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Background : Injury management and trauma registry are undeveloped in many Low- and Middle-Income Countries (LMICs). The objectives of the study were to assess the injury pattern and compare physical assault with other mechanisms of injury in this region. Materials and methods : A cross sectional study was conducted among trauma patients attending in the Emergency Department (ED) of the largest tertiary referral centre in the South-Eastern Bangladesh from 1-15 September, 2019. Patients’ demography, time of arrival in the ED, time of injury, occupation, residence, mechanism, type, mode and site of injury, and outcome were analysed and compared between physical assault and other mechanisms of injury. Results : Among a total of 839 patients, males were 2.42 times more than females. Age ranged from 3 months to 100 years, median 27 years. Majority (52.7%) of the patients belonged to ages between 20 and 40 years. The most common mechanisms of injury were physical assault (230, 27.4%), Road-Traffic Accident (RTA) (196, 23.4%) and falls (146, 17.4%). Physical assault was the commonest mechanism (39.2%) in female and among all age groups except in more than 70 years of old. More physical assaults occurred at night than other mechanism (p

Background: Adolescence is an important phase of life and adolescent girls have specific health related problems. The aim of the study was to address the health-related issues of urban school going adolescent girls from a lower-middle income country. Materials and methods: A cross-sectional study was performed among 1315 school high-school girls. Demographic and socioeconomic parameters were recorded and health related behaviours and problems analysed. Results: Age ranged from 10 to 17 years. Immunization and deworming rates were 98.17% and 57.41%, respectively and deworming significantly reduced in higher classes (p=0.00). Major physical complaints were eye problems (583, 44.33%), allergy to various substances (500, 38.02%), headache (435, 33.08%) and menstrual problems (334, 25.40%). Obesity and overweight were significantly more in higher classes and underweight in lower classes (p

Background Lump or mass formation due to delayed presentation after appendicitis is common, and it is frequently complicated by perforation, gangrene, pus, or abscess formation. Care of patients and management vary between developed world and developing country. The aim of the study is to analyze outcome of early surgery for appendicular mass from a developing country perspective. 220 patients of appendicular mass who underwent early appendectomy over a period of 5 years in the Department of Pediatric Surgery, at author’s institute were retrospectively reviewed. Early appendectomy was defined as appendectomy done within 24 h of admission. Presentation, examination findings, investigations, type of surgery, operative findings, post-operative complications, and hospital stay were analyzed. Results Age of patients ranged from 2 to 12 years (mean 9.04 ± 2.54 years) and male to female ratio was 2:1. Abdominal pain was the most common presentation followed by vomiting and fever. Mean pain duration was 4.35 ± 4.23 days. There was raised temperature in 140 (63.64%) patients, 154 (74.04%) had tachycardia, and 75.86% had raised WBC count. Laparoscopic appendectomy was done in 31 (14.09%) patients, and the rest 189 (85.91%) patients underwent open surgery. Perforated appendix was the most common (171 patients, 77.73%) peri-operative finding followed by formation of pus (135 patients, 61%). Pus was found more in patients less than 5 years old (18 patients out of 23) than patients more than 5 years old (114 patients out of 197) (P = 0.045). Younger patients also had significantly more complications (39.13% vs 17.26%, P = .000) and hospital stays (mean 15.61 days vs 9.87 days, P = 0.014) than older boys. Complications developed in 42 (19.09%) patients, and wound dehiscence (26 patients, 11.82%) was the most common complication. Conclusion Early appendectomy for appendicular mass is a feasible option in the developing world, and laparoscopic appendectomy has good prospect.

While high income countries (HICs) have reduced the mortality from child injury, it is increasing in the low- and middle-income countries (LMICs). However, injury registry and reporting are inconsistent and not well developed in the LMICs. This study aims at describing the epidemiology of child injury in a tertiary paediatric surgical centre in Bangladesh. We retrospectively analysed all patients of injury between 0 and 12 years of age admitted in the Department of Paediatric Surgery, Chattogram Medical College Hospital during January 2017 to June 2020. Analysis was done for the hospital prevalence, age and sex distribution, seasonal variations, mechanism of injury, site of involvement, and mortality from injury. There were a total of 538 patients and male to female ratio was 2.01:1. Hospital prevalence was 6.71%. Mean age was 6.60 ± 3.32 years. School age children were affected more (51.7%); and “6-10 years” age group had the highest number injuries (251 patients, 46.65%). The most common mechanisms of injuries were road-traffic accident (RTA, 35.32%), followed by fall (26.39%) and „stab or cut injury‟ (20.63%). Males experienced more abdominal injuries and females had more perineal injuries (P=0.00). RTA was the commonest mechanism in males (37.05%) and falls were the commonest mechanism in females (32.96%). „Stab or cut injury‟ was the commonest mechanism in infants and toddlers, and RTA was commonest among pre-school and school age children. There were no significant seasonal variations (P=0.09). There were 5.76% intentional injuries. Mortality was 2.60% and major causes of mortality were RTA and animal assaults. Injuries were more prevalent during the mid-childhood with an overall increasing trend with age. Mechanism of injury and site of involvement were different among different age groups and between sexes. Asian J. Med. Biol. Res. September 2020, 6(3): 577-586

Aims: While the developed world has significantly reduced mortality from surgical conditions in children, there is lack of adequate data on the outcome of children’s surgical conditions in the developing world. This study aims at assessing the spectrum of mortalities from children’s surgical conditions in a low-middle income country (LMIC). Methods: Mortality data were collected for a period of 12 years (2008 to 2019) among 0 to12-year old children to analyse the diseases which had higher mortality trends, age -group specific mortality trends and categorize those according to body system. Results: Among a total of 30,301 admitted children, 1228 (4.05%) patients died. Among them 53.01% were neonates, 20.28% were infants and 26.71% were children. Male to female ratio was 1.95:1. Mortality from neonatal surgical conditions was 24.21%. Infant mortality rate was 5.65% and child mortality rate was 1.41%. Neonatal surgical admission and mortality had a higher yearly trend. Anorectal malformation (ARM) was the most common cause of death (12.05%), followed by intestinal obstruction (11.40%) and gastroschisis (8.63%). Tracheo-oesophageal fistula/ oesophageal atresia (TOF/OA) had the highest mortality rate (83.33%), followed by gastroschisis (80.92%) and intestinal atresia (42.535) among the respective admissions. Other important causes of mortality were jejuno-ileal atresia (5.37%), trauma (5.05%), Hirschsprung disease (4.64%), intestinal perforation (4.48%), omphalocele (4.15%), burn (4.07%) and posterior urethral valves (PUV), 3.58%. Conclusion: Overall mortality rate was much higher than developed countries and lower than some African countries. Neonatal mortality rate was very high and among them TOF/OA and gastroschisis had extremely high mortality rates.

Aims: Birth defects are structural or functional abnormalities which occur during the intrauterine life but can be identified at birth or a later age. Birth defects are major public health concerns and the World Health organization (WHO) is supporting countries for earlier diagnosis and better treatment of these conditions. The aim of the study was to assess the hospital-based prevalence and types of birth defects among the surgical children from a part of the world where these are underreported. Materials and Methods: We retrospectively analyzed patients of birth defects admitted in the Department of Pediatric Surgery, Chattogram Medical College Hospital, Bangladesh for a period of 12 years (2008-2019). Data were extracted from annual admission reports, annual audits, mortality and morbidity audits, death registers and computerize data base. Yearly distribution of birth defects, type of defects and their systemic distribution and mortality were analyzed. Results: Among a total of 30,301 admitted patients 30.72% (9307 patients) had birth defects. The most common system involved with birth defects was gastrointestinal (GI) system, 30.61% followed by genitourinary (GU), 29.15% system. Congenital inguinal hernia (17.50%) was the most common disease, followed by hypospadias (14.54%) and anorectal malformation (ARM); 13.98%. Mortality from birth defects were 53.25% of all mortalities. ARM was the most common cause of death (23%), followed by gastroschisis (16%) and intestinal atresia (11%). Highest mortality rates were in tracheo-esophageal fistula/esophageal atresia (TEF/EA)- 83.33%, gastroschisis-80.92%; intestinal atresia-42.53%; omphalocele-32.48%; and congenital diaphragmatic hernia (CDH)- 27.78%. Conclusion: Pattern of birth defects and outcome varied from other countries. The prevalence is 31% among pediatric surgical admissions. Some conditions have extremely high mortality rates and need better management.

Objective: Although Bangladesh is rapidly gaining economic development, education and health related indices are not equally developed in all parts of the country. The objective of the study was to compare the socio-economic and health status of students in public and private primary schools. Methods: This was a cross sectional study conducted among 99 public and 128 private primary school children during 2018. Two public and two private primary schools were selected purposively from 2 villages of Chandpur. Subjects were divided into 2 groups: public primary school students and private primary school students. During a ‘free health check-up and treatment program’, guardians were asked to participate in the study. After taking informed written consent, students and guardians were asked about demographic, socioeconomic (such as, education, occupation, monthly income), and health related factors (such as, antenatal checkup, mode of delivery, immunization, deworming); then, anthropometric measurements (height, weight) and physical examinations of the children were done. Comparison was done between groups. Results: On socioeconomic status, monthly family income was more and paternal education was higher in private-school students than the public-school students. On health indices, antenatal care (ANC), Caesarian section (CS), living standard, use of sanitary latrine, and nutritional status of private school students were significantly better than public-school students. However, Public school students had higher deworming rate. Conclusion: Students in private schools had better socio-economic and health status in Bangladesh. Health-related indices are comparable to national parameters. It is recommended that socio-economic and education status needs further improvements for sustainable health and well-being.

Surgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life.Epidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries.An estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year.Improving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life.

Background : Recommendations for age at orchidopexy for Undescended Testis (UDT) have changed from time to time in accordance with change of knowledge regarding its pathology and prognostic features. In most developed countries, recommendation for ideal time of orchidopexy is between six months to one year. This study investigates the age of patients who underwent orchidopexy for undescended testis in this institute to assess the current trend of age at orchidopexy in this region. Materials and methods : This is a retrospective study carried out in the Department of Pediatric Surgery, Chittagong Medical College Hospital from January 2017 to December 2019. Patients of UDT who visited the outpatient department, admitted in this ward or underwent orchidopexy in this department were retrospectively evaluated from hospital records, operating theatre register, patient files and admission profile and departmental audits. Number of patients, side of involvement and age distribution were calculated. Results: A total of 218 patients of UDT attended OPD (1.91% of total OPD) 96 patients were admitted (1.33 % of all admissions) and 82 patients underwent orchidopexy (1.48 % of total surgeries) during the study period. Age at orchidopexy ranged from 8 months to 12 years with a median age of 5 year 11 months. Only 5 patients (6.10 %) underwent orchidopexy at the recommended time of between 6 months to one year. Conclusion: Many patients attended OPD after the recommended age and many underwent surgery at a later age which increases their risk of malignancy and testicular atrophy. JCMCTA 2019 ; 30 (2) : 47-51

Although umbilical hernias are common in children, most close spontaneously or are operated within 5 years of age. We report a case of neglected proboscis umbilical hernia in a 10-year-old boy which became incarcerated and was about the size of the boy's abdominal cavity.

Objective: To report an easy and feasible technique of hydrostatic reduction of intussusception using plane x-ray in resource limited setting and summarize the radiological findings. Method: Records of all patients of hydrostatic reduction between May 2015 and April 2020 were retrospectively evaluated to document patient demography, seasonal variations, type of intussusception, duration of procedure, number of x-ray exposures, reflux of contrast through ileocecal valve, location of intussusception mass, presence of redundant colon and outcome. Hydrostatic reduction was performed with water soluble contrast using intermittent shots of plane x-ray, instead of ultrasound (US) or fluoroscopy guidance. Results: Among a total of 204 patients, male to female ratio was 1.7:1. Age ranged from 5 days to 16 years (median 10 months). There were more cases during Winter and Spring (110, 53.9%). Right hepatic flexure was the commonest (115, 56.4%) site of obstruction. Hydrostatic reduction was successful in 172 (84.3%) patients. Median duration of the procedure was 27 minutes and, on an average, 8.4 ± 1.7 exposures were needed for one hydrostatic reduction. There was no significant relation of age group and sex with successful hydrostatic reduction but site of obstruction was significantly related with success (p=0.00). There was one (0.5%) recurrence and no mortality. Conclusion: Hydrostatic reduction using contrast enema under x-ray guidance is a rational alternative to US or fluoroscopy guided reduction in resource limited settings.

BACKGROUND Nonoperative treatment (NOT) of pediatric appendicitis as opposed to surgery elicits great debate and is potentially influenced by physician preferences. Owing to the effects of the COVID-19 pandemic on health care, the practice of NOT has generally increased by necessity and may, in a post–COVID-19 world, change surgeons’ perceptions of NOT. OBJECTIVE The aim of this study was to determine whether the use of NOT has increased in South Asia and whether these levels of practice would be sustained after the pandemic subsides. METHODS A survey was conducted among pediatric surgeons regarding their position, institute, and country; the number of appendicitis cases they managed; and their mode of treatment between identical time periods in 2019 and 2020 (April 1 to August 31). The survey also directly posed the question as to whether they would continue with the COVID-19–imposed level of NOT after the effect of the pandemic diminishes. RESULTS A total of 134 responses were collected out of 200 (67.0%). A significant increase in the practice of NOT was observed for the entire cohort, although no effect was observed when grouped by country or institute. When grouped by position, senior physicians increased the practice of NOT the most, while junior physicians reported the least change. The data suggest that only professors would be inclined to maintain the COVID-19–level of NOT practice after the pandemic. CONCLUSIONS Increased practice of NOT during the COVID-19 pandemic was observed in South Asia, particularly by senior surgeons. Only professors appeared inclined to consider maintaining this increased level of practice in the post–COVID-19 world.

Background Nonoperative treatment (NOT) of pediatric appendicitis as opposed to surgery elicits great debate and is potentially influenced by physician preferences. Owing to the effects of the COVID-19 pandemic on health care, the practice of NOT has generally increased by necessity and may, in a post–COVID-19 world, change surgeons’ perceptions of NOT. Objective The aim of this study was to determine whether the use of NOT has increased in South Asia and whether these levels of practice would be sustained after the pandemic subsides. Methods A survey was conducted among pediatric surgeons regarding their position, institute, and country; the number of appendicitis cases they managed; and their mode of treatment between identical time periods in 2019 and 2020 (April 1 to August 31). The survey also directly posed the question as to whether they would continue with the COVID-19–imposed level of NOT after the effect of the pandemic diminishes. Results A total of 134 responses were collected out of 200 (67.0%). A significant increase in the practice of NOT was observed for the entire cohort, although no effect was observed when grouped by country or institute. When grouped by position, senior physicians increased the practice of NOT the most, while junior physicians reported the least change. The data suggest that only professors would be inclined to maintain the COVID-19–level of NOT practice after the pandemic. Conclusions Increased practice of NOT during the COVID-19 pandemic was observed in South Asia, particularly by senior surgeons. Only professors appeared inclined to consider maintaining this increased level of practice in the post–COVID-19 world.

BackgroundNon-operative treatment (NOT) of pediatric appendicitis as opposed to surgery elicits great debate and is potentially influenced by physician preferences. Owing to the effects of the COVID pandemic on healthcare, the practice of NOT has generally increased by necessity and may, in a post-COVID world, change surgeons’ perceptions of NOT.ObjectiveThe objective was to determine whether the use of NOT has increased in usage in South Asia and whether these levels of practice would be sustained after the pandemic subside.MethodsA survey was conducted by pediatric surgeons regarding their position, institute, country, number of appendicitis cases managed, and their mode of treatment between identical time periods in 2019 and 2020 (April 1 to August 31). It also directly posed the question as to whether they would continue with the COVID imposed level of NOT after the effect of pandemic diminishes.ResultsA total of 134 responses were collected. A significant increase in the practice of NOT was observed for the entire cohort, although no effect was observed when grouped by country or institute. When grouped by position, seniors increased the practice of NOT the most, while juniors reported the least change. The data suggests that only professors would be inclined to maintain the COVID level of NOT practice after the pandemic.ConclusionsIncreased practice of NOT during the COVID pandemic was observed in South Asia, particularly by senior surgeons. Only professors appear inclined to consider maintaining this increased level of practice in the post-COVID world.

BackgroundAlthough hydrostatic reduction of intussusception with ultrasound (US) or fluoroscopy guidance is well known, it is not yet well established in many low-income and middle-income countries. The aim of the study is to report our results of hydrostatic reduction with intermittent radiography, which has the potential to be practiced in resource-limited settings.MethodsWe retrospectively analyzed our patients with intussusception from 2009 to 2019 (11 years). Hydrostatic reduction was performed using water-soluble contrast medium (iopamidol), and reduction was followed with intermittent X-rays taken after every 50 mL of diluted contrast injection. The procedure was not continuously monitored by US or fluoroscopy. Differences in outcome based on age and gender, and yearly trends of admission for intussusception, types of treatment and mortality were analyzed.ResultsAmong 672 patients, the ratio of boys to girls was 2.46:1.0, and their ages ranged from 1 month to 15 years (median 8 months). Hydrostatic reduction was performed successfully in 351 (52.23%) patients; 308 (45.83%) patients underwent surgery; and 13 (1.93%) patients died before any intervention. There were significant differences in age between patients with successful hydrostatic reduction (median 7 months) and patients needing surgery (median 9 months) (p2=0.88). One patient (0.15%) died after hydrostatic reduction, and 10 (1.49%) died after surgery.ConclusionHydrostatic reduction with intermittent radiography was performed successfully in more than half of the patients with acceptable complication rates.

A double-J (D-J) stent is usually kept in situ during Anderson–Hynes (A–H) pyeloplasty for pelvi-ureteric junction (PUJ) obstruction. The aim of the study is to determine whether early removal of D-J stent is better than long-term stenting. In this prospective comparative study, conducted from January 2018 to April 2019 in Chittagong Medical College Hospital, patients with PUJ obstruction, age less than 12 years, were divided into group A (long-term stenting) and group B (short-term stenting) by simple randomization. Main outcome variables were urinary tract infection (UTI), stent colonization, encrustation, renal cortical thickness, differential renal function (DRF), glomerular filtration rate (GFR), and flow rate in DTPA renogram. There were 31 patients in each group. Median age was 5 years (IQR: 2.3 to 7 years) and male to female ratio was 2.1:1. Frequency of post-operative UTI and stent colonization were significantly higher in group A than group B (p

Traumatic abdominal wall hernia (TAWH) is uncommon in children and most cases are related to handle bar injury. We report a case of TAWH and pelvic fracture following road traffic accident at an unusual site. Part of the transverse colon, along with its mesocolon, was herniated into a defect in the wall of left lower chest and of left upper quadrant of abdomen. Laparotomy was done and the hernial defect was repaired.

Background The epidemiology of Hirschsprung's disease (HSCR) in Bangladesh has never been studied. The aim of this study was to determine the epidemiological characteristics of HSCR in Bangladesh. Methods Data from fifty patients were collected prospectively from two hospitals in Chittagong, Bangladesh. Results The rate of consanguinity (16%) among parents of HSCR patients was higher than that of the general population (10%). Maternal age at the time of birth of the affected child was ≤30years in all cases except one. No association was found between parents' occupation and HSCR. No patient was born preterm and only three patients (6%) had low birth weight. Nine patients (18%) had associated anomalies. We found coexistence of bilateral accessory tragi and ankyloglossia in one patient, and coexistence of rectal duplication cyst in another. Neither anomaly had been previously reported in HSCR patients. Conclusions Our study suggests that consanguinity might increase the risk of HSCR whereas advanced maternal age does not. HSCR patients were found more likely to born at term and with normal birth weight. The coexistence of HSCR with previously unreported anomalies highlights the diversity of conditions that can co-occur with HSCR. Levels of evidence IV

The anticipated level of aganglionosis can influence the surgical planning in Hirschsprung's disease (HD). The aim of this study was to find out the role of barium enema in diagnosis of HD. Barium enema is usually performed in patients referred for investigation for constipation. This prospective study was performed in the department of pediatric surgery Chittagong Medical College & Hospital. During this period a total of 198 patients were clinically diagnosed as HD. All patients were initially evaluated by plain x- ray abdomen in erect posture. Among 198 patients, 43 patients had perforation in plain x- ray and 31 were clinically unstable at presentation. Those 74 patients were excluded from the study. Rest 124 participating patients were divided into three groups: Neonate, Infant and children according to their age. Male to female ratio was 2.44: I. Barium enema X- ray early film, 24 hours delayed film (Antero-posterior and lateral view) were done for every patient. Length of radiological narrow zone (RNZ), radiological Transitional zone (RTZ) and Recto-sigmoid index (RSI) was measured in cm. Photo of X- ray was taken for every patient. RIZ was demonstrated in 74 (60%) patients. RNZ was demonstrated in 94 (75%) studied population. RSI was measured in 65 (52.42%) subjects. Retention of barium more than 24 hours was found in 95 (75%) patients. Redundant sigmoid colon was found in 54 (43.5%) patients. Right-sided sigmoid colon was present in 46(30.6%) patients. Saw-toothed appearance in spastic colon was seen in 38 (30.6%) patients. Mucosal edema and irregularities were present in 25 (20.2%) patients. Rounded transverse colon was seen in 6 children. Barium mixed with stool was found in 32 (25.8%) patients. Mosaic pattern of colon was present in 10 patients. Visualization of RTZ is a reliable sign ofH13. Besides the RIZ BE in HD has various other radiological features.

Objectives Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma. Methods This is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs). Results There were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns. Intra-abdominal and intra-thoracic injuries accounted for 3 and 2% of injuries. The mechanisms and injuries sustained differed significantly between HICs and LMICs. Median length of stay was 1 day and 19% required an operative intervention; this did not differ significantly between HICs and LMICs. No mortality and morbidity was reported from HICs. In LMICs, in-hospital morbidity was 4.0% and mortality was 0.8%. Conclusion The spectrum of paediatric trauma varies significantly, with different injury mechanisms and patterns in LMICs. Healthcare structure, access to paediatric surgery and trauma prevention strategies may account for these differences. Trauma registries are needed in LMICs for future research and to inform local policy.

Background: The postoperative complications of urethroplasty in hypospadias surgery still remain a great challenge to Paediatric urologists. The aim of the study was to find out the cause and incidence of meatal stenosis and stricture urethra following urethroplasty and to solve the postoperative complication. Materials and methods : This Prospective study was carried out in the department of Paediatric Surgery, Chittagong Medical College Hospital from April 2013 to October 2014 for a total of 19 months. A total of 50 hypospadias patients were selected for this study. After urethroplasty, outcome was assessed in terms of meatal stenosis and stricture urethra in the study period. Results : Meatal stenosis occurred in 5 patients in first follow up, which responded to regular dilatation in 3 patients in second follow up and till the end of third follow up, 2 patients were continuing regular meatal dilatation. In this study, urethral stricture occurred in 2 patient (4%) in second follow up, which was treated with regular urethral dilatation under general anaesthesia. Conclusion : It is evident from this study that, meatal stenosis is not very uncommon after urethroplasty which can very easily be treated by regular meatal dilatation. Urethral stricture, though not common, can also be treated by regular urethral dilatation under General Anaesthesia (GA). JCMCTA 2017 ; 28 (1) : 13 - 16

BackgroundIn the pediatric population, appendectomy is one of the most common emergency operations. Laparoscopic appendectomy (LA) is an accepted way of dealing with suspected uncomplicated appendicitis in children. The role of laparoscopy in appendicular lump is more controversial and remains undefined and is not well practiced in low-middle income countries. The aim of this study was to determine a better surgical treatment plan for early appendicular lump in children.MethodsThis prospective observational study was performed in Pediatric Surgery Department of Chittagong Medical College and Hospital for a period of 1 year from April 2018 to March 2019. Sixty children with appendicular lump selected consecutively as per eligibility criteria underwent either LA or open appendectomy (OA), that is, 30 children per group. They were followed up until hospital discharge to observe outcomes.ResultsThere were no differences in terms of patient’s age, sex, clinical presentation and laboratory findings between the two groups. Postoperative pain severity was significantly less in the LA group than that in the OA group (pConclusionThe study findings suggest that LA is feasible and should replace OA in cases of early appendicular lump in children.

The extra challenges faced by both patients and doctors in the developing world are presented, with emphasis on Bangladesh.

Foreign body (FB) ingestion is common in children worldwide. Type of FB ingestion varies among cultures and countries. We retrospectively reviewed all patients of foreign body ingestion who were admitted in Department of Pediatric Surgery, Chittagong Medical College Hospital from January 2017 to December 2019 (total 3 years). Age, Sex, type of foreign body, hospital stay, management and outcome were analyzed. A total of 91 children were admitted with ingestion of FB during this period; male 61, female 30 (male to female ratio 2:1). Age ranged from 3 months to 12 years (median 3.5 ± 3.8 years). Fifty eight percent were less than 5 years old. Children ingested 21 different types of FB; however ingestion of coin was most common (24 patients, 26.37%) followed by different types of pins (19 patients, 20.88%), nail (6 patients, 6.59%), battery (5 patients, 5.49%), screw (5 patients, 5.49%), needle (4 patients, 4.40%), ring (4 patients, 4.40%) and others (18 patients). Sharp object ingestion is higher in older (>5 year) age group. Hospital stay ranged from 0 day to 19 days (mean 1.6 ± 2.1 day). Endoscopic removal needed in 4 patients (coin-2, chain 2), bronchoscopic removal in 1 (pin) and one patient needed laparotomy (open hair pin). There was no mortality. The pattern of FB ingestion is similar to many other countries. Small, smooth objects pass spontaneously. Endoscopic or surgical intervention is sometimes needed if significant symptoms develop or if the object fails to progress through the gastrointestinal tract. Asian J. Med. Biol. Res. June 2020, 6(2): 299-304

Hutchinson–Gilford progeria syndrome or progeria is a rare finding, Herein, we report a 4-year- old boy with progeria who underwent herniotomy and herniorrhaphy for left indirect inguinal hernia. The hernial sac was large and thick with surrounding adhesion. Tissue had an adult texture with very thick vas deference.

Cost of getting health services is a major concern in Bangladesh as well as in many other countries. A family has to bear more than half of the health care cost despite many facilities provided by the public hospitals. This out-of-pocket (OOP) expenditure drives many families under the poverty line. The aim of this study was to find out the exact cost incurred by the family for a surgical operation of their child in the public and private sectors in Bangladesh. A cross-sectional study was conducted to find out the cost of child surgery in different settings of public and private hospitals in Chittagong division, Bangladesh. Cost of herniotomy was then compared across different settings. In this study, cost of operation in urban private hospitals was highest mostly due to surgeon and anesthetist fee. The cost was lowest in outreach programs as surgeon fee, anesthetist fee and accommodation cost was nil; food and transport cost was minimum. However, cost of accommodation, food, transport and medicine contributed significantly to OOP expenditure especially in tertiary-level public hospitals, in both indoor and day care settings, and also in private urban hospitals. Our study provides some insight into the OOP expenditure in different health care settings in Bangladesh. This study might be useful in developing a strategy to minimize the OOP expenditure in this country.

Intussusception is a common cause of intestinal obstruction in young children and is a common emergency in infants and children. Hydrostatic reduction of intussusception is a less invasive procedure for both diagnosis and treatment of it. We describe our experience with hydrostatic reduction of intussusception. A retrospective review of the patients of Intussusception admitted in the department of Pediatric Surgery Chittagong Medical College Hospital (CMCH) Chittagong, Bangladesh from January 2009 to December 2013 was done. Patients underwent hydrostatic reduction were evaluated separately. Data were analyzed with regard to success and failure of hydrostatic reduction, necessitating laparotomy, complication and mortality. There were 231 patients of Intussusception. Age range was lmonth to 15 years with median age of 8 months. Male to Female ratio was 2.9:1. Mean duration of presentation was 40 hours after onset of symptoms. Hydrostatic reduction was attempted in 142 patients and was successful in 107 patients, 35 patients needed surgery in whom per-operative manual reduction was done in 28 patients and intestinal resection anastomosis was done in in 7 patients. There were 2 cases of recurrence following hydrostatic reduction and no case of perforation due to hydrostatic reduction. 2 patients died following JCMCTA 2015 ; 26 (1) : 9-13

Traumatic rupture of the diaphragm is rarely observed in children with thoracoabdominal trauma. Although dyspnea is the commonest symptom, early diagnosis is difficult as chest radiography can diagnose only half of the cases. Prompt diagnosis and surgical repair is life saving. Patient may suffer from multiple associated injuries which is often fatal. A 8 years old boy was admitted with severe respiratory distress and restlessness follwing a history of landslide few hours back. He was pale, cyanosed with hypotension, tachycardia and sweating. Bruise noted over left upper abdomen and left lower chest wall. Surgical emphysema and restricted movement during respiration was noted in the left chest wall with absent breath sound. Abdomen was scaphoid having normal bowel sound. Resuscitation was started and insertion of left intercostal chest drain tube had failed to relieve respiratory distress. A portable chest radiograph showed the chest drain tube in abdomen with mediastinal shifting to opposite side and collapsed lung margin. Left dome of the diaphragm was not clearly visualized. Re institution of chest tube was planned for immediate relief and on withdrawal of the previous drain tube dragged the omentum with it. Then the diagnosis of diaphragmatic rupture was obvious. Laparotomy showed extensive tear of left hemidiaphragm with herniation of abdominal contents. Left costal margin was also torn but abdominal viscera were found intact. Repair was done with interrupted unabsorbable suture after keeping a chest drain tube. Post operatively the patient was kept in ward with adequate analgesia. Check X-ray on 1st post operative day, showed well expanded left lung. The patient had recovered well. Drain was removed on 3rd postoperative day and was discharged on 7th post operative day. High index of suspicion is needed for correct diagnosis. Outcome is satisfactory if treated in time without any associated injury.J. Paediatr. Surg. Bangladesh 3(2): 81-84, 2012 (July)

Background: Neonatal intestinal obstruction due to jejunoileal atresia is not uncommon. Recommended treatment is resection with end to back anastomosis and post operative care in Neonatal Intensive Care Unit (NICU) with Total Parenteral Nutrition (TPN) support. In a setup without NICU and TPN, mortality of primary anastomosis is very high due to unusual delay in starting enteral feeding. Bishop Koop technique seems to allow early oral feeding and rapid establishment of normal gastrointestinal function and thus reduce mortality and morbidity. Objective: To find out the outcome of Bishop Koop procedure in patients with Jejunoileal atresia. Methods: This is an ongoing study started from March, 2011 in the Department of Pediatric Surgery, Chittagong Medical College Hospital. Here we are presenting our initial experience till June, 2012 (duration of 16 months). During this period total 13 patients of uncomplicated Jejunoileal atresia was treated surgically. Four patients were treated by classical end to oblique anastomosis and all died. Rest of the 9 patients were treated by Bishop Koop technique. Overall outcome of this technique was assessed considering time to establish oral feeding and normal bowel movement, ceasation of coming distal stoma’s effluent, weight gain, death etc. Result: Out of 9 patients, 6 patients weighing less than 2.5 Kg. Type- III A was the commonest variant. Two patients died following surgery due to sepsis. Oral feeding was possible within 4-7 postoperative day in all survived patients except one. In follow up satisfactory weight gain was observed in all those patients. Conclusion: Bishop Koop technique could be considered as preferred surgical option in a set up without NICU and TPN. J. Paediatr. Surg. Bangladesh 3 (1): 5-11, 2012 (January)

Objective We aimed to assess how the diagnosis and determination of gender identity of disorders of sex development (DSD) is different in a developing country from Western medicine, and whether a pediatric surgery department can determine the underlying diagnosis and use simple tools to determine the likely gender identity (GI). Material and methods We reviewed the records of DSD patients admitted to the Department of Pediatric Surgery, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh, from January 2006 to December 2012 and performed a cross-sectional study on GI and gender-related behavior in these patients during the year 2012. DSD boys and girls answered a GI interview and had their gender role behavior assessed by observations of structural toy play and analyzed for differences in scores. Results This cohort of DSD patients presented in mid-childhood (6 months–16 years, mean 6.9 years) rather than infancy, and 30% came from consanguineous unions. Congenital adrenal hyperplasia (CAH) constituted only 11 of 50 (22%) of the DSD cohort, and not all families had access to steroid hormone replacement. A simple assessment of GI and gender-related behavior allowed effective gender assignment, as there was significant difference between DSD boys and girls in GI and gender-related behavior score. Conclusions DSD management in Bangladesh provides some unique challenges because of limited resources. A national reference laboratory for biochemical and genetic testing and development of a quaternary referral center for DSD patients will be helpful. Continued use of the GI interview and gender-related behavior study will enable effective interim decisions about diagnosis and management.

Introduction: Birth defects are one of the most common causes of disability in developed and developing countries. Birth defects are structural or functional anomalies, including metabolic disorders, which are present at the time of birth. Although the worldwide incidence of birth defects is estimated at 3-7%, the rate varies widely between countries. In this paper, we categorized the birth defects most commonly seen in Bangladesh and their outcome. We hope to use this information to guide the strategies used to manage these problems.Materials and Methods: This hospital based, descriptive study was done in the Department of Pediatric Surgery in Chittagong Medical College and Hospital from January 2008 to December 2012. Records of all patients with birth defects in our hospital and departmental database were reviewed. Types of birth defects, age, sex, surgery performed and outcome were analyzed in patients admitted during this period. Data were analyzed by SPSS 17. Statistical analysis was performed by the chi-square test and mean and percentage values were calculated. P

Intussusception is a common gastrointestinal emergency in children and appears to have a somewhat different clinical spectrum in developing countries. Its etiology is still unclear, but a link to infective agents and viruses has been highlighted. This study aimed to assess the gender and seasonal variation and the disease load of intussusception in Chittagong Medical College and Hospital (CMCH). A retrospective review of the patients of Intussusception admitted in the department of Pediatric Surgery, CMCH, Chittagong; Bangladesh from January 2009 to December 2013 was done. Help was also taken from yearly departmental audits of 2009 to 2013. Data were analyzed with regard to occurrence, seasonal variation, gender variation, diagnosis, treatment and mortality. Statistical analysis was performed by the chi-square test, and mean and percentage values were calculated. P

Spontaneous bile duct perforation (SBDP) is a relatively rare condition. The cause of SBDP is still speculative. Presentation , site of the perforation and management varies. Pancreatic lithiasis ( PL) is a very rare entity in childhood. Biliary perforation on the background of PL is still a rare event. This is a case report of 10 years old girl presented as acute abdomen with theclinical diagnosis of acute on chronic pancreatitis, for which conservative treatment followed by laparotomy was carried out.Common bile duct (CBD) perforation was found near it’s junction with cystic duct. T tube was instituted and a drain was kept in situ. Postoperative period ( POP )was uneventful. T Tube Cholangiogram was carried out on 12th postoperative day( POD ) that showed dye had passed to duodenum easily and patency and caliber of the CBD was found normal. Multiple stones were noted in the vicinity. No apparent cause of CBD perforation was found. After one month, in follow up visit the patient was found alright. She was asked to come after 3 months for further evaluation. The plan is to evaluate the patient’s conditions clinically and biochemically and to do an MRCP to see details ofpancreatic pathology. As SBDP in children with PL is a rare condition, high index of suspicion is needed for early diagnosis and proper management of such patient.DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19553

Background: Ascariasis is a common gastrointestinal infestation worldwide. It affects more children who live in poor hygenic condition. Pediatric surgeons are supposed to manage related surgical complications of ascariasis. Objective: To evaluate the recent pattern of occurrence of intestinal and biliary ascariasis with morbidity and mortality related to it. Materials and Methods: Study design: Retrospective study. Period of study: Study was conducted between Jan 2006 - Dec 2011 (total 06 years). Place of study: This study was carried out in the department of Pediatric Surgery, Chittagong Medical College Hospital (CMCH), Chittagong; Bangladesh. Study Subjects: Patients admitted and diagnosed as intestinal (1591) and biliary (181) ascariasis in the department of Pediatric surgery, CMCH were evaluated. Results: A total of 1772 patients were admitted with surgical complication of ascariasis. Among them 1591 (89.78%) patients were diagnosed as intestinal ascariasis and 181 (10.22%) patients as biliary ascariasis. Age range was 6 months to 12 years with mean age of 6 years for intestinal ascariasis. Biliary ascariasis presented between 3 years to 12 years with mean age of 7 years. Male (1060) suffered more than female (531). Male to female ratio was 2:1 for intestinal ascariasis while females (120) suffered more than male(61) in biliary ascariasis ( ratio 2: 1). Total 231 surgery both elective and emergencies were done. Discussion: Most of the patients (52-81% ) were treated by endoscopic removal of worm from common bile duct. Some patients (15 - 31 %) were treated successfully by conserevative approach. Only a few patients needed open surgical procedure. No patient had died from biliary ascariasis and death from complications of intestinal ascariasis reduced from 20% to 4% over the last 6 years. Conclusion: There has been a reduced number of disease burden over the last few years from ascariatic and biliary ascariasis. DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19551

Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants with a prevalence of 1.5 to 4.0 per 1000 live births. It has been suggested that the incidence is increasing. USG is the most useful method for diagnosis supplanting physical examination and pyloromyotomy is the time honored treatment option. A retrospective review of the patients of IHPS admitted in the department of Pediatric Surgery, Chittagong Medical College Hospital (CMCH) Chittagong, Bangladesh from January 2008 to December 2012 was done. Help was also taken from yearly departmental audits of 2008 to 2012. Data were analyzed with regard to occurrence, seasonal variation, gender variation, presentation, diagnosis, treatment and outcome. Statistical analysis was performed by the chi-square test, and mean and percentage values were calculated. P

Identification and management of serious intra abdominal and associated injuries due to blunt mechanisms are challenging. This study aims to evaluate current approach to manage such patients in a leading teaching hospital of a low income country. Methods: This prospective study was carried out in the departments of General surgery and Paediatric surgery, Chittagong Medical College and Hospital; Chittagong; Bangladesh from July, 2001- June, 2002. Total 132 patients suffering from blunt abdominal trauma (BAT) were evaluated. Results: The majority of the trauma victims aged 30 years and below with male predominance. Road traffic accident (RTA) was the leading cause (57.57%). Sixty eight percent (68%) patients were brought to the hospital within 24 hours of injury. Abdominal pain was the commonest mode of presentation (83.33%). External signs of injury in abdomen were noticed in only 39% patients. The most important abdominal finding was features of peritonitis (generalized muscle guard/ rigidity 56% and localized 42%) and absence of bowel sound (73%). Plain X-ray abdomen (100%) and Ultrasonography (USG) were the principal imaging tool (46.87%). Extra abdominal associated injuries were found in 55% patients. Thirty four patient (26.56%) were managed non-operatively. Ileum injury was maximum (21.87%) and liver was the most frequently injured solid organ (14.06%). Wound infection (23.40%), wound dehiscence (17%) and anastomotic leakage (10.63%) were the complications related with laparotomy. Total 8 patients died (mortality 6.06%). Conclusion: Early detection of abdominal visceral injury by proper clinical evaluation and imaging is the key for successful management. The main danger is on delay, not always to the extent of injury, as most of the blunt abdominal trauma patients are amenable to surgical treatment. JCMCTA 2013 ; 24 (1): 35-40

Fetus- in- fetu is a rare abnormality secondary to the abnormal embryogenesis in a diamniotic, monochorionic pregnancy. It is a rare pathological condition and fewer than 200 cases have been reported in the literature. We are reporting a case in which a 15 year old girl presented with a painful lump in left upper abdomen. Preoperative imaging, exploration and macroscopic examination of the excised specimen revealed it a case of fetus- in - fetu. This case is unique in terms of age of presentation and mature fetus like external appearance. DOI: http://dx.doi.org/10.3329/jpsb.v2i1.15162 Journal of Paediatric Surgeons of Bangladesh (2011) Vol. 2 (1): 36-39

The published surgical literatures have referred only to females as having cloacal defects and the incidence in males is not well established. As during embryogenesis, both sexes have to pass through the stage of a cloaca, there is every chance of development of cloacal anomalies in males also. Here, we are presenting our experience of male cloacal malformations.We identified four cases of male cloaca by reviewing medical records of all anorectal malformation (ARM) patients treated at our institution in the past 19 years. Time of presentation, clinical, radiological, cystoscopic and operative findings, and outcomes were analysed.Out of 1,837 patients, we identified four cases (0.2 %) of male cloacal variants. All presented after 45 days (range 46 days to 28 years). Three of them had proximal hypospadias, two had a vaginal remnant and cystoscopic evaluation showed the length of the common channel ranged from 0.5 to 8 cm. One patient died of multiple anomalies and the other patients are doing well following reconstruction.None of the male cloacal patients presented in the neonatal period, proximal hypospadias was the common external genital abnormality and half of them had a vagina. Surgical outcome was satisfactory. The scarcity of reported cases of this group is a subject of further research.