Aphallia or absence of the penis is a very rare congenital anomaly with an estimated incidence of 1 in 10,000,000 births. A total of about 80 cases have been documented so far. We present a case of 1-day neonate who was born preterm at 30 weeks by normal vaginal delivery with a birth weight of 1.9 kg. The neonate's phallus was absent, the scrotum was normal with two normally descended testes with palpable vas deferens. Urethral meatus could not be located anywhere in the scrotum or over the pubis. Meconium was mixed with urine which was due to a urethrorectal fistula. Urethral opening was catheterized with 5 no. infant feeding tube. The neonate was in respiratory distress with tachypnea, tachycardia, central cyanosis, and bilateral coarse crepitations on auscultation. The patient was referred to the Neonatal Intensive Care Unit where the neonate was intubated and kept on a ventilator for neonatal respiratory distress syndrome.

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Background: Postoperative ileus (POI) is a common complication of many surgical procedures. It is generally defined as a cessation of bowel motility. The pathogenesis of POI is multifactorial with bowel dysmotility being caused by disturbances in immunologic, inflammatory, neurologic, electrolyte and receptor-mediated functioning. Materials and Methods: Between January 2013 to June 2014, 140 patients with elective abdominal surgery were included in the present prospective study. The factors that were studied to see their effect on the return of bowel motility are type of surgery, duration of surgery, handling of bowel and electrolytes level. Results: It was found that these factors were significantly associated with POI. Out of the 140 patients enrolled in the study, appearance of bowel motility within 4 days was in 126 (90.00%) while after 4 days in only 14 (10.0%) patients. Discussion: This study showed that POI was an undeniable complication of abdominal surgeries; however, it was dependent on a host of factors, including age, type of surgery, category of bowel handling, duration of surgery and electrolyte imbalance. Although most of these are unmodifiable risk factors, however, a skilful handling, selection of appropriate operative technique and fluid management could help to reduce this complication.

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Retroperitoneal ganglioneuroma (RGN) is a very rare entity especially in female older children and adolescents. It most often manifests as an asymptomatic mass. The relative rarity of this tumor in conjunction with the lack of definitive imaging findings makes its preoperative diagnosis difficult and is usually based on histopathological findings after surgical excision. We report a case of RGN, and suggest its consideration as one of the differential diagnosis in patients with abdominal pain.

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Neurofibromatosis (NF) is a term that has been applied to a variety of related syndromes, characterized by neuroectodermal tumors arising within multiple organs and autosomal-dominant inheritance. NF-1, known as well as Recklinghausen's disease, is the most common type of the disease accounting 90% of the cases. A case of 50-year-old patient with NF is presented with a mass in the left side of the neck since 1-year and progressive dysphagia since 6 months worse for solids than liquids. Intraoperatively a large solid mass was found occupying the left side of the neck pushing the trachea and esophagus to the right side, infiltrating a portion of the wall of esophagus. The mass was resected en bloc along with a portion of the wall of esophagus, and primary esophageal repair was done. Histology revealed plexiform neurofibroma.

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Crossed fused ectopia is an asymptomatic fusion anomaly usually diagnosed incidentally or due to symptoms of associated urinary abnormalities. They are rarely associated with an ectopic opening of the ureter. We present a case of 6-year-old female with constant dribbling diagnosed to have left to right inferior crossed fused kidney with ipsilateral ureteral ectopy.

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Introduction: Surgeon's case volume,hospital volume and specialisation improve the outcome of many major surgical procedures gastrectomy, esophagectomy and rectal surgery. The exact role of specialist centers in more common surgical operations like inguinal hernioplasties and varicose vein, is still not so clear. Hernioplasty done by a resident may allow consultant to concentrate on major critical cases. In this study we analysed whether well-trained surgical residents are able to perform Lichtenstein operation with an acceptable immediate and long-term outcome compared to the experienced specialist consultants in hernia surgery. Materials and Methods: Patients were subjected randomly to lichenstein mesh hernioplasty by well trained residents (after assisting 10 operation with consultant) and consultants. Parameters were noted during operation and in follow up accordingly. Hernioplasty done by experienced consultant surgeon (n=51) and by residents (n=53). Results: The mean operating time taken by the residents (66 ± 10 minutes) was significantly higher than that of the consultant surgeons (49 ± 10 minutes). The post-operative infection rates in the current study for surgeries done by residents and consultants were 7.7% and 3.9%, respectively. The occurrence of post-operative wound hematoma, scrotal oedema and hospital stay,resumption to normal activity was not significantly different (P>0.05) between patients operated by residents and consultants. Severity of post-operative pain (based on VAS scores) was also not significantly different (P>0.05) between patients operated by consultants and those operated by residents. Only 1 patient (1%) had recurrence of hernia after 6 months following hernia repair. Conclusion: Open mesh repair under local anaesthesia was a safe operation and the long-term results were acceptable among the patients operated by surgical trainees. There was no statistcally significant difference in the occurrence of post-operative complications except for increased operative time.

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