[show abstract][hide abstract] ABSTRACT: Distal migration of ventriculoperitoneal shunt is rare. We present this unusual complication in 5 patients. The lower end of the shunt was extruded from right lumbar region, cervical area, umbilicus and rectum. The cause of such extrusion is not known. The patients were managed by shunt removal followed by shunt replacement on the opposite side.
[show abstract][hide abstract] ABSTRACT: To study the clinical profile of the cases of esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) and various factors affecting the surgical and early postoperative management and their outcome.
A prospective analysis of 127 cases of EA from February 2004 to May 2006 was performed. Waterston prognostic criteria were used for grading.
EA with TEF was the commonest type in 117 cases (92%). Associated congenital anomalies were present in 52 (41%) patients, the commonest being the cardiac anomalies, which was followed by the gastrointestinal anomalies. VACTERL was found in 6 (5%) cases. Prematurity, associated congenital anomalies, gap between esophageal ends and preoperative respiratory status were the significant factors affecting the survival (P = < 0.001). Primary extrapleural repair was the surgical approach in most of the patients. Azygos vein was preserved in 46 cases and no retropleural drainage was used in 27 cases. Staged procedures were performed in 19 cases, including 6 cases of isolated esophageal atresia. Pneumonitis and sepsis were the most common early postoperative complications (42%). Hypoxia and cardiorespiratory arrest were the most common causes of mortality (11 cases). Anastomotic leak complicated 13 cases, including 9 major and 4 minor leaks. Major leak followed by sepsis caused 7 deaths. Survival as per Waterston criteria was 100% in group A, 83% in group B and 22% in group C.
Factors affecting the survival are major or life-threatening associated anomalies, long gap, pneumonia and sepsis at presentation or that acquired during hospitalization and major leaks. The high incidence of low birth weight, delayed diagnosis, poor referral, low-socio economic status and lack of advanced neonatological back up are important contributory factors to poor outcome.
Journal of Indian Association of Pediatric Surgeons 01/2008; 13(1):2-6.
[show abstract][hide abstract] ABSTRACT: migration is 10%  . Approximately 30–35 patients un-dergo VP shunt insertion at our institute annually. The incidence rate of all sorts of complications in these pa-tients is around 22%. Unusual distal catheter migration with extrusion was seen in 5 patients. As would have been expected, not all but 1 patient had associated features of meningitis. No specific cause of the abnormal migration could be identified. Case Summary Five patients with spina bifida with lumbosacral defects un-derwent VP shunt placement due to associated hydrocephalus. The age at shunt placement ranged from 1 to 3 months. The age at time of shunt extrusion ranged from 3 to 6 months with the average time interval of 3 months. The patients presented with the distal end of the shunt cath-eter tip coming out from the right lumbar region in 1 patient (fig. 1), cervical region in 2, umbilicus in 1 (fig. 2) and rectum in 1 (fig. 3). In all patients, the catheter tip was draining CSF well, as observed after pressing the shunt reservoir. The 1st patient with the extrusion from the right lumbar region had an associated lumbar hernia due to neurological deficit. He presented with meningitis and severe septicemia to which he succumbed later on. This was the only mortality in the presented series. In the remain-ing 4 patients, there were no features of meningitis. Cerebrospinal fluid taken through aspiration of shunt reservoir showed growth of coliforms in the 1st patient with lumbar extrusion. The remain-ing 4 patients had negative CSF growth. Abstract Distal migration of ventriculoperitoneal shunt is rare. We present this unusual complication in 5 patients. The lower end of the shunt was extruded from right lumbar region, cervical area, umbilicus and rectum. The cause of such extru-sion is not known. The patients were managed by shunt re-moval followed by shunt replacement on the opposite side.
[show abstract][hide abstract] ABSTRACT: The aim of this study is to report a series of patients with the Azygos vein preserved during the surgery for esophageal atresia with tracheoesophageal fistula (EA&TEF), highlighting the advantages in terms of survival and prevention of anastomotic leak. Ninety-six neonates with EA&TEF, admitted to the Department of Pediatric Surgery, King George Medical University between 2004 and 2006, were reviewed prospectively; the babies were randomly allocated to two groups: Group A (n = 46) in which the Azygos vein was preserved and Group B (n = 50), wherein it was ligated. The two groups were comparable in respect to sex, weight, prematurity, associated anomalies, Waterston classification, Spitz classification and distance between the pouches after mobilization. Anastomotic leak occurred in three cases (6%) in Group A and ten cases (20%) in Group B and was responsible for mortality in one (2%) case in Group A and six cases (12%) in Group B. Preservation of Azygos vein resulted in significant reduction in the number of anastomotic leaks. We propose that preservation of the Azygos vein prevents early postoperative edema of the esophageal anastomosis by maintaining the venous drainage and thus may form an additional protective factor against anastomotic leaks.
Pediatric Surgery International 01/2008; 23(12):1215-8. · 1.22 Impact Factor
[show abstract][hide abstract] ABSTRACT: Spontaneous perforation of extrahepatic bile duct is rare. The cause is idiopathic once trauma and choledochal cyst are ruled out. The condition presents a diagnostic dilemma. Preoperative recognition is necessary as early surgical intervention gives excellent prognosis. We report clinical observations made in three cases with acute presentations. Diagnosis is to be suspected by the presence of jaundice after an initial anicteric period of good health with biliary ascites. This is confirmed by bilious abdominal paracentesis, signs of peritonitis and absent free gas on X ray. The constellation of these three findings was constant in three patients. The presented paper highlights the same as reliable clues to diagnosis.
The Indian Journal of Pediatrics 06/2007; 74(5):509-10. · 0.72 Impact Factor