MULTIPLE SYNCHRONOUS SMALL BOWEL ADENOCARCINOMAS IN A CASE OF BOWEL OBSTRUCTION DUE TO FAECALOMAS SECONDARY TO MULTIPLE STRICTURES - A DIAGNOSTIC SURPRISE

Small bowel adenocarcinoma(SBA)is a rare neoplasm presenting usually in elderly patients as a single tumour. Multiple synchronous SBA is unique and difficult to diagnose due to non-specific presentations.Faecalomas have been described in association with Hirschsprungs disease, psychiatric patients, Chagas disease, both inflammatory and neoplastic conditions, and in patients suffering with chronic constipation.We herein report a case of multiple faecalomas secondary to multiple small bowel strictures leading to small bowel obstruction in a patient with previous history of pulmonary tuberculosis.Thepatient was successfully treated surgically. The strictures on histopathology turned out to be low grade adenocarcinoma. Multiple synchronous SBA as well as multiple fecalomas are individually rare entities, and their combined occurrence is even rarer.

“Bowel Management” program for children with congenital malformations and neurogenic bowel after surgery

BACKGROUND: After the surgical treatment of children for anorectal malformations, spinal pathology, and Hirschsprungs disease, their quality of life is significantly reduced due to fecal incontinence. For patients with persistent defecation disorders, the Bowel Management program is offered. AIM: This study analyzes the Bowel Management program implemented in the clinic. MATERIALS AND METHODS: A prospective analysis of the program used in children after surgical correction of malformations was conducted. The program comprised the following components: lectures for patients/parents, hospitalization, irrigography with water-soluble contrast, teaching patients/parents about cleansing enemas, keeping a bowel movement diary, plain abdominal X-ray, changing the recipe for enema solution, monitoring the effectiveness, and correcting recommendations. RESULTS: A total of 66 children from 1.5 to 17 years old were treated. Three groups were identified: (I) anorectal malformations (n = 26), (II) spinal pathology (n = 30), and (III) Hirschsprungs disease (n = 10). The results were considered satisfactory if the bowel cleansing procedure was painless for the child and did not cause stress reactions; the parents were satisfied with the result of the prescribed program if after the enema a sufficient amount of stool was removed within 45 minutes, there were no episodes of defecation during the day. With the help of the Rome IV revision criteria, fecal incontinence was noted in all cases against the background of stool retention. In 11 (16.7%), there was no fecal incontinence even in cases of prolonged stool retention. A correlation was found between high lesions (in the lumbar spine) in spinal hernias with the absence of fecal incontinence with prolonged stool retention compared with the low sacral localization of the hernia. In group I, 91.7% had spinal cord fixation. In group II, 86.7% had it, and none were present in group III. The effectiveness of the program was 83.3%. CONCLUSION: The Bowel Management is easy to use and effective in 83% of patients. It can be recommended for the rehabilitation of children with defecation disorders, fecal incontinence after surgical correction of congenital malformations (anorectal malformations, spinal pathology and Hirschsprung's disease).

Death of Paediatric Surgical Patients in NICU of CMH, Dhaka

Introduction: The purpose of this study was to explore clinical characteristics and primary surgical diagnosis associated with in-hospital death in pediatric surgical patients admitted to the neonatal intensive care unit (NICU) of Combined Miilitary Hospital (CMH), Dhaka. Aim: To explore the clinical factors associated with in-hospital death in paediatric surgical patients admitted to the NICU over a period of 4 years in CMH Dhaka. Methods: This retrospective study includes all patients admitted to NICU of CMH Dhaka for paediatric surgical diseases between July 2013 and December 2017. Data analyzed to asses factors associated with in-hospital death. Results: A total of 72 cases were included and 61(84.7%) underwent surgery. Fifteen patients (20.8%) died while hospitalized in the NICU. The 5 most common surgical diagnoses were Anorectal Malformation, Intestinal Atresia/ Stenosis, Hirschsprungs disease, Intestinal perforation and meconium related obstruction. Esophageal atresia, necrotizing entero-colitis cases had the highest mortality rate. Conclusion: This study describes EA, NEC, Low birth weight (LBW), prematurity and caesarean delivery associated with significant number of deaths of surgical patients in NICU. Novel approaches for these conditions are required to improve the survival. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 26-28

Diagnostic problems of hirschsprung’s disease in neonates: clinical examples

Hirschsprungs disease usually manifests from the first days of life and is diagnosed in the newborn period. In some patients Hirschsprungs disease cant be diagnosed in the newborn period because of different forms of disease and clinical features. From 2008 to 2019 75 patients with Hirschsprungs disease were operated in the City Childrens Hospital No. 1. 21 patients had delayed diagnosis. 11 newborns didnt have very clear clinical symptoms, intestinal obstruction disappeared after decompression. 2 patients with associated chromosomal disorders were diagnosed with Hirschsprungs disease later because of. In some of older patients disease manifested with severe constipations. Also, we presented some clinical cases of major diagnostic errors in patients with Hirschsprungs disease. Conclusion. Diagnostic errors in patients with Hirschsprungs disease are associated with the lack of alertness of neonatologists and inadequate interpretation of clinical manifestations and X-ray study. For many years these children can be treated by different specialists before having surgical consult.

Prolapse of colostomy in children; characteristics, predisposing factors and preventive measures in four health facilities in Southern Nigeria

IntroductionThe protrusion of the bowel through the stoma in a colostomy is one of thecommon complications of colostomy. Though it rarely gets secondarilycomplicated, it causes significant morbidity by virtue of the increasing bowel massoutside. The predisposing factors and progression in children are not well reportedin our region.AimTo evaluate the characteristics and occurrence of colostomy prolapse in childrenand to identify any factors predisposing to this complication in our practice.Patients and MethodsThis is a five year prospective study of paediatric colostomy in the authors’ servicebetween March 2013 and April 2018. Patients were categorized into those thatdeveloped prolapse (Pro group), and those that did not (Non Pro group). Othervariables investigated were gender, age at creation of colostomy, indication, type,and duration of colostomy, presence of raised intra abdominal pressure. Statisticswas with SPSS 21.ResultsTwenty seven (28.4%) of 95 children who had colostomy during the study perioddeveloped prolapsed. Prolapse occurred more in patients who had their colostomyat a relatively older age. There was a positive association of prolapse andHirschsprungs disease but no association with the gender or duration of stoma.ConclusionColostomy prolapse is a common complication seen in our practice. Cases ofneglected Hirschsprungs disease in children have increased risk of thiscomplication. Extra caution is therefore needed in forming colostomy in this groupof patients.