Cervicofacial Rhabdomyosarcoma ‑ Success of a Free Fibular Graft Varsha M. Totadri, Viji Geetha, Samir Kant Acharya, Prasanth J. Narayanan, Shafeek M. Palakundan, Nidhi Sugandhi, and Anjana Sreedharan Medknow ABSTRACT Cervicofacial rhabdomyosarcoma (RMS) presents surgical complexities in children due to its aggressive nature. This study presents a successful case of oral RMS treatment with a free fibular graft in a 7-year-old patient. Despite follow-up challenges, the efficacy of the approach is evident.
Metabolic profile and outcome of pre- And post-ampullary gastrointestinal obstruction in children: Conventional or unconventional wisdom Sarita Syal, Amita Sen, Nidhi Sugandhi, Monika Nanda, and Avinash Jhadav Medknow Background: Conventionally, it is well accepted that the intestinal obstructions in children, especially gastric outlet obstruction are associated with significant metabolic derangement which has impact on its outcome. The study aimed to compare the metabolic profile and treatment outcome of pre- and post-ampullary gastrointestinal obstruction in children at a tertiary care setting. Materials and Methods: A prospective observational study was conducted on 30 children with intestinal obstruction and categorised into Group 1 (pre-ampullary, n = 11) and Group 2 (post-ampullary, n = 19) as per their anatomical site of pathology. Patients were evaluated at both pre- and post-operative period (Day 1 and 10) with haematological, biochemical and blood gas. The pre- and post-operative metabolic profile, resuscitative time and outcome were compared in two groups. Results: Except mild leucocytosis (Group II > I), rest of the pre-operative and post-operative haematological parameters were within normal range and statistically comparable among groups. Although the pre-operative sodium values were within the normal limit in both groups, it was relatively higher in Group I (Group I = 137.82 ± 4.238 vs. Group II = 134.26 ± 4.653), (P = 0.04). The mean bicarbonate values were within the normal limit in both groups (22.49 and 19.34), but the difference was statistically significant (P = 0.031). Mean partial pressure of carbon dioxide level was higher than normal range in Group I (38.464 ± 20.6493) but was comparable with Group II (P = 0.15). The time required for pre-operative resuscitation was 16.6 versus 24.87 h in Group I versus Group II (P = 0.02). In Group I, all children were improved, whereas four children expired in Group II. Conclusion: Metabolic profile in both pre- and post-ampullary intestinal obstruction was found to be normal in majority of the scenario. Children with post-ampullary obstruction need extensive pre-operative resuscitation and have relatively poor outcome.
Repair of ruptured omphalocele sac in the neonatal period and beyond Veereshwar Bhatnagar, Nidhi Sugandhi, Manoj Saha, and AnjanKumar Dhua Medknow Conservative management of giant omphalocele in the neonate period is a known strategy to allow tissue growth aiding in anatomical closure. However, rupture of the covering sac is considered an absolute contraindication for continuing conservative management. We report a case where a ruptured sac of giant omphalocele was ingeniously sutured to restore its integrity, and conservative management continued. The giant omphalocele later became a huge ventral hernia and was gradually reduced and primary closure was achieved with multiple surgeries over a period of 4 years.
Total intestinal atresia: Revisiting the pathogenesis of congenital atresias Nidhi Sugandhi, Neel Aggerwal, Harshita Kour, Goutam Chakraborty, SamirKant Acharya, Amit Jadhav, and Deepak Bagga Medknow Despite various theories to explain the pathogenesis of atresias, the exact mechanism is still controversial. Currently, atresias are believed to result from vascular accidents and less likely due to the failure of recanalization. We report a case which challenges this belief. A 1-day-old neonate was explored for suspected jejunal atresia. Apart from Type III jejunal atresia, 15 cm from DJ junction, there was surprisingly no distal lumen in the intestine from jejunum till rectum. Multiple enterotomies revealed the whole of the remaining jejunum, ileum, and large colon to be a solid cord-like structure. No distal luminal contents or histopathological evidence of ischemic damage was seen, thus suggesting the probable etiology to be a failure of recanalization of the gut cord rather than a late vascular accident. Such rare cases provide insights into possible embryogenetic mechanisms which can then aid in formulating preventive measures.
Occult adenoma in patent vitellointestinal duct presenting as an umbilical fistula: Cause for concern? Himani Bhankar, Surbhi Goyal, Sufian Zaheer, Nidhi Sugandhi, and Ashish Kumar Mandal Informa UK Limited ABSTRACT Introduction: Prevalence of vitellointestinal duct anomalies varies from 2-4%. Though a completely patent vitellointestinal duct is a common symptomatic embryological defect with a prevalence of 0.0063–0.067%, other vitellointestinal abnormalities are rarely reported. Ours is the first case to describe histopathological features of an umbilical fistula harboring an occult tubular adenoma. Case Report: We report a case of one-month old child, presenting with umbilical fistula for which excision and ileal anastomosis was performed. Routine histopathologic examination revealed an occult tubular adenoma in tip of the fistula. Conclusion: Adenoma arising in an umbilical fistula at such an early stage of infancy has never been reported before. Detection of occult adenoma warrants screening GI endoscopy, genetic testing for syndromic gastrointestinal adenomatosis and carcinomas and lifelong surveillance. Our case highlights the importance of routine histopathologic examination in detection of occult premalignant lesions as it significantly affects the patient management and prognosis.
Aortoesophageal fistula in a child Sandeep Agarwala, SushilKumar Kabra, AbdusSami Bhat, Rakesh Lodha, Prashant Joshi, AkshayKumar Bisoi, Arundeep Arora, ArunKumar Gupta, ShasankaShekhar Panda, Ruma Ray,et al. Medknow Aortoesophageal fistulae (AEF) are rare and are associated with very high mortality. Foreign body ingestions remain the commonest cause of AEF seen in children. However in a clinical setting of tuberculosis and massive upper GI bleed, an AEF secondary to tuberculosis should be kept in mind. An early strong clinical suspicion with good quality imaging and endoscopic evaluation and timely aggressive surgical intervention helps offer the best possible management for this life threatening disorder. Our case is a 10-year-old boy who presented to the pediatric emergency with massive bouts of haemetemesis and was investigated and managed by multidisciplinary team effort in the emergency setting.
Gastric teratoma: unusual location and difficulties in diagnosis. N Sugandhi, AK Gupta, and V Bhatnagar EMED Publishing 2006; 20:1594-9. 3. Kibria SM, Hall R. Recurrent bile duct stones after transduodenal sphincteroplasty. HPB (Oxford). 2002;4:63-6. 4. Rizzutti, RP, McElwee TB, Carter JW. Choledochoduodenostomy. A safe and efficacious alternative in the treatment of biliary tract disease. Am Surg. 1987; 53:22–5. 5. Caroli-Bosc FX, Demarquay JF, Peten EP, Dumas R, Bourgeon A, Rampal P, et al. Endoscopic management of sump syndrome after choledochoduodenostomy: retrospective analysis of 30 cases. Gastrointest Endosc. 2000; 51 :180-3.