No abstract

Background: Duplications of the alimentary tract are known for their embryonic, anatomical, clinical, and pathologic variations. Summarizing the features of these lesions would reveal these characteristics and guide appropriate management. The objectives of this study are to describe the clinical features and characteristics of all cases of duplication of alimentary tract managed at a tertiary center. Materials and Methods: A retrospective study on all cases of duplications of the alimentary tract managed at a tertiary center from July 2015 to June 2020 (5 years) was conducted after approval from the Institutional Ethics Committee. Data regarding history, demographic details, symptoms, clinical features and investigation results, and intraoperative and histopathologic findings were collected from the hospital records and analyzed. Results: Twenty-eight cases of duplication were managed during this period. They had different locations (esophageal-5 [cervical-2 and thoracic-3], gastric-1, jejunal-3, ileal – 11, cecal-3, appendicular-2, colorectal-1, rectal-1, and posterior anal canal-1) and site-specific symptoms but definite histopathology with evidence of adjacent gastrointestinal tissue on microscopic examination. Unique cases included cervical esophageal duplication, bleeding ileal duplication (ID) with heterotopic mucosa, ID with bezoar, jejunal duplication with malrotation, appendicular duplication with type 2 pouch colon and anorectal malformation, rectal duplication, and posterior anal duplication. Case-specific management ensured minimal complication without any mortality. Conclusion: Variable location and site-specific symptoms necessitate individualized case-specific management of duplication anomalies. Histopathology confirms both native and heterotopic gastrointestinal tissues and is indispensable for the diagnosis.

A crossed-fused ectopic kidney is a rare congenital anomaly, and uncommonly we see an aberrant vessel as a cause of hydronephrosis in a kidney. We report a case of 4-year-old boy with crossed-fused right renal ectopia with hydronephrosis in the both kidneys. The aberrant renal vessel was found pressing the left pelvi-ureteric junction causing hydronephrosis. Dismembered pyeloplasty of the left kidney was performed anterior to the aberrant vessel. The patient is doing well in the follow-up visits and his renal function is stabilized. Aberrant blood supply may be a cause of hydronephrosis in the crossed-fused ectopic ipsilateral kidney. Keeping this entity in differential diagnosis will help in successful management of the crossed-fused ectopic kidney.

Importance of day-care surgery in pediatric age group is ever increasing and nowadays bulk of surgery is performed as a day-care procedure. Day-care procedure requires short intra-operative period and less postoperative complications. The introduction of tissue adhesive has been received enthusiastically since they may result in equivalent tensile strength-improved cosmetic appearance of the scar and lower infection rate when compared to sutures, staples and adhesive tape. We have used isoamyl 2-cyanoacrylate as a tissue adhesive for skin closure in day-care surgery. Novocryl is ideal for such procedure as it is a sterile, inert, non-toxic, biocompatible and bacteriostatic liquid topical skin adhesive containing isoamyl 2-cyanoacrylate formulation. We applied isoamyl 2-cyanoacrylate glue in 100 patients over skin cut margin after stitching subcutaneous tissue. Skin margin were held together by means of skin hook for 1-2 min. The cosmesis was better as there were no suture marks or lumpiness. There were no major complications in our study. Thus, isoamyl 2-cyanoacrylate can be considered as an alternative to skin suturing in the pediatric day-care surgery.