Novel approach to vaginal calculus in a girl with urogenital sinus anomalyIsolated urogenital sinus can cause distended bladder and/or vagina and may present with an abdominal mass and sepsis during infancy. Older children may present with recurrent urinary tract infections and hematocolpos. We describe a 3-year-old girl with recurrent urinary tract infections thought to be secondary to vesicoureteric reflux. On further investigation, an isolated urogenital sinus anomaly with a calculus inside one of the hemivaginae was noted. She was managed expectantly with a plan to intervene at puberty.
Novel use of skin substitute as rescue therapy in complicated giant exomphalosGiant exomphalos can be successfully managed using conservative or surgical techniques. However, if treatment is complicated by sepsis, early skin cover of the defect becomes necessary. Options include split skin grafting, but in the presence of ongoing infection the risk of graft failure is high and limited skin is available for regrafting. We describe the novel use of a skin substitute (Integra Artificial Skin, Integra Life Sciences Corporation, Plainsboro, NJ) as an alternative to primary grafting in the management of infected giant exomphalos.
Transillumination of H-type tracheoesophageal fistula using flexible miniature bronchoscopy: an innovative technique for operative localizationPrecise localization of the fistula is the most important step in the operative strategy for dealing with H-type tracheoesophageal fistula. Bronchoscopic cannulation of the fistula with a Fogarty or ureteric catheter has been recommended to aid ready identification, but it is not always successful. We report an innovative technique that permitted localization of H-type fistula intraoperatively. A flexible pediatric 2.2-mm bronchoscope (Olympus BF Type N20) was steered through a standard endotracheal tube, and the fistula tract was illuminated, making its identification and subsequent repair straightforward.