Sujoy Neogi

Congenital lung hernia is extremely rare with less than 50 reported cases.We report two cases of lung hernia, secondary to congenital absence of ribs – A 4?year?old girl without any antecedent history of chronic cough or chest trauma presenting with a left lower lobe hernia secondary to an absent left 9th rib; a 7 month?old girl with recurrent pneumonia presenting with severe respiratory distress, fever and severe malnourishment, found to have absent 6th-9th ribs on right side with associated liver and lung herniation. The older girl has been kept on observation without surgery but the infant expired within 48 hours of admission due to respiratory failure. The clinical scenario is a rarity and can be managed conservatively in most cases. Surgical treatment should be considered in symptomatic patients and in those with severe complications. Repair for cosmetic reasons is sometimes justified.   Keywords: Pulmonary hernia, Absent rib

Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague symptoms and inconclusive imaging make it an elusive diagnosis, more so in children. Only 30 pediatric cases have been reported worldwide till date. We report a case of a 7yrs old boy presenting 2 weeks after a road accident with a gallbladder rupture which was eventually discovered on a diagnostic laparoscopy. This is the second such case being reported from India. The injury is most often identified at exploration and although cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ. The classification system of Losanoff and Kjossev has merit in guiding treatment. The various presentations, mechanisms and modes of injury have been highlighted along with the clinical and imaging findings. Despite the developments in modern radiology, identifying gallbladder perforation has always been difficult because of the rarity of the condition. In a child with blunt abdominal trauma and intra-abdominal free fluid without any solid organ injury, a diagnostic peritoneal tap may be helpful. Based on the current evidence, we advocate a low threshold for performing a diagnostic laparoscopy in all such cases.   Keywords: Gallbladder, Perforation, Laceration, Abdominal, Trauma, Injury

Neonatal intussusception is rare entity.We report this very rare case of a term male newborn, with acute jejunojejunal intussusception without any lead point. He presented with abdominal distension and signs of intestinal obstruction and abdominal sonography showed a jejunojejunal intussusceptions which was confirmed at laparotomy. Interestingly, no lead point was found. Rather 8cm of bowel distal to intussuscepted segment was found to be gangrenous bowel. Resection with Bishop Koop anastomosis done for the baby resulted in good outcome. The case is being presented for rare presentation of a rare surgical condition in a neonate with an endeavour to establish etiology for its occurrence. Keywords: Intussusception, Jejunojejunal, Lead point, Neonate, Gangrene.

We are reporting an unusual case of diffuse chylous mesenteric cyst extending to the retroperitoneum in a neonate. The lump was unresectable as it was diffuse and mesenteric vessels traversed through it. The child was followed till one year of age and is asymptomatic. Repeat imaging shows persistence of the cysts. Keywords: Mesenteric cyst, Chylous cyst, Chyle, Chylo-lymphatic cyst.  

Esophageal Atresia (EA) with tracheo-esophageal fistula (TEF) is a common congenital anomaly diagnosed at birth. These children either undergo primary anastomosis of esophageal pouches or a diversion procedure (cervical esophagostomy & feeding gastrostomy), depending on the gap between the two pouches intraoperatively. Sham oral feeds are encouraged in these babies in order to stimulate brain development. We present an unusual case of diverted TEF who presented to us with recurrent fever, runny nose and blood stained discharge from esophagostomy. Keywords: Esophageal atresia, Tracheoesophageal fistula sham feed esophagostomy gastrostomy.

Aims: The recto-urethral (RUF) and recto-vestibular fistula (RVF) are varieties of anorectal malformation (ARM) with distinct clinical behaviour. In this study post-operative clinico-manometric comparison has been done. Materials and Methods: The study was conducted for 2 year period and included post-operative cases of RUF and RVF. Post-operative follow up was done clinically and by anal manometry. Statistical analysis used: Kruskal Wallis test, Mann Whitney U test, and Spearman correlation test were done to find out the statistical significance. Results: A total of 21 patients with RUF and RVF were included. The average basal and squeeze pressure of RVF group was (cm H2O) 34.66 13.2 and 89.35 30.8 respectively. These pressures were higher than those of RUF which were 26.74 12.8 and 71.20 42.8 respectively. Rectoanal inhibitory reflex (RAIR) was present in 84.6% cases of RVF in comparison to 62.5% in RUF group. The mean combined (RUF + RVF) basal pressure in RAIR positive group was 32.97 12.2 compared to 24.5 4.6 cm H2O in RAIR negative group. The mean combined squeeze pressure in RAIR positive group was 84.34 36.2 compared to 68.83 32.75 cm H2O in RAIR negative group. Conclusions: The anal pressures of RVF group were higher than RUF group. Anal pressures also higher in RAIR positive group than the RAIR negative group. Anal pressures and RAIR status may have some role in post-operative outcome in cases of ARM. Keywords: Anorectal malformation, Anal manometry, RAIR in anorectal malformation, Recto-urethral fistula, Vestibular fistula.