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Background: Evaluation of the result of early and delayed repair of anterior and distal penile hypospadias. A total number of 144 patients of anterior and distal penile hypospadias with/without chordee were evaluated by follow up study in our hospital and private hospital from January 2010 to July 2013. Redo cases, complex hypospadias and proximal hypospadias were excluded. Simple Random sampling technique was followed to the patients were grouped into Group-A (72 patients) and Group-B(72 patients) on the basis of age of the patients. Both Group-A, age between 6 to 18 months and Group-B, more than 18 month to 14 years were operated by Snodgrass procedure. We did follow up 12- 24 months postoperatvely. It can be recommended for repair of anterior and distal penile hypospadias within 6 to 18 months whenever the question of post urethroplasty cosmosis, wound disruption and formation of urethra cutaneous fistula.J Shaheed Suhrawardy Med Coll, December 2015, Vol.7(2); 69-72

Constipation is a very common presentation, both in primary and secondary care. Considerable variation in ‘normal’ bowel habit in children is accepted. A normal pattern of stool evacuation is thought to be a sign of health in children of all ages. Especially during the first months of life, parents pay close attention to the frequency and the characteristics of their children’s defecation. Any deviation from what is thought by any family member to be normal for children may trigger a call to the nurse or a visit to the pediatrician. Stool frequency is also agedependent. Infants have a mean of 4 stools per day during the first week of life. It reduces progressively in early childhood, from more than four stools a day to a mean average of 1.7 stools per day at 2 years of age and 1.2 a day at age 4 years, 2,3 by which age 98% of children are toilet trained. Some normal breast-fed babies do not have stools for several days or longer. After 4 years, the frequency of bowel movements remains unchanged. The normal frequency of bowel movements at different ages has been defined (Table 1).

Introduction : Necrotizing enterocolitis (NEC) is a major cause of neonatal morbidity and mortality. To explore whether abdominal ultrasound (AUS) provide additional information over plain radiography in cases of necrotizing enterocolitis (NEC). Materials & Methods : This study is a prospective study of 30 premature neonates with NEC in our neonatal intensive care unit between September 2013 and November 2014. Fifteen premature control neonates were also included in the study. Results: Patients were classified into two groups: the first group with suspected NEC (stage I) (n = 14) and the second with definite NEC (stage II or III) (n = 16). In group I abdominal ultrasound (AUS) revealed intramural air (n = 9) and portal venous gas (PVG) (n = 1) while plain radiography showed only gaseous distension. In group II, intramural air (n = 10), PVG (n = 2), free fluid (n = 6) focal fluid (n = 1) and free air (n = 6) detected by AUS compared to pneumatosis intestinalis (PI) (n = 2) PVG (n = 1) and free air (n = 5) by plain radiography. Additionally bowel wall thinning was detected in 2 neonates of group I and 3 of group II. Conclusion: Our results suggest AUS to be superior to plain radiography in early detection of complication as intestinal perforation by eliciting PVG and fluid collection and so early surgical management. Therefore this may decrease morbidity and mortality rates. J. Paediatr. Surg. Bangladesh 6 (2): 47-53, 2015 (July)

Appendicitis is one of the most common causes of acute abdominal pain in pediatrics and is the most common indication for emergency abdominal surgery in childhood. The diagnosis of pediatric appendicitis remains challenging. To evaluate the role of pediatric appendicitis score (PAS) in the diagnosis of appendicitis of children. Methods: In this study, 200 suspected appendicitis patients attended in four private hospitals in old Dhaka city over a period of about 34 months from January 2011 to May 2014 were selected as study subjects. Patient age, sex and each of the eight PAS components were collected. Children who had PAS less than six were discharged and contacted by telephone upto 1 month to verify final outcome. Rest of the children with PAS equal or more than 6 were underwent appendectomy. Results: Two hundred patients were assessed in this study. Out of them 67 (33.5%) children had appendicitis and 76 (38.0%) children had PAS equal or more than 6. In appendicitis children, maximum (85.3%) children were in age group 10- 16 years and 10 (14.7%) patients were in age group 5-9 years. Male (73.5%) were predominant than female (26.5%) in appendicitis children. Migration of pain, nausea and anorexia were in 43 (63.2%), 45 (66.2%) and 48 (70.6%) appendicitis children respectively. Fever, cough/percussion tenderness and tenderness in RLQ were in 37 (54.4%), 52 (76.5%) and 59 (86.8%) appendicitis children respectively. Leukocytosis andneutophilia were present in 42 (61.8%) and 46 (67.6%) appendicitis children respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy rate of PAS were 80.6%, 83.5%, 71.1%, 89.5% and 82.5% respectively. Conclusion: Paediatric Appendicitis Score is a good tool but not good enough for diagnosis of paediatirc appedicitis. It cannot be recommended for diagnosis of paediatric appendicitis because its negative appendicectomy rate as well as wrongly discharged rate is high. J. Paediatr. Surg. Bangladesh 6 (1): 16-19, 2015 (Jan)

Desmoplastic small round cell tumor (DSRCT) is a rare pathologic entity that most frequently affects the peritoneal cavity and presents in pediatric and adolescent boys. It often presents at an advanced stage and has a generally poor prognosis. Sometimes it may involve liver at diagnosis. We present an unusual case of DSRCT who was present with mass in lower abdomen, pain, hepatomegaly and mild ascites. This tumor is characterized by nests of small undifferentiated cells that show immunohistochemical evidence of epithelial, mesenchymal and neural differentiation. In our patient histologicaly tumor had the characteristic features of DSRCT and were composed of small round cells with hyperchromatic nuclei and scanty cytoplasm. With various difficulties in diagnosis we ultimately reached at diagnosis by open biopsy and immunohistochemistry. Now patient is on multidrug chemotherapy (modified p6 protocol). Diagnosis and management of a rare tumor needs high level of suspicion and in time intervention.DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19552

Background: Different treatment modalities and procedures have been tried for the management of infantile hypertrophic pyloric stenosis. But surgery remains the mainstay for management of IHPS. Ramstedt’s pyloromyotomy was described almost over a hundred years ago and to date remains the surgical technique of choice. An alternative and better technique is the double-Y pyloromyotomy, which offer better results for management of this common condition. Methods: A prospective comparative interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. The study was designed that all patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy(DY) and the next by aRamstedt’s Pyloromyotomy (RP). Data on patient demographics, operative time, anesthesia complications, postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test. Results: From July 2008 through July 2010, fourty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group (1.21 ± 0.45days) vs Ramstedt’s pyloromyotomy (RP) group(3.03 ± 0.37days) p= 0.0001.Weight gain after 1st 10 days DY vs RP is ( 298 ± 57.94 gm vs193±19.8 gm p=0.0014), after 1 month (676.67±149.84 gm vs 466.67 ± 127.71 gm, p=0.0001), after 2months (741.33± 278.74 gm vs 490±80.62 gm, p=0.002) and after 3 months (582±36.01gm vs 453.33±51.64 gm, p=0.0001).No long-term complications were reported and no re-do yloromyotomy was needed. Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain. DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19532

Lumbar hernias are rare in children. We report a case of bilateral lumbar hernia in a 39 days old boy who was admitted at pediatric surgery department in Dhaka Medical College Hospital with the chief complaints of bilateral flank swellings since birth. There were no urinary or bowel complaints. Palpation revealed reducible, non-tender, soft to firm swellings involving iliolumbar region in left and lumbar region in right . These were increased on crying. On auscultation bowel sounds were present in left side and absent in right side. There were no other congenital anomalies.Ultrasonography revealed herniated bowel loops in left iliolumbar region and mild pelvicalicial dilatation in left kidney and slightly bigger right kidney in right lumbar region. On the basis of these findings a diagnosis of congenital bilateral lumbar hernias were made. Closer of the defects were done by prosthetic material and non- absorbable suture material. He came back for follow-up after 2 weeks, 4 weeks and 6 weeks. Defects were clinically absent and the patient was pain and recurrence-free.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19537

Introduction: The aim of this study was to determine the feasibility, safety, cost effectiveness and functional outcome between single stage and multiple stage operation of anorectal malformation (ARM) with rectovestibular fistula (RVF).Materials & Methods: This interventional study was conducted on 40 female children born with ARM with RVF from July 2007 to June 2009 in the Department of Pediatric Surgery, Dhaka Medical College Hospital. Their age range was from 3 months to 7 years. Anterior sagittal anorectoplasty (ASARP) was done as definitive treatment of RVF. 20 out of 40 patients underwent single stage procedure and the rest underwent multiple stage procedure. Good preoperative bowel preparation and postoperative wound care were ensured for optimum outcome.Results: Mean operating time was 70 minutes in single stage and 80 minutes in multi stage definitive procedure. Average hospital stay was 10 days in single stage procedure where as 22-24 days in multi stage procedure. Partial perineal wound dehiscence occurred in two patients with single stage procedure and one patient with multi stage procedure. Wound infection was seen in two patients of single stage and also two patients of multi stage procedures. Fecal continence was good in all patients older than 3 years. Average number of bowel movement was 2-3 times daily in older patients and 2-4 in younger patients. Constipation developed in three patients with multiple stage procedure and in two patients with single stage procedure. Both groups were managed conservatively for all complications. In Dhaka Medical College Hospital, treatment cost is mostly free, so we could not compare this cost but the incidental expenses in single stage treatment was Tk. 10,000.00 and Tk. 30,000.00 in multistage treatment in three settings.Conclusion: Adequate preoperative bowel preparation, good surgical skill, proper analgesia and postoperative wound care remain the key factors to produce a cost effective excellent outcome of single stage correction of RVF.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19523

Background: Various treatment modalities have been applied for the management of infantile hypertrophic pyloric stenosis. However surgery remains the mainstay of treatment for IHPS of which Ramstedt's pyloromyotomy remains the surgical technique of choice. Objective: To see the outcome of surgical management of infantile hypertrophic pyloric stenosis by double-Y pyloromyotomy. Methods: A prospective interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. All patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy (DY) and the next by a Ramstedt's Pyloromyotomy (RP). Data on patient demographics, operative time, anaesthesia complications and postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test. Results: From July 2008 through July 2010, forty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group vs Ramstedt's pyloromyotomy (RP) group was significant (p= 0.0001). Weight gain after 1st 10 days DY vs RP is 298 ± 57.94 gm vs 193±19.8 gm (p=0.0014), after 1 month 676.67±149.84 gm vs 466.67 ± 127.71 gm (p=0.0001), after 2 months 741.33± 278.74 gm vs 490±80.62 gm (p=0.002) and after 3 months 582±36.01gm vs 453.33±51.64 gm (p=0.0001). No long-term complications were reported and no re-do pyloromyotomy was needed. Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain. J Shaheed Suhrawardy Med Coll, 2011;3 (2): 38-40 DOI: http://dx.doi.org/10.3329/jssmc.v3i2.12076