Md. Kabirul Islam, Md. Shah Alam, Abdul Hanif, Md. Kamrul Hasan, Mahbubur Rahman
We report a case of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome in a 25 year old married lady. Though it is a congenital abnormality, she presented as primary infertility after 2 year of her marriage and was referred to us from a Gynaecologist. She had absent vagina, rudimentary uterus with no cervix. Her ovaries were severely hypoplastic. The anus was placed anteriorly and opened into the vulva. In spite of absence of her vagina, the lady somehow maintained her married life by doing intercourse through the anteriorly placed rectum. The vagina was made from the lower end of existing rectum which opened into the vulva. The proximal end of the rectum and left colon were pulled through the pelvis and opened into the perineum. It improved her quality of life. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19468
{"title":"Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome – A Case ReportRT","authors":"Md. Kabirul Islam, Md. Shah Alam, Abdul Hanif, Md. Kamrul Hasan, Mahbubur Rahman","doi":"10.3329/JPSB.V1I1.19468","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19468","url":null,"abstract":"We report a case of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome in a 25 year old married lady. Though it is a congenital abnormality, she presented as primary infertility after 2 year of her marriage and was referred to us from a Gynaecologist. She had absent vagina, rudimentary uterus with no cervix. Her ovaries were severely hypoplastic. The anus was placed anteriorly and opened into the vulva. In spite of absence of her vagina, the lady somehow maintained her married life by doing intercourse through the anteriorly placed rectum. The vagina was made from the lower end of existing rectum which opened into the vulva. The proximal end of the rectum and left colon were pulled through the pelvis and opened into the perineum. It improved her quality of life. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19468","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130529431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Hanif, K. Hasina, A. Hossain, S. Huda, M. K. Hassan, M. Alam, A. Z. Hossain
Purpose: In order to achieve the Millennium Development Goal (MDG) 4 target of a two-thirds reduction in under-five mortality from 1990 to 2015, major reductions are going to be required in neonatal mortality. Congenital anomalies have become the fourth cause of neonatal deaths and most of these are curable. Dhaka Medical College Hospital is the largest public hospital of the country and serving the poor and lower middle class people where surgery and medical facilities are mostly free of cost. This study was done to see the types of neonatal surgical patients admitted in this hospital and their management out come with limited facilities and find out the ways to improve the scenario to contribute in achieving the MDG. Materials & Methods: This was a retrospective study done over a period of 8 years from July 2001 to June 2009 and carried out in the Department of Pediatric Surgery, Dhaka Medical College Hospital, Dhaka. A total of 650 neonates were admitted during this period and it was the 17.99% of total number of 3612 pediatric surgical admission upto12 years of age. Data was collected from hospital records and analyzed retrospectively. Results: Out of these 650 neonates 533(80%) were admitted for Neonatal Intestinal Obstruction (NIO) and omphalocele were 59 (9.07%), ectopia vesicae are 14 (2.15% ), posterior urethral valves (PUV) were 19 (2.92%), gastroschisis were 7 (1.07%) , congenital diaphragmatic hernia (CDH) were 16 (2.46%),Tracheo-oesophageal fistula 1 (0.15%), and Conjoint twin 1 (0.15%). The most common cause of NIO was anorectal malformation (ARM) and 194 (66.43%) patients have high variety and 98(33.56%) patients have low variety ARM. Next was Hirschsprung disease and 137 (21.07%) neonates presented with this. Thirty-Five (5.38%) patients presented with septicemia and 40 (6.15%) presented with intestinal atresia, 20 (3.07%) neonates had meconium ileus and 9 (1.38%) patients presented with volvulus neonatorum. Five hundred and Fifty-nine patients (86.00%) were managed surgically. Out of 650 patients, 69 died, so mortality was 10.61% and before surgery 2.76% and after surgery was 7.84%. Conclusion: Pediatric surgeons by their skill and teamwork greatly improved the neonatal surgical service and contributing significantly in reducing infant mortality rate and to achieve MDG 4. But to improve further, neonatal intensive care unit (NICU) and other support systems are essential as well as support from UNICEF and World Health Organization (WHO) to include pediatric surgery and surgeons in their activities especially in developing countries. Due to socio-political and economic reasons of the developing countries the roll of pediatric surgeons are multidimensional. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19463
{"title":"NEONATAL SURGERY: DEMAND AND SURVIVAL BOTH ARE INCREASING: EIGHT YEARS EXPERIENCE IN DHAKA MEDICAL COLLEGE HOSPITAL, BANGLADESH","authors":"A. Hanif, K. Hasina, A. Hossain, S. Huda, M. K. Hassan, M. Alam, A. Z. Hossain","doi":"10.3329/JPSB.V1I1.19463","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19463","url":null,"abstract":"Purpose: In order to achieve the Millennium Development Goal (MDG) 4 target of a two-thirds reduction in under-five mortality from 1990 to 2015, major reductions are going to be required in neonatal mortality. Congenital anomalies have become the fourth cause of neonatal deaths and most of these are curable. Dhaka Medical College Hospital is the largest public hospital of the country and serving the poor and lower middle class people where surgery and medical facilities are mostly free of cost. This study was done to see the types of neonatal surgical patients admitted in this hospital and their management out come with limited facilities and find out the ways to improve the scenario to contribute in achieving the MDG. Materials & Methods: This was a retrospective study done over a period of 8 years from July 2001 to June 2009 and carried out in the Department of Pediatric Surgery, Dhaka Medical College Hospital, Dhaka. A total of 650 neonates were admitted during this period and it was the 17.99% of total number of 3612 pediatric surgical admission upto12 years of age. Data was collected from hospital records and analyzed retrospectively. Results: Out of these 650 neonates 533(80%) were admitted for Neonatal Intestinal Obstruction (NIO) and omphalocele were 59 (9.07%), ectopia vesicae are 14 (2.15% ), posterior urethral valves (PUV) were 19 (2.92%), gastroschisis were 7 (1.07%) , congenital diaphragmatic hernia (CDH) were 16 (2.46%),Tracheo-oesophageal fistula 1 (0.15%), and Conjoint twin 1 (0.15%). The most common cause of NIO was anorectal malformation (ARM) and 194 (66.43%) patients have high variety and 98(33.56%) patients have low variety ARM. Next was Hirschsprung disease and 137 (21.07%) neonates presented with this. Thirty-Five (5.38%) patients presented with septicemia and 40 (6.15%) presented with intestinal atresia, 20 (3.07%) neonates had meconium ileus and 9 (1.38%) patients presented with volvulus neonatorum. Five hundred and Fifty-nine patients (86.00%) were managed surgically. Out of 650 patients, 69 died, so mortality was 10.61% and before surgery 2.76% and after surgery was 7.84%. Conclusion: Pediatric surgeons by their skill and teamwork greatly improved the neonatal surgical service and contributing significantly in reducing infant mortality rate and to achieve MDG 4. But to improve further, neonatal intensive care unit (NICU) and other support systems are essential as well as support from UNICEF and World Health Organization (WHO) to include pediatric surgery and surgeons in their activities especially in developing countries. Due to socio-political and economic reasons of the developing countries the roll of pediatric surgeons are multidimensional. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19463","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116709733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The concept of infantile obstructive cholangiopathy started in 1974 by Landing and remained till early 1980s. However, the concept has not been used much since then as nothing new has developed over the last 40 years sufficient enough to change the course of the disease or identify its etiology. This review article is an attempt to consolidate evidence on review of literature pointing towards a common etiopathological process leading to the spectrum of anomalies constituting neonatal cholestasis. The importance of early referral of any case with neonatal jaundice in a full term neonate, preferably at 2 weeks age is highlighted. This will help to identify and treat more cases within the correctable range and prevent the disease from progressing to a life threatening situation especially in developing countries where the resources for liver transplantation are meagre. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19465
{"title":"Revival of Landing's Concept of Infantile Obstructive Cholangiopathy – A Plea to Hand Over the 2 Week Old Jaundiced Full Term Neonate to the Surgeon!","authors":"Shilpa Sharma, D. Gupta","doi":"10.3329/JPSB.V1I1.19465","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19465","url":null,"abstract":"The concept of infantile obstructive cholangiopathy started in 1974 by Landing and remained till early 1980s. However, the concept has not been used much since then as nothing new has developed over the last 40 years sufficient enough to change the course of the disease or identify its etiology. This review article is an attempt to consolidate evidence on review of literature pointing towards a common etiopathological process leading to the spectrum of anomalies constituting neonatal cholestasis. The importance of early referral of any case with neonatal jaundice in a full term neonate, preferably at 2 weeks age is highlighted. This will help to identify and treat more cases within the correctable range and prevent the disease from progressing to a life threatening situation especially in developing countries where the resources for liver transplantation are meagre. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19465","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129765305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Individuals having ambiguous genitalia have been described since antiquity. But their association with the occurrence of any cancer is not well established. Here we report a case of perineal rhabdomyosarcoma associated with ambiguous genitalia. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19473
{"title":"Ambiguous Genitalia with Perineal Rhabdomyosarcoma: A Case Report","authors":"T. Banu, T. Chowdhury, M. Hoque","doi":"10.3329/JPSB.V1I1.19473","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19473","url":null,"abstract":"Individuals having ambiguous genitalia have been described since antiquity. But their association with the occurrence of any cancer is not well established. Here we report a case of perineal rhabdomyosarcoma associated with ambiguous genitalia. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19473","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122760590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Hanif, K. Hasina, Md. Kamrul Hassan, S. Talukder, Md. Kabirul Islam
We are reporting two cases in a family, Elder sister was 10 year old & younger one was 8 years old. Both of them were presented to us with the features of gastric outlet obstruction. Further examination revealed that there is pigmentation on their mucocutanious junction of lips. Their father also had pigmentation on the muco cutanious junction of lips. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19471
{"title":"Two Case Reports of Peutz Jegher's Syndrome","authors":"A. Hanif, K. Hasina, Md. Kamrul Hassan, S. Talukder, Md. Kabirul Islam","doi":"10.3329/JPSB.V1I1.19471","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19471","url":null,"abstract":"We are reporting two cases in a family, Elder sister was 10 year old & younger one was 8 years old. Both of them were presented to us with the features of gastric outlet obstruction. Further examination revealed that there is pigmentation on their mucocutanious junction of lips. Their father also had pigmentation on the muco cutanious junction of lips. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19471","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123787034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Md. Akbar Hossain Bhuyian, Md. Ashraf Ul Huq, M. Kabir, S. H. Chowdhury
For decades, vesical stone has been removed by traditional cystolithotomy. It gives a big scar and adds considerable morbidity to the patient. Here we tried a new indigenous technique to remove the bladder stone with a laparoscopic grasper . The aim was to minimize the morbidity and an almost invisible scar to the patient. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19469
{"title":"Endoscopic Removal of Vesical Calculus Through Suprapubic Route: A Case Report","authors":"Md. Akbar Hossain Bhuyian, Md. Ashraf Ul Huq, M. Kabir, S. H. Chowdhury","doi":"10.3329/JPSB.V1I1.19469","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19469","url":null,"abstract":"For decades, vesical stone has been removed by traditional cystolithotomy. It gives a big scar and adds considerable morbidity to the patient. Here we tried a new indigenous technique to remove the bladder stone with a laparoscopic grasper . The aim was to minimize the morbidity and an almost invisible scar to the patient. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19469","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132021002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pelvi-ureteric junction obstruction (PUJO) is among the most common causes of congeni tal urinary obstruction. With the introduction of antenatal sonography and its universal acceptance a larger number of cases of asymptomatic hydronephrosis are picked up early in the natural history of the disease. However, this hydronephrosis tends to improve or resolve spontaneously in a large number of cases and has forced the treating personnel to alter their understanding of the disease process and redefine the indications for surgical management. In today’s scenario, we are equipped with a lot many options directed towards the management of PUJ obstruction. The spectrum of these options ranges from watchful waiting at the conservative end to balloon dilatation, endopyelotomy and pyeloplasty which could be open, laparoscopic or robotic. Then we have certain exclusively salvage options like ureterocalicostomy or even nephroureterectomy at the extreme end of the spectrum. However, there are a lot many controversies that surround the management of PUJO. The main indication for performing pyeloplasty include; a symptomatic child with pain, sepsis, lump and deteriorating renal functions. A frusemide induced renal scan showing not only the dilatation but also the retention of the isotope even after 4 hours and an obstructive pattern of the drainage curve (in absence
{"title":"Postoperative Results Following Surgery for PUJO in Children","authors":"P. Goel, D. Gupta","doi":"10.3329/JPSB.V1I1.19466","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19466","url":null,"abstract":"Pelvi-ureteric junction obstruction (PUJO) is among the most common causes of congeni tal urinary obstruction. With the introduction of antenatal sonography and its universal acceptance a larger number of cases of asymptomatic hydronephrosis are picked up early in the natural history of the disease. However, this hydronephrosis tends to improve or resolve spontaneously in a large number of cases and has forced the treating personnel to alter their understanding of the disease process and redefine the indications for surgical management. In today’s scenario, we are equipped with a lot many options directed towards the management of PUJ obstruction. The spectrum of these options ranges from watchful waiting at the conservative end to balloon dilatation, endopyelotomy and pyeloplasty which could be open, laparoscopic or robotic. Then we have certain exclusively salvage options like ureterocalicostomy or even nephroureterectomy at the extreme end of the spectrum. However, there are a lot many controversies that surround the management of PUJO. The main indication for performing pyeloplasty include; a symptomatic child with pain, sepsis, lump and deteriorating renal functions. A frusemide induced renal scan showing not only the dilatation but also the retention of the isotope even after 4 hours and an obstructive pattern of the drainage curve (in absence","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127172798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gazi Md. Zakir Hossain, Mofizur Rahman, Rashedul Hasan
Objectives: To present our initial experience with laparoscopic pyeloplasty and to evaluate the safety and short-term outcome of this technique. Methods: Five patients underwent laparoscopic dismembered pyeloplasty for the management of ureteropelvic junction obstruction (UPJO) at Chittagong between July’2007 to Mach’2009. Patient age at surgery was 8–22 years. There were two boys and three girls. All had unilateral UPJO with a normal contralateral kidney. We used 5 mm instruments for grasping, blunt dissection, incising and suturing to facilitate safe and precise surgery. The outcome was measured by the operative time, perioperative complications and resolution of obstruction and symptoms. Results: Mean operative time was 195 minutes (range 175–220 min). No major perioperative complications occurred in any cases. Overall, successful resolution of UPJO was observed in all the five cases evident by renogram. Conclusions: Laparoscopic pyeloplasty represents a safe and effective option in the surgical treatment of UPJO. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19448
{"title":"Laparoscopic Pyeloplasty - Our Early Experience","authors":"Gazi Md. Zakir Hossain, Mofizur Rahman, Rashedul Hasan","doi":"10.3329/JPSB.V1I1.19448","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19448","url":null,"abstract":"Objectives: To present our initial experience with laparoscopic pyeloplasty and to evaluate the safety and short-term outcome of this technique. Methods: Five patients underwent laparoscopic dismembered pyeloplasty for the management of ureteropelvic junction obstruction (UPJO) at Chittagong between July’2007 to Mach’2009. Patient age at surgery was 8–22 years. There were two boys and three girls. All had unilateral UPJO with a normal contralateral kidney. We used 5 mm instruments for grasping, blunt dissection, incising and suturing to facilitate safe and precise surgery. The outcome was measured by the operative time, perioperative complications and resolution of obstruction and symptoms. Results: Mean operative time was 195 minutes (range 175–220 min). No major perioperative complications occurred in any cases. Overall, successful resolution of UPJO was observed in all the five cases evident by renogram. Conclusions: Laparoscopic pyeloplasty represents a safe and effective option in the surgical treatment of UPJO. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19448","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126040694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Purpose : As minimal invasive surgery,laparoscopy assisted anorectal pull-through has been reported with new devices. However, it is not easy to create an accurate pull-through canal (PTC), because of the narrow space between the urethra and puborectal sling. The authors describe a new method employing perineal ultrasonography. Methods: The rectourethral prostatic fistula was dissected laparoscopically. Externally, electrostimulation identified the center of the muscle contraction, over which a 1.2 cm of skin incision was made, and the lower part of PTC was created by hemostat forceps guided by electrostimulation. An ultrasonographic probe applied to the perineum demonstrated the urethra, and the forceps was advanced behind the urethra into the pelvic cavity using the ultrasonographic guide. Anorectal pullthrough was performed following dilatation of the PTC with dilators. Results: The authors applied this procedure in 9 cases of male high anomalies. Surgical damages to the urethra, the levator and vertical muscles were not encountered. Postoperative MRI demonstrated a good location of the rectum, and fluoroscopic study showed a good anterior angulation and intact contraction and relaxation of those muscles. Conclusion: The combination of laparoscopic dissection, pinpointing the center of anal sphincter by electrostimulation and identification of the urethra by ultrasonographic images from the perineum facilitated creation of appropriate PTC in the muscle complex. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19447
{"title":"Laparoscopically Assisted Anorectoplasty Using Perineal Ultrasonographic Guide","authors":"A. Kubota","doi":"10.3329/JPSB.V1I1.19447","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19447","url":null,"abstract":"Background/Purpose : As minimal invasive surgery,laparoscopy assisted anorectal pull-through has been reported with new devices. However, it is not easy to create an accurate pull-through canal (PTC), because of the narrow space between the urethra and puborectal sling. The authors describe a new method employing perineal ultrasonography. Methods: The rectourethral prostatic fistula was dissected laparoscopically. Externally, electrostimulation identified the center of the muscle contraction, over which a 1.2 cm of skin incision was made, and the lower part of PTC was created by hemostat forceps guided by electrostimulation. An ultrasonographic probe applied to the perineum demonstrated the urethra, and the forceps was advanced behind the urethra into the pelvic cavity using the ultrasonographic guide. Anorectal pullthrough was performed following dilatation of the PTC with dilators. Results: The authors applied this procedure in 9 cases of male high anomalies. Surgical damages to the urethra, the levator and vertical muscles were not encountered. Postoperative MRI demonstrated a good location of the rectum, and fluoroscopic study showed a good anterior angulation and intact contraction and relaxation of those muscles. Conclusion: The combination of laparoscopic dissection, pinpointing the center of anal sphincter by electrostimulation and identification of the urethra by ultrasonographic images from the perineum facilitated creation of appropriate PTC in the muscle complex. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19447","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130097870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sharif Md. Noman Khaled Chowdhury, A. Hanif, K. T. Islam, Ehsan Mahmud, S. S. Hossain
Objective: The authors present their experiences in the management of xtradural haematoma in children which involved an aggressive diagnostic approach, prompt surgical evacuation of the haematoma results in an excellent outcome. Subjects and methods: 138 consecutive patients with cranial extradural haematoma who underwent surgery in department of Neurosurgery from 1st January 2006 to 31st July 2009 were included in this prospective study. Each of the patients were evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome. Results: Out of 138 cases 72.47 % were boys and 13.78 % were girls. The boys and girls ratio was 2.64: 1. Age ranges from 1.8 to 15 years with a mean age of 9.49 years. Most of the victims are in first half of second decade of life and closely followed by the 5-10 years age group. The most common mode of injury was fall 40.58 %, (n = 56) followed by Road traffic Accident (RTA) 31.89 %, (n = 44) .The Most common clinical presentation was altered sensorium 59.43 %, (n = 82), followed by Headache / Vomiting 56.53 %, (n = 78). Conclusion: Extradural haematoma in children is a recognized and one of the most rewarding neurosurgical emergencies. It must be recognized and evacuate early to prevent potential mortality and morbidity. Many factors affect the outcome of extradural haematoma surgery. In addition to influence of presence cranial fractures, associated brain lesions and pre-operative neurological condition of patient, duration of time interval between onset of coma and surgical intervention, morbidity and mortality have also been shown to be affected by age – with better prognosis in patients under 10 years of age. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19450
{"title":"Extradural Haematoma in Children: Surgical Experiences and Prospective Analysis of 138 Cases","authors":"Sharif Md. Noman Khaled Chowdhury, A. Hanif, K. T. Islam, Ehsan Mahmud, S. S. Hossain","doi":"10.3329/JPSB.V1I1.19450","DOIUrl":"https://doi.org/10.3329/JPSB.V1I1.19450","url":null,"abstract":"Objective: The authors present their experiences in the management of xtradural haematoma in children which involved an aggressive diagnostic approach, prompt surgical evacuation of the haematoma results in an excellent outcome. Subjects and methods: 138 consecutive patients with cranial extradural haematoma who underwent surgery in department of Neurosurgery from 1st January 2006 to 31st July 2009 were included in this prospective study. Each of the patients were evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome. Results: Out of 138 cases 72.47 % were boys and 13.78 % were girls. The boys and girls ratio was 2.64: 1. Age ranges from 1.8 to 15 years with a mean age of 9.49 years. Most of the victims are in first half of second decade of life and closely followed by the 5-10 years age group. The most common mode of injury was fall 40.58 %, (n = 56) followed by Road traffic Accident (RTA) 31.89 %, (n = 44) .The Most common clinical presentation was altered sensorium 59.43 %, (n = 82), followed by Headache / Vomiting 56.53 %, (n = 78). Conclusion: Extradural haematoma in children is a recognized and one of the most rewarding neurosurgical emergencies. It must be recognized and evacuate early to prevent potential mortality and morbidity. Many factors affect the outcome of extradural haematoma surgery. In addition to influence of presence cranial fractures, associated brain lesions and pre-operative neurological condition of patient, duration of time interval between onset of coma and surgical intervention, morbidity and mortality have also been shown to be affected by age – with better prognosis in patients under 10 years of age. DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19450","PeriodicalId":137868,"journal":{"name":"Journal of Paediatric Surgeons of Bangladesh","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125194262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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