BACKGROUND Ovariectomy used to be the conventional treatment for ovarian torsion in the paediatric age group. A paradigm shift in the management of paediatric ovarian torsion was reported in recent years, with ovarian recovery documented with simple detorsion, even for cases which macroscopically appeared necrotic or gangrenous. Our study was undertaken to analyse the management and outcome after detorsion of twisted ovaries in children. METHODSA prospective study of 20 consecutive cases of paediatric ovarian torsions that presented in a tertiary level Paediatric Surgery Dept. from 2010 to 2014 was done. Neonatal and infantile cases were excluded. Pre-operative parameters (age, symptoms and duration, menarchal status, sonographic features, doppler assessment of flow, tumour markers, time to surgery from presentation at hospital) and per-operative parameters (site, size, appearance, colour and response to detorsion) were assessed. The cases were categorized into 3 groups-Group A-Detorsion with or without aspiration. Group B-Detorsion with immediate ovarian sparing cystectomy. Group C-Ovariectomy. Post-operatively, patients were followed up clinically and with sonograms. RESULTSIn all cases of Group A and B, the ovary could be salvaged as documented with sonograms, irrespective of the initial macroscopic appearance of the ovary. All cases in group B, where cystectomy was done along with the initial detorsion, had smaller ovaries in follow up sonograms. There were no cases of ovarian malignancy undergoing torsion. 55% of cases were that of normal ovary undergoing torsion. In ovarian torsions, where the size was more than 5 cms and/or volume of the involved side was more than 20 times that of the opposite normal ovary, 82% had an associated cyst/benign lesion at the time of torsion. CONCLUSIONSOvarian preservation should be the basic tenet of surgical approach irrespective of the pre-operative Doppler findings and intra-operative color of the twisted ovary.

Background: Intussusception is one of the most frequent causes of acute bowel obstruction in infants and toddlers. Abdominal sonogram is highly specific, accurate and is the first line diagnostic modality. The primary treatment options are non-operative hydrostatic or pneumatic reduction. In our institution, we use normal saline for reduction of intussusception under ultrasound guidance (USGR). The aim of the study is to analyse the clinical pattern and treatment outcome of intussusception. Methodology: Retrospective analysis of all cases admitted with intussusception in our department during 2014-2018 was done. Results: 785 cases (527 males: 258 females) with a mean age of 25 months and median of 16 months had abdominal pain (92.5%), vomiting (59%) and blood in stools (32%) as the predominant symptoms. 710/785 cases (90.4%) underwent successful USGR and 75/785 of the failed cases underwent surgery. Age group < 12 months, presence of blood in stools irrespective of its duration and prolonged vomiting >48 hours were found to be significant factors for failed USGR. Vomiting and blood in stools were found to be significantly higher in children <12 months of age (p<0.005), whereas pathological lead points were more frequent in children >3 years of age. Conclusion: With a high success rate and no significant complication rate, USGR is an effective non-operative treatment modality for intussusception. Age group <12 months, prolonged vomiting and presence of blood in stool were found to affect the success rate of hydrostatic reduction. Keywords: Intussusception, saline, ultrasound, hydrostatic reduction.

Introduction: Undescended testis is a common surgical problem in children which needs to be treated by one and a half year of age. When testis is non palpable, it could be either absent, and when present intra-abdominal or inguinal. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with nonpalpable undescended testis from January 2016 to June 2021. Results: Mean age of intervention was 43.7 months (range 7 to 153 months). Incidence of absent testis was 30.97%. in 156 children who had ipsilateral undescended testis, 92 had intra-abdominal testis and 43 had inguinal testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy were suggestive of absent ipsilateral testis (p <0.001). Testis is absent in 11.3% only when ipsilateral hemi scrotum is under developed. Conclusion: Proportion of absent testis is 30.97% in children with unilateral undescended testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy are predictive of ipsilateral testicular absence. Keywords: Undescended testis, atrophic testis, Contralateral hypertrophy.

Introduction: Foreign Body Aspiration (FBA) is a common and serious paediatric emergency condition. A Suspected Foreign Body Aspiration (SFBA) is based on Clinical History (CH), Physical Findings (PF), and Chest Radiograph (RAD/CXR). The predictive accuracy of these factors as indicators of FBA and to perform Rigid Bronchoscopy (RB) based on these factors has been debated. Aim: To evaluate the sensitivity, specificity, positive predictive value and negative predictive value of clinical history, physical findings and radiology in SFBA. Materials and Methods: A retrospective analysis was conducted on paediatric patients with suspicion of foreign body aspiration, admitted in the Department of Paediatric Surgery at Government Medical College, Thiruvananthapuram, Kerala, India, between January 2006 and December 2020. Factors in CH, PF, and RAD were subjected to univariate and multivariate analysis to evaluate the predictive accuracy of these factors as indicators for bronchoscopy. Sensitivity, specificity, positive and NPV were calculated for the clinico-radiological indicators in predicting FBA. The association between evidence of FBA and clinico-radiological indicators was evaluated by Pearson Chi-square test; and p-values <0.05 were considered to be statistically significant. Results: A total of 458 children (263 males and 195 females) were admitted with SFBA having mean age of 29.49±24.92 months, 389 had confirmed FBA, and 69 had no FBA. The age group of 1-2 years was found to be a statistically significant factor for FBA (p-value=0.03). Foreign Body aspiration Witnessing Event (FBEW) (p-value <0.0001, sensitivity=91%, specificity=31%), choking spell (p-value <0.0001, sensitivity=95%, specificity=25%), acute cough (p-value <0.0001, sensitivity=87%, specificity=46%), tachypnea (p-value <0.0167, sensitivity=89%, specificity=20%), decreased breath sound (p-value <0.0001, sensitivity=92%, specificity=35%), abnormal CXR (p-value <0.0001, sensitivity=94%, specificity=37%) and hyperinflation (p-value <0.0001, sensitivity=95%, specificity=31%) were found to be independent statistically significant factors in FBA. Multivariate analysis showed a PPV of 97% when the aspiration event was witnessed along with abnormal physical and radiological findings. Conclusion: It was observed that assessment of clinico-radiological parameters is valuable in predicting FBA. The indications of RB in SFBA can be safely based on these clinico-radiological parameters.

Introduction: The Coronavirus Disease-2019 (COVID-19) had profound repercussions on routine medical practices all over the globe. There are fewer studies on the impact of the pandemic on childhood surgical conditions like Acute Appendicitis (AA), which is the most common paediatric surgical emergency. Aim: To analyse whether COVID-19 has influenced the clinical profile and management of paediatric appendicitis during the pandemic period. Materials and Methods: A retrospective study was carried out in the Department of Paediatric Surgery, SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India, comparing AA cases during the pandemic period (group A=from February 2020 to January 2022) with AA cases during the prepandemic period (group B=from February 2018 to January 2020). Analysis of data regarding patient demographics (age, sex), duration of symptoms and hospital stay, type of appendicitis, total and differential leucocyte count, ultrasonographic findings, treatment modality and complications was done. Subgroup analysis of children in group A was done by comparing AA cases with active/recent COVID-19 infection (Subgroup A1) with the rest of AA in the group (Subgroup A2). Pearson’s Chi-square test was used for the analysis of categorical variables and independent t-test was used for numerical data. p-value<0.05 was considered significant. Results: There were 826 AA cases, with 375 children in group A and 451 in group B. A significant reduction in the number of AA cases was noted during the first year of the pandemic (n=167 vs n=242, p-value=0.009) and a significantly higher number of cases were managed conservatively during the pandemic period (n=48 vs n=10, p-value <0.0001). Children with active/ recent COVID-19 infection presented late (p-value=0.03), had a significantly higher incidence of complicated appendicitis (p-value=0.02), decreased total leucocyte count (p-value=0.01), decreased polymorph count (p-value=0.02) and higher incidence of the conservative modality of treatment (p-value<0.005). Conclusion: Overall, there were no significant differences in the clinical profile of AA during the pandemic period. But, children with AA who had active/recent COVID-19 infection had a longer duration of symptoms and a higher incidence of complicated appendicitis. The pandemic influenced the management protocols with an increase in the number of AA cases being managed conservatively when compared to the prepandemic period.