The Profile of Infantile Hypertrophic Pyloric Stenosis in a Tertiary Children's Hospital in Nepal

Introduction: Infantile Hypertrophic Pyloric Stenosis (IHPS) is the most common surgical cause of non-bilious vomiting in infancy and in the developed world. It is more common among male infants with a peak age at presentation of 4 weeks. This study aims to review the mean age at the time of diagnosis, serum electrolyte changes, ultrasonographic pyloric dimensions and surgical outcomes in IHPS at a tertiary children’s hospital in Nepal. Methods: A retrospective chart review of patients with IHPS who presented to Kanti Children’s Hospital between June 2016 and June 2020 was performed. Data on age, sex, laboratory and ultrasonographic dimensions, treatment and outcomes of treatment were collected and analysed. Results: The clinical record of 150 infants were retrieved and analysed who were diagnosed according to the clinical manifestations, laboratory and ultrasound examination from 2016 to 2020. The mean age at presentation was 46.57 ± 27.3 days with male preponderance of 84%. The proportion of IHPS cases with hyponatremia and hypokalemia was 31.3% and 18.0% respectively. The mean pyloric muscle thickness and pyloric length was 5.4 mm and 20.28 mm respectively. All cases were managed with Ramstedt pyloromyotomy with an average length of hospital stay of 5.03 days. There was no mortality and also no significant major complications. Conclusions: This study has shown that IHPS is a common condition in our setting. More attention should be paid to diagnose early. Paediatricians and general surgeons should have high index of suspicion in infants with non-bilious vomiting to avoid delay in diagnosis.

Congenital Partial Intercostal Liver Herniation

Congenital intercostal liver herniation is a rare entity. The exact etiology of congenital intercostal liver herniation is unknown. Left sided intercostal herniation is even rarer. We present a case report of an eight-day old female who presented to the emergency department of Kanti Children's Hospital with tissue mass protruding through a defect in the left side of anterior chest wall since birth. Sonographic and radiological investigation revealed the tissue to be an extension of the part of the left lobe of the liver with decreased vascularity. There were no other congenital anomalies. Laparotomy with thoracotomy with resection of the non-viable herniated part and closure of defect was done. During postoperative period patient developed surgical site infection and wound dehiscence for which daily dressing and later secondary suturing was done. Keywords: Intercostal liver herniation.

Prevalence of Tracheoesophageal Anomaly Cases among Neonates Undergoing Surgery in a Tertiary Care Children’s Hospital

INTRODUCTION

Tracheo-oesophageal anomaly is the abnormal communication between trachea and oesophagus. The most common type of tracheo-oesophageal anomaly is oesophageal atreasia with distal tracheo oesophageal fistula. Tracheo-oesophageal anomaly is a common neonatal problem requiring an urgent surgery. Tracheo-oesophageal anomaly can be diagnosed as an isolated malformation or as part of polymalformative syndrome with possible vertebrae anomalies also known as Vacterl syndrome. The aim of the study is to find out the prevalence of tracheo-oesophageal anomaly cases among neonates undergoing surgery in a tertiary care childrens hospital in Nepal.

METHODS

This is a descriptive cross sectional study conducted in a tertiary care children’s hospital in Nepal taking into account the medical records from period of 01 Jan, 2018 to Dec 31, 2019. Study population included the infants undergoing operative procedure in the operation theatre of Kanti Children’s Hospital. The calculated sample size was 306. Data was collected by retrospective chart review technique and listed in performa. Consecutive sampling technique was used. Thus collected data was entered in SPSS version 20 and necessary calculations were done.

RESULTS

The prevalence of tracheo-oesophageal anomalies was found out to be 30 (9.8%) at 95% confidence interval. The most common problem, with which infants were brought to Kanti Children’s Hospital, that required urgent neonatal surgical intervention was anorectal malformation constituting 94 (30.72%) of the surgeries followed by intestinal obstruction 76 (24.84%) which included duodenal atresia, jujunal atresia and ileal atresia.

CONCLUSIONS

Tracheo-oesophageal anomaly constitutes a major portion of neonatal disease condition requiring surgery in Nepal.

Paediatric Postoperative Intussusception

Intussusception is one of the common causes of acute abdomen in early childhood, particularly in children younger than two years of age. The majority of cases in children are idiopathic. Pathologic lead points can be identified in only 25 percent of cases. Here. we present a case of 15 months female child with Ileoileal postoperative intussusception with an anastomotic margin as a lead point, following resection anastomosis done for patent vitello intestinal duct. Role of high clinical suspicion, investigations and judgement are highlighted in managing the case. Keywords: Anastomosis; ileoileal; postoperative intussusception; patent vitello-intestinal duct.