scholarly journals Classic Swenson abdomino perineal pull through in the treatment of Hirschsprung’s Disease – 3 years experience in a tertiary care Paediatric Hospital in Bangladesh

2017 ◽  
Vol 8 (1) ◽  
pp. 185-188
Author(s):  
Khalid Mahmud ◽  
AR Khan ◽  
BH Nazma Yasmeen ◽  
MK Islam ◽  
Sabbir Karim
Keyword(s):  
Urinary Incontinence ◽  
Fecal Incontinence ◽  
Tertiary Care ◽  
Operation Time ◽  
Definitive Treatment ◽  
Paediatric Surgery ◽  
Short Term ◽  
Total Colonic Aganglionosis ◽  
Female Ratio ◽  
Pull Through

Background : Hirschsprung disease (HD)is a common cause of intestinal obstruction. Definitive treatment is to excise aganglionic segment and anastomosis with anal remnant.Objective : The aim of the study was to analyze the short term outcome of children who have undergone the Classic swenson abdominoperineal pull through operation in the treatment of Hirschsprung’s disease.Methods : This Prospective study had been carried out in the department of paediatric surgery, Dhaka shishu (Children) Hospital during the period of January 2013 to January 2016. Total 50 patients with Hirschsprung’s disease with or without colostomy except total colonic aganglionosis were included in this study.We also excluded those patients with major co-morbidities and patients who did not agree to close stoma within 12 weeks of pull through. Consideration was given to postoperative complications(Cuff /anastomotic/pelvic abscess, wound infection, anastomotic leakage,fecal incontinence, urinary incontinence, mortatality), operation time and post operative hospital stay and as well as the short term outcome.Result : Among the study population 36 (72%) were male and 10(28 %) were female with a male female ratio of 2.5:1. Mean age at presentation was 17.96±12.05 months.Thirty eightpatients had diverting colostomy and underwent staged procedure.On the other hand 12 patients had no colostomy and underwent single stage procedure.Four patientsdeveloped anastomoticabcess, 3patients developed urinary incontinence,4 fecal incontinence and 2 patients developed post operative intestinal obstruction.The mean Operation time was114.14±13.02 minutes and mean hospital staywas 6.18±1.83 days.Thirty seven patients were discharged without any complications.Conclusion : The Classic Swenson’s procedure is an effective procedure in the treatment of HD .Northern International Medical College Journal Vol.8(1) July 2016: 185-188

scholarly journals A Comparative Study between Swenson Abdominoperineal Pull-through and Transanal, Full Thickness, Swenson like Approach for Hirschsprung Disease

2017 ◽  
Vol 5 (1) ◽  
pp. 23-27
Author(s):  
Khalid Mahmud ◽  
MK Islam ◽  
M Rashedul Alam ◽  
Sabbir Karim
Keyword(s):  
Urinary Incontinence ◽  
Fecal Incontinence ◽  
Comparative Study ◽  
Operation Time ◽  
Hirschsprung Disease ◽  
Paediatric Surgery ◽  
Full Thickness ◽  
Group A ◽  
Pull Through ◽  
Group B

Background: Hirschsprung disease (HD) is a congenital developmental disorder of intrinsic component of enteric nervous system leading to severe complication which needs operative correction. There are different operative techniques existing and each technique has its advantages and disadvantages.Objective: The aim of the study was to evaluate the better outcome between Transanal full thickness swenson like pull through and Swenson abdomino-perineal pull through.Method: The Prospective comparative study had been carried out in the department of paediatric surgery, Dhaka Shishu (Children) Hospital during the period of January 2014 to July 2016. Total 56 patients with HD patients were included in the study irrespective of colostomy except major co-morbidities which can influence the general outcomes and who did not agree to close stoma within 12 weeks of pull-through operation. Patients were allocated in both groups by purposing sampling. Twenty eight patients with long segment HD were allocated in Group-A and operated by Swenson abdominoperineal pull through and 28 patients with short segment disease were allocated in group-B and operated by Transanal, full thickness, swenson like procedure.Result: Among the study population 32 (57.14%) were male and 24 (42.86%) were female with age range was 1 day- 96 months. Four patients developed urinary incontinence, 3 patients developed cuff abscess and 2 patients developed fecal incontinence. And in group-B no patient developed urinary incontinence but 4 developed cuff and anastomotic abscess and no patient developed fecal incontinence. The mean operation time 114.14 ± 13.02 in group-A and 68.36 ± 16.12 minutes in group-B. Mean hospital stay in group-A was 6.18 ± 1.83 days and 5.05 ± 0.43 days in group-B.Conclusion: The newer modification, Transanal, full thickness Swenson like procedure can be better technique in the management of HD.Bangladesh Crit Care J March 2017; 5(1): 23-27

Modified Duhamel Retrorectal Pull-Through for Hirschsprung’s Disease

2021 ◽  
Vol 15 (10) ◽  
pp. 2886-2889
Author(s):  
Shafiq ur Rehman ◽  
Muhammad Anwar ◽  
Zarlish Fazal
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Operation Time ◽  
Clinical Score ◽  
Toilet Training ◽  
Paediatric Surgery ◽  
Short Term ◽  
Female Ratio ◽  
Bowel Habits ◽  
Pull Through

Objectives: To evaluate the post-operative complications and short-term outcomes of modified Duhamel retrorectal pull-through procedure for Hirschsprung’s disease. Design: Prospective descriptive study Place and Duration of Study: Department of Paediatric Surgery Sahiwal Teaching Hospital Sahiwal from 1stJanuary 2018 to 31st December 2020. Methodology: Thirty seven histologically confirmed cases of Hirschsprung’sdisease having previous decompressing colostomy/stoma age between 1 to 12 years of agewere included. Children under one year of age, with sever comorbidities like Down syndrome and cardiac abnormalities, and those who require re-do pull through procedure were excluded. Modified Duhamel retrorectal pull-through procedure was performed in all cases. The demographic information included age, sex, proximal level of aganglinosis, complications of definite procedure, length of hospitalization andmortality. Other information recorded included long term complications like obstructive symptoms, enterocolitis, incontinence and soiling at follow up. Krickenbeck classification was used to evaluate faecal incontinence and constipation. Kelly’s clinical score was used to assess the anal sphincter. Bowel habits were assessed only in children above three years of age. Results: Twenty six (70.27%) were males and 11 (29.72%) females with male to female ratio 2.3:1 and mean age at operation was 2.89±1-9 years. Twenty nine (78.37%) children were ≤3 years of age and 8 (21.62%) were >3 years. Mean weight was 12.91 kgs, operation time was 126.81 time, fasting time was 6.67 days and hospital stay was 11.91 days. Length of aganglionic segment was short segment 27 (72.97%), long segment 9 (24.32%) and total colonic 1 (2.7%). Hirschsprung associated enterocolitis 7 (18.91%) and wound infection 6(16.21%) were most common reported complications. Constipation in 5(13.51) and soiling with retentive constipation was present in 3 (8.10%) patients. Out of total 31 patients who reached toilet training age, 28 (90.32%) developed satisfactory voluntary bowel habits. Conclusion: Modified Duhamel pull-through procedure was found to be safe, applicable and with lower associated complications and satisfactory short term functional outcomes in our settings. Key words: Hirschsprung’s disease, Modified Duhamel pull-through procedure, Complications, Outcomes

Delay in time from diagnosis to treatment in metastatic melanoma, lung, and colon cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23186-e23186
Author(s):  
Muhammad Salman Faisal ◽  
Ahmed Khattab ◽  
Vida Jahangiri ◽  
Hira Shaikh ◽  
Soorih Shaikh ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Colon Cancer ◽  
Demographic Data ◽  
Tertiary Care ◽  
The United States ◽  
Definitive Treatment ◽  
Metastatic Colon Cancer ◽  
Female Ratio ◽  
Number Of Patients ◽  
Delay In Treatment

e23186 Background: Delay in cancer treatment is anxiety provoking both for the patient and clinician. We conducted the study to evaluate the patterns of delay in treatment of patients with metastatic colon cancer, lung cancer and melanoma from diagnosis to the initiation of the treatment, and to identify the causes of delay. Methods: In this retrospective study, patients with metastatic colon cancer, lung cancer and melanoma diagnosed between 01/01/2016 to 12/31/2016 in a tertiary care network in the United States were studied. Data was collected from electronic health record (EHR) database, ‘Epic’. Variables such as demographic data, including patient age and gender, and type of cancer, and treatment received were analyzed. The causes of the delay were also evaluated when available. Results: Total number of patients in the study was 288. Mean age was 68.3 years (median 69 years) and 36% were alive at the time of data analysis. Male to female ratio was 1.4:1. 66.7% people had lung cancer, 30% had colon cancer and 3% had melanoma. 67 (23.6%) of total analyzed patients had denied definitive treatment and chose to undergo palliative management. Of the rest, most started treatment with chemotherapy (39.5%), followed by surgery (22.6%) and then radiation (14.6%). With the time of pathological diagnosis of the tumor taken as the date of diagnosis, mean delay from the day of diagnosis to the start of treatment in this study population observed was 27.7 days. 67 patients (23.3%) had a delay of more than 30 days, with the most common reason being systemic factors in 39 patients (58.2%), followed by patient factors in 23 patients (34.3%) and physician factors in 5 patients (7.5%). On logistic regression analysis, time from diagnosis to treatment didn’t predict mortality (OR = 0.99, 95% CI P = 0.10(0.97-1.002). Conclusions: Delay in treatment is common and the system factors one of the common reasons as exhibited by our study. Time from diagnosis to treatment didn’t predict mortality.

scholarly journals Clinical and laboratory profile of dengue fever in children in a tertiary care hospital of Navi Mumbai, India

2020 ◽  
Vol 7 (8) ◽  
pp. 1747
Author(s):  
Minakshi Bhat ◽  
Anjali Otiv
Keyword(s):  
Risk Factors ◽  
Dengue Fever ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Definitive Treatment ◽  
Severe Dengue ◽  
Care Hospital ◽  
Female Ratio ◽  
Elevated Liver Enzymes ◽  
Laboratory Profile

Background: Dengue fever is a mosquito born arboviral illness endemic in tropical countries and causes significant mortality and morbidity due to lack of definitive treatment. The objective of this study was to assess the clinical and laboratory profile of confirmed cases of dengue in children up to 12 years of age and also to charactrise the risk factors for severe dengue.Methods: This is a descriptive, observational, retrospective study done in the Department of Pediatrics, Terna Medical College, Nerul, Navi Mumbai, India.   Medical records of all children up to 12 years of age diagnosed to have dengue   were reviewed.  Their clinical and laboratory profile were recorded in a pro forma and analyzed. All cases were classified as per WHO guidelines into non severe and severe dengue cases.Results: Among the 117 confirmed dengue cases, (84.6%) had non severe dengue and (15.4%) had severe dengue. The most common age group affected was 9-12 years (45.3%) with a male to female ratio of 2.4:1. Fever was the most common clinical feature seen in all cases followed by headache (83%), myalgia (81%), ascites (24.7%), vomiting (17.9%). Clinical signs of ascitis, hepatomegally, gastrointestinal bleeding, pleural effusion and shock were predominantly associated with severe dengue cases. Laboratory parameters showed leukopenia in 58.1% and thrombocytopenia (platelet counts <20,000/cumm3) in16.2% cases. Elevated liver enzymes, raised hematocrit (36.3%) and coagulation abnormalities were seen in over 50% dengue cases and were significantly associated with severe dengue dengue.Conclusions: Knowledge of clinical   and laboratory profile of dengue cases of a particular area will help in early prediction of risk factors for severe dengue resulting in favourable outcome of such cases.

Two Siblings with Total Colonic Aganglionosis Extended to the Ileum

Swiss Surgery ◽  
2003 ◽  
Vol 9 (4) ◽  
pp. 187-189
Author(s):  
Aslan ◽  
Caglar ◽  
Karagüzel ◽  
Melikoglu
Keyword(s):  
Intestinal Obstruction ◽  
Loop Ileostomy ◽  
Good Condition ◽  
Disease Type ◽  
Definitive Treatment ◽  
Entire Colon ◽  
Total Colonic Aganglionosis ◽  
Protective Ileostomy ◽  
Definitive Surgery ◽  
Partial Intestinal Obstruction

Total colonic aganglionosis (TCA) extended to the ileum is seen quite rare among infants with Hirschsprung's disease. Type and timing of definitive surgery in these patients are controversial. This report was presented to discuss the management of two siblings with TCA. Case 1: A two-day-old girl was operated for partial intestinal obstruction. During laparotomy, serial frozen biopsies proved TCA extended to the terminal ileum and a loop ileostomy was performed. At five months of age, a modified Duhamel-Martin procedure without protective ileostomy was performed. An endo-GIA stapler was transanally used for colo-ileal anastomosis. She is doing well for the last five years. Case 2: A one-day-old boy admitted to the hospital with similar findings to his sister. Frozen biopsies during first laparotomy proved that majority of ileum and entire colon was aganglionic and a proximal ileostomy was performed. At 10 months of age, he underwent a similar Duhamel-Martin operation. He is in a good condition for the last four years. Conclusion: In infants, our modification on Duhamel-Martin procedure, which is based on the use of an endo-GIA stapler transanally for colo-ileal anastomosis without protective ileostomy, may be utilized as an alternative method in the definitive treatment of patients with TCA.

scholarly journals Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years’ experience at a tertiary care centre

2021 ◽  
Author(s):  
Szabolcs Ábrahám ◽  
Illés Tóth ◽  
Ria Benkő ◽  
Mária Matuz ◽  
Gabriella Kovács ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Cholecystitis ◽  
Conversion Rate ◽  
Clinical Success ◽  
Definitive Treatment ◽  
Success Rates ◽  
Female Ratio ◽  
Gallbladder Drainage ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Iii

Abstract Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

scholarly journals Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

2021 ◽  
Author(s):  
Sukriti Das ◽  
Bipin Chaurasia ◽  
Dipankar Ghosh ◽  
Asit Chandra Sarker
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Head Injuries ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Acute Subdural Hematoma ◽  
Care Hospital ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

Short term outcome for colorectal cancer patients undergoing surgery in Tertiary care center in Eastern India

2021 ◽  
Vol 47 (2) ◽  
pp. e50-e51
Author(s):  
Abhitesh Singh ◽  
Anshul Jain ◽  
Dillip Muduly ◽  
Mahesh Sultania ◽  
Jyoti Ranjan Swain ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Eastern India ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome ◽  
Colorectal Cancer Patients
Sign in / Sign up

Export Citation Format

Share Document