African Journal of Paediatric Surgery : AJPS

INTRODUCTION: Primary vesicoureteric reflux (VUR) is a prevalent cause of end-stage renal failure in children. Scars on radionuclide imaging indicate irreparable damage to the growing kidneys. This study aims to determine whether a urinary tract infection (UTI) associated with primary VUR promotes the development of new renal scars or progression in the pre-existing ones. MATERIALS AND METHODS: Children with primary VUR on continuous antibiotic prophylaxis at a tertiary teaching hospital's paediatric nephrourology clinic were observed prospectively...

BACKGROUND: Abdominal pain is a common complaint encountered by paediatric surgeons. This complaint could be related to surgical or non-surgical causes. With coronavirus disease 2019 (COVID-19), the incidence of abdominal pain has increased and mimicked acute appendicitis in paediatric patients. OBJECTIVE: The objective of this study was to assess the impact of the COVID-19 pandemic on paediatric acute appendicitis in terms of demographic data (age and sex), and operative findings, specifically, the complicated appendicitis and negative appendectomy rates...

Extra-abdominal desmoid fibromatosis arising from the oesophagus and the contemporaneous traction diverticula due to an oesophageal tumour is extremely rare. We present this complex situation in a 2-year-old girl which posed a surgical challenge requiring simultaneous management of multiple pathologies. Surgery addressed both the entities and the presence of the diverticulum facilitated achieving negative surgical margins.

Vaginal discharge is a common gynaecologic complaint in pre-menarchal girls. However, an intravaginal foreign body (FB) must be suspected when it is persistent. We report the case of a referred 4-year-old girl with a 5-month history of persistent foul-smelling vaginal discharge. Clinical examination confirmed purulent vaginal discharge, along with a vaginal granuloma. A hard, intravaginal object was felt through the anterior rectal wall on digital rectal examination. A plain pelvic X-ray revealed a radiopaque object whose intravaginal position was confirmed by ultrasonography...

A chemoport is widely used in paediatric oncology population. Removal is a relatively easy procedure, but difficulty can be encountered in case the catheter is densely adherent to the vascular wall. It is a rare complication and is associated with long indwelling duration and acute lymphoblastic leukaemia (ALL). Forceful traction can lead to vascular injury and high morbidity. Herein, we report a 7-year-old girl with precursor B ALL who had delayed chemoport removal due to the coronavirus disease (COVID-19) pandemic...

Genitourinary prolapse in newborn females as an introital mass is an uncommon entity. The usual causative mechanisms are poor pelvic innervation, damage or pressure on pelvic musculature and ligaments etc. Different methods of reduction as treatment were proposed in the past. Apart from uncommon occurrence of genitourinary prolapse in newborns, its association with anorectal malformation is not reported in English literature after searching on PubMed and Google Scholar. We report three cases of genitourinary prolapse with anorectal malformation in newborn females where decompressing colostomy was curative for the condition reflecting increased intra-abdominal pressure as causative mechanism...

Coexisting congenital cystic adenomatous malformation of the lungs and severe pectus excavatum (PE) is an uncommon presentation that poses significant management challenges. Conventionally managed in a staged manner, there are increasing reports of superior outcomes with single-staged concurrent repair with minimally invasive techniques (video-assisted thoracoscopic surgery [VATS] and minimally invasive repair of PE [MIRPE]). The outcome of a single-stage open repair for both anomalies has not been previously reported to the best of our search...

Splenic abscess is a life-threatening condition, which is very rare in children. There is usually an infective focus or pre-disposing factors such as immunodeficiencies towards developing splenic abscesses. Only one case of splenic abscess with brain abscesses in an adult has been reported in the English literature. We, therefore, report a case of an 11-year-old boy who was otherwise healthy, but presented with fever and weight loss for 2 months, right upper abdominal pain, vomiting, hypochondrial tenderness for 1 week and later on developed a left hemiplegia and right facioparesis 2 days before presentation...

Clitoral enlargement (clitoromegaly) due to non-hormonal causes, particularly due to vascular malformation, is rare. Only eight such cases are reported in the literature. We report an additional case of isolated vascular malformation implicating the clitoris of a young girl child and its surgical management.

Transmesentric hernias are a type of internal hernia, in which there is herniation of bowel loops through a defect in the mesentery. They present with a wide variety of symptoms without any specific radiological features, leading to a delay in diagnosis and high mortality rate. Here, we present a case series of four patients with this rare but fatal cause of small bowel obstruction. Three children presented to the emergency department with small bowel obstruction. The other baby was a preterm neonate with an antenatal scan showing small bowel obstruction...

Tailgut cysts are rare congenital abnormalities that develop due to failure of embryologic tailgut to involute. This generally manifests as a presacral, retrorectal and multicystic mass. It has a high propensity in female patients including paediatric age group. The clinical presentation varies depending on the age of patient, location and size of the cyst. The symptoms are mostly due to mass effects and rarely complications such as malignancy. Being a rare entity, it is generally misdiagnosed. Differential diagnosis mostly includes rectal duplication cyst, sacrococcygeal teratoma and anterior meningocele...

BACKGROUND: Nephroblastoma is the most common primary malignant renal tumour of childhood. The survival rates in high-income countries are approximately 90%. However, low-income countries have low survival rates of 20%-50%. This study assessed factors associated with treatment outcomes of children post-nephrectomy for nephroblastoma at the University Teaching Hospital and Cancer Diseases Hospital in Lusaka, Zambia. MATERIALS AND METHODS: A retrospective observational cohort study was conducted, where all children diagnosed with unilateral Wilms tumour below the age of 16 years who had nephrectomy from July 2016 to June 2019 were enrolled...

BACKGROUND: The neurological, airway, respiratory, cardiovascular and other, with a subscore of surgical severity (NARCO-SS) is a scoring system which assesses the presence of systemic disease and the risk the operation poses to the patient. A number of patients that undergo major abdominal surgery suffer adverse events. The aim of the study was to determine the reliability of NARCO-SS in predicting peri-operative adverse events and to determine the risk factors for peri-operative adverse events in paediatric patients undergoing elective abdominal surgery...

INTRODUCTION: Sickle cell disease (SCD) is a haemoglobinopathy that leads to the formation of distorted sickle-shaped red blood cells that are prone to vaso-occlusion. This may lead to vaso-occlusive crises that may affect any organ. Acute pancreatitis (AP) in SCD patients may be mimicked by a vaso-occlusive crisis in the abdomen. The objective of this article is to analyse the clinical profiles of SCD patients with AP and understand the differences in the presentation of AP compared to an abdominal vaso-occlusive crisis and the difference between its presentation in SCD patients in comparison to other patients...

Blunt abdominal trauma is one of the leading causes of trauma-related deaths in children. The commonly affected organs include the spleen, liver and kidneys, followed by uncommon ones such as the pancreas and intestine. Isolated duodenal injury is very rare and, at times, poses a diagnostic challenge due to the paucity of clinical symptoms and signs. Hence, delayed presentation is not uncommon. In this write-up, five such cases are presented with emphasis on their clinical presentation, diagnosis, management and outcome...

BACKGROUND: Evaluation of quality of life (QoL) in paediatric surgical patients has not always received enough attention in the past. Our aim was to follow up patients with abdominal wall defects for a decade and (1) to analyse children's view on QoL and to analyse parent's view on QoL, (2) to evaluate satisfaction and psychological problems, (3) to assess present complaints including subjective aspects such as food intake, reduced appetite, pain in scar area and general abdominal pain and (4) verifiable clinical symptoms assessed through a physical examination and ultrasound...

Atypical neurofibromatous neoplasm with uncertain biologic potential presenting as a paratesticular scrotal mass in a neonate with congenital giant melanocytic nevus is rare. Only one such case of neonatal scrotal neurofibroma has been reported earlier. We report an additional case and its management.

Cleft palate leads to difficulty in suckling, speech abnormalities, dental problems, hearing loss and middle ear infections. Feeding plate acts as a barrier between the oral and nasal cavities allowing the normal development of jaws and enhanced nutritional supply to the patient. Fabrication of the feeding plate using digital means provide better adaptability due to the engagement of all the possible favourable anatomic undercuts, thereby, providing better retention. This case report discusses the hybrid technique including both the digital and conventional means for fabrication of a feeding plate to obturate the defect between the oral and nasal cavity...

We present a case report of a 15-month-old baby with an isolated unilateral paramedian cleft palate. A cleft palate is usually seen in children born to their parents through consanguineous marriage. However, a paramedian cleft palate is a very rare finding and very few cases have been reported in the world and none have been published, hence our initiative to present this case report and a modified technique for closure of the same. Along with the conventional von Langenbeck technique, a modification using a rotational flap from the retromolar fossa was done to close the oral mucosal layer...

Gastric teratomas are very rare tumours. They present with upper abdomen distension which can easily be confused with other common conditions with mass per abdomen in the paediatric age group. Surgical excision is curative for gastric teratomas. The diagnosis is confirmed by radiological evaluation followed by histopathological analysis of excised specimen. We are reporting two such cases of gastric teratomas who presented with complaints of upper abdomen distension. They were evaluated with radiological imaging and successfully managed by surgical excision...