Aim : To analyze our experience of choledochal cysts. The results of complete excision of cyst and hepaticodochoduodenostomy have been analyzed in particular. Material and Methods : Period of study: January 1993 to August 2010. Apart from basic investigations, we did ultrasonography (USG) of abdomen, contrast-enhanced computerized axial tomography scan (CECT), endoscopic retrograde cholangiopancreatography (ERCP), operative cholangiogram, hepatic isotope scan (HIDA), magnetic resonance cholangiopancreatogram (MRCP) and choledochoscopy. The patients were divided into six groups according to the management done and the results analyzed. Results : The total number of cases was 79 (Male : Female = 26 : 53). The mean age of presentation was 5.18 years . The most common mode of presentation was abdominal pain in 86% cases. Types of cysts - Type I: 63; Type IV: 12; Forme fruste: 1; Caroli's disease: 1; Cyst with atresia in the lower end of common bile duct: 2. Two patients of group A (cyst excision and Roux-en-Y hepaticojejunostomy) had recurrent pain and cholangitis. One patient required revision for stricture. In group E (n=53) (excision of cyst and hepaticodochoduodenostomy), three patients developed occasional epigastric pain and they responded to omeprazole. One patient developed anastomotic stricture and was lost to follow up. One patient of cyst with biliary atresia with biliary cirrhosis died. Conclusions : In choledochal cyst, complete excision of cyst and good bilioenteric anastomosis with wide stoma should be done. Hepaticodochoduodenostomy with wide stoma is a simple, quick procedure with preservation of normal anatomy and physiology and minimum complications. It also avoids multiple intestinal anastomoses and so should be the preferred approach.

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We report a case of congenital renal tuberculosis in a 34-day-old child presenting as severe hematuria. Adequate antitubercular treatment may provide protection to fetus in subsequent pregnancies.

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Pancreatic cystic lesions are rare clinical entities. To the best of our knowledge, only 38 cases have been reported in the English literature in children under the age of 2 years. We present a 2-month-old infant with a cystic lesion in the head of pancreas. We reviewed the possible causes and present our dilemmas in the management of these patients.

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Glial heterotopia is a rare congenital mass lesion which often presents as a clinical surprise. We report a case of extranasal glial heterotopia in a neonate with unusual features. The presentation, management strategy, etiopathogenesis and histopathology of the mass lesion has been reviewed.

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Background and Aims : Introduction of intestinal tissue in the urinary tract results in numerous metabolic changes. This study investigates the effects of augmentation sigmoid colocystoplasty on the physical growth and bone mineralization in bladder exstrophy patients. Materials and Methods : Physical growth, serum biochemistry and bone mineral density were assessed pre and post augmentation in 34 of 54 patients who were treated by staged sigmoid colocystoplasty for classical bladder exstrophy during the period 1985-2007. Physical growth was determined by comparing the height and weight for age with standard growth charts. Serum biochemistry included calcium, phosphate and alkaline phosphatase levels. Bone mineral density (BMD) was determined at the femoral head using the dual energy X-ray absorptiometry (DEXA) scan at 15 ± 4.5 months after the augmentation. The DEXA scan findings were compared with 22 normal Indian children who served as controls and 18 unaugmented patients with bladder exstrophy. In 13 augmented patients, the DEXA scan could be repeated after an interval of six months. Results : The mean percentile height and weight were comparable in the pre and post-augmentation period with no statistically significant difference (P=0.135 for height and P=0.232 for weight). Biochemical parameters of bone metabolism also did not show any statistically significant changes after colocystoplasty. The BMD was 0.665 ± 0.062 g/cm ² in the controls and 0.612 ± 0.10 g/cm ² in the unaugmented bladder exstrophy patients. In the augmented patients, the BMD was 0.645 ± 0.175 g/cm ² and six months later it was 0.657 ± 0.158 g/cm ² . These differences were not statistically significant. Conclusions: In our study, no significant effects on the physical growth and bone mineral metabolism were observed in exstrophy bladder patients following sigmoid colocystoplasty.

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Pancreas is a rare location for desmoplastic small round cell tumor. The present case highlights the dilemma in diagnosis and ascertaining the site of tumor origin. Morphologic and immunohistochemical features were complemented with the molecular markers and tumor origin which was initially nebulous was subsequently confirmed on exploratory laparotomy.

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This report describes two unusual cases of anorectal malformation. The first had a type III congenital pouch colon with a colovesical fistula. In the other very similar case, segmental dilatation of the colon was present along with penoscrotal hypospadias and, distally, a length of normal colon ending in a rectourethral fistula. In both patients, the appendix was short, stubby and a Y-shaped duplication of the normal colon was present just proximal to the dilated segment of colon.

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Background: A significant number of esophageal atresia and tracheoesophageal fistula patients have long gaps and a high propensity to leak. Anastomotic leak in esophageal atresia is associated with a significant morbidity and mortality. Aim : In a prospective randomized trial, we analyzed the risk factors leading to anastomotic dehiscence and studied the effect of pleural wrap as an additional vascular cover around the esophageal anastomosis. Materials and Methods: Forty patients were divided into two groups A and B randomly. In 20 patients of group A, pleural wrap was utilized for covering the anastomosis and in 20 patients of group B, no such wrap was utilized. Results: Both the groups were comparable regarding age, sex, weight, gap length, tension at anastomosis and the hospital stay. The overall leak rate was 25% (10/40) in both the groups. The leak rate was not significantly different in two groups whenever a gap length was less than 2 cm or more than 3 cm. However, for a gap length of 2-3 cm, the leak rate in group A was 18% (2/11) and in group B was 50% (4/8) (P = 0.05). Thirty percent (3/10) of patients, whose anastomosis was under tension, leaked in group A as compared to 75% (6/8) in group B patients (P = 0.001). Conclusions: Use of pleural wrap was associated with less anastomotic dehiscence in patients with moderate gap esophageal atresia (2-3 cm) especially when the anastomosis was under tension.

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Anterior mediastinal abscesses (MAs) due to a non-traumatic etiology are extremely rare in childhood and only 13 such cases have been reported in the literature. We report a 5-year-old male child with disseminated staphylococcal infection and a large non-traumatic anterior MA, who had a successful recovery after surgical drainage of the abscess.

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Report of a hitherto unreported association of polysplenia, teratoma and eventration of diaphragm.

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