Per rectal bleeding is a frequently encountered clinical complaint in routine medical/surgical practice in paediatric patients. It has different aetiology in both extremes of age. This study was carried out in an attempt to find out causes, presentation and the proper management that can be offered to the affected infants and children.This retrospective study was carried out from January 2012 to December 2014 in the department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All patients presenting with the complaint of per rectal bleeding were included. But patients who needed emergency surgical intervention were excluded from this study. The data were reviewed for gender, age, causes of rectal bleeding and type, number, site, recurrence rate and the modality of treatment employed in children having colorectal polyp. Technetium-labeled red blood cells scans was used for the diagnosis of Meckel's Diverticulum. Complete blood picture and routine stool examination were done for all cases.Most polyp cases were diagnosed with digital rectal examination (DRE). Colonoscopy was performed for some cases in the Paediatric Gastroenterology Department of BSMMU. Also all the rectal polyps and colonic mucosal biopsies taken during colonoscopy submitted to histopathological examination. Per rectal bleeding was the chief complaint in 326 (1.5%) patients Out of 21,533 patients presenting to the outpatient department of Paediatric Surgery of BSMMU, Dhaka, Bangladesh over a period of three years. In this study, it was reviewed 326 patients, among them 208 (63.89%) were boys and 118 (36.19%) were girls. The male female ratio was 1.8:1. The ages ranged from 14 months to 14 years (mean age: 5.8years) at diagnosis. The most common aetiology was juvenile polyps which were found in 209 (64.11%) of the cases. It was to be found that anal fissure in 33 (10.12%) patients, rectal prolapse in 27 (8.2%) patients, non-specific colitis in 15 (4.60%) patients, Meckel's Diverticulitis in 3 (0.9%) patients, juvenile polyposis coli in 5 (1.5%) patients and familial adenomatous polyposis coli (FAP) in 4 (1.2%) patients. However, the cause of per rectal bleeding remained unknown suspecting chronic constipation in 30 (9.20%) patients. No statistically significant differences were observed between males and females as well as different age groups regarding the means of the underlying causes of per rectal bleeding in children(p > 0.05). The prevalence of anal fissure in less than 2 years old patients and juvenile polyps in the 2-6 years old patients were significantly higher than the other causes (p < 0.001). Other causes of per rectal bleeding prevailed in children were more than 2 years old. Colorectal polyps are common causes of per rectal bleeding in children. Proper physical examination including DRE along with the colonoscopy promotes both rapid and accurate diagnosis and the opportunity for immediate therapeutic measures.

Background: Hypospadias is a congenital defect involving the male urethra characterized by the absence of urethral meatus at its normal position. This anomaly is usually associated with the ventrally deficient but dorsally hooded skin. In some cases, the penis is ventrally curved. Surgery is the option for this defect. So many procedures have been developed but none is free from the development of urethrocutaneous fistula. Now-a-days, the popular Snodgrass procedure is widely practiced but still fistula occurs. Many factors are thought to be responsible for it. The most important one is defective ventral penile skin which is deficient of vascular and collagen tissues. To minimize these deficient factors, a dorsal vascular preputial flap is transferred ventrally (modified) to reduce fistula formation further. A comparative study was disigned to determine the role of dorsal vascular flap.Methods: The prospective observational study was conducted in the department of pediatric surgery, Bangabandhu Sheikh Mujib medical university, Dhaka, Bangladesh since February 2017 to May 2021.Results: A total of 40 patients with distal penile hypospadias were included in this study. They were divided into Group A and group B, 20 for each. Snodgrass procedure was for Group A and the modified Snodgrass procedure was done for group B. The outcome of both the groups was determined in terms of fistula formation. Seven patients in group-A and one patient in group B developed fistula. The results were analyzed and were found statistically significant.Conclusions: Modified Snodgrass urethroplasty has a better outcome.

Background: The most common paediatric disorder among boy is undescended testis (UDT) which is usually identified during birth and these patients require proper treatment at the appropriate time due to increased risk of torsion, infertility, testicular cancer and associated inguinal hernia(>90%) as well as for cosmetic purposes. Objective: The purpose of this study was to determine side, palpability, age at presentation, associated anomalies and treatment plan in our institution. Methodology: This retrospective study was carried out in the department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to June 2019. Results: In this study 1.08% (213 children had UDT out of total paediatric outdoor 19803 patients) boys had UDT. They were aged from 7 months to 15 years (mean 5.61±3.81 years) at presentation. Only 16 (7.5%) patients presented within the 1 years of age in this study. 51.8% of patients presented at the age of >1yrs-5yrs. > 5yrs-10yrs of age was 33.5% cases and 13.6% of patients presented as late as 10yrs to 15 yrs. Unilateral UDT was found in 184 (86.4%) patients and bilateral was in 29(13.6%) patients. Right- sided unilateral UDT was in 112(52.6%) patients, left -sided unilateral UDT was in 72 (33.8%) patients. Palpable testis was found in 178(83.6%) patients and non-palpable found in 35(16.4%) patients. Associated anomalies of UDT were seen in 64(30%) patients. Hypospaedias was in 19(08%) patients and intersex disorders were in 15 (07%) patients. Orchidopexy was done in 192(90.1%) cases and orchidectomy was done only in 4(1.9%) cases. No testis was found in17 (08%) cases. Conclusion: UDT is one of the commonest disorders of paediatric age group. Very important issue is the early diagnosis and treatment of this anomaly. To treat the UDT in proper time help to optimize testicular function, earlier diagnosis of testicular malignancy, give cosmetic benefits and to prevent complications such as a clinical hernia or torsion. Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 173-176

Peutz-Jeghers syndrome (PJS) is a rare hamartomatous polyposis of the gastrointestinal GI) tract, sometimes associated with pigmentation around lips and oral mucosa. The case of a 4-year-old girl who presented with duodenal obstruction is reported. Along with multiple small polyps in the duodenum, a large polyp was found to be the cause of the duodenal obstruction. Histologically most of the polyps were hamartoma. PJS is a rare autosomal dominant disease. Most patients have recurrent episodes of polyposis in the gastrointestinal tract causing gastrointestinal obstruction as well as these patients have an increased risk of both gastrointestinal and non-gastrointestinal malignancy and need regular screening.

Background: The impact of Covid-19 on global health and especially on the low-resource countries’ health system has been serious. The lack of personal protective equipment, masks, sanitizers, and lack of testing has made the surgical delivery even more challenging. These delays in management of these surgical cases are going to stack up in the future and increase mortality and morbidity. However, the emergent nature of some of the neonatal surgical cases cannot be postponed. Materials and Methods: This is a retrospective observational study done from April 2020 to September 2020 in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Surgical neonates were tested for SARS-CoV-2 by using the real-time PCR on oropharyngeal swabs. The reports of the tests were received only 24 h later. Results: A total of 22 neonates with surgical conditions were admitted during the study period. Eighteen were tested for Covid-19, whereas 4 were tested but reports were not awaited for surgery. All the babies tested negative for Covid-19. There were a variety of cases admitted, predominately hydronephrosis, clubfoot, meningocele, intestinal obstruction, cleft lip, and palate. Among the 22 surgical neonates, 6 received the surgical management, whereas 16 were managed conservatively and kept on follow-up. Regarding the outcome, 17 patients (3 managed surgically and 14 nonemergent cases were managed conservatively) were discharged to home. Mortality were 5 in number (3 postoperative patient and 2 while managing conservatively). Conclusion: During the unprecedented times of Covid-19, extreme precaution and protocol must be followed to carry on neonatal surgeries to protect both health workers and children.