Management of early appendicular lump in children - laparoscopic technique versus open surgery: a comparative study in low-middle income country perspective.

Background: In 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. Methods: This 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. Results: There 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 (p<0.01). The incidence of wound infection was significantly lower in the LA group than that in the OA group (6.7% in LA and 46.7% in OA; p<0.01). Children in the LA group had a shorter duration of hospital stay in comparison to the OA group [median (IQR) was 8 (5.75-11.25) days and 12 (7.75-18.00) days, respectively, in LA and OA groups; p=0.01]. Conclusion: The study findings suggest that LA is feasible and should replace OA in cases of early appendicular lump in children.

Colorectal carcinoma in first decade of life: our experience.

INTRODUCTION: Though the lifetime risk of colorectal carcinoma (CRC) in general population is 5-6 %, it is uncommon in pediatric age group. Here, we are reporting our experience of CRC in the first decade of life. METHODS: From January 2010 to December 2013, seven patients with histopathologically confirmed colorectal carcinoma were treated in the Department of Pediatric Surgery, Chittagong Medical College and hospital. Age, sex, presenting symptoms, location of the primary tumor, serum CEA level, treatment modalities and outcomes were evaluated. RESULTS: There were four male and three female patients and age ranged from 6.5 to 10.5 years. Rectum (3 patients) and rectosigmoid (2 patients) were the most common primary sites. Serum carcinoembryonic antigen level was obtained in six patients and in only one patient the level was raised markedly (137 ng/ml). Two patients of familial adenomatous polyposis had localized disease and others presented in an advanced stage. Histopathologically, poorly differentiated adenocarcinoma was noted in five patients with one signet ring cell type and well differentiated in rest of the two patients. Only one patient was surviving at the last follow up. CONCLUSION: Advanced stage at diagnosis, aggressive histologic subtype and poor survival are the hallmarks of pediatric CRC.

Cloacal malformation variants in male.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.