Background:Ventriculoperitoneal (VP) shunt is commonly used in the treatment of hydrocephalus. Migration and extrusion of the distal end of the VP shunt are relatively rarely occurring complications.Aim:To retrospectively analyze patients with extrusion of the abdominal end of ventriculoperitoneal shunts and evaluate the possible etiology and outcome.Settings and Design:All patients presenting with extrusion of lower end of the shunt were included. The variables collected were age, sex, site of extrusion, time duration of extrusion, presence of local infection, meningitis, shunt dependency, and treatment received. Contrast-enhanced computed tomography of brain was carried out in all patients to rule out retrograde migration of infection in the cranial cavity.Materials and Methods:Eight patients of abnormal migration and extrusion of lower end of VP shunt were included.Results:The distal end of VP shunt was extruded from the anus (n = 3), vagina (n = 2), and anterior abdominal wall (n = 3). In five of these patients, shunt catheter was draining cerebrospinal fluid (CSF), the children were afebrile and CSF was sterile. In three children with extrusion of the shunt through the abdominal wall, the shunt tract was infected. Two of these patients had abscess in the shunt tract, which required incision and drainage. Both these patients had meningitis with a growth of Streptococcus species from CSF. Seven patients required further CSF diversion such as endoscopic third ventriculostomy (n = 3) or placement of VP shunt (n = 4).Conclusion:Distal tip migration of VP shunt may prove to have potentially serious complications such as meningitis. A prompt and aggressive protocol of management is recommended.

Introduction:Lumbar disc herniation is one of the main causes of discogenic low back pain and reported to affect 60%–80% of people during their lifetime. The two main surgical modalities for intervertebral disc surgery are standard open discectomy and minimally invasive discectomy which include percutaneous endoscopic lumbar discectomy and microendoscopic discectomy (MED). We report our experience with the same technique of MED to evaluate the efficacy of MED for lumbar disc pathology.Aims and Objectives:The aims and objectives were to study the efficacy, advantages, and associated limitations and complications of MED in lumbar disc herniations.Materials and Methods:This study was carried out on 300 patients who had single-level herniated disc. The procedure was done by Microscopic Endoscopic Tubular Retraction System. Preoperative assessment of Visual Analog Scale (VAS) and modified Suezawa and Schreiber (MSS) clinical scoring system was documented 1 day prior to surgery. Postoperative results were determined to be excellent, good, fair, or poor according to MacNab criteria and also evaluated by MSS clinical scoring system on postoperative day 7 and after 6 months.Results:A total of 187 patients were males and 113 patients were females and a majority of patients were in the age group of 31–40 years. A total of 192 patients had disc herniations at L4–L5 level. The mean operative time was 82 min and the mean hospital stay was 5.3 days. Eighteen cases (6%) developed postoperative complications including discitis, dysesthesia, recurrent prolapsed intervertebral disc, residual disc, dural tear, and nerve root injury. Mean preoperative VAS score was 8.7 and the mean postoperative VAS scores at postoperative day 7 and at 6 months were 2.25 and 1.12, respectively. The mean preoperative MSS score was 3.27 and the MSS scores at postoperative day 7 and at 6 months were 7.42 and 8.2, respectively. The overall successful outcome of the endoscopic discectomy after 6-month follow-up on the basis of VAS improvement percentage was 87.6%, MSS scoring percentage was 91.6%, and MacNab scoring percentage was 92.67%.Conclusion:MED is a safe and effective technique. It offers decreased blood loss, shorter operative time, shorter in-hospital stay, decreased need for pain medication, decreased rate of infection, and a shorter return to work time. Limitations of this technique include a learning curve which is related to surgery time, complications, conversion to open procedures, and recurrent disc herniation.

Tubercular osteomyelitis, a form of extrapulmonary tuberculosis (TB), represents less than 2% of all TB cases and about 10% of all cases of extrapulmonary TB. Isolated involvement of the posterior elements of the spine and calvarial TB are rare manifestations of extrapulmonary TB, especially in immunocompetent patients. We, hereby, present a case of a 12-year-old female patient with the mentioned multifocal skeletal involvement presenting with spastic paraparesis. Magnetic resonance imaging (MRI) of the cervicodorsal spine was suggestive of lesion involving the posterior elements of the spine from C7 to D3 vertebra with marrow edema and without involvement of the vertebral bodies and intervertebral discs. The MRI of the brain was suggestive of a lenticular-shaped extra-axial lesion in the right frontal region arising from inner table of calvaria. The patient was first operated for the lesion in the cervicodorsal spine due to acute-onset paraparesis followed by complete excision of frontal lobe lesion, which was done after 2 weeks of removing the spinal lesion. Histopathological examinations of both the lesions were suggestive of TB. Majority of patients with multifocal skeletal TB have nonspecific generalized somatic symptoms and signs at presentation and inconclusive radiological findings. All these factors can lead to a delay in diagnosis in such cases. Hence, a high index of suspicion for TB is necessary for patients presenting with multiple somatic symptoms and multiple destructive skeletal lesions, particularly in areas where TB is endemic.

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Exploratory laparotomy revealed a large retroperitoneal mass of size 32x15x15cms with solid and cystic components. Tumor was located posterior to descending colon and mesocolon. Stomach and pancreas were pushed upwards and anteriorly where as left kidney was grossly ABSTRACT Of all primary retroperitoneal teratomas, less than four percent occur in children and 90% are benign. Here we report a case of malignant retroperitoneal teratoma (dermoid) in a 15 year old girl who presented to our hospital-Acharya Vinoba Bhave Rural Hospital (AVBRH). She presented with a tender, large, irregular mass with variegated consistency in the entire left side of abdomen crossing midline. Ultrasound of abdomen suggested a complex intraabdominal mass with septations and lobulations. It was not feasible to use other imaging modalities for evaluation due to poor socioeconomic status and illiteracy. Patient underwent exploratory laparotomy with tumor resection along with left kidney and part of the descending colon which was densely adhered to tumor. Histopathological examination of tumor was suggestive of immature teratoma. Post operative recovery was uneventful and patient was discharged from the institution. Tissue adherence which can be observed in both benign and malignant form of teratomas, requires extended surgery for removal of adhered organ for the completeness of surgery and good prognosis.