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.
A preterm, severe IUGR , low birthweight(2kg) baby presented with acute intestinal obstruction, found to have obstructed left inguinal hernia. After stabilization, urgent exploration revealed a strangulated hernia with ischaemic bowel and testis. Release of strangulation, revitalization of intestine and partial revitalization of testis was achieved on table. Hernia was repaired and the ischaemic testis was preserved for a second look assessment. After 24 hours, the exploration revealed a vitalized testis and epididymis which was fixed in scrotum successfully. The child is recovered well in NICU. The revival of ischaemic testis in strangulated hernia is extremely rare to experience. It’s management is a huge dilemma on table.This relatively new technique has tremendously improved the quality of life of the reimplantation kids
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.