Delayed presentation of congenital rectal stenosis associated with Down's syndrome and hypothyroidism: Case report.

Rectal stenosis is a rare variety of rectal atresia. A membrane separates the rectum from the anal canal in the presence of a normal anus. We report a case of rectal stenosis associated with Down's syndrome and hypothyroidism in whom rectal stenosis was diagnosed at the age of 17 years.

Epidemiological characteristics of Hirschsprung's disease (HSCR): Results of a case series of fifty patients from Bangladesh.

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 challenges in diagnosis and gender assignment in disorders of sex development presenting to a pediatric surgical unit in a developing country: the role of laparoscopy and simple tests for gender identity.

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.

Bringing surgery to rural children: Chittagong, Bangladesh experience.

There is unequal access to surgical health care in underdeveloped countries such as Bangladesh. Bangladesh has a large young population, with 70 % of the population living in rural areas. All of the pediatric surgical services of the country are situated in major cities. We therefore organized an outreach service with the aim of providing surgical services to these rural children by utilizing the existing facilities of primary and secondary care centers. The program originated at the Department of Pediatric Surgery, Chittagong Medical College and Hospital in Sept 2008. The data presented here are from its 2008 beginning to Nov 2011. A yearly plan is sent to the Divisional Director of Health Services for Chittagong Division, who notifies all of the concerned district hospitals (DHs) and Upazila Health Complexes (UHCs). A member of the outreach team contacts each center via telephone 1 month prior to the visit to help organize it. Doctors at each participating hospital in which day surgery is possible are informed as to which commonly performed day surgeries are available, and they then select the appropriate patients to be examined at that visit. The local doctors are also advised to choose other pediatric surgical patients as outpatients. The local doctors perform the follow-up. If necessary, patients are referred to our department for further management. During the study period, we made 32 visits to 5 DHs and 10 UHCs. In all, 674 children were seen as outpatients, and 407 underwent surgery, of which inguinal hernia repair was the most common. There were no deaths. Outreach service is a good way to extend curative care to the grass-roots population.

Cystoscopic removal of leeches in the lower urinary tract: our experience.

INTRODUCTION: The purpose of this study is to describe the experience of managing leech infestation in lower urinary tract from a tropical country. MATERIALS AND METHODS: Medical records (January 2002 to December 2010) of children with history of leech infestation in the urinary system, admitted in the Department of Pediatric Surgery, Chittagong Medical College & Hospital, Chittagong, Bangladesh were reviewed. All patients underwent saline irrigation through urethral catheter. When saline irrigation failed, cystoscopic examination was done with removal of leeches by flexible graspers. Follow-up was done 2 weeks later. RESULT: The study included 117 patients. Age ranged from 4 to 12 years. Male and female ratio was 3.7:1. All patients had per urethral bleeding. 51 (43.6%) patients had suprapubic pain. All children underwent saline irrigation through urethral catheter. Spontaneous expulsion occurred after saline irrigation in 57 (48.7%) patients. The expelled leeches were alive in 11 cases; dead in 46 patients. Cystoscopic removal of leeches was done in 60 patients (51.3%). In the cystoscopic group, 54 of the removed leeches were dead and 6 were alive. CONCLUSION: Cystoscopic removal can be a useful technique for the removal of leeches from the urinary tract when saline irrigation fails.