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Hernia of umbilical cord is a well-known entity which presents with herniation of small bowel into the proximal part of umbilical cord. It has very good prognosis after surgical repair. Occasionally, it can have distinct presentations and varied malformations at the umbilicus which have bearing on the course of treatment and final outcome. Herein, we describe various presentations and malformations associated with hernia of umbilical cord. Embryological extrapolation is attempted for the malformations at umbilicus.

Background: Congenital pouch colon (CPC) is a rare entity in patients of anorectal malformations (ARM) requiring special consideration as to the management. This study is aimed at evaluating the presentation, management, and the outcome of initial surgery in patients with CPC., Materials and Methods: This retrospective study was conducted in the department of Pediatric Surgery of our institute during May 2007- May 2010. The Information about the demography, clinical features, investigations, management, and the outcome of initial surgery was retrieved and analyzed., Results: There were 21 patients of CPC managed during the study period. Sixteen (76%) were males and five (24%) females (M:F 3.2:1). Mean age of presentation was 4.8 days with a range of 12 hours to 45 days. In 18 (85.7%) patients, CPC was found with high ARMs, whereas, in 3 (14.3%) patients it was associated with low ARMs. Imperforate anus with moderate to massive abdominal distension was the presentation in 16 (76%) patients. Abdominal radiographs helped in preoperative diagnosis in 8 patients. Two patients had pneumoperitoneum on abdominal radiographs. At operation, type I CPC was found in 9 (42.8%) patients, type II in 5 (23.8%), type III in 2 (9.5%) patients, and type IV CPC in 5 (23.8%) patients. In 11 (52.4%) patients, pouch was emptied and retained with proximal enterostomy. In 7 (33.3%) patients, end enterostomy with pouch excision was done. In two patients, a window colostomy was formed. In one patient, pouch was disconnected from the normal bowel and Hartmann's pouch with end ileostomy was formed. There were 2 (9.5%) deaths in our series., Conclusion: CPC is a rare malformation. Massive abdominal distension with imperforate anus is the common presentation. Optimum management can reduce the morbidity and mortality.

Duodenal atresia has been reported in association with various malformations and syndromes common being Down syndrome, malrotation, and annular pancreas. Its association with multiple anomalies is rare and scarcely reported in literature. Herein 3 cases of duodenal atresia associated with multiple congenital anomalies are being reported.

Background: Colonic atresia and stenosis are rare entities. On average 1 case per year of colonic atresia is being seen in most of pediatric surgical centers and to date less than 10 cases of colonic stenosis have been reported., Material and Methods: The medical record of patients of colonic atresia and stenosis managed during March 2006 to March 2010 was reviewed., Results: A total of 15 patients of colonic atresia (11) and stenosis (4) were the study population. Four were ascending colon atresia, 2 at hepatic flexure and transverse colon each, and 1 at sigmoid colon. Two patients had multiple colonic atresias. One patient of ascending colon atresia also had pyloric atresia. In colonic stenosis population (two congenital and two secondary to necrotizing enterocolitis), two were transverse colon stenosis and two were sigmoid colon stenosis. The preoperative diagnosis was distal small bowel atresia in 11 patients. Colonic atresias were managed by colocolic anastomosis with covering ileostomy in 8 patients. The remaining 3 patients were managed by exteriorizing both ends of atresia. Colonic stenosis cases were managed by primary colocolic anastomosis in 1 patient and colocolic anastomosis under covering ileostomy in 3 patients. Three patients of colonic atresia succumbed postoperatively., Conclusion: Colonic atresia and stenosis are rare entities. Associated alimentary tract malformations may result poor prognosis. Colonic atresia can safely be managed by colocolic anastomosis with covering ileostomy.