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Suleman M, Sadiq A, Amsi P, Lodhia J. Gallbladder perforation: An uncommon cause of peritonitis in a child. Int J Surg Case Rep 2022; 100:107765. [PMID: 36302315 PMCID: PMC9614562 DOI: 10.1016/j.ijscr.2022.107765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction and importance Gallbladder perforations are infrequently encountered in the pediatric group but can be a cause of peritonitis with significant morbidity and mortality if not diagnosed and managed promptly. Case presentation We present a case of a 10-year-old female who presented with peritonitis due to a perforated gallbladder diagnosed by CT-scan. She was managed surgically successfully. Clinical discussion Gallbladder perforation due to cholecystitis is usually seen in the elderly population but is uncommon among the pediatric population. Mortality rate can be as high as 26 % hence early diagnosis is vital. Management is mostly surgical as seen in the index case. Conclusion Clinicians should keep gallbladder perforation in mind as a differential diagnosis of acute abdomen in children although uncommon.
Gallbladder perforation is uncommon to the pediatric population. If encountered in children, causes significant morbidity and mortality Clinicians should keep it as a differential diagnosis of peritonitis with a high index of suspicion. Prompt management through surgery yields favourable outcome.
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Affiliation(s)
- Mujaheed Suleman
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Adnan Sadiq
- Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania; Department of Radiology, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Patrick Amsi
- Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania; Department of Pathology, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania
| | - Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P O Box 3010, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania.
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2
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Gauba R, Sodhi KS, Bhatia A, Mahajan JK, Malik MA, Saxena AK. Spontaneous Gallbladder Perforation in a Child With Anomalous Pancreaticobiliary Junction. Pancreas 2022; 51:e71-e72. [PMID: 35775644 DOI: 10.1097/mpa.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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3
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Ajmal HB, Hasnain N, Sagheer S. Spontaneous Acalculous Gallbladder Perforation in an Adolescent Male: A Case Report and Literature Review. Cureus 2021; 13:e20077. [PMID: 35003945 PMCID: PMC8723727 DOI: 10.7759/cureus.20077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/05/2022] Open
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4
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Contained gallbladder perforation due to typhoid fever managed without operation or drainage. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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5
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Obasi AA, Igboanugo AA. Gall Bladder Complications Resulting from Typhoid Fever in Children: Challenges of Management and Lessons Learned. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:35-38. [PMID: 35531587 PMCID: PMC9067634 DOI: 10.4103/jwas.jwas_31_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Surgical complications of typhoid fever present commonly as gut perforation and very rarely as gall bladder gangrene or gall bladder perforation. Gall bladder complications are rare in children and when they occur they are often the result of an infective condition. Occasionally, typhoid fever causes concomitant gall bladder complications and gut perforation. The coexistence of both conditions accentuates morbidity and mortality. We present two cases of typhoid fever with gall bladder perforation and gall bladder gangrene, respectively. Challenges of diagnosis and treatment are highlighted. The need for surgeons in endemic areas to consider these conditions while evaluating children with peritonitis is emphasized. Ultrasound detection of thickened distended gall bladder with pericholecystic fluid in a child with typhoid fever may be a sign of impending gall bladder perforation. To reduce the high morbidity and mortality from surgical complications of typhoid fever, the implementation of proven preventive measures must be encouraged. In addition, public enlightenment of this scourge must be pursued with vigor.
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Affiliation(s)
- Akputa Aja Obasi
- Paediatric Surgery Unit, Department of Surgery, Alex Ekwueme Federal University Teaching, Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University Abakaliki, Abakaliki, Ebonyi State, Nigeria
| | - Arinze Aetelbert Igboanugo
- Paediatric Surgery Unit, Department of Surgery, Alex Ekwueme Federal University Teaching, Hospital Abakaliki, Abakaliki, Ebonyi State, Nigeria
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Goel A, Bindal V, Kalhan S, Bhatia P, Khetan M, John S. Laparoscopic management of gall bladder perforation secondary to typhoid-induced acalculous cholecystitis: A rare entity. J Minim Access Surg 2019; 16:276-278. [PMID: 31793452 PMCID: PMC7440013 DOI: 10.4103/jmas.jmas_30_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gall bladder perforation as a sequel of typhoid-induced acalculous cholecystitis is a rare clinical encounter, reported sparsely in literature. Here, we discuss a case wherein successful laparoscopic management of typhoid-induced gall bladder perforation was performed. A 24-year-old female presented with a history of 5 days of fever and acute pain in the abdomen for 2 days. Computed tomography scan suggested gall bladder perforation which was confirmed on diagnostic laparoscopy. Laparoscopic cholecystectomy with peritoneal lavage was performed. The patient did well postoperatively and was discharged on post-operative day 4 after drain removal. One should be aware about the possibility of gall bladder perforation as a sequel of acalculous cholecystitis in typhoid fever. Minimal access surgery techniques can be applied for confirming the diagnosis as well as the definitive treatment.
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Affiliation(s)
- Anupam Goel
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivek Bindal
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sudhir Kalhan
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Parveen Bhatia
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mukund Khetan
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Suviraj John
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Patel G, Jain A, Kumar RB, Singh N, Karim T, Mishra R. Gallbladder Perforation: A Prospective Study of Its Divergent Appearance and Management. Euroasian J Hepatogastroenterol 2019; 9:14-19. [PMID: 31988861 PMCID: PMC6969324 DOI: 10.5005/jp-journals-10018-1289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Gallstone disease is one of the most common surgical diseases. Complications associated with cholelithiasis is not uncommon, but gallbladder perforation is a rare complication of acute cholecystitis with cholelithiasis. This gallbladder perforation may present in different ways like free perforation inside peritoneal cavity causing generalized peritonitis, localized collection around gallbladder fossa after perforation and in chronic cases cholecystoenteric fistula. Here we present our experience of this condition with a review of literature for a different presentation of this condition. Materials and methods This study was done for 2 years, and patients who were diagnosed with gallbladder perforation either preoperatively or intraoperatively were included. Results There was a total of 16 patient included in the study during this period which were either diagnosed preoperatively or intraoperatively of gallbladder perforation (GBP). Conclusion GBP, though a rare complication of cholecystitis with high morbidity and mortality, has no specific pathognomic feature and is often misdiagnosed or late diagnosed. Nowadays most cases can be managed with improved diagnostic means and therapeutic modalities (endoscopic, laparoscopic, endostaplers). How to cite this article Patel G, Jain A, et al. Gallbladder Perforation: A Prospective Study of Its Divergent Appearance and Management. Euroasian J Hepatogastroenterol 2019;9(1):14-19.
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Affiliation(s)
- Gaurav Patel
- Department of Surgery, ESI Posgraduate Institute of Medical Science and Research and Hospital, New Delhi, India
| | - Atul Jain
- Department of Surgery, ESI Posgraduate Institute of Medical Science and Research and Hospital, New Delhi, India
| | - Ram B Kumar
- Department of Surgery, ESI Posgraduate Institute of Medical Science and Research and Hospital, New Delhi, India
| | - Nirbhay Singh
- Department of Surgery, ESI Posgraduate Institute of Medical Science and Research and Hospital, New Delhi, India
| | - Tanweer Karim
- Department of Surgery, ESI Posgraduate Institute of Medical Science and Research and Hospital, New Delhi, India
| | - Raghav Mishra
- Department of Surgery, ESI Posgraduate Institute of Medical Science and Research and Hospital, New Delhi, India
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Poddighe D, Sazonov V. Acute acalculous cholecystitis in children. World J Gastroenterol 2018; 24:4870-4879. [PMID: 30487697 PMCID: PMC6250923 DOI: 10.3748/wjg.v24.i43.4870] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/11/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses (such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Vitaliy Sazonov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Pediatric Intensive Care Unit, UMC National Research Center for Mother and Child Health, Astana 010000, Kazakhstan
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Yi DY, Chang EJ, Kim JY, Lee EH, Yang HR. Age, Predisposing Diseases, and Ultrasonographic Findings in Determining Clinical Outcome of Acute Acalculous Inflammatory Gallbladder Diseases in Children. J Korean Med Sci 2016; 31:1617-23. [PMID: 27550491 PMCID: PMC4999405 DOI: 10.3346/jkms.2016.31.10.1617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 06/24/2016] [Indexed: 12/23/2022] Open
Abstract
We evaluated clinical factors such as age, gender, predisposing diseases and ultrasonographic findings that determine clinical outcome of acute acalculous inflammatory gallbladder diseases in children. The patients were divided into the four age groups. From March 2004 through February 2014, clinical data from 131 children diagnosed as acute acalculous inflammatory gallbladder disease by ultrasonography were retrospectively reviewed. Systemic infectious diseases were the most common etiology of acute inflammatory gallbladder disease in children and were identified in 50 patients (38.2%). Kawasaki disease was the most common predisposing disease (28 patients, 21.4%). The incidence was highest in infancy and lowest in adolescence. The age groups were associated with different predisposing diseases; noninfectious systemic disease was the most common etiology in infancy and early childhood, whereas systemic infectious disease was the most common in middle childhood and adolescence (P = 0.001). Gallbladder wall thickening was more commonly found in malignancy (100%) and systemic infection (94.0%) (P = 0.002), whereas gallbladder distension was more frequent in noninfectious systemic diseases (60%) (P = 0.000). Ascites seen on ultrasonography was associated with a worse clinical course compared with no ascites (77.9% vs. 37.7%, P = 0.030), and the duration of hospitalization was longer in patients with ascites (11.6 ± 10.7 vs. 8.0 ± 6.6 days, P = 0.020). In conclusion, consideration of age and predisposing disease in addition to ultrasonographic gallbladder findings in children suspected of acute acalculous inflammatory gallbladder disease might result in better outcomes.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Eun Jae Chang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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Badru F, Litton T, Puckett Y, Bansal S, Guzman M, Vane D, Villalona GA. Spontaneous gallbladder perforation in a child secondary to a gallbladder cyst: a rare presentation and review of literature. Pediatr Surg Int 2016; 32:629-34. [PMID: 27062138 DOI: 10.1007/s00383-016-3891-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/19/2022]
Abstract
Spontaneous gallbladder perforation is rare in children. The etiology of gallbladder perforation varies greatly and is often unknown. Identified causes include infection, congenital, stones or choledochal cysts. Presently there are only five reported cases of spontaneous gallbladder perforation in children in the English literature. As such, the optimal method of diagnosis and management remains controversial. We report the case of a 2-year-old girl who presented with peritonitis secondary to spontaneous gallbladder perforation.
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Affiliation(s)
- F Badru
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA.
| | - T Litton
- Department of Radiology, St Louis University Hospital, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Y Puckett
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA
| | - S Bansal
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA
| | - M Guzman
- Department of Pathology, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - D Vane
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA
| | - G A Villalona
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA
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11
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Kumar S, Kumar S, Kumar S, Gautam S. Spontaneous gallbladder perforation in a patient of situs inversus totalis, misdiagnosed as perforation peritonitis due to gas under the right dome of the diaphragm. BMJ Case Rep 2015; 2015:bcr-2014-208003. [PMID: 26123454 DOI: 10.1136/bcr-2014-208003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute biliary tract disease is a common condition in adults. Apart from bile duct perforation, spontaneous perforation of the gallbladder itself is very rare in all age groups; to date, all recorded cases are secondary to coexistent disease. We present the case report of a 60-year-old adult having an idiopathic gallbladder perforation. In our case, an unusual presentation was situs inversus totalis and fundal gas shadow was considered as free air under the right dome of the diaphragm by mistake. The patient underwent laparotomy and emergency cholecystectomy was performed in the perforated gallbladder. To date, no case has been described in the literature.
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Affiliation(s)
- Sanjeev Kumar
- Department of General Surgery, King George's Medical University Lucknow, Lucknow, Uttar Pradesh, India
| | - Shailendra Kumar
- Department of General Surgery, King George's Medical University Lucknow, Lucknow, Uttar Pradesh, India
| | - Suresh Kumar
- Department of General Surgery, King George's Medical University Lucknow, Lucknow, Uttar Pradesh, India
| | - Shefali Gautam
- Department of Anaesthesiology, King George's Medical University, Lucknow, Lucknow, Uttar Pradesh, India
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Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies. Langenbecks Arch Surg 2014; 400:421-7. [PMID: 25539703 DOI: 10.1007/s00423-014-1267-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. MATERIALS AND METHODS This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. RESULTS LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. CONCLUSIONS We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.
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Abstract
Atypical manifestations of acute hepatitis A virus (HAV) infection include ascites, pleural effusion, acute renal failure, aplastic anemia, and neurological manifestations. Although association of HAV and acute cholecystitis is known, presentation of hepatitis A infection with acute cholecystitis has not been reported in pediatric emergency medicine literature. Primary acute acalculous cholecystitis in children is rare and commonly attributed to systemic infections. We report a case of a child developing acute viral cholecystitis as a presenting feature of sporadic HAV infection and review HAV-associated cholecystitis in children. The article provides a brief illustration of evaluating acute abdominal pain in older children in the emergency department in a developing country.
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Karkera PJ, Sandlas G, Ranjan R, Gupta A, Kothari P. Authors' reply. J Indian Assoc Pediatr Surg 2011; 16:119-20. [PMID: 21897578 PMCID: PMC3160056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Parag J. Karkera
- Department of Pediatric Surgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India,Address for correspondence: Dr. Parag Karkera, Department of Paediatric Surgery, Okmanya Tilak Municipal General Hospital, Sion, Mumbai - 400 022, Maharashtra, India. E-mail:
| | - Gursev Sandlas
- Department of Pediatric Surgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Ritesh Ranjan
- Department of Pediatric Surgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Abhaya Gupta
- Department of Pediatric Surgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
| | - Paras Kothari
- Department of Pediatric Surgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India
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