Neonatal Intestinal Obstruction Management: Ten Years Experience in Combined Military Hospital, Dhaka

Introduction: Neonatal intestinal obstruction is the commonest surgical emergency in neonatal period. The outcome in neonatal intestinal obstruction has improved dramatically due to the improvements in diagnostic facilities and neonatal intensive care, and surgical advances. Objective: To detect the pattern of neonatal intestinal obstruction, to find out their cause and outcome after management. Materials and Methods: This was a 10 years retrospective review of all children aged 28 days and below, managed for intestinal obstruction between March 2006 and February 2016 at the Pediatric Surgical Division of Combined Military Hospital, Dhaka. Patients who were presented with septic shock, pneumonia, very low birth weight and extreme prematurity, Anorectal malformation were excluded from the study. Result: Out of 196 patients, male patients were 135(68.87%), female 61(31.12%) and male to female ratio was 2.2:1. Most common cause of intestinal obstruction was Intestinal atresia 55(28.08%) followed by Hirschsprung disease 45(22.93%), Meconium ileus 43(21%), Malrotation of gut 23(11.73%), duodenal atresia 12 (6.12%), gastroschisis 10(5.10%) and other case 8(4.01%). Majority of neonates 158(80.61%) presented within 1st week of life and survival rate was 83.16%. Mortality in preterm was much higher 19(70.35%) than in term newborns 21(12.42%). Conclusion: Dedicated delicate neonatal surgical care, early diagnosis and intervention are the crucial factors in improving operative outcome in neonatal surgery. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 24-28

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Neonatal intestinal obstruction : patterns, problems and outcome

Bangladesh Medical Journal Khulna ◽

10.3329/bmjk.v45i1-2.13638 ◽

2013 ◽

Vol 45 (1-2) ◽

pp. 6-10 ◽

Cited By ~ 1

Author(s):

Amar Kumar Saha ◽

Md Barkot Ali ◽

Sunil Kumar Biswas ◽

HM Zafor Sharif ◽

Anwerul Azim

Keyword(s):

Surgical Treatment ◽

Intestinal Obstruction ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Intestinal Atresia ◽

Postoperative Management ◽

Meconium Ileus ◽

College Hospital ◽

Female Ratio ◽

Neonatal Intestinal Obstruction

Neonatal intestinal obstruction is the most common surgical emergency in newborn. Ideally neonatal surgery should be done in an organized neonatal surgical unit. This study was done mostly in general surgical setup in Khulna without any facility of NICU and TPN. The aim of this study was to detect the patterns of neonatal intestinal obstruction and to find out the problems and outcome of surgical treatment. This retrospective study was done between January 2008 and December 2010, in Khulna Medical College Hospital, Khulna Shishu Hospital and a private clinic in Khulna. A total of 205 neonates with intestinal obstruction were treated surgically. Babies of both sexes up to 28 days of age were included in this study. Common causes of neonatal intestinal obstruction were anorectal malformation (ARM), intestinal atresia, Hirschsprung's disease (HD), meconium ileus and malrotation of midgut. Male-female ratio was 1.6:1 and about 13% was premature. Out of 205 neonates, there were ARM-73, HD-47, meconium ileus-38, intestinal atresia-29, malrotation-13 and others-5. Total 172 (84%) survived. Those were ARM (94%), Hirschsprung's disease (91%), meconium ileus (79%), intestinal atresia (55%), malrotation of gut (85%) and others (40%). Overall mortality after initial surgical treatment was 16%. Prognosis of surgical treatment depends on early intervention, expert anaesthesia, associated anomaly and complication, gentle handling of delicate tissue and intensive postoperative management. Medical practitioners were the first attending physician in most instances. So both physicians and surgeons have a contributing role in reducing mortality. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13638 Bang Med J (Khulna) 2012; 45 : 6-10

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Etiology and Treatment Outcome of Neona tal Intestinal Obstruction in a Tertiary Hospital

TAJ Journal of Teachers Association ◽

10.3329/taj.v22i2.37723 ◽

2009 ◽

Vol 22 (2) ◽

pp. 198-203

Author(s):

SS Islam ◽

MA Nowshad ◽

A Jator ◽

I Faisal ◽

M Ahmed

Keyword(s):

Intestinal Obstruction ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Intestinal Atresia ◽

Paediatric Surgery ◽

College Hospital ◽

Female Ratio ◽

Neonatal Intestinal Obstruction ◽

Surgery Department

A prospective study was conducted on 54 cases of neonatal intestinal obstruction, admitted in Paediatric surgery department of Rajshahi Medical College Hospital during the period from January 2008 to December 2008, a period of 12 months. The objective of the study was to find out etiological aspect and outcome of admitted patient with neonatal intestinal obstruction. The patient constituted 33.7% of total neonatal admission in Paediatric surgery department during the study period. The male: female ratio was 1.4:1 with age ranging from 1 to 28 days. Birth weight of most of the patients was above 2 kg. Most of the patients came from poor and average family. Patients from poor family are slightly ahead. Plain x-ray abdomen was done in all cases in our study. Contrast radiography performed in selected cases. Ultrasound scan done to in selective case to rule out IHPS. No rectal biopsy was taken in case of suspected Hirschsprung's disease. The causes of neonatal intestinal obstruction were in order of frequency-Hirschsprung's disease (45.2%), Intestinal atresia (24.5%), malrotation (9.4%), bands & adhesion (5.6%), meconium ileus (5.6%), volvulus neonatarum (5.6%), meconium plug syndrome (1.8%), unknown (3.7%). 50 patients were treated operatively. 28.3% cases developed complications. Most of the complications were related to colostomy and sepsis. Overall mortality was 20.8%. Mortality was maximum in intestinal atresia. Every patient was advised to come for follow up at the time of discharge but most of the people did not report. In the study only 17 (32.1%) patient came for follow up as per advice.TAJ 2009; 22(1): 198-203

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Closed Gastroschisis

Journal of Neonatal Surgery ◽

10.21699/jns.v6i3.599 ◽

2017 ◽

Vol 6 (3) ◽

pp. 61 ◽

Cited By ~ 5

Author(s):

Mohammed Abdel-Latif ◽

Mohamed Hisham Soliman ◽

Khaled Mohaned El-Asmar ◽

Mohamed Abdel-Sattar ◽

Ibrahim M Abdelraheem ◽

...

Keyword(s):

Intestinal Obstruction ◽

Short Bowel Syndrome ◽

Intestinal Atresia ◽

Rare Entity ◽

Short Bowel ◽

Neonatal Intestinal Obstruction

Closed gastroschisis is a rare entity usually associated with intestinal atresia and short bowel syndrome. We report two cases of closed gastroschisis presenting with neonatal intestinal obstruction and para-umbilical evisceration without an abdominal defect.

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Severe Cutaneous Adverse Drug Reactions in Bangladesh: A Review in a Tertiary Level Hospital

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v12i2.41098 ◽

2016 ◽

Vol 12 (2) ◽

pp. 71-75

Author(s):

Md Niamul Gani Chowdhury ◽

Mohammad Enamul Hoque ◽

Md Abdul Latif Khan ◽

Md Shirajul Islam Khan

Keyword(s):

Adverse Drug Reactions ◽

Armed Forces ◽

Stevens Johnson Syndrome ◽

Military Hospital ◽

Case Report Form ◽

Drug Reactions ◽

Female Ratio ◽

Medical College ◽

Johnson Syndrome ◽

Systemic Symptoms

Introduction: The Severe Cutaneous Adverse Drug Reactions (SCADRs) are rare but life-threatening as these encompass drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and acute generalized exanthematous pustulosis (AGEP). Objective: To estimate the incidence of SCADRs and to find out the cause in Bangladesh. Materials and Methods: 50 patients with SCADRs were studied over a period of 1 year from January 2015 to December 2015 in the Department of Dermatology, Combined Military Hospital, Dhaka. Data were collected from the informant and recorded in structured Case Report Form. Quantitative data were expressed as mean and standard deviation and qualitative data as frequency and percentage. Results: Clinical diagnosis of the study subjects recognized 46.0% cases as SJS, 28(19.0%) as TEN, 16.0% as DRESS and 10.0% as AGEP. The maximum incidence (46%) was seen in the age group of 31-50 years; mean age of the patient was 37.42+5.3 years. Male and female ratio was 2.84:1. Anticonvulsant group of drugs could give rise to maximum incidence of SCADRs. Carbamazepine was responsible in 22.0% cases of SCADRs, followed by Phenytoin in 16.0% patients and Phenobarbital in 14.0% cases. Conclusion: SCADRs were seen mostly with the anticonvulsant drugs belonging to Carbamazepine and Phenytoin group. SCADRs deserve continuous monitoring to plan preventive strategies. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 71-75

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Congenital Neonatal Intestinal Obstruction: Retrospective Analysis at Tertiary Care Hospital

Journal of Neonatal Surgery ◽

10.21699/jns.v5i4.393 ◽

2016 ◽

Vol 5 (4) ◽

pp. 49 ◽

Cited By ~ 3

Author(s):

Vijay Singh ◽

Manish Pathak

Keyword(s):

Intestinal Obstruction ◽

Clinical Presentation ◽

Tertiary Care ◽

Intestinal Atresia ◽

Duodenal Atresia ◽

Care Hospital ◽

Abdominal Radiography ◽

Colonic Atresia ◽

Neonatal Intestinal Obstruction ◽

Overall Mortality

Background: The purpose of this study is to analyze the etiology, clinical presentation and outcome of neonatal intestinal obstruction at our institute.Materials and Methods: The medical record of all the patients, presented with intestinal obstruction in neonatal period during 2014 and 2015 was reviewed retrospectively for etiology, clinical features, investigations, management, and outcome.Results: Out of total 53 cases of neonatal intestinal obstruction, 27 were of intestinal atresia (9 cases (17%) were of duodenal atresia, 7 (13%) were of jejunal atresia and 8 (13%) were ileal atresias and 3 cases were found with colonic atresia); 7 were malrotation, 17 were Hirschsprung’s disease (HD). All the patients were investigated with abdominal radiography and sonography. All patients were managed surgically. Overall mortality was 10/53 (18.8%). Out of 27 cases of atresia, 9 patients died (33% mortality). Septicemia was the cause of death in 7 patients (58.3%). Anastomotic leak was present in one mortality case.Conclusion: The most common cause of neonatal intestinal obstruction is atresia. Duodenal atresia was the most common atresia in our study followed by ileal atresia. Postoperative complications like septicemia led to most of deaths in our series. Septicemia, wound infection, hypothermia, prematurity need special attention for survival of neonates.

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Patterns of Neonatal Admission and Outcome in Neonatal Intensive Care Unit of a Tertiary Care Hospital

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i2.41376 ◽

2019 ◽

Vol 13 (2) ◽

pp. 49-53

Author(s):

Jesmin Sultana ◽

Nure Ishrat Nazme ◽

Nurun Nahar Fatema Begum

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Birth Asphyxia ◽

Military Hospital ◽

Care Hospital ◽

Female Ratio

Introduction: Analyzing the neonatal admission pattern helps the policymakers to make better strategies for healthcare provider to deliver better service. Objective: To demonstrate the admission pattern and outcome of patients in the Neonatal Intensive Care Unit (NICU) in a tertiary care hospital of Bangladesh. Materials and Methods: This retrospective descriptive study was conducted on all neonates admitted to the NICU of Combined Military Hospital (CMH), Dhaka from January to December 2015. Data were collected from file records of the patients regarding age, gender, mode of delivery, working diagnosis, length of stay in NICU and immediate outcome. Results: A total of 502 neonates were admitted during the study period. Majority of the patients (77.3%) were admitted on the 1st day of life. There were 279(55.6%) males with a male to female ratio 1.2:1. The major cause of admission was prematurity (23.1%) and other leading causes were birth asphyxia (BA)14.9%, infant of a diabetic mother (IDM) 13.5%, neonatal sepsis 12.5%. Most of the neonates (82.7%) were delivered by caesarean section. About 84.1% were discharged after improvement, 65(12.94%) died and 15(3%) were referred to other specialties for further management. Within the first 24 hours of admission, 9.4% deaths occurred and two common causes of neonatal death were preterm (49.18%) and birth asphyxia (23%). Conclusion: Good outcome of a neonate depends on adequate management, monitoring and good nursing care in an intensive care unit. By paying good attention to perinatal services and improving the facilities in the unit, morbidity and mortality in neonates can be reduced. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 49-53

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Clavien Classification of Complication of Surgery in Emergency Laparotomy: A Study of 40 Cases in Combined Military Hospital.

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v11i2.39818 ◽

2019 ◽

Vol 11 (2) ◽

pp. 7-13

Author(s):

Md Mahboob Hasan ◽

Md Abdul Matin ◽

Sardar Shahnabi Jafran ◽

Syeda Zeenat Laila ◽

Md Monjur Hasan Mamun

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Armed Forces ◽

Outcome Data ◽

Military Hospital ◽

Emergency Laparotomy ◽

Female Ratio ◽

Clavien Classification

Introduction: Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers, therapies and over time. Objective: Objective of the study was to assess the Clavien classification of surgical complications of patients who underwent emergency laparotomy. Materials and Methods: The classification was tested on 40 patients who underwent emergency laparotomy in various Combined Military Hospitals (CMH) over a period of 09 years. Data recorded including demographics, clinical presentations, operating techniques, incision, post-operative complications and the duration of hospital stay. Results: Out of the total 40 patients, 28(70%) were male and 12(30%) female. Male: Female ratio was 2.33:1. A total of 29(72.50%) patients experienced postoperative complications. More than one complications occurred in 14(35%) patients. There were 13(32.50%) patients in the Clavien grade-I category, 09(22.50%) patients were classified as grade-II and grade-IIIa, 05(12.50%) patients had IIIb complications, grade-IVb and V complications occurred in 03(07.50%) patients each. The mean length of hospital stay was 15.28 days. Conclusion: This classification seems to be applicable in most parts of the world and may even be used by surgeons who are less experienced. In addition, standardization of postoperative care is essential to minimize postoperative complications. Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 7-13

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Haematological Changes of Critically ill Patients Admitted in CMH, Dhaka

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v12i1.39971 ◽

2016 ◽

Vol 12 (1) ◽

pp. 63-67

Author(s):

Masuma Ahmed Salsabil ◽

Md Manirul Islam ◽

Jannatul Ferdous ◽

Shameem Montasir Hossain

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Armed Forces ◽

Military Hospital ◽

Mean Corpuscular Hemoglobin ◽

Female Ratio ◽

Coagulation Parameters ◽

Haematological Changes

Introduction: Haematological status is an important parameter for the management of critically ill patients. Objective: To see the status of the haematological changes of critically ill patients admitted in CMH, Dhaka. Materials and Methods: This cross sectional study was conducted in the Department of Haematology of Armed Forces Institute of Pathology and Intensive Care Unit of Combined Military Hospital, Dhaka from March 2014 to September 2014 for a period of 6 months. All the patients who were admitted in the Intensive Care Unit of Combined Military Hospital, Dhaka at any age with either sex were included in this study. The complete blood count and coagulation parameters were considered and data sheet was prepared. Results: A total number of 862 samples were analyzed. Male female ratio was 1.8:1. Anaemia was found in 43.2% patients and 22.3% patients had Erythrocytosis. Normocytic Normochromic Anaemia was the most common morphological subtype of Anaemia. 13.8% patients had Leukopenia and 55.1% patients had Leukocytosis; 7.3% patients had Neutropenia and 49.0% patients had Neutrophilia. 10.0% patients had Eosinophilia. 26.3% patients had Lymphopenia and 14.7% patients had Lymphocytosis. 39.1% patients had Thombocytopenia and 20.3% patients had Thrombocytosis. MCV (Mean Corpuscular Volume) was below normal in 36.5% patients and was above normal in 16.8% patients. MCH (Mean Corpuscular Hemoglobin) was below normal among 49.7% patients and 11.1% patients above normal. MCHC (Mean Corpuscular Haemoglobin Content) was below normal level in 61.8% patients and 3.7% patients had above normal. Abnormal coagulation parameters that is prolonged PT, APTT and raised FDP was found in 36.3%, 18.6% and 35.8% patients. Conclusion: Critically ill patients were suffering from anaemia and thrombocytopenia with significant changes in other blood cells counts and coagulation parameters. Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 63-67

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Aetiological Evaluation of Pleural Effusion in a Selected Hospital

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i2.41366 ◽

2019 ◽

Vol 13 (2) ◽

pp. 15-17

Author(s):

Saleh Mohammad Shahedul Islam ◽

Md Abdul Ali Miah ◽

Shah Md Mahbubur Rahman ◽

Chandan Kumar Roy

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Tertiary Care ◽

Armed Forces ◽

Smoking History ◽

Military Hospital ◽

Care Hospital ◽

Female Ratio ◽

Presenting Symptoms ◽

Fluid Analysis

Introduction: Pleural effusion is a common clinical manifestation of varying aetiology. Its outcome varies according to underlying aetiology. The causes and prognosis vary between developed and developing countries. Objectives: To find out the most common causes of pleural effusion in a tertiary care hospital of Bangladesh. Materials and Methods: Total 50 patients were enrolled in the study during the period from January 2014 to November 2015 in combined military hospital, Dhaka. Informed written consent was obtained from all patients under the study, explaining the risk benefits and objectives of the study before sampling. Data were collected using a structured questionnaire containing all the key variables along with radiological, laboratory and pleural fluid analysis report. Data presented as frequency and percentage and Chai-square test was performed by using SPSS 23.0. Results: Patients' mean age was 48.28 ± 12.53 years and ranged from 12 to 70 years where half of them were above 50. Male-female ratio was 1.63:1. Sixty five percent of the patients had positive smoking history. Persistent cough, fever and weight loss were the main presenting symptoms. Radiological findings revealed 50% had isolated right-sided pleural effusion and laboratory investigation found 28% cases ESR value 50-100 mm in 1st hour. Pleural fluid examination revealed 75% patient had straw coloured pleural fluid. Sputum for Acid-Fast Bacilli and other relevant investigations revealed 44% patients had tuberculosis, 16% had pneumonia, 8% had malignancy and 24% had other causes of pleural effusion. Conclusion: This study revealed that the tuberculosis is the predominant cause of pleural effusion followed by pneumonia and malignancy. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 15-17

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Demographic Pattern, Management, and Outcome of Intestinal Atresias Among Neonates in a Tertiary Care Indian Hospital

Journal of Neonatology ◽

10.1177/09732179211054084 ◽

2021 ◽

pp. 097321792110540

Author(s):

Prasanta Kumar Tripathy ◽

Pradeep Kumar Jena

Keyword(s):

Intestinal Obstruction ◽

Tertiary Care ◽

Late Presentation ◽

Management Approach ◽

Gradual Improvement ◽

Female Ratio ◽

High Risk Factors ◽

Neonatal Intestinal Obstruction ◽

Tertiary Care Centers ◽

Improvement In Survival

Objectives: To analyze the incidence, management approach, and outcome of intestinal atresias among neonates in our hospital. Design: Retrospective observational study. Settings: Tertiary care pediatric institute located in eastern part of India. Study period: January 2015 to December 2019. Results: Intestinal atresias constituted 54% of neonatal intestinal obstruction cases ( n = 369). Out of 201 cases of intestinal atresias, only 120 patients presented during first week of life and the male to female ratio was 1.3:1. The mean (±SD) weight at presentation was 2.03 (±0.49) kg and newborns below 1.5 kg were associated with significantly higher mortality ( P =.001). Jejunoileal atresias were found to be the most common type of atresia ( n = 116, 58%) followed by duodenal atresias ( n = 67, 33%). Colonic and pyloric atresias were found in 14 (7%) and 4 cases (2%), respectively. The overall mortality in the present study was 18% ( n = 36) and septicemia was the leading cause. Conclusion: Intestinal atresias were the most common cause of intestinal obstruction and surgical emergency in neonates. Although, there is gradual improvement in survival in these newborns, low birth weight, late presentation, and associated comorbidities are high risk factors. Increased awareness about these congenital anomalies, early referral to tertiary care centers, and timely management can improve the outcome.

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