Santosh Kumar Mahalik

Urinary bladder agenesis is an extraordinarily rare congenital anomaly, often associated with complex genitourinary malformations and poses significant diagnostic challenges in infancy. We report an infant girl with progressive abdominal distension, continuous urinary dribbling and bilateral hydronephrosis, ultimately found to have bladder agenesis with bilateral pelviureteric junction obstruction, ectopic ureteric insertion into the vagina and malrotated kidneys. Multimodality imaging, including ultrasonography, radionuclide diuretic renography with single-photon emission CT/CT and contrast-enhanced CT, was essential for establishing the diagnosis when the bladder was not visualised on initial evaluation. The child underwent staged management with initial decompression by percutaneous nephrostomy followed by left pyeloplasty, and was planned for delayed bladder reconstruction, but was lost to follow-up. This case highlights the need for high index of suspicion when the bladder is not visualised on imaging in infants with continuous dribbling and upper tract dilatation. It underscores the need to prioritise relief of obstruction before definitive reconstruction.

Urethral duplication is an uncommon congenital anomaly, exceptionally rare in girls, with very few cases reported worldwide. We present the case of a preschool-aged girl with recurrent urinary tract infections, ultimately diagnosed with right-sided grade V vesicoureteral reflux and a paraureteric (Hutch) diverticulum. Examination under anaesthesia revealed an additional urethral opening caudal to the orthotopic urethral meatus. Cannulation and cystoscopy confirmed urethral duplication, an association not previously reported in the literature. The patient underwent ureteric reimplantation and excision of the diverticulum, while the duplicated urethra was managed conservatively as it was asymptomatic. At the 6-month follow-up, she remained symptom-free with no further urinary tract infections. To our knowledge, this is the first report describing the association of female urethral duplication with high-grade vesicoureteral reflux and Hutch diverticulum and highlights the importance of considering urethral duplication in female patients with complex urinary symptoms and demonstrates a novel combination of urogenital anomalies.

Duodenal anomalies represent a spectrum of congenital malformations that may present with similar clinical and radiological findings. We report a rare case of a congenital duodenal band mimicking duodenal atresia in a neonate. A primigravida woman in her 20s presented with polyhydramnios and suspected fetal duodenal atresia on antenatal ultrasound. Postnatally, the male child exhibited a double bubble sign on abdominal X-ray. Exploratory laparotomy revealed a duodenal band compressing the second part of the duodenum without intrinsic atresia or web. The band was released, and the infant recovered uneventfully. This case highlights the importance of considering duodenal bands in the differential diagnosis of neonatal duodenal obstruction.

Thyroglossal duct cysts are the most common midline neck swelling in childhood, occurring in the line of descent of the thyroid, anywhere between the foramen caecum and the isthmus of the thyroid. However, the most common location is the thyrohyoid. We present a case of an adolescent male who presented with a suprasternal mass, which was clinically diagnosed as a branchial cyst. However, on histopathology, it was diagnosed to be a suprasternal thyroglossal cyst. With this article, we aim to highlight the importance of keeping thyroglossal cyst as a differential diagnosis for midline neck swelling, even below the location of the thyroid gland, so that proper excision of the tract can be planned and review the literature on suprasternal thyroglossal cyst.

Aims: This study primarily aimed to correlate liver fibrosis (LF) assessed by transient elastography (TE) using liver stiffness measurement (LSM score) with liver biopsy fibrosis scoring (METAVIR score) in biliary atresia (BA). Secondary objectives were to assess the diagnostic accuracy of TE in distinguishing BA from other causes of neonatal cholestasis (NC) and the correlation of preoperative LSM score with surgical outcomes 3 months post Kasai portoenterostomy. Methodology: Infants under 6 months with conjugated hyperbilirubinemia (July 2022–February 2024) were cases and age- and gender-matched healthy infants served as controls. Cases were evaluated using predefined standard diagnostic tests and TE using Fibroscan^® Expert 630 (Echosens) device was additionally performed preoperatively and 3 months postoperatively. METAVIR scoring was calculated on liver histopathology. Results: Fifty-one NC patients (28 boys, 23 girls) were included. A preoperative LSM ≥ 11.4 predicted significant fibrosis (METAVIR score – F3/F4) with 94% sensitivity and 46% specificity (P = 0.053). A preoperative LSM ≥ 13.2 fairly predicted the presence of BA with 74% sensitivity, 71% specificity (P = 0.006), and 72.5% diagnostic accuracy. Median preoperative LSM (interquartile range) for clearance of jaundice (COJ) (14.1 [10.28–18.48]) versus no clearance (15.7 [12.1–35]) showed no statistical difference (P = 0.359). Discussion and Conclusion: TE is an effective noninvasive screening tool to differentiate BA from other causes of NC with a cutoff of >13.2 kPa. The predictive value of TE for postoperative COJ and complications like cholangitis based on the preoperative LF measurements cannot be commented on based on our results.

Hydatid disease, a zoonotic infection caused by Echinococcus granulosus, primarily affects the liver and lungs but can involve other areas, including muscle tissue, though muscle involvement is rare. This case describes an adolescent girl with a psoas muscle hydatid cyst presenting with abdominal pain, a palpable mass and polymenorrhoea. Imaging and serology confirmed the diagnosis, and treatment included albendazole therapy and surgical excision via transperitoneal laparotomy, followed by a successful recovery with no recurrence at an 18-month follow-up. Hydatid disease is transmitted from definitive hosts, like dogs, to humans. Diagnosis can be challenging due to non-specific symptoms, and it typically relies on ultrasound, CT and serology. Surgical removal combined with antiparasitic drugs remains the primary treatment, though newer methods like ultrasound-guided aspiration are emerging. This case underscores the need to consider hydatid disease in differential diagnoses of cystic masses in endemic areas, particularly in paediatric cases.

Meckel’s diverticulum is a common congenital anomaly of the gastrointestinal (GI) system, which remains asymptomatic unless some complications occur. Littre’s hernia is a rare complication of Meckel’s diverticulum, where it herniates into the hernial sac. It is difficult to diagnose this condition preoperatively. Strangulation and incarceration are common, which may lead to necrosis and perforation of Meckel’s diverticulum. In this report, we describe the successful management of a boy in his early childhood presenting with an irreducible and strangulated right inguinal hernia, which turned out to be Littre’s hernia on exploration. Additionally, we conducted a literature review using Google Scholar and PubMed to identify publications on Littre’s hernia in paediatric patients.

Foreign body (FB) ingestion is one of the most common and challenging scenarios encountered in an Emergency Department. The incidence varies in different centers. They may be blunt objects, sharp-pointed objects, magnets, food boluses, and disk batteries. Most FBs pass spontaneously through the gastrointestinal (GI) tract, but the management of pointed, sharp FBs remains controversial. The relation between the length and width of sharp-pointed FBs and the mode of management remains questionable. In this case report, we discuss the management of a toddler who accidentally ingested an iron nail. We reviewed the existing literature and guidelines to find out the management of sharp-pointed foreign body ingestion in children.

Objective To estimate the prevalence of neural tube defects among all birth outcomes in Odisha during 2016–2022. Additionally, to estimate the identification rate of neural tube defects during Pradhan Mantri Surakshit Matritva Abhiyan sessions. Design A population-based cross-sectional study with a household survey for neural tube defects using pictorial card as well as a hospital-based study for antenatal ultrasonography data. Setting The sample population was selected through multistage random sampling. In the first stage, one district from each zone was selected randomly. In the second stage, using simple random sampling, one community health centre and one urban primary health centre were selected from each district. In the third stage, the population from a block and ward were picked from the selected rural and urban settings, respectively. Participants All married women in the reproductive age group (18–49 years) residing in these cluster villages in the selected districts were enrolled. Results The study surveyed 49 215 women and recorded 50 196 birth outcomes, including 49 174 live births, 890 stillbirths and 132 medical terminations of pregnancy. A total of 30 neural tube defect cases were detected. The overall prevalence rate of neural tube defect was 0.59 per 1000 birth outcomes. Spina bifida was the most prevalent neural tube defect with the prevalence of, followed by anencephaly and encephalocele. Despite 26 860 mothers receiving antenatal ultrasonography Pradhan Mantri Surakshit Matritva Abhiyan session, data on neural tube defects and other birth defects detected through these scans is unavailable. Conclusion This study found a low prevalence of neural tube defect in Odisha, which is far lower compared with the older studies from India. There is an urgent need to strengthen the quality of antenatal care services provided under Pradhan Mantri Surakshit Matritva Abhiyan through better training regarding anomaly scans and better data keeping at public healthcare facilities. Trial registration number CTRI/2021/06/034487.