ABSTRACT: The medical records and investigations of all patients treated for choledochal cyst between January, 1993 and December, 1998 were reviewed. Twenty three patients(Girls 14 and Boys 9)were operated. Age ranged from 3 months to 10years with majority between 7 and 10 years of age. Upper abdominal pain was the most common presentation(86 percent)followed by jaundice and abdominal lump. Ultrasonography was done in all patients. CT Scan, ERCP(Endoscopic Retrograde Cholangiopancreatography),Operative cholangiogram were done in some of the patients. Operative management include cholecystectomy in all cases along with various forms of cystoenterostomy or bilioenterostomy(e.g. anastomosis with common hepatic duct-HDJ(Hepaticodochojejunostomy)or more high near the porta hepatis, PE(Portoenterostomy))with or without excision of the cyst. Submucosal excision of the cyst with high anastomosis gives excellent result. There was no morality in our series. Three patients had cholangitis after operation and one of them required revision of anastomosis. Two patients (one patient of cystojejunostomy and the other patient of cystoduodenostomy) were lost to follow up.

ABSTRACT: Objective: To review our experience in the management of neonates with TPN induced bile plug obstruction. Subjects: Although cholestatic jaundice is a known complication in infants on prolonged total parenteral nutrition(TPN), till recently no specific cause had been implicated. We treated two neonates who developed severe cholestasis following TPN therapy in the postoperative period. Result: In both neonates a Hippuran Imminodiacetic Acid(HIDA)scan showed absence of intestinal excretion at 24 hours. In one patient, laparotomy revealed Common Bile Duct(CBD) obstruction with a bile plug which was relieved by biliary irrigation. Icterus resolved postoperatively in 3 weeks. The second patient was not operated; death occurred at 9months of liver failure. Conclusions: We propose that biliary hyper viscidity may be a predominate factor causing hepatic dysfunction in some neonates on TPN therapy. In this paper we report a simple staging of hepatic dysfunction in post TPN cholestasis and suggest a stagewise management protocol with emphasis on preventive aspects. The treatment of bile plug obstruction in particular, has been discussed in detail.

ABSTRACT: This prospective randomized double Blind study was conducted to evaluate the efficacy of a single dose thoracic paravertebral block in the management of intraoperative pain in children. Eighteen children aged 2-7 years undergoing elective lateral thoracotomy were included in the study. Following induction and intubation the children in group I (n=9) received a single dose paravertebral block with 0.5 ml/Kg bupivacaine 0.25 percent with 1: 200,000 adrenaline, while those in group II(n=9)were given an equivalent volume of 0.9 percent saline. Heart rate (HR), mean arterial pressure(MAP) and the rate pressure product(RPP)were determined at preincision(basal),skin incision, rib retraction, rib retraction release and skin closure. In group I a significant increase in HR from 98.44+-5.22 to 106.11+-6.0 at skin incision and from 98.44+-5.22 to 107.56+-5.54 during rib retraction was seen(p0.01), whereas in group II the HR remained elevated significantly at the above mentioned specific time intervals(p0.01). The MAP in group I remained stable following the block and there was no significant change from the basal value. However, in group II the MAP was significantly higher following skin incision (75.48+-4.22 to 81.63+-2.26),at rib retraction(75.48+-4.22 to 82.37+-3.83) and also at rib retraction release and during skin closure(p0.01). There was also a significant rise in the RPP in group II at all the time intervals (p0.001). The date suggest that a single dose of thoracic paravertebral block with bupivacaine administered following induction of anaesthesia is safe and effective in the hemodynamic responses to painful stimuli in patients undergoing lateral thoracotomy.

ABSTRACT: A study of clinical presentation of appendicitis in children was carried out over a period of four and a half year. A total of 39 patients under 7 years of age was studied. It was found that 7 out of 8 patients below 4 years presented with features of peritonitis(4 patients)or intestinal obstruction(3 patients) whereas 27 of 31 patients above 4 years of age presented with features of uncomplicated appendicitis. All the patients underwent surgery and the clinical findings were coroborated. There was no mortality. It was evident from the study that infants and young children usually presented with complications of acute appendicitis because of a delay in the diagnosis due to the difficulties in verbal communication with them.

ABSTRACT: In this retrospective study, 76 cases of diaphragmatic hernia and eventration admitted in JIPMER Hospital, Pondicherry, from the year 1981 to 1996 were studied. Our main aim was to study the risk factors affecting mortality. Respiratory distress was the commonest presenting symptom in our patients. Decreased breath sounds on the affected side was the commonest sign elicited. Our study concluded that presentation before 72 hours of birth was found to significantly worsen the outcome. The study also showed that the need for continuous postoperative ventilation was statistically significant in determining the outcome.

ABSTRACT: Unilateral Autosomal Dominant Polycystic Kidney Disease in children is rare. Association of this rare entity with another rare condition in children, Klippel Trenaunay syndrome is presented in this case report. Clinical features and the details of the management of this child are described. Literature review is made.

ABSTRACT: A six year old boy presented with recurrent upper abdominal pain. Boy was investigated, USG and intravenous pyelography showed right sided hydronephrosis and hydroureter of the upper part with narrowing of the ureter at L3 level. The ureter behind the venacava was mobilised, stenotic post coval ureter was excised and uretero ureteral anastomosis was done. The baby is doing well now.

ABSTRACT: A 7 1/2 year old boy presented with intractable constipation and recurrent fecal impactions refractory to medical therapy. History and findings suggested that the child had a low anorectal malformation(ARM) with an anal membrane which ruptured spontaneously soon after birth. The boy had undergone surgery at 2 days of age for peritonitis when a grossly ectatic rectum and sigmoid colon were found along with a small perforation in the sigmoid colon. During the present admission, the anus was found to be of normal caliber with good sphincteric tone. Barium enema revealed a massive localized dilatation of the rectosigmoid colon. Complete cure of symptoms was achieved by subtotal resection of the dilated segment and anastomosis of normal descending colon with the lower rectum. Megasigmoid probably results from a primary congenital anomaly of the terminal bowel and has several features in common with segmental dilatation of the colon(SDC) and congenital pouch colon (CPC)d.

ABSTRACT: Pyloric obstruction during fetal development could lead to distention of the stomach and this in turn could possibly lead to the eventration of the diaphragm. A 2 day old full term male child presented with pyloric obstruction and the investigations revealed the associated eventration of the diaphragm. Pyloroplasty and plication of the diaphragm was performed. Distension due to the any cause at the pyloric region can lead to the eventration of the diaphragm

ABSTRACT: Spontaneous duodenal perforation in an infant is a rare entity. A seven month old underweight infant, who presented with peritonitis and shock, was resuscitated and operated upon. At laparotomy, a 0.5 cm perforation in the posterior wall of duodenum at the junction of its first and second part, abutting the head of pancreas was found. Perforation was closed and omentoplasty was performed. Post operatively, the patient developed features of DIC (Disseminated Intravascular Coagulation)but recovered. Possible etiology of perforation could be acute duodenal ulcer with low flow state due to prolonged septicemic shock. Timely surgery and efficient pediatric care led to survival of the infant.

ABSTRACT: A 8 year old female presented with huge abdominal distention for 3 months but with no acute symptoms. Abdomen was explored after initial tube drainage and conservative therapy. A huge thick walled pseudocyst occupied the whole anterior abdomen and posterior wall of it covered the intestines akin to what is seen in giant cystic meconium peritonitis in neonates. After excising the pseudocyst a single small ileal perforation was located and local resection with end to end anastomosis was successfully done. Surprisingly, except for the caseous mesenteric nodes, there were no other manifestations of intestinal tuberculosis. The patient recovered with antitubercular drugs. Such late and unusual presentation of tubercular perforation with unusual operative findings has not yet been reported.