describe a four year male child with right inguinal swelling with occasional pain and gradually increase in size. The diagnosis of lipoma of the cord was made. Up on inguinal exploration, coincidently Hydatid cyst was detected. Postoperatively histopathological examination (HPE) of the cyst confirmed the diagnosis of Hydatid disease and patient was put on albendazole therapy for three months. Hydatid disease is very rare in the inguinal canal and no case in children has been reported. In adults fewer than five cases has been reported and is usually coincidently detected during surgical exploration, as was in our case. Ultrasonography, CT, MRI and other serological tests may help in pre-operative diagnosis. In endemic areas, patients with progressive enlargi...

Background. Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Aims. To study the outcome of surgical treatment (STSG and multiple Z-plasties) in postburn contractures of groin and perineum. Material and Methods. We conducted a study of 49 patients, with postburn groin and perineal contractures. Release of contracture with split thickness skin grafting (STSG) was done in 44 (89.79%) patients and release of contracture and closure by multiple Z-plasties was done in 5 (10.21%) patients. Results. Satisfactory functional and cosmetic outcome was seen in 44 (89.79%) patients. Minor secondary contractures of the graft were seen in 3 (6.81%) patients who were managed by physiotherapy and partial recurrence of the contracture in 4 (8.16%) patients required secondary surgery. Conclusion. We concl...

Objectives: The main objective of the present study was to study the outcome of surgical treatment of dermatofibrosarcoma protuberans. Materials and Methods: This study included 45 patients both retrospective and prospective from December 1995 to December 2010. Results: Out of 45 patients, 30 were males and 15 females with the male to female ratio of 2:1. Mean age of presentation was 38.4 + 13.2 years. Commonest mode of presentation was raised firm multinodular lesion with fixity to overlying skin. Site distribution was 42.22% trunk, 57.88% extremities and head and neck. None of the patients had lymph node involvement All patients underwent wide local excision. On histological examination, 8 patients had positive margins. Overall recurrence rate was 22.22%. (please clarify what is the difference between the rate of recurrence following surgery and the overall recurrence rate) Only 2 patients developed metastasis to lungs in the course of their follow‑up. Out of 45 patients, 35 remai...

Meckel’s Diverticulum (MD) is a frequent congenital anomaly of small bowel often difficult to diagnose. It is usually asymptomatic and can present as bleeding, obstruction and inflammation. We report a case of MD in a 3 year old male child, diagnosed by 99mTc pertechnetate scan and confirmed on laparotomy. Excised specimen revealed a large MD with multiple ileal ulcers, as a source of massive bleeding per rectum. The clinical features and need for early diagnosis and treatment are discussed. DOI: http://dx.doi.org/10.3126/jnps.v33i3.7802   J. Nepal Paediatr. Soc. 2013;33(3):227-229

Suppurative involvement of salivary gland in neonates is a rare disorder. Parotid gland being the most commonly involved. We described a case of suppurative parotitis leading to abscess formation and subsequent involvement of the submandibular gland. Incision and drainage of the abscess was performed, most of the purulent material was drained. Symptoms and signs resolved within 2 days. Pus culture grew Staphylococcus aureus.

Solitary crossed renal ectopia (SCRE) is a very rare anomaly of urinary tract. Most cases are diagnosed incidentally. We report a case of SCRE associated with vesicoureteric junction obstruction in a 7-year-old child which has not been reported in the literature till date.

We report an unusual case of multiple pyogenic liver abscesses containing Ascariasis lumbricoides in a 35-year-old post-partum female who had delivered 1 month back. Open drainage of liver abscess along with liver worm was done. Patient did well post-operatively.

ABSTRACT Objective: Circumcision is one of the most frequently performed elective procedures in male. In general, post circumcision complications are minor and treatable but complications requiring expert intervention are seen when the circumcision is perrformed by inexperienced/untrained person and in non-sterile setting and inadequate equipments. Materials and Methods: From March 2008 to May 2012, 59 patients with circumcision related complications were received at age range of 6 months to 5 years with a mean age of 2.4 years. The most common complication was urethra– cutaneous fi stulae in 18 patients, followed by meatal stenosis in 9, bleeding in 6, incomplete circumcision in 6, buried penis in 5, glanular injury in 4, skin bridge in 4, complete amputation of phallus 3, hole in the prepuce in 3 patients and one patient with coronal constriction and fi stula. Results: Urethral fi stulae were closed in all 18 patients with recurrence in 16%. Two patients with extensive bleeding required blood transfusion and all 6 children required hematoma evacuation under general anesthesia in the operating room. The circumcision was revised in those with an incomplete procedure, a hole in prepuce, burried penis and residual skin bridge. Meatotomy was the procedure of choice in 6 of 9 patients with meatal stenosis, but in the remainder meatal dilatation was efffective. Glanular injuries were managed conservatively. A short residual after glanular injury needed grafting. Conclusion: Circumcision is considered a simple and minor surgical procedure, yet it needs to be performed competently by only medically qualifi ed and trained personnel and with a great care.

Joubert's syndrome is an autosomal recessive congenital disorder having characteristic clinical features like hypotonia, ataxia, developmental delay and many neurological problems. Other variable features include retinal dystrophy, cystic kidney disease liver fibrosis etc. Treatment for Joubert syndrome is symptomatic and supportive. Infant stimulation and physical, occupational, and speech therapy may benefit some patients. Infants with abnormal breathing patterns should be monitored. Key words: Joubert's syndrome; molar tooth sign; cerebellar peduncles; vermis hypoplasia. DOI: 10.3126/jnps.v31i2.3908 J Nep Paedtr Soc 2010;31(2):141-142

A case of hydatid cyst involving posterior triangle of neck in a 10 year old male child is reported. Diagnosis was confirmed by MRI. Surgical excision of the cyst was done. Hydatid cyst in posterior triangle should be considered one of the possibilities in evaluating a cystic swelling in this region. DOI: http://dx.doi.org/10.3126/jnps.v32i3.5768 J. Nepal Paediatr. SocVol.32(3) 2012 261-262

Dermatofibrosarcoma protuberans (DFSP) is a rare mesenchymal skin tumor with intermediate to low grade malignancy and occasional distant metastasis and high rate of recurrence locally. It mostly involves trunk, extremities, scalp, and neck. This article describes a middle-aged married male with a DFSP lesion involving ventral aspect of glans and distal shaft of penis who underwent local excision and primary closure. The patient was tumor-free at three years of follow-up.

The intermittency effect has been studied for the interactions of 4.5 A GeV/c 28Si, and 4.1 A GeV/c 22Ne with emulsion using the distributions of both the pseudorapidity interval and the azimuthal angle interval of the shower particles emitted in the central rapidity region. The reduced scaled factorial moments as a function of the bin size in pseudorapidity and in azimuthal angle have been calculated and have revealed the presence of an intermittent behaviour which may be due to the random cascading property of the reaction. The anomalous fractal dimension has been found to increase with the increase of rank of the moment.

Wide local excision (WLE) is the preferred treatment of dermatofibrosarcoma protuberans (DFSP). The aim is to achieve negtive margins. We followed the impact of radiotherapy used postoperatively for both margin-negative and margin-positive DFSP tumors. Outcome of treatment of 36 patients of DFSP treated at our hospital was assessed. Thirty patients received radiotherapy postoperatively and six patients received radiotherapy alone. The maximum dimension of the lesion was 15 cm(2). Patients were followed up for varying periods of time for any recurrence. 10-year actuarial local control rate was determined. Local control was realized in six patients who were treated with radiotherapy alone. 30 patients were treated by radiotherapy and surgery. Out of these 30 patients, there were 6 local failures (failure rate 10%). Actuarial control rate was 82%. The failures were among patients who had positive margins. Radiotherapy is effective, and it decreases the recurrence rate in the treatment of DFSP. It is especially helpful in margin-positive disease. This appears true for patients treated with radiotherapy alone or radiotherapy used postoperatively.