sandip kumar rahul

Tissue deficiency accompanying failed hypospadias surgery makes further reconstruction difficult. Modified Cecil-Culp technique utilizes penile mobility to place the repair in a scrotal location for a short duration which helps to accomplish tension-free apposition using dartos and skin of the scrotum. A series of four cases is described where this technique proved beneficial despite adding a short subsequent procedure after a few months.

Although Duplication anomalies are common in the Gastro-intestinal tract, appendicular anomalies are rare with variable anatomy.

 To describe the series of appendicular duplication cases managed at a tertiary care center.

 Data regarding the clinical features, associated anomalies and management of cases of appendicular duplication at a tertiary care center from January, 2019 to December, 2020 were collected retrospectively and analyzed.

 Four children with appendicular duplication were managed during this period; three neonates presented with high anorectal malformation and type two pouch colons with a large colovesical fistula. They had a single caecum with two separate appendices symmetrically on either side (type B1). They were managed by division of colo-vesical fistula, mobilization of colonic pouch after limited pouchoplasty and anoplasty as a single stage procedure. None of the appendix was removed. In one of these cases, bilateral ureters were dilated. The fourth case presented as a 3 year-old with pain abdomen and during surgery for suspected appendicitis, partial duplication of inflamed appendix was found (type A). Appendicectomy relieved this child of his symptoms. All patients are doing well on follow-up.

 The position, anatomy and associated anomalies of appendicular duplication can be variable complicating its presentation and management.

Malrotation with midgut volvulus often results in gangrene of midgut with relative sparing of duodenum. An extremely unusual case of Malrotation with isolated necrosis of distal duodenum is described with brief review of literature. Isolated duodenal necrosis in association with malrotation is very rare; it increases the complexity of surgery and prolongs hospital stay.

To assess the role of Percutaneous nephrostomy in poorly functioning kidneys of ureteropelvic junction obstruction in pediatric patients. Several studies have addressed the unique management challenges in poorly functioning kidneys with ureteropelvic junction obstruction. Trial with percutaneous drainage of such kidneys as a guide to management would be a solution to this dilemma.  A prospective study was performed on poorly functioning kidneys (split renal function<10% on renal dynamic scan) of patients with unilateral ureteropelvic junction obstruction from August, 2016 to January, 2018. Ultrasound-guided nephrostomy was inserted in these patients. Data regarding the differential renal function and glomerular function rate was collected before and after nephrostomy insertion. Decision regarding pyeloplasty or nephrectomy of the involved kidney was taken if differential function and Glomerular filtration rate increased following drainage. Data collected was analyzed statistically.   33 patients of unilateral ureteropelvic junction obstruction with poorly functioning kidneys were treated during this period. 30 patients had significant increase in differential function and glomerular filtration rate. These patients underwent pyeloplasty. In 2 patients, these parameters did not increase much and they benefitted from nephrectomy. One patient had an infected kidney which did not improve significantly on drainage and had to be removed. Of the 30 patients who had pyeloplasty, two developed obstruction after 3 months of removal of double-J stent and had to be re-operated. Percutaneous nephrostomy in poorly functioning kidneys with ureteropelvic junction obstruction helps to identify potentially salvageable kidneys which merit pyeloplasty. Kidneys which do not improve with nephrostomy are unlikely to improve with pyeloplasty and therefore nephrectomy is done in such cases.