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Background Laparoscopic appendectomy (LA) is the preferred approach in uncomplicated appendicitis. However, in patients with complicated appendicitis (CA), the best approach is still unclear though laparoscopy is being increasingly preferred over open appendicectomy (OA) nowadays. Aim To comprehensively review the current literature and compare the associations of LA and OA concerning various postoperative outcomes in order to determine the best approach for children with CA. Methods The PRISMA guidelines were adhered to and an electronic database search was extensively performed. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Methodological and statistical heterogeneity, as well as publication bias of the included studies, were assessed. Results Four randomized controlled trials (266 LA versus 354 OA) and thirty-six case-controlled trials (2580 LA versus 3043 OA) were included in the analysis. Compared to OA, LA has a shorter length of stay, a lower rate of surgical site infection as well as a significantly lower overall complication rate. The rates of intraabdominal abscess formation, post-operative fever, pneumonia and ileus are similar in the two groups. So are the rates of readmissions and reoperations. LA was also shown to have a shorter time taken to oral intake and a lesser requirement of analgesics as well as intravenous antibiotics. Operative time for OA was found to be significantly shorter than that for LA. Conclusion This meta-analysis objectively demonstrates that laparoscopy has a better overall complication profile compared to OA and should be the procedure of choice in children with complicated appendicitis.

Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague symptoms and inconclusive imaging make it an elusive diagnosis, more so in children. Only 30 pediatric cases have been reported worldwide till date. We report a case of a 7yrs old boy presenting 2 weeks after a road accident with a gallbladder rupture which was eventually discovered on a diagnostic laparoscopy. This is the second such case being reported from India. The injury is most often identified at exploration and although cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ. The classification system of Losanoff and Kjossev has merit in guiding treatment. The various presentations, mechanisms and modes of injury have been highlighted along with the clinical and imaging findings. Despite the developments in modern radiology, identifying gallbladder perforation has always been difficult because of the rarity of the condition. In a child with blunt abdominal trauma and intra-abdominal free fluid without any solid organ injury, a diagnostic peritoneal tap may be helpful. Based on the current evidence, we advocate a low threshold for performing a diagnostic laparoscopy in all such cases. Keywords: Gallbladder, Perforation, Laceration, Abdominal, Trauma, Injury

Congenital lung hernia is extremely rare with less than 50 reported cases.We report two cases of lung hernia, secondary to congenital absence of ribs – A 4‐year‐old girl without any antecedent history of chronic cough or chest trauma presenting with a left lower lobe hernia secondary to an absent left 9th rib; a 7 month‐old girl with recurrent pneumonia presenting with severe respiratory distress, fever and severe malnourishment, found to have absent 6th-9th ribs on right side with associated liver and lung herniation. The older girl has been kept on observation without surgery but the infant expired within 48 hours of admission due to respiratory failure. The clinical scenario is a rarity and can be managed conservatively in most cases. Surgical treatment should be considered in symptomatic patients and in those with severe complications. Repair for cosmetic reasons is sometimes justified.

We are reporting an unusual case of diffuse chylous mesenteric cyst extending to the retroperitoneum in a neonate. The lump was unresectable as it was diffuse and mesenteric vessels traversed through it. The child was followed till one year of age and is asymptomatic. Repeat imaging shows persistence of the cysts. Keywords: Mesenteric cyst, Chylous cyst, Chyle, Chylo-lymphatic cyst.

Neonatal intussusception is rare entity.We report this very rare case of a term male newborn, with acute jejunojejunal intussusception without any lead point. He presented with abdominal distension and signs of intestinal obstruction and abdominal sonography showed a jejunojejunal intussusceptions which was confirmed at laparotomy. Interestingly, no lead point was found. Rather 8cm of bowel distal to intussuscepted segment was found to be gangrenous bowel. Resection with Bishop Koop anastomosis done for the baby resulted in good outcome. The case is being presented for rare presentation of a rare surgical condition in a neonate with an endeavour to establish etiology for its occurrence. Keywords: Intussusception, Jejunojejunal, Lead point, Neonate, Gangrene.

Omental and mesenteric cysts are rare intra-abdominal pathology in children. Children with these pathologies mostly present with abdominal distension with or without palpable abdominal mass. It can mimic ascites, gross hydronephrosis, abdominal tuberculosis, etc. The preferred treatment of choice is complete excision. We present a case of a 6-year-boy child with gradually increasing abdominal distension with suspicion of the mesenteric cyst. The laparoscopic intervention was done, which led to the correct diagnosis, that is, giant omental cyst. Histopathology was suggestive of cystic lymphangioma.

Aims: The recto-urethral (RUF) and recto-vestibular fistula (RVF) are varieties of anorectal malformation (ARM) with distinct clinical behaviour. In this study post-operative clinico-manometric comparison has been done. Materials and Methods: The study was conducted for 2 year period and included post-operative cases of RUF and RVF. Post-operative follow up was done clinically and by anal manometry. Statistical analysis used: Kruskal Wallis test, Mann Whitney U test, and Spearman correlation test were done to find out the statistical significance. Results: A total of 21 patients with RUF and RVF were included. The average basal and squeeze pressure of RVF group was (cm H2O) 34.66 13.2 and 89.35 30.8 respectively. These pressures were higher than those of RUF which were 26.74 12.8 and 71.20 42.8 respectively. Rectoanal inhibitory reflex (RAIR) was present in 84.6% cases of RVF in comparison to 62.5% in RUF group. The mean combined (RUF + RVF) basal pressure in RAIR positive group was 32.97 12.2 compared to 24.5 4.6 cm H2O in RAIR negative group. The mean combined squeeze pressure in RAIR positive group was 84.34 36.2 compared to 68.83 32.75 cm H2O in RAIR negative group. Conclusions: The anal pressures of RVF group were higher than RUF group. Anal pressures also higher in RAIR positive group than the RAIR negative group. Anal pressures and RAIR status may have some role in post-operative outcome in cases of ARM. Keywords: Anorectal malformation, Anal manometry, RAIR in anorectal malformation, Recto-urethral fistula, Vestibular fistula.

Esophageal Atresia (EA) with tracheo-esophageal fistula (TEF) is a common congenital anomaly diagnosed at birth. These children either undergo primary anastomosis of esophageal pouches or a diversion procedure (cervical esophagostomy & feeding gastrostomy), depending on the gap between the two pouches intraoperatively. Sham oral feeds are encouraged in these babies in order to stimulate brain development. We present an unusual case of diverted TEF who presented to us with recurrent fever, runny nose and blood stained discharge from esophagostomy. Keywords: Esophageal atresia, Tracheoesophageal fistula sham feed esophagostomy gastrostomy.

The aim is to compare the diagnostic accuracy of laboratory investigations and ultrasonography (USG) in distinguishing complicated appendicitis (C-AA) from uncomplicated appendicitis (UC-AA).Forty-six children who underwent appendicectomy at our center between November 2018 and July 2020 were included. Based on intraoperative findings, they were divided into two groups - complicated (perforated, gangrenous, or associated with fecal peritonitis;At admission, the mean values for total leukocyte count (TLC) (16090.56 vs. 11739.29 per mmCombining laboratory data with sonological findings significantly improves the predictive value for differentiating C-AA from UC-AA and can help decide operative approach and prognosticating.

Background: Mortality in surgical neonates contributes to neonatal mortality rates. The study was conceptualized to study clinical and nonclinical factors affecting mortality in surgical neonates so that timely intervention could result in improved survival of the neonates. Materials and Methods: The study was initiated after approval from the institutional ethics committee and included 120 surgical neonates over a period of 18 months after obtaining consent from the parents/caregivers. Predesigned pro forma was used to record the details of antenatal care received, place of birth, travel history, maternal education and gestational age, and clinical condition at the time of admission. Values of biochemical tests such as serum electrolytes, serum creatinine, and arterial blood gasses were recorded. The need of inotrope support, blood or blood product transfusion, and postoperative ventilator support and intensive care unit (ICU) care was recorded. The results of the two groups, i.e., survivals and mortality, were compared. Outcome was recorded as mortality at 30 days or earlier. Results: Irrespective of the surgical condition, the survival rate was significantly better in those babies who weighed more than 2.5 kg at the time of admission, had capillary refill time of

This is a rare case of a pediatric gastric adenocarcinoma which presented like gastric outlet obstruction and mimicked strongly like tuberculosis. Malignancy could not be diagnosed until the post-operative biopsy report. Keywords: Pediatric gastric carcinoma, Gastric adenocarcinoma, Gastric outlet obstruction, Tuberculosis.

Congenital pulmonary adenomatoid malformation (CPAM) is a rare entity. The authors searched the US National Library of Medicine Database, EMBASE, Google Scholar, PubMed Central for anesthetic management in CPAM. The search was performed using the terms: congenital cystic adenomatoid malformation, congenital pulmonary adenomatoid malformation, CCAM, CPAM, anesthetic management. The prognosis of CPAM depends on timely diagnosis, presence of hydrops, degree of hypoplasia of remaining lung, and the size of the lesion. Symptomatic patients must be treated surgically and lobectomy is considered the gold standard. Anesthetic management of such cases is challenging as it involves thoracotomy or thoracoscopic lobectomy or cystectomy and can lead to sudden hemodynamic Collapse. Early extubation should be considered to avoid iatrogenic ventilator-induced bronchial stump dehiscence resulting from positive pressure ventilation.

Purpose Pediatric spigelian hernias are very rare. They are often missed or misdiagnosed. A series of cases with spigelian hernia, presented to a tertiary care center are presented here with emphasis on different anatomy of spigelian hernias with cryptorchidism and those without associated cryptorchidism. Materials and Methods Over a period of seven years, nine cases of spigelian hernia presented to our tertiary care center. Male:female ratio was 3:1.There was a preponderance of right sided hernias. Three patients had associated cryptorchidism. One patient had associated lumbar hernia. All three patients with cryptorchidism had low spigelian hernia while others had classical spigelian hernia. Conclusion There is a likelihood of anatomical variation in SH associated with UDT and those without UDT. Understanding this anatomy may help in correct scrotal placement of testis. Type of Study Prospective Observational. Level of Evidence 4.

Polydactyly is one of the most common anomalies of hand and/or foot. Postnatal torsion of pedunculated polydactyly is a well known complication but intranatal torsion has been infrequently described in published literature. Here, we describe a case of pedunculated ulnar polydactyly which was gangrenous at birth due to intranatal torsion. Controversies surrounding the management of narrow pedicled pedunculated polydactyly by traditional method of suture ligation at base are also discussed.

Angiomatosis is a diffuse vascular lesion which clinically mimics hemangioma or vascular malformation. It usually involves multiple tissues and is histopathologically characterised by proliferation of vessels of varying calibre intimately admixed with large amount of adipose tissue. Its surgical removal is very difficult because of its infiltrative nature. Therefore, a precise histopathological diagnosis is of utmost importance. It is usually seen in females in the first two decades and commonly involves lower extremities. Angiomatosis of head and neck region is very rare. Here we present a rare case of angiomatosis of the lower face involving right cheek and lip in a 4-year-old boy clinically diagnosed as hemangioma. Histopathological differential diagnosis of angiomatosis is also discussed.

We present a rare case report of a malignant, high-grade, urothelial bladder carcinoma in a 4-year-old boy. The tumor recurred quickly after resection. The recurrence was treated with partial cystectomy plus MVAC (methotrexate, vinblastine, Adriamycin, cisplatin). This is the first reported use of the MVAC regimen for a pediatric bladder tumor.

Gastric teratoma is an uncommon neoplasm in infancy. Most of the gastric teratomas described have mature elements while some have immature elements. Occurrence of nephroblastic rests in gastric teratoma has not been described in available literature earlier.

Prolapse of rectum of varying degrees is a well-known entity in children. Spontaneous rupture of the rectum along with massive ileal evisceration because of increased intraabdominal pressure is a rare complication of rectal prolapse in the adults. Rectal prolapse in children is usually a benign condition. Known complications of the rectal prolapse in children include recurrent mucosal ulceration, bleeding, and proctitis. Spontaneous rupture of the rectum with or without ileal evisceration has not been previously reported in infants.

Introduction: Fournier’s gangrene in pediatric population is rare and because of low incidence the etiopathogenesis in children is not well known. Case Report: We report a rare case of a 10­month­old male infant with severe Fournier’s gangrene occurring after an episode of prolonged diarrhea. The progression of the disease was very fast and in spite of undergoing a diversion transverse colostomy, the child could not survive. Conclusion: Fournier’s gangrene in children is rare and the course of the illness in our case was very rapid. The relation of this severe form of fasciitis with a common condition like diarrhea is rare and must be known to the treating clinicians.