No abstract

Aim:To assess the results of primary posterior sagittal anorectoplasty (PSARP) in male neonates with high anorectal malformations (ARM) who on invertogram showed well descended rectum.Materials and Methods:Twelve full-term male neonates with high ARM over a period of one and half years were selected for primary PSARP based on the findings of invertogram. Primary PSARP was performed in all neonates with lower limit of rectal gas bubble at or below the ossified fifth sacral vertebra. The patients were followed-up for a period between three to four and half years. The clinical evaluation of fecal continence was performed using Pena's criteria for assessment of continence.Results:All neonates underwent PSARP on second to fourth postnatal day. The fistula with urinary tract was found in 11 patients (seven had fistula to bulbar urethra and four to prostatic urethra). Rectal tapering was not required in any neonate. No patient had urinary problems after removal of catheter. Most of the neonates were discharged by ninth day. Postoperatively, two patients had superficial wound infection of anoplasty without any disruption or bowel retraction. Two patients had severe perianal excoriation. No patient had anorectal stenosis. Nine of twelve patients on follow-up had good voluntary bowel movements. Of the three patients who had grade I soiling two had recto-prostatic urethral fistula. No patient had constipation. All patients had good urinary stream.Conclusions:Repair of high ARM in male neonates with a well descended rectum is feasible without significant morbidity and good continence.

No abstract

Attacks by wild boar are very few reported in literature. We report a rare case of perineal injury caused by a wild boar attack resulting in a recto-vesico-cutaneous fistula.A wild boar attacked a 24-year-old male, residing in a village of Gadchiroli district, from behind while collecting dried branches of trees in forest. He was hit by the boar in perineal region. His accompanying friends rescued him. Patient was brought to our centre three days after the injury. At presentation, he had no desire to pass urine and had continuous dribbling of urine from the perineal wound. He was in septic shock at presentation. Resuscitation was done with intravenous crystalloids, and broad spectrum antibiotics were given. On initial examination, a 3x2 cm cruciate shaped penetrating wound was seen in perineum. Clear fluid admixed with fecal matter and blood clots, was dribbling from wound continuously. On digital examination, this penetrating wound was found to be communicating with anterior wall of rectum with a rent of approximately 1.5x2 cm in the antero-lateral rectal wall. Further, there was erythema and tenderness in perineal and scrotal region with some necrotic patches over scrotum. No other body site was injured other than few abrasions over abdominal region.Perineal wound was thoroughly washed with normal saline and betadine. Patient was given tetanus toxoid booster dose, as he was initially immunized but had not received last dose in five years. Antirabies immunoglobulins, together with the dosage of anti rabies vaccine were given. On evaluation with Computed Tomography, a well defined tract delineated by contrast was seen arising from the postero-lateral aspect of bladder and communicating with the anterior wall of rectum posteriorly and there was contrast collection and extravasation through the perineal wound. Urethral injury was ruled out [Table/ Fig-1].Patient was stabilized and shifted to the operation theatre. On proctoscopy, there was a perforation in anterior rectal wall extending from 1 o' clock to 3 o' clock position. A Foley catheter was inserted through anterior rectal wall perforation. Exploratory laparotomy was done through midline incision and bladder was opened. There was a rent of 1x1 cm in posterior bladder wall, approximately 1.5 cm above trigonal region, communicating with the anterior rectal wall. Ureteral continuity was confirmed, and any other injury was ruled out. Bladder and rectum were separated. Edges were freshened. Thorough antibiotic wash was given. It is very uncommon for a boar to become aggressive in nature against human unless they are cornered. A wild boar attacked a 24-yearold male from behind in perineal region. At presentation, he had continuous dribbling of urine and fecal matter from perineal wound. On CT-scan, a well defined tract delineated by contrast was seen between postero-lateral aspect of bladder and anterior wall of rectum, and there was contrast extravasation through perineal wound. After resuscitation, fistula was repaired through abdominal approach, and perineal wo...

Aim:The aim of the study was to compare the efficacy and postoperative complications of stented and nonstented open pediatric dismembered pyeloplasty for ureteropelvic junction (UPJ) obstruction.Settings and Design:A balanced, parallel group, prospective randomized controlled trial comparing stented and nonstented Anderson-Hynes Dismembered Pyeloplasty.Subjects and Methods:It included 42 children who required Anderson-Hynes dismembered pyeloplasty for UPJ obstruction (UPJO). Patients were randomized into stented (double “J” [DJ] stent) and nonstented pyeloplasty groups. The intraoperative and postoperative course was compared. Both groups were analyzed for problems such as dysuria, frequency, pain, hematuria and urinary tract infection, and postoperative renal status.Statistical Analysis:Mann–Whitney U-test, Fisher's exact test, Student's t-tests, and Chi-squared test were used.Results:Surgical duration was significantly shorter for the nonstented group as compared to the stented group (60.4 ± 6.49 min vs. 78.9 ± 8.17 min). The intraoperative negotiation of DJ stent was troublesome in 21.7% patients belonging to the stented group. The hospital stay was comparable in both groups (4.67 ± 1.9 vs. 4.28 ± 0.67 days). Patients in stented group had experienced dysuria, loin pain, lower abdominal spasmodic pain, and frequency significantly higher than nonstented group. However, the other problems such as fever, hematuria, and urinary tract infections were more common in stented group, but the difference was not statistically significant. There was no difference in resolution of hydronephrosis in both groups.Conclusions:There is no statistically significant difference in resolution of hydronephrosis following nonstented or stented dismembered pyeloplasty in children with UPJO. However, the patient is more symptomatic due to stent in the postoperative period.