The objective of this study is to compare Bianchi supra umbilical curvilinear incision with a right upper transverse incision in patients presenting with infantile hypertrophic pyloric stenosis (IHPS) in terms of level of difficulty faced during the procedure, operative time, postoperative cosmesis, wound infection and wound dehiscence. A prospective comparative study was conducted at the Department of Paediatric Surgery, The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad. The total duration of the study was 1 year from 1st March, 2020 to 28th February, 2021. The anticipated sample was minimum of 20 cases in Group A (Bianchi) and 20 cases in Group B (right upper quadrant incision), i.e. total 40 cases of IHPS. All infants up to 12 weeks admitted with the diagnosis of IHPS were added in the study. The study outcome was determined in terms of duration of surgery, wound infection and cosmetic effect after intervention with Bianchi and right upper transverse incision. Age and gender distribution was found equal when compared between study groups with male preponderance. The mean duration of surgery was 47.0 min in Group A, as compared with 32.5 min in Group B. Similarly, hospital stay was found slightly longer in Group A than Group B (5.3 versus 4.8 days, respectively). The level of difficulty while performing the surgery was slightly greater in Group A. The scar was detectable in all 20 (100.0%) patients in Group B compared with only 2 (10.0%) in Group A. Wound dehiscence was found in one (5.0%) patient in Group A, whereas none (0.0%) in Group B had it. The management of IHPS can be safely and successfully done with both Bianchi technique and right upper quadrant incision. The duration of surgery, level of difficulty while performing surgery and postoperative complications like wound infections and dehiscence were slightly more prevalent in Group A, whereas scar was significantly associated with Group B (100.0 versus 10.0%).

Objectives Intrauterine testicular torsion is extremely rare and the exact cause remains largely unknown. It is the result of an ischemic insult intrauterine, which presents as either extra-vaginal or intravaginal testicular torsion. Urgent surgical exploration and fixating the contralateral testis is key in the management of this condition. Case presentation We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in right but positive in the contralateral testis. Both hernial orifices were normal. Doppler ultrasound of the inguinoscrotal area found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color doppler analysis. An urgent scrotal exploration was undertaken. Intra-operatively there was frank necrotic right testis with intravaginal torsion of the testis and minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed. Conclusions Intrauterine testicular torsion should be treated as a surgical emergency. We advocate early recognition of intrauterine testicular torsion, alongside surgical exploration and simultaneous contralateral orchidopexy.