Introduction Rapunzel syndrome is characterized by a large trichobezoar in the stomach with a tail extending beyond the pylorus into the small bowel, causing mechanical obstruction of the small bowel. A 7-year-old girl presented to the emergency room with severe epigastric pain. Computed tomography suggested trichobezoar causing jejuno-jejunal intussusceptions, bowel wall thickening, and dilated small bowel loops proximal to the obstruction. On laparotomy, two concealed perforations were noted at the duodenojejunal (DJ) junction and 40 cm distal to the DJ junction. An enterotomy incision was given at the antimesenteric border of the distal jejunal perforation site, and the mass was successfully extracted. Primary repair was done at the DJ perforation site, and resection was followed by an end-to-end anastomosis at the distal jejunal perforation site. Surgery confirmed a complex mass of tangled hair within the gastric cavity with a tail extending into the pylorus of the stomach and small intestine, consistent with trichobezoar. Conclusion Computed tomography is superior to other radiological imaging modalities for diagnosing trichobezoars as it helps diagnose and demonstrate mechanical bowel complications.

BACKGROUND Hirschsprung's disease is the commonest cause of functional intestinal obstruction in children. Majority of children with Hirschsprung's disease will have delayed passage of meconium in newborn period with abdominal distension and older children present with chronic constipation. This study describes the clinical characteristics and outcome of management of this disease in our setting where frozen section facilities are difficult. MATERIALS AND METHODS A total of three hundred and nineteen patients were analysed over twelve years' duration; stage I 147 patients and stage II 172 patients. The presentation, diagnostic investigations, operative management and complications were described. Study Design-This is a retrospective study with record based analysis. RESULTS Patients of Hirschsprung's disease both in stage I (Colostomy) and stage II (Pull-through) developed significant number of complications with severity ranging from minor to major. CONCLUSION Although complications are common, majority of the complications are manageable and attain a socially satisfactory bowel habit.

BACKGROUNDAnorectal malformations are among the more frequent congenital anomalies encountered in paediatric surgery with an estimated incidence ranging between 1 in 3500 and 1 in 5000 live births. Most cases are diagnosed in the early neonatal period. There i s a wide spectrum of abnormalities ranging from low anomalies with perineal fistula having simple management to high anomalies with complex management.It is a retrospective study of anorectal malformations in our Institute during July 2005 to July 2017 from our department over the 12-year period and the aim of the study is to analyse type of anomalies, procedures done and outcome in our settings. Study Design-Retrospective record based study. MATERIALS AND METHODSWe collected data from our records from July 2005 to July 2017, from our Paediatric Surgery Department over 12-year period. A total of 690 patients were analysed from our records; 478 were male children, 212 were female children from Government General Hospital and Guntur Medical College, Guntur, Andhra Pradesh. RESULTSOut of 690, 478 were male (69.3%) and 212 (30.7%) were female; 191 males had low anomaly (39.9%) and 18 female had low anomaly (8.49%). Total 209 patients of both male and female sex had low anomalies (30.2%). All low anomalies were treated by anoplasty. A total of 481 children of both sex had high or intermediate anomalies (69.8%), managed by either staged procedures or single stage repair at appropriate weight gain. CONCLUSIONMost of the low anomalies and majority high anomalies have reasonably acceptable result with achievement of complete fecal and urinary continence with good quality of life, which is long-term goal of these malformations.