Objective: To highlight the case of a patient with acute respiratory failure, whose diagnosis of Boerhaave’s syndrome only became apparent after a trial of non-invasive ventilation. Clinical Presentation and Intervention: A 68-year-old female presented with a clinical picture of community-acquired pneumonia and exacerbation of asthma that was supported by radiological evidence of a large left-sided pleural effusion. Within 20 h, she deteriorated and progressed to severe type 2 respiratory failure. After initiation of first non-invasive and then invasive ventilation, a tension pneumothorax developed. An emergency decompression of the chest revealed gastric contents in the left hemithorax. A diagnosis of Boerhaave’s syndrome was made. Subsequent management included a thoracotomy, defunctioning oesophagectomy, and gastrostomy with ventilatory and inotropic support. However, despite best efforts, the severe systemic inflammatory response resulted in death 3 weeks after initial presentation. Conclusion: It is important to have an open diagnostic mind with a thorough review of investigations and therapy as a patient deteriorates. This case illustrates the importance of considering the remote possibility of oesophageal rupture prior to commencing non-invasive ventilation, especially with regard to chest radiograph features.

The parameatal cyst (PMC) is a benign lesion that occurs primarily in male children, generally present after birth, but may also occur in girls and adults. Although expectant management, needle puncture, decapping, and marsupialization are described as different modalities of treatment, all are associated with recurrences. We present nine pediatric cases with PMC, their clinical presentation, treatment, and outcome along with a review of the literature.

Background: An additional flap during the tubularization of incised urethral plate urethroplasty (TIPU) is believed to minimize the postoperative complications. It is still debatable whether using an additional flap is worth the risk given the hazards associated with doing so. This study aims to re-evaluate the benefits and drawbacks of TIPU with or without a preputial dartos (PD) flap. Materials and Methods: We assessed the results of patients with distal hypospadias who underwent surgery in our institute over the past 2 years. The urethral plate’s width, thickness, and depth, the periurethral tissue’s quality, and the width of the glans at the mid-glans level determined whether the neourethra was covered with a PD flap or left uncovered. Data on intra-operative blood loss, operating time, length of hospital stay, postoperative complications, and outcome were analysed. Results: There were 96 patients: 58 received an extra PD flap, whereas the other 38 did not. In the flap group, ventral skin necrosis was a prevalent problem, whereas meatal stenosis predominated in the no-flap group. Both the flap group (25.66%) and the no-flap group (23.86%) experienced comparable postoperative complications (P = 0.503). In comparison to the no-flap group, the flap group showed statistically significant differences (P<0.001) in intra-operative blood loss (22.10 ± 6.96 vs. 10.34 ± 3.02 mL), operating time (96.34 ± 6.661 vs. 71.39 ± 9.76 min), and hospital stay (10.04 ± 0.87 vs. 8.47 ± 1.64 days). Conclusion: The additional PD flap does not always affect the result of TIPU in terms of complications.

Animal (dog, cat, and rodent) bite injuries in neonates are common in developing countries, especially when the mother leaves the baby at the side of the field in which she is working. A wide spectrum of rat-bite injuries is described in the literature. Disease following the bite of a rat has been known for many years and has been described as rat-bite fever. We report a case of a 17-day-old female neonate who presented with a severe rat-bite injury to the face, with consequent problems in management.

Intussusception is the telescoping of one bowel segment into another. Usually, children below 1 year of age experience this condition and have classical symptoms such as abdominal pain, vomiting, and bleeding per rectum. However, unusual clinical presentations, especially in older children, may deceptively mislead the diagnosis, particularly in the absence of the classical symptoms. We report a case of an 11-year-old male child who presented with seizures, altered sensorium, and nonbilious vomiting. During the emergency surgery, he was diagnosed with an ileoileal intussusception with proximal gut perforation and peritonitis. He had a speedy recovery from neurological symptoms after the surgical intervention.