No abstract

Chylous ascites is the accumulation of triglyceride-rich lymph in the abdomen. Its occurrence during the infantile period is quite rare. Congenital chylous ascites (CCA) is one, which occurs in children <3 months of age, due to maldevelopment of the lymphatic system. There is no clearly defined treatment protocol for CCA; however, the use of medium-chain triglycerides (MCT)-based diet or total parenteral nutrition (TPN) with octreotide has been successful. Failure of conservative management, however, leads to surgical exploration to deal with those leaking lymphatics. In our case, we had initially given a trial of managing the child with MCT-based diet followed by a TPN along with octreotide. However, the failure of both leads us to operate the child during which we incorporated the use of fibrin glue over the leaking mesenteric lymphatic vesicles, which ultimately led to the resolution of the chylous ascites.

Gastric perforation in neonate has always been a catastrophe associated with high morbidity. The high mortality rate reflects to a certain extent the precariousness of the neonatal period, but the process evolves so rapidly that prompt diagnosis is necessary if improved survival rates are to be achieved. It is a mysterious entity regarding its cause, but three mechanisms; spontaneous perforation, trauma and ischemia are acceptable reasons for neonatal gastric perforation. Nonetheless, we present you here a rare case of malrotation with mid gut volvulus which presented with apparently spontaneous gastric perforation (1x1cm). Primary repair of the perforation with derotation of the volvulus was done. We question the spontaneity of neonatal gastric perforation and urge the need to look for the contributing cause.

Introduction Diagnostic laparoscopy is the gold standard for evaluating a child with impalpable undescended testis (UDT). During the diagnostic laparoscopy, if the vas and vessels are seen coursing through the inguinal canal, the standard norm is to explore the inguinal canal via an inguinal crease incision. In this study, however, we explored the feasibility of laparoscopic inguinal exploration without any additional inguinal crease incision. Materials and methods The prospective study was done from 1.1.2019 to 30.6. 2019 to assess the feasibility of the laparoscopic inguinal exploration in cases of impalpable undescended testis, where testicular vessels are found to course into the inguinal canal during a diagnostic laparoscopy. The data including the descriptive characteristics, intraoperative findings, and surgical technique were collected and analysed. Results There were 17 cases of impalpable UDT operated in the Department of Pediatric Surgery from January 2019 to June 2019. Mean age of the patients was 8.5 years (1-16 years). Two patients had testicular vas and vessels coursing through the inguinal canal, both of which underwent laparoscopic inguinal exploration. In both of these cases, vas and vessels were found to end in testicular nubbin, at the level of the neck of the scrotum, which were excised laparoscopically, thus avoiding the open inguinal incision. Conclusion Laparoscopic inguinal exploration is a feasible and attractive alternative in cases of impalpable UDT where testicular vas and vessels are found to course through the inguinal ring.