Omental torsion is a rare cause of acute abdominal pain, and clinically mimics acute appendicitis. A 11-year-old boy presented with symptoms and signs suggestive of appendicitis. A computed tomography of abdomen revealed findings suggestive of omental torsion. Diagnostic laparoscopy confirmed the diagnosis of torsion of a segment of the greater omentum.

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Aim: Review of our experience and to develop an algorithm for salvage procedures in the management of hypospadias cripples and treatment of urethral strictures following hypospadias repair. Methods: This is a retrospective review of hypospadias surgeries over a 41-month period. Out of a total 168 surgeries, 20 were salvage/re-operative repairs. In three children a Duplay repair was feasible, while in four others a variety of single-stage repairs could be done. The repair was staged in seven children - buccal mucosal grafts (BMGs) in five, buccal mucosal tube in one, and skin graft in one. Five children with dense strictures were managed by dorsal BMG inlay grafting in one, vascularized tunical onlay grafting on the ventrum in one, and a free tunical patch in one. Three children were treated by internal urethrotomy and stenting for four weeks with a poor outcome. Results: The age of children ranged from 1.5-15 years (mean 4.5). Follow-up ranged from 3 months to 3.5 years. Excellent results were obtained in 10 children (50%) with a well-surfaced erect penis and a slit-like meatus. Glans closure could not be achieved and meatus was coronal in three. Two children developed fistulae following a Duplay repair and following a staged BMG. Three repairs failed completely - a composite repair broke down, a BMG tube stenosed with a proximal leak, and a stricture recurred with loss of a ventral free tunical graft. Conclusions: In salvage procedures performed on hypospadias cripples, a staged repair with buccal mucosa as an inlay in the first stage followed by tubularization 4-6 months later provides good results. A simple algorithm to plan corrective surgery in failed hypospadias cases and obtain satisfactory results is devised.

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Congenital arhinia or absence of nose is a rare condition with only 30 cases reported so far. We report a rare case and briefly review the literature.

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We report a rare case of a 3-year-old male child with scapular bronchogenic cyst. The cyst was excised because of associated pain and discharge from the swelling. Till date, 64 cases of cutaneous bronchogenic cyst have been reported in the literature. Only 12 of these patients had lesion located in periscapular area. The treatment is surgical as it can undergo malignant transformation.

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Aim: To review 12 cases of anovestibular fistula with normal anal opening. Methods: Retrospective analysis of 12 children with anovestibular fistula and normal anal opening were treated between the years 2000 and 2007. Of these, 11 patients were diagnosed as having acquired anovestibular fistula with normal anal opening and were managed by conservative management. Results: Most of them presented with diarrhea and labial redness. One patient was considered to have fistula of congenital origin and was managed surgically. Eleven patients presented between the ages of 1.5-11 months and were considered as cases of acquired anovestibular fistula and only two of them required surgical management in the form of colostomy and fistula excision. Others were successfully managed by conservative treatment; the fistulous output and labial redness decreased gradually within a period of 5-19 (average 11.5) days. Conclusions: Not all presentations of anovestibular fistula with normal anal opening can be considered as congenital. Presence of inflammation, paramedian fistula, and a favourable response to conservative management/colostomy suggest acquired etiology. Trial of conservative management should be given in the acquired variety.

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Disseminated intravascular coagulation (DIC) is a complex clinical syndrome, described as a sequential activation of the coagulation and fibrinolytic system. Trauma and sepsis are some of the known precipitating factors. We report a case of nonovert disseminated intravascular coagulation presenting as a huge renal mass in a 3-year-old child, suspected to be a Wilms' tumor. On imaging studies, it was found to be a renal hematoma. Laboratory investigations revealed an underlying chronic disseminated intravascular coagulation caused by sepsis. The child recovered with conservative treatment; follow up investigations showed resolution of renal hematoma with renal function returning to base line. Clinical presentation of Chronic DIC is variable. Laboratory investigations usually help to diagnose the condition and also to monitor the progress of the treatment. The treatment of the triggering cause is the cornerstone of the management of this condition.

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Aims: Evaluation of the pediatric appendicitis score (PAS), in all patients who had an appendicectomy over a one-year period. Methods: Retrospective study of 56 patients aged 4-15 years, who underwent an emergency appendicectomy. PAS was applied and patients were divided according to the PAS protocol into high probability and low probability groups. These results were then correlated with histology. Results: The PAS had sensitivity 0.87, specificity 0.59, positive predictive value 0.83, and negative predictive value 0.67. The negative appendicectomy rate would have been reduced to 17%, but five patients with appendicitis would have been denied early surgical treatment and may have been discharged. Conclusions: The PAS cannot be recommended as it would lead to an unacceptable risk of wrongly discharging or delaying necessary surgery in 13% of patients with appendicitis.

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Paraesophageal hiatus hernia (PEHH) is an uncommon type of diaphragmatic hernia in the pediatric age group. Two patients aged 5-months and 8-months presented with respiratory symptoms and underwent a laparoscopic repair. Preoperative assessment included chest x-ray and CT scan. We suggest that laparoscopic repair of PEHH in infants is safe and preferred mode of the treatment.

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A neonate with perineal lipoma associated with penoscrotal transposition and bifid scrotum is reported.

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Aim: Report of a series of 12 cases of juvenile polyposis coli. Methods: The study period was from 1995 to 2005. All the patients were treated by total colectomy with rectal mucosectomy and endorectal ileoanal pullthrough with or without ileal pouch formation. Covering ileostomy was avoided in all the cases. Time taken for the surgery, postoperative complications and continence were documented. Results: The mean operating time was 4.2 h (range: 4-5 h). The mean duration of hospital stay was 16.3 days (range: 15-18 days). The most common postoperative complication was pouchitis and perianal excoriation. Initially, all the patients were passing stools at an interval of 2 h, and after 3 weeks, the frequency has reduced to 6-8 stools per day. In the follow-up after 3 months, the frequency was 3-5 per day with minimal soiling. Conclusions: Single-stage total colectomy with rectal mucosectomy and endorectal ileoanal pull-through without covering ileostomy and pouch formation is a safe and definitive treatment for juvenile polyposis coli if the patient selection is appropriate.

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Presence of thymus in the normal position as well as in the posterior mediastinum is an unusual phenomenon. We report here a case of posterior mediastinal mass in a 20-month old male child who presented with dysphagia and dry cough. Investigations revealed it to be a solid posterior mediastinal mass, suspected to be either lymphoma or a neuroblastoma. Excision of the mass followed by histopathologic examination revealed the mass to be a normal thymus. This case indicates that a benign mass, an accessory thymus, though rare, can be located in the posterior mediastinum and cause symptoms similar to solid mediastinal tumors.

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We report an isolated giant solid macronodular tuberculoma in an 8-year-old boy. A large-space-occupying lesion in the right lobe with nodular surface and hard consistency mimicked liver malignancy. This case is unusual as the ultrasonography, computed tomography scan, and aspiration cytology were all suggestive of a malignant tumor. Laparotomy confirmed a 15 x 10 cm nodular tumor present in the right lobe of liver. The segments 5, 6, 7, and 8 were excised. The histopathology revealed tuberculosis.

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