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Introduction: As a result of the coronavirus disease (COVID-19) pandemic, more than 28 million planned surgeries worldwide could be cancelled leading to patients facing long waiting period for their treatment. The outbreak of COVID-19 caused by severe acute respiratory syndrome coronavirus (SARS CoV-2) has spread to more than 220 countries around the world and has almost stopped all routine surgical work. In children, the delay in the management of surgical diseases could result in significant morbidity and mortality. Material and Method: Herein, we describe our experience with the management of Paediatric Surgical patients at our centre which is a tertiary level hospital catering to both COVID-19 positive and Non-COVID patients in all specialties. Observation and Results: During the COVID-19 pandemic, 69.41% fewer paediatric surgical patients underwent surgery relative to the corresponding period 1 year earlier. However, the number of emergency cases performed increased during the COVID pandemic by 62.12%, mostly involving, urological and gastrointestinal emergencies. Conclusion: As we gain experience in effective protocol-based management, which can be revised based on the evolving scientific evidence. It will be appropriate to resume the elective work in selected patients, following the appropriate level of precautions.

Introduction: Early appendicectomy has been found to be a safe and better alternative for management of appendicular mass in various studies in adults, while very few studies report such advantages in the paediatric population. We conducted this study to assess the safety, efficacy and need of early laparoscopic appendicectomy (ELA) in child patients with appendicular mass. Materials and Methods: All patients with appendicular mass who underwent ELA at our institute between September 2011 and August 2014 were retrospectively reviewed. Appendicular mass was defined as a right iliac fossa mass in a case of acute appendicitis, diagnosed by clinical, laboratory and radiological evaluation, and palpation under anaesthesia, the patient being subjected to laparoscopic treatment. Results: Forty-eight (48) patients were confirmed to have appendicular mass intraoperatively and were included in the analysis. There were 30 males and 18 females, with ages ranging 7-13 years (mean 9 years). In the present study, appendicular complications included appendicular abscess (62.5%), gangrenous appendicitis (25%), sloughed-out appendix (8.33%) and appendicular perforation (4.16%). The average operative time was 72 min (range 45-93 min). One case (1.92%) required conversion to open procedure due to failure of identification of the appendicular base of a sloughed-out appendix. Post-operative complications were found in 4 (7.69%) patients, of whom 3 (5.76%) had minor wound infection at the umbilical port site and 1 (1.92%) had post-operative pelvic abscess, which was managed with percutaneous aspiration. Discussion: ELA avoids misdiagnosis, treats complicated appendicitis at its outset, and avoids complications and/or failure of non-operative treatment of a potentially lethal, diseased appendix. This approach is associated with minimal complications in experienced hands and is a safe and feasible option in children with appendicular mass.

Background: To evaluate 490 consecutive children who underwent hernia repair over a 3-year period. Technical details and clinical results are reported. Methods: Retrospective study of open and laparoscopic inguinal hernia repair performed in dept. of pediatric surgery, NSCB Medical College, Jabalpur, M.P. during July 2009 to July 2012 was done. The variables evaluated were age, sex, type of inguinal hernia, presence of an associated hydrocele, side of hernia, incarceration, obstruction, strangulation, occurrence of opposite-side hernia, recurrence, and other associated complications and conditions. Correlation between radiology and intraopearative findings was done. A total of 540 open internal rings were closed surgically in 490 children (boys and girls, aged 02 days to 14 years, mean 32 months). 400 cases underwent open repair by standard technique and 90 cases underwent laparoscopic surgery. In laparoscopic technique one 5-mm and two 3-mm instruments were used to access the peritoneal cavity. The internal inguinal ring was closed with a non-absorbable suture or tacker as described in paper. Results: There were no significant intraoperative complications. Length of procedure ranged between 20 and 50 minutes with a mean of 35 minutes in laparoscopy and 20 min in open surgery. Postoperative hospital stay ranged from 1 to 3 days. Five children who presented with a right-sided hernia and three with a left hernia (total of 8) were found to have a patent contralateral internal ring on laparoscopy. Mean follow-up was 20 months. There were 2 hernia recurrences (0.4%) 1 in open and 1 in laparoscopic group. Conclusions: Ultrasonography of inguinal region is good adjuvant for diagnosis in doubtful cases. Majority of hernia cases were operated by standard open surgical technique. Laparoscopic hernia repair in children is a safe and feasible technique. There is clear visualization of structures and vas remains untouched and opposite patent ring is seen which can be managed in same setting. As per our experience the recurrence rate is comparable to that of the traditional open approach with a superior cosmetic result.

Background: Haemorrhoids is a common disease affecting humans. Surgical treatment of haemorrhoids includes by using stapler and conventional or open method. Both the methods have its own advantages and disadvantages. This study is done to evaluate the efficacy of both the procedures in our settings. Objective of the study was to study the efficacy of two surgical methods of treatment of hemorrhoids, in terms of (1) operation time; (2) post-operative pain; (3) hospital stay; (4) return to normal activity and return to work; (5) complications; (6) recurrence; (7) patient satisfaction. Methods: A comparative study was done between open and stapling methods for the treatment of symptomatic hemorrhoids in CMCH, Bhopal, India over a period from November 2011 to December 2014. Results: There was major statistically significant difference was seen among different parameters between these two procedures of haemorrhoidectomy, open versus stapler procedure for prolapsing hemorrhoids (PPH). Conclusions: In present study there is definite difference noted between two surgical methods as evident from table 1- 10 as evident from p-value. As far as satisfaction of patient is considered in both the groups satisfaction is similar except for the cost of device which added for the most cause of dissatisfaction.

Aims: To evaluate the technique of Paediatric Percutaneous Nephrolithotomy in terms of safety, outcome and efficacy in age group 1 to 14 years. Material & Methods: The observational study was donefrom October 2011 to October 2014 in Chirayu Medical College Bhopal. 25cases of renal stone in paediatric age group were admitted in our hospital and evaluated for size of the stone, number of stones, associatedcongenital anomalies and complications. PCNL was done by standard technique. Results: A total number of 25 children were operated. Sex distribution in our study was male 15 and female 10, most of the patients were of age group 10-14 years 15(60%).Most of the children15(60%) had large stones >2cm stones and small stone was seen in 6(24%) cases.Malrotated kidney having stone was seen in 8(32%) cases.Complications as fever and haematuria was observed in 1 (4%) case. The maximum sheath size used inchildren was 24 F. Out of 25 children, only one patient required blood transfusion. Conclusion: Paediatric PCNL is safe procedure in expert and experienced hands. Minimal invasive procedures are beneficial in paediatric age group because of longer life expectancy andmore riskof recurrence.

Introduction: Study was planned to compare the safety and efficacy of Fentanyl and Midazolam combination with Ketamine and Midazolam combination for “procedural sedation” in pediatric patients. Methodology: Sixty ASA1and 2 pediatric patients satisfying inclusion criteria were included in the study. These patients were enrolled by convenience sampling. They were randomized to receive ketamine or midazolam/fentanyl. Both the groups were comparable with respect to age, sex and body weight and proposed procedures. Hemodynamic and respiratory changes occurring during sedation, surgical procedure and during recovery, after administration of the test drug were studied. Measures used for efficacy of drug, that is quantification of distress, pain, anxiety, sedation and complications were also evaluated. Results: On Comparison of age, gender, weight at different time intervals of cases between both groups were comparable with respect to age and weight of patients. On comparison of Pulse Rate at different time intervals of cases between K/M and F/M groups. The mean value of Pulse Rate in K/M and F/M groups is statistically significant (p

Background: Mesenteric adenitis is self-limiting inflammatory process mimicking appendicitis and affects the mesenteric lymph nodes in the right lower quadrant. Ultrasonography with graded compression is the main modality to diagnose this entity. Aim: of this study was to evaluateand analyse the incidence of enlarged mesenteric nodes with ultrasound in pediatric patients referred for abdominal pain. Material and Method: A total 100 patients attending paediatric and paediatric surgery clinic in Chirayu Medical College and hospital Bhopal, from May 2011 to May 2014 presenting with abdominal pain of various causes were included in this study. The presence of enlarged nodes, their location, size and other ultrasonographic findings were recorded. Final diagnosis was established after patient management and follow up. Result: On the basis of this study, it was observed that the incidence of enlarged lymph nodes increases with age with the peak incidence is at around 7 years range (5-8) years and decrease thereafter.A review of the dimensions of the lymph nodes detected shows that the transverse diameter of the lymph nodes was by and large always greater than the antero- posterior diameter .The maximum transverse diameter values was seen between 10- 14 mm whereas antero- posterior diameter values was seen between 4-8 mm. Our study also showed that the 80% of the lymph nodes were seen in the right lower quadrant followed by 12% in the left lower quadrant and 8% in the peri-aortic region. Conclusion: The possible variation in the clinical presentation of abdominal pain due to mesenteric lymphadenitis is a challenging task for physicians to diagnose. Mesenteric lymphadenitis is found to be self limiting entity, usually viral in origin. Hence surgical intervention can be avoided if diagnosis is accurately made.

Background: The lifetime prevalence of kidney stone disease is estimated at 1-15%. The various treatment options available for urinary calculus disease are open surgery, ureterorenoscopy, percutaneous nephron-lithotomy retrograde intra-renal surgery & extracorporeal shock wave lithotripsy. The aim of the study was to study whether performing extracorporeal shockwave lithotripsy (ESWL) under intravenous anesthesia can reduce no. of sessions by increasing intensity of shockwaves and its comparison with ESWL under local anesthesia and also to study the safety of higher intensity shock waves. Methods: The nucleus of this prospective study done between March 2011 to February 2015 was 60 patients with renal or upper ureteric solitary calculus less than or equal to 2 cm in size, in which ESWL is elected as the treatment. These were randomized into one of the two groups with 30 patients in each - Group I: in which patients underwent ESWL under IV anesthesia & group II: in which patients underwent ESWL under local anesthesia. Results: For age group, P value of age difference of the two groups was 0.6 and not significant. During the study it was found that there was statistically significant reduction in number of sessions required for complete stone clearance in Group I. In group I the average number of shock waves used was 3800, whereas in group II it was 5967. The P value of difference between the means was extremely significant (P =0.003). Time taken for clearance of stone in group I was 1 month in 22 patients and 3 months in 8 patients with the average being 1.53. In group II time taken for clearance was 1 month in 9 patients and 3 months in 21 patients and the mean was 2.4. Conclusions: The use of total intravenous anesthesia (TIVA) for ESWL reduces the number of sessions significantly by allowing higher intensity and number of shock waves & improved fragmentation due to regular and controlled respiratory excursions, and immobility of the patient, leading to significantly less wastage of shockwaves when compared to ESWL without TIVA.

INTRODUCTION: The goal of management of a non-palpable testis is to identify whether a viable testis is present and, if so, either perform an orchiopexy or, in selected cases, an orchiectomy. Management of palpable undescended testis is quite straightforward and diagnostic studies are usually not necessary. However, management of non-palpable testes is more complex. MATERIAL AND METHODS: It was a prospective hospital based study conducted in the department of surgery, Chirayu Medical College, Bhopal during the period of January 2012 to June 2014. 30 patients were selected in the study. Surgical management was not done before 6 months of age. Open orchiopexy was performed in palpable group. For impalpable group, diagnostic laparoscopy was done and managed accordingly. RESULTS: Forty undescended testes were operated upon, of which twelve (40%) were situated in the inguinal canal, twelve (40%) external ring and three (10%) each at the level of internal ring and intra-abdominal respectively. 6 patients (aged five to nine years) with canalicular testes had macroscopically atrophic testes, as did three (aged four to twelve years) with abdominal testes and one (two years) with the testes at the level of the internal ring. CONCLUSION: Laparoscopy is a safe and effective method for the diagnosis of non-palpable and undescended testis. Microvascular orchiopexy is a feasible technique even in small children with good results.

BACKGROUND AND AIMS: The study was done to know the accuracy of Triple assessment and management strategies for breast cancer patients. MATERIALS AND METHODS: Patients with carcinoma breast were analyzed in a tertiary care hospital of central India from January 2012 to June 2013. Thorough Clinical and physical examination was done, mammography, USG and FNAC was used for diagnosis of cancer Breast. RESULTS: maximum cases (90%) were diagnosed clinically & by FNAC. USG was more sensitive for dense breasts of young patients, whereas mammography was more sensitive for breasts of older patients. Among pathological diagnosis Trucut biopsy was more sensitive than FNAC having diagnostic accuracy of 100% as compared to FNAC whose diagnostic accuracy was 90%. Diagnostic accuracy of triple assessment was 100% for diagnosing carcinoma breast. CONCLUSION: Most common symptom was lump in breast among postmenopausal women from urban area. Lack of education was responsible for their delayed presentation. Left upper and outer quadrant being the commonest site, Infiltrating duct carcinoma was the most common type, diagnostic accuracy of triple modality i.e. clinical, radiological and pathological assessment was 100%.

Introduction: Anorectal malformations are commonly associated with craniospinal abnormalities like hydrocephalus, tethered cord syndrome, occult spinal dysraphism, syringomyelia, meningomyelocele and Arnold Chiari malformation. Aim of our study was to identify the incidence of craniospinal anomalies in patients with anorectal malformation and to analyse utility of Ultrasound and MRI as a screening tool in these patients to detect such anomalies. Material and Method: 52 infants male and female of anorectal malformation were included. All underwent ultrasonography of brain and spinal cord and 27 patients underwent MRI to detect craniospinal anomalies. Result: Out of 52 cases 38(73.07 %) were males and 14(26.93 %) were females. High type ARM (34.61 %) and Vestibular fistulas(19.23 %) were most common type in male & female child respectively. On ultrasonography in this series no craniospinal abnormality was found. On ultrasonography subarachnoid space was normal in all cases and central canal diameter was found

BACKGROUND: Ovarian torsion presents as acute abdominal pain and early surgical management is required to prevent further adnexal damage. It accounts for 3% of all cases of acute abdominal pain in adult women. As signs and symptoms can mimic other acute abdominal conditions, the preoperative diagnosis often remains a challenge for primary care physicians. AIMS AND OBJECTIVES: To study the characteristics of adnexal torsion and factors influencing adnexal preservation. MATERIAL AND METHODS: All 14 patients were admitted in a tertiary endoscopic surgical unit with the complaints of pain in abdomen, nausea and vomiting of varying duration. The minimum duration of symptoms was 3 days and a maximum of 1 year. All patients were evaluated by ultrasound examination preoperatively. The time interval between the onset of symptoms and definitive surgery varied from 3 days to one year. Laparoscopic approach was offered to all patients except one where the patient was antenatal at 10 weeks of gestation. RESULTS: Out of 14 patients the youngest patient was a neonate 28 days old and oldest was 68 years of age. Most patients (n=9) were between 10 to 30 years of age. Intra operatively complete torsion (torsion of both ovary and fallopian tube) was found in 9 cases, 3 were torsion of hydrosalpinx and one case was torsion of a paraovarian cyst. One case was torsion of the adnexa in antenatal period. Adnexal congestion and edema was the most common finding (n=6) simulating hemorrhagic cyst. One patient the oldest in series age 68 years had torsion of an ovarian mass which was histologically confirmed as mucinous cystadenoma. Two patients had ovarian dermoid where ovary was salvaged in one by doing cystectomy and in the other a salpingoophorectomy was performed. In one patient it was torsion of parovarian cyst where cyst wall excision was performed. In antenatal at 11 weeks gestation a mini laparotomy was performed under epidural analgesia and detorsion was performed. In all 4 patients who had hydrosalpinx (n=3) and parovarian cyst (n=1), a salpingectomy and cyst excision was performed respectively. In rest with complete torsion (n=9, excluding fetal adnexal torsion) ovarian preservation was possible in 4 patients (44.45%) and 5 patients (55.55%) required oophorectomy. CONCLUSION: Adnexal torsion affects all ages of women and ovarian preservation is possible, if detorsion is possible. Delay in diagnosis prevents ovarian preservation. Though limited by small sample size it indicated that ovarian debulking may not be needed and detorsion relieves the venous congestion and edema. Laparoscopic approach remains the gold standard for the management of adnexal torsion and enables quick recovery.

BACKGROUND: Hysterectomy is one of the most commonly performed obstetrics and gynecology surgical procedure worldwide, second only to cesarean section. Even with use of conservative therapies, approximately 6 lakh hysterectomies are performed each year in United States. MATERIAL AND METHODS: This was a comparative cross sectional study conducted in the Department of Obstetrics and Gynecology of Chirayu Medical College and Hospital, Bhopal from Jan 2011 to June 2013. A total of 50 patients were selected in each group using inclusion and exclusion criteria. Statistical software (SPSS version 20) was used to analyze the data and level of significance for all types of analytical data was set at 0.05 and p value less than 0.05 was considered significant. RESULTS: 64% patients in our study were in age group 36-45 years with mean age of 43.2 years and most of them were multiparous. Six patients were nulliparous with symptomatic large fibroids and failed medical management. Abnormal Uterine Bleeding (AUB) was the most common indication (43.3%)followed by fibroid uterus(33.3%) and pelvic pain(23.3%).The mean size of uterus in our study was 8.87weeks.The mean operation time was significantly higher in laparoscopic method than other routes (P

BACKGROUND: After P. falciparum, P.vivax is the most significant malaria species, often both may coexist. Clinical features include fever, chills, sweating, headache, diarrhoea, abdominal pain, distension, cough, hepatomegaly and splenomegaly. Large studies from Islands of New guinea now show a strong association between P. vivax infection and severe disease and even death. MATERIAL AND METHODS: This was a cross sectional study, carried out in the department of Medicine, Surat Municipal Institute of Medical Education & Research during the period of June 2009 to August 2010. Patients of age 18 years or above fitting in the case definition of malaria with positive peripheral smear for P.vivax were included in the study. The details of the patients along with their clinical features, routine hematological and biochemical investigations were recorded in a standard proforma. The diagnosis of P.vivax was made from thick smear examination and if positive it was further confirmed by examining a thin smear slide. RESULTS: Most common clinical presentation was fever which was high grade, intermittent along with chills seen in 99% of patients. Bodyache, headache was observed in 65% & 61% respectively. Out of 140 patients 46(32%) had Hb >12gm% and 5(4%) had Hb

Introduction: A debate still exists in literature whether to ligate the indirect hernia sac during herniotomy in orchiopexy and hernia surgery. The study is designed with the aim to evaluate whether the ligation of hernial sac during orchiopexy is necessary to prevent the development of postoperative hernia. Material and Methods: This prospective study was conducted in 25 children with an age range of 6 months to 15 years with a diagnosis of palpable undescended testis. Of the 25 cases, 19 were unilateral and 6 were bilateral cases. Of the 19 unilateral undescended testis, 8 were right-sided and 11were left-sided. All children underwent open orchiopexy without the ligation of the hernia sac. Results: Clinically and radiologically all the patients were followed up to a period of two years. No evidence of inguinal hernia was detected during the follow-up in any patient. Conclusion: According to this study ligation of hernial sac is not necessary during orchiopexy and leaving the remnant stump open is safe with no recurrence.

BACKGROUND: Malaria is commonly associated with various degrees of haematological complications most frequently with anaemia and thrombocytopenia. However there are contrasting reports about frequency of thrombocytopenia in P. vivax infection. MATERIAL AND METHODS: A total of 140 patients were included in the study. The details of the patients history along with their clinical features, laboratory reports were recorded in a standard proforma. Sample of venous blood were collected for haematological examination like Haemoglobin, total and differential count and platelet count, which was done under automated cell counter. RESULTS: Out of 140, there were 119(85%) patients who had thrombocytopenia, of them 75(54%) patients had mild, 38(27%) patients had moderate and 6(4%) patients had severe thrombocytopenia., 30(21%) out of 140 patients had leucopenia. Significant inverse association was seen between degree of parasitemia and platelet count. CONCLUSION: Various theories have been postulated for the cause of thrombocytopenia in P. Vivax infection but none of them is conclusive. Frequency or severity of thrombocytopenia doesn't appear to be any particular strain of plasmodium infection.

BACKGROUND: Vitamin B12 (Cobalamin) plays an important role in DNA synthesis and neurologic function. Deficiency can lead to a wide spectrum of hematologic and neuropsychiatric disorders that can often be reversed by early diagnosis and prompt treatment. MATERIAL AND METHODS: Cross sectional descriptive study carried out in Medicine department, SMIMER, Surat during the period from June 2009 to December 2010. 30 patients whose Serum Vitamin B12 level

BACKGROUND: Abdominal Tuberculosis remains a major health problem in the developing countries especially in Indian subcontinent. Abdominal tuberculosis is a disease which has no clear clinical features even after a complete range of investigations. Thus, a high index of clinical suspicion is required to establish a diagnosis. Tuberculosis of GI tract accounts for 50% of all gastrointestinal cases. MATERIAL AND METHOD: The study was conducted in the Department of Surgery, Chirayu Medical College and hospital Bhopal from January 2011 to August 2013 to assess the clinical presentation management and outcome of abdominal tuberculosis. All patients with clinical features suggestive of abdominal tuberculosis were included in the study. Records of the patients were retrieved and reviewed to measure parameters of age, gender, socio-economic status, mode of presentation, operative findings, hospital stay and complications. The diagnosis of abdominal tuberculosis was confirmed by histopathology. RESULTS: A total of 51 patients were included in the study. Out of these, 26 patients (62%) were male and 25 patients (38%) were female. 21 patients (41.17 %) presented with acute while 30 patients (58.82 %) presented with chronic onset of disease. Intestinal obstruction was seen in 11 (21.56%) patients and perforation peritonitis was present in 10(19.60%) patients. Subacute intestinal obstruction was seen in 23(45.09%) cases. 4 patients (7.8%) presented with mass in right iliac fossa. 27 patients (52.94%) were treated conservatively while rest of them 24 (47.0%) underwent laparotomy. Grossly ileum was involved in 17 cases (9perforation and 8 stricture).During hospital course, 15 (29.41%) patients had post operative wound infection, 2(3.92%) had burst abdomen and 1(1.90%) had faecal fistula. Histopathological confirmation of tuberculosis was done in 72.54 % of cases. All patients were prescribed anti tuberculosis drugs for 12 months duration. Mean hospital stay was16 ± 14.67 days. CONCLUSION: Abdominal tuberculosis is a disease that is frequently overlooked, with consequent delay in treatment. As a treatable condition, abdominal TB should be considered early in the differential diagnosis of abdominal symptoms in our country. Failure to recognise this disease early may lead to increase morbidity and mortality, as many of the patients need surgical intervention and prolonged hospitalization in addition to chemotherapy with anti tuberculosis drugs.

BACKGROUND: Since 1990 laparoscopic cholecystectomy is the gold standard treatment for symptomatic gall stones disease. The aim of this study was to evaluate the results of three port laparoscopic cholecystectomy in symptomatic patients with gall stones in terms of conversion rate, length of hospital stay, post operative complications, morbidity and mortality. METHODOLOGY: The retrospective study was carried out in Department of Surgery at Chirayu Medical College and Hospital, Bhopal. All the patients who underwent laparoscopic cholecystectomy in the department of surgery from (May2011- April 2013) were reviewed from department records. Patients with co morbidities, altered Liver function test and obstructive jaundice were excluded from the study. Demographics with patient details, conversion to open, complications of anaesthesia and surgery were reviewed from clinical notes, and department register. Data was analysed using SPSS-18 and results were compared with international studies. RESULTS: Out of 200 patients174 were females (87%) and 26(13%) males. The mean age of patients was 40.47±12yrs, the youngest patient was10 yrs old and oldest patient was 80 yr old. Mean operative time was 50min±11.16 min. The conversion rate in our series was 6(3.0%) cases; Port site wound infection was seen in 6 (3%) patients. There was no bile duct injury, major haemorrhage or bowel injury necessitating opening surgery. On follow up no patient had post operative abdominal abscess, port site hernia or post operative bile duct stricture, there was no mortality in our study. CONCLUSION: Laparoscopic cholecystectomy with three ports is effective & safe modality to treat gall stones. Good training careful case selection, initial learning curve, meticulous technique, well trained team and high standard equipments are of paramount importance to ensure good results.

Ventriculo-peritoneal (VP) shunting used in the treatment for hydrocephalus is associated with several complications. Mechanical failure of shunt is the commonest complication of all. Visceral/bowel perforation is an unusual but serious complication of VP shunting. This article reports our experience in the management of ten children who had VP Shunt catheter protrusion from anus. This is a retrospective study of ten patients who had VP shunt catheter protrusion from anus, admitted in the department of paediatric surgery between Jan 1996 and Dec 2005. The records of above ten cases were reviewed for their clinical presentation and management, etc. We had performed 398 VP shunt operations in the last 10 years. Two hundred and seventy one (68.09%) VP Shunts were done for congenital hydrocephalus of which 164 were done in infancy/neonatal period and 107 VP shunts were done in the age group of >1-12 years. One hundred and twenty-seven (31.90%) VP shunt operations were done for patients who had hydrocephalus as a complication following tubercular meningitis (TBM). Out of 398 VP shunts, ten patients (2.51%) had protrusion of the distal end of peritoneal catheter from anus without causing/leading to peritonitis. We observed a 08.29% mortality of all VP shunt operations. Protrusion of VP shunt catheter per rectum can occur without producing peritonitis. Formal exploration and localization of entry of VP shunt catheter in bowel is not mandatory. Mini laparotomy and revision of peritoneal part of shunt can be done if there is no shunt infection.

A full term female baby of 2.3 kg was born to a Gravida I Para 0, 22-years- old mother on June12, 2006. She was brought to us one hour after birth. The pregnancy and hospital delivery were uneventful. There was no history of infection, intake of any teratogens, drugs or exposure to radiation, etc. in antenatal period. Clinical examination revealed peripheral cyanosis with heart rate of 146/min and respiratory rate of 48/min. Her heart was lying outside the thoracic cavity and apex of the heart was pointing anterio -superiorly . The heart had pericardial covering and coronary and few great vessels could be seen [Figure 1]. She also had associated right­sided complete cleft lip and cleft palate, cystic hygroma at right side neck of 4 x 3 cm in size. Syndactyly of little, ring, and middle fingers of right hand also present [Figure 2]. Investigations revealed no diaphragmatic hernia. After mobilization of skin around the heart, it was easily reposited within the thoracic cavity and skin closure was done. She died 2 hours after operation due to cardiac arrest. W e presumed that our patient also had intrinsic cardiac defects, echocardiography nor post-mortem examination was done.

due to obstructed labour on A ugust 27, 2006. Antenatal history was nothing significant. He weighed 2.5 kg including placenta, which was adherent to his head. A preterm, eight hour-old male with cranio-facial Also evident were associated exencephaly and cleft of deformities was born normally at a hospital to a GP lip and palate on the right side [Figure 2]. He also had

Aim : The aim of this study was to analyze the clinical and management aspect of congenital pouch colon. Materials and Methods : This retrospective study was carried out on 40 cases of congenital pouch colon managed in the department of paediatric surgery from 01, January 2000 to 31, December 2005. Results : The incidence of congenital pouch colon (CPC) in the present study was 11.290 % (40 of 354) of all anorectal malformations (ARM) and 19.60% (40 of 204) of high ARM. Of these 40 cases of CPC included in the study, 82.5% were male and 17.5% were female. The average age of presentation to hospital was 3.36 days with a range of 1-11 days; of these 25% patients were admitted with poor general condition. Preoperative diagnosis of CPC was possible in 75% of cases in our study. 60% ( n =24) of cases had incomplete pouch colon (Type III and IV) while 40% ( n =16) had complete pouch colon (Type I and II). Right transverse colostomy was done in 16 patients and colostomy at descending colon just proximal to pouch in two patients for incomplete (Type III and IV) CPC as a primary initial procedure. Ileostomy was done in 14 patients and window colostomy in three patients for complete (Type I and II) CPC. As definitive procedures, pouch excision and abdomino-perineal pull-through of colon was done in 17 patients, coloplasty and abdomino-perineal pull-through of coloplasty colon was done in four patients and pouch excision and abdomino-perineal pull-through of terminal ileum in four patients in our series. None of our patients underwent primary single stage procedure. Conclusion: (1) CPC comprises 11.290 % of all ARM and 19.60% of high ARM. (2) Right transverse colostomy was opted for incomplete pouch colon, while Ileostomy and window colostomy were opted for complete pouch colon as initial surgical procedures. (3) Staged surgical procedures for management of CPC were well tolerated in our series.

A Prune Belly syndrome with VATER/VACTERL association is an extremely rare. They are either stillborn or die within few days of life, only few such cases have been reported in literature. We are presenting here a male neonate of Prune Belly syndrome associated with incomplete VACTERL with brief review of literature.