Isolated cleft sternum is a rare congenital defect of the anterior chest wall and is the result of failed ventral midline fusion of sternal bands. We present two cases operated 18 and 24 days after birth with satisfactory results. Surgery is indicated to protect the heart and mediastinal contents.

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Background: Hirschsprung's disease (HD) is a common cause of intestinal obstruction in children. Despite increased understanding of the disease and several techniques of treatment, significant complications continued to be associated with its management. Objective: To study the outcome of management of HD in the University Teaching Hospital, Ilorin, Nigeria. Materials and Methods: The clinical records of all children managed for HD between January 1998 and December 2005 were retrospectively reviewed. Demographic data, modes of presentation, methods of diagnosis, age at colostomy formation, age and type of definitive operations were noted from patients' records. Complications associated with colostomy, pre- and postoperative complications, final outcome and duration of follow-up were also noted. Results: Twenty-one patients (20 males, one female) managed for HD were reviewed. Eight (38%) were diagnosed in the neonatal period, the mean age at diagnosis being 22 months. Fourteen patients had completed the three stages of the operation, one is awaiting colostomy closure and two patients are waiting for definitive operations. Out of the 15 patients who had definitive surgery, nine had Swenson's pull-through operations while six had Duhamel operations. At presentation, six patients had enterocolitis, one of whom had spontaneous colonic perforation, two patients had sepsis. Colostomy-related complications recorded included sixteen patients with dermatitis, nine with colostomy prolapse, one patient with colostomy diarrhea and one with enterocolitis and sepsis. Following definitive surgery, three patients had wound infection, one partial intestinal obstruction, one postDuhamel hemorrhage and two enterocolitis. Complications after colostomy closure included two wound infections and one severe enterocolitis. There were five deaths (23.8%)-two from sepsis, two from enterocolitis and one from an adverse drug reaction. One of the children who had enterocotitis preoperatively died of enterocolitis after colostomy. Range of follow-up was six weeks- to eight years. Conclusions: Many complications from HD resulted from late presentation to our unit. Colostomy caused unacceptable morbidity. Most deaths were due to sepsis and enterocolitis. The Swenson's and Duhamel operations gave satisfactory results. Early presentation and improved facilities in our pediatric surgical unit will reduce morbidity and mortality.

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Phrenic nerve preservation is an important factor in operations involving the resection of an extralobar pulmonary sequestration. We present a case of secondary diaphragmatic eventration due to damage to the phrenic nerve after resection of an extralobar pulmonary sequestration.

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Objective: To determine the contribution of corporal punishment to ocular morbidity and visual impairment in Nigerian children. Materials and Methods: A prospective study was conducted of all patients aged 0-15 years seen with ocular injuries over a four year period. Those who sustained ocular injuries during the administration of corporal punishment were further studied. Relevant information was documented using a semistructured questionnaire. Data was analyzed by simple descriptive statistics using SPSS statistical package version 10. Results: A total of 186 children were seen within the study period. Eighty-nine (47.8%) had ocular injuries and 27 (30.3%) had ocular injuries resulting from corporal punishment. Of the latter group, eighteen were males and nine were females. Their ages ranged from 3-15 years (mean = 8.5 ± 2.4 years). Corporal punishment-associated injuries occurred most commonly as seen in 17 (63%) of our study population who were aged 7-12 years. These 27 cases of injuries were sustained in the schools: 13 (48.2%), homes: eight (29.6%), market place: three (11.1%), workshop: two (7.4%) and worship houses: one (3.7%). A stick was the object mostly implicated in causing ocular injuries in 13 (48.2%) followed by a belt in five (18.5%) and a whip in four (14.8%). Severe visual impairment occurred in two (7.4%) patients while blindness occurred in three (11.1%) patients. Conclusion: Corporal punishment is a major cause of ocular morbidity and blindness in Nigerian children.

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A 11 year-old girl presented with pain in the abdomen, an abdominal mass and jaundice. Clinical examination and investigations suggested a diagnosis of a type 1 choledochal cyst. Upon operation, a solitary, unruptured hydatid cyst was found obstructing the common bile duct. Intrinsic obstruction of the extrahepatic bile duct by a solitary hyatic cyst without any hepatic involvement as seen in this unique case, has not been reported until now.

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Mesenteric cysts are uncommon lesions with a variable clinical presentation. A provisional diagnosis is possible on clinical and radiological grounds, while confirmation is subject to histopathological examination. We present two cases of mesenteric cysts, both occurring in children. Following clinical examination and histopathological analysis, both were diagnosed as cases of chylous mesenteric cysts.

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A case of a choledochal cyst managed with cyst excision and an antiperistaltic hepaticoappendicoduodenostomy (HAD) is reported. Although the possibility of a postoperative evaluation using endoscopic retrograde cholangiopancreaticography has been considered previously, this is probably the first reported case where postoperative stenting of HAD has been successfully performed to treat postoperative biliary leak.

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Most neonates with congenital diaphragmatic hernia (CDH) present with CDH symptoms within the first 24 h of life. However, the presentation may be delayed in 10-20% of the cases. The presenting symptoms are nonspecific and are usually gastrointestinal in nature. We report a case of a 9 day-old neonate presenting with abdominal distention. The investigation was suggestive of CDH with the possibility of perforation which was confirmed by emergency laparotomy. A review of literature revealed one similar case report. This case highlights the risk of bowel incarceration in delayed cases presenting with gastrointestinal symptoms.

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A 2-month-old girl came with breathlessness of 5 days' duration. Clinical examination and plain chest radiograph showed it to be pleural effusion. On sonographically guided aspiration, the effusion fluid was found to be chyle. Introduction of intercostal thoracic drainage tube and antibiotics helped the baby to recover. It is mainly the role of nutritional support in the form of using medium-chain-triglyceride-containing feed, which is discussed in details in the case report. There was no need of any surgery.

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Ascaris lumbricoides, or the common roundworms, has a worldwide distribution but is mainly seen in Asian and Latin American countries. In humans the usual habitat is in the small intestine, mainly in the jejunum. But if the worm load is high, which may go up to a thousand worms, the worms tend to migrate away from the usual site of habitat. This brief paper aims at highlighting the condition of biliary ascariasis through the authors' experience in managing three such cases over a period of 1 year. The clinical features which arouse suspicion of biliary ascariasis, as well as diagnostic modalities and management, are described. Initially the cases were managed conservatively, but we conclude that if worms are retained in biliary tree for more than 10 days, surgery should be performed; since retention of degraded and calcified dead worm can occur, and this can lead to complications which are difficult to manage.

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Aims: An isolated bowel segment (IBS), a viable loop of bowel completely free of its mesenteric attachments, has potential clinical use in bowel lengthening and other techniques. The end point of successful creation of an IBS is the development of adequate collateral circulation. In this experimental study, we report the use of fluorescein test to demonstrate collateral vascularity of the IBS in rats. A simple technique for the visualization and photography of fluorescein in the tissues is also described. Materials and Methods: In nine Wistar rats, 5 cm of distal ileum was anastomosed side-to-side to 5 cm of proximal colon using 6/0 PDS. In one rat (control), the colon patch was isolated from the rest of the large bowel immediately and fluorescein test was performed. The remaining eight (study group) rats were operated after 8 weeks and the procedure followed as in the control rat. In the last rat, the mesentery of the colon patch was severed; and 2 weeks later, the fluorescein test was performed. Results: The colon patch in the control rat showed complete lack of fluorescence; in the seven rats tested after 8 weeks, patchy fluorescence was demonstrated in the colon patch; and in the last rat, bright fluorescence of the whole patch could be demonstrated within a few seconds following fluorescein injection. Conclusion: This study describes a simple technique for the fluorescein test. The observation that the vascular collaterals were more abundant after mesocolic division was obviously due to the opening up of collaterals over a period of time. The fluorescein test is a rapid and easy test and can be easily reproduced.

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Aims: Long-term sequelae in children with Hirschsprung's disease (HD) are usually related to abnormalities in defecation. However, some of these patients also suffer from voiding dysfunction. The aim of this study is to assess and define the effects of Swenson's 'pull through' procedure in patients with HD on lower urinary tract function by means of urodynamic studies (UDS) performed before and after surgery. Materials and Methods: Six patients with Hirschsprung's disease underwent UDS before and after the definitive procedure. Parameters observed were maximum cystometric capacity, compliance, unstable detrusor contraction (UDCS), leak point pressure, residual volume, end filling pressure, volume at Pdet <20 cm H ₂ O and volume at Pdet <30 cm H ₂ O. Results: On UDS evaluation, one patient (16.6%) showed a small-capacity bladder and one patient (16.6%) showed a large-capacity bladder with occasional uninhibited detrusor contraction (UDCS) preoperatively. All the children had good compliant bladders. Postoperatively, one child was clinically symptomatic and showed hyporeflexic large-capacity bladder without any UDCS, one patient showed a small-capacity bladder with UDCS. Conclusions: In Hirschsprung's disease, neurovesical dysfunction may exist preoperatively and though the incidence of postoperative changes in neurovesical function may appear high, a larger study is required for statistical validation. Children who present with urinary problems after surgery should be assessed urodynamically.

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