A 13 year old girl has been successfully treated by total Laparoscopic excision of type 1 –C Choledochal cyst and hepatico-duodenostomy . She has been having recurrent abdominal pain, post feeding discomfort, nausea, occasional fever and vomiting. After thorough evaluation a large type 1c Choledochal cyst associated with hepatosplenomegaly was diagnosed. After preparation, Laparoscopic excision and bilio-enteric anastomosis was carried out. She had highly vascular and thick fibrotic cyst wall with adhesions due to multiple cholangitic attacks. The surgery could be completed completely Laparoscopically with minimal blood loss. Child had a very comfortable post operative recovery, starting oral feeds 48 hours after surgery with excellent cosmetic outcome.
Currently minimally invasive technique is being the procedure of choice for such complex anomalies with excellent outcomes.
One stage Trans-anal Swenson’s Pullthrough was performed for Hirschsprung Disease in a 3 months old girl child. This child had presented with life threatening enterocolitis when she was diagnosed with Hirschsprung’s disease affecting Rectum, distal half of sigmoid colon. After intense bowel management , she underwent complete trans anal mobilization of rectum and colon upto mid sigmoid and with Frozen section guidance normal ganglionic segment was identified and excision of aganglionic segment with coloanal anastomosis was performed. Typically this procedure is done in stages with colostomy and laparotomy/laparoscopy which requires multiple surgeries, anaesthesia s and leaves a large scar. Child required minimal analgesia,could be fed few hours after surgery and passed stool spontaneously , discharged in 2 days post op.
There is no scar on her abdomen or perineum which is a great cosmetic benefit to the girl child.
Fetal volvulous is an extremely rare condition and a challenge to diagnose and manage. Only few cases have been reported in the world literature with instances of fetal death , still births in neglected cases. It’s a complex multidisciplinary approach with state of the art NICU care which helps in survival of potentially morbid and lethal condition.