Background: Pancreatitis is an inflammatory condition of the pancreas, which might extend to local and distant extra-pancreatic tissues. It can be acute, acute recurrent or may be chronic. The diagnosis of different types of pancreatitis is based on a combination of clinical signs and symptoms, laboratory investigations and imaging techniques. Objective: To describe and find out the association of the laboratory and imaging profiles of different variety of pancreatitis in children. Methods: It was a an observational study conducted at the department of Paediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University from July 2018 through June 2020. A total of 48 cases were included in this study. The diagnosis of acute, acute recurrent and chronic pancreatitis was based on diagnostic criteria made by INSPPIRE group. Clinical characteristics, hematological, biochemical and imaging profile of the different variety of pancreatitis and their hospital outcome were observed. Result: Among 48 cases, acute recurrent pancreatitis were 56.3%. Mean age of the patients at presentation was 10.3 years. Laboratory tests showed serum calcium and C-reactive protein was significantly altered among acute, acute recurrent and chronic pancreatitis with characteristic imaging findings. Among imaging modalities, abdominal ultrasonogram showed swollen pancreas (58.3%) was significantly common in acute recurrent pancreatitis than chronic pancreatitis, whereas shrunken pancreas (28%) was significantly common findings in chronic pancreatitis. In addition to ultrasonogram, MRCP aided diagnosis of chronic pancreatitis. Complications developed in 25% of acute pancreatitis cases, which included hypocalcemia (58.3%), ascites (86.7%), pleural effusion (66.7%), pseudocyst (33.3%) and pancreatic necrosis (25%). Hospital stay was significantly prolonged in acute pancreatitis cases, when compared to other types of pancreatitis . Conclusion: Low calcium level and high CRP level were found in acute pancreatitis than in acute recurrent and chronic pancreatitis. Swollen pancreas with beaded and tortuous pancreatic ducts were found in case of chronic pancreatitis. Bangladesh J Child Health 2023; Vol 47 (2) : 95-102

Solitary rectal ulcer syndrome (SRUS) is a relatively uncommon but troublesome chronic benign disorder more in young adults and less in children. It is usually presented as rectal bleeding, constipation, copious mucous discharge, prolonged excessive straining, tenesmus, lower abdominal pain, localized pain in the perineal area, feeling of incomplete defecation and rarely rectal prolapse.The underlying etiology is not well known. It is diagnosed based on symptoms and endoscopic and histological findings. J Enam Med Col 2021; 11(1): 47-51

Purpose Perinatal cytomegalovirus (CMV) infection can lead to biliary atresia (BA) in different entities. This study aimed to compare the clinical, hematological, biochemical, and histological features of infants with BA based on their CMV immunoglobulin M (IgM) status at presentation. Methods This cross-sectional descriptive study was carried out between January 2019 and June 2020 at the Department of Pediatric Gastroenterology and Nutrition at the Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka. Forty-three patients with BA were selected purposively and categorized into either the CMV IgM-positive or CMV IgM-negative BA group. Categorical variables were compared using Fisher’s exact test and chi-square tests, while the Student’s t-test and Mann–Whitney U-test were used to compare continuous variables. For all statistical tests, a p-value <0.05 was considered statistically significant. Results Thirty-three (76.7%) of the cases were between 2 and 3 months of age on admission. The clinical, hematological, and biochemical parameters did not differ significantly between the CMV IgM-positive and CMV IgM-negative BA groups. Most (50.0%) of the CMV IgM-positive cases had fibrosis stage F2, while 43.5% of the CMV IgM-negative cases had fibrosis stage F3, with no significant difference between the groups (p=0.391). Conclusion Our data shows no significant distinction between CMV IgM-positive and CMV IgM-negative BA, suggesting that CMV does not contribute to BA pathogenesis.

Solitary rectal ulcer syndrome (SRUS) is an uncommon benign rectal disorder. Typically, young adults are affected and it is rare in children. Straining during defecation, self-induced trauma and paradoxical contraction of puborectalis muscle are the major contributing factors of this condition. Clinical features of SRUS are rectal bleeding, mucorrhoea, excessive straining during defecation, tenesmus, feeling of incomplete defecation and constipation. A complete and thorough history is most important for diagnosis of SRUS. Rectal bleeding may be misinterpreted as originating from an anal fissure caused by constipation or as other causes of rectal bleeding such as a juvenile polyp. The best and most accurate diagnostic method of SRUS is rectal biopsy. The major histological feature of SRUS is fibromuscular obliteration of the lamina propria. Avoiding straining, regular toilet habit, use of bulk laxatives, steroid and sucralfate enemas are the mainstay of treatment. Biofeedback mechanism is another treatment option. Because the clinical presentation varies, the diagnosis requires a high index of suspicion for both the clinician and the pathologist.

Abstract not available DS (Child) H J 2021; 37(1): 75-77

Introduction: Acute hepatitis may be caused by a variety of insult which may also progress to acute liver failure a condition associated with high morbidity & mortality without liver transplant.It is important to establish the underlying aetiology of acute hepatitis, as the outcome varies according to aetiology & risk of progression to acute liver failure also differs accordingly.

Histoplasma capsulatum is the most common cause of endemic mycosis in developing countries. It is a self-limited and asymptomatic disease in immunocompetent individuals but remains a frequent cause of opportunistic infection in patients with compromised immune status. Liver involvement as a part of disseminated histoplasmosis is well known. However, liver infection as a primary manifestation of histoplasmosis without evidence of primary lung involvement is rare. In conclusion, clinicians should be aware of isolated histoplasmosis affecting the hepatobiliary system, and careful evaluation is warranted to confirm the diagnosis. Given the appropriate clinical context, histoplasmosis should be considered in both immunocompetent and immunocompromised patients, regardless of pulmonary symptoms, in non endemic as well as endemic areas.

Background: Chronic diarrhea is insidious onset that persists for 14 days and more, usually of noninfectious origin. Chronic diarrhea in children is not an uncommon problem in our country. Objectives: Objective of this study was to evaluate children with chronic diarrhea by clinical-biochemical profile and outcome. Methods: It was a retrospective observational study done in the department of paediatric gastroenterology and nutrition, BSMMU. The study was done during January 2017 through December 2018. Forty-five patients diagnosed as chronic diarrhea between the ages of 6 months to 18 years were included in this study. We Clinical, laboratory data and outcome of patients were analyzed. Results: Mean age of children was 5.96±2.3 year, 60%(27) were male and 40% (18) were female. Among them under 5 years were 55%(25). All children presented with diarrhea (100%) along with fever (24%), FTT (22%), abdominal pain (20%) and weight loss (20%). About 58% of children had anemia and 14% had hepatomegaly and/or splenomegaly. Raised ESR (40%), leukocytosis (20%), thrombocytosis (16%), raised CRP (13%) and electrolyte imbalance (16%) were observed. Intestinal TB (18%) was the most common etiology of chronic diarrhea. Moreover, chronic constipation with fecal incontinence mimicking diarrhea (11%), IBD (9%), coeliac disease (8%), IBS (7%), HIV enteropathy (4%), primary immunodeficiency disorder (4%) were also found. Improvement of diarrhea was observed in 96% children, 4% patient died due to diarrhea-related complications. Conclusion: Chronic diarrhea in children is not uncommon in Bangladesh and diagnosis of etiologies are challenging. Intestinal tuberculosis found to be an important cause of chronic diarrhea in this study. Although in the majority of the cases, etiology could not be identified, some remote etiologies were found on this study, like chronic constipation with fecal incontinence mimicking diarrhea, IBD, HIV enteropathy, primary immunodeficiency. DS (Child) H J 2020; 36(1) : 46-51

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Introduction: Abdominal pain is a common complaint in children. In most cases it may be functional. Among all organic causes, an abdominal cyst of omental or mesenteric origin is an uncommon etiology. Case Presentation: A 7-year-old girl presented with a short history of abdominal pain for 1 month associated with gradual abdominal distention. Physical examination revealed a large oval palpable firm, non-tender mass extending almost the whole abdomen. Imaging studies were suggestive of an intra-abdominal cyst, and the diagnosis was confirmed after exploratory laparotomy. The patient was managed surgically by enucleation of the cyst. Conclusion: Omental cysts are a rare benign condition, but should be considered as a diagnostic hypothesis in children with abdominal pain with or without a mass. It is difficult to diagnose an omental/mesenteric cyst clinically. A proper imaging study can guide the diagnosis. After confirming the diagnosis, the main treatment would be surgical excision.

This article has no abstract. The first 100 words appear below: An 11-year-old boy presented with 15 months history of diarrhea with up to 10-20 times small volume stool daily with mucus. It was associated with a feeling of incomplete defecation and excessive straining. The frequency of diarrhea increased to 20-30 times per day over the last 8 months. Subsequently, he developed fecal incontinence, for which he couldn't attend his school. He also had a history of significant weight loss in the last 7 months. According to his mother's statement, his body weight was reduced to 64 kg from 77 kg during this illness.

Background: Constipation is a common problem throughout childhood. It is important to be fully aware of the factors involved in developing constipation in children. There are few published articles on childhood constipation in Bangladesh. In this study, our aim was to evaluate demography and probable/potential risk factors for functional constipation in Bangladeshi children.Methods: The study was carried out among 179 children from May 2018 to June 2019 in the department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU) both indoor and outdoor basis. Children with constipation who fulfilled the ROME III criteria were evaluated for demography and probable/potential risk factors of constipation.Results: A total of 179 subjects were included in the final analysis. Among them, 54.75% were boys and 45.25% were girls. Constipation was found more in the age group above 5 years (56.42%), then in 2 to 5 years age group (33.52%) and lower in below 2 years of age (10.6%). Constipation was more among children living in urban area (55.3%) than in rural area (44.69%). Constipation was the presenting complaint in 76.54% subjects, other complaints were abdominal pain (47.49%), anorexia (24.02%), vomiting (19.56%). Diet low in fiber (72.63%) was found as the most common potential risk factor, other factors were ingestion of cow’s milk (32.96%), not having regular meals with parents (19.55%), consumption of junk foods (28.49%). Staying with grandparents (16.76%), living in hostel or madrasa / residential religious institute (5.03%), long period of academic activity, [homework (10.61%) / tutor and coaching (7.26%)], unhygienic toilet in school (6.14%) were also found to be probable associated factors in this study.Conclusions: Functional constipation was found more in boy’s and above five year age group. Low dietary fiber, consumption of cow’s milk and junk food, unwillingness to use toilets in school, long time in academic activity, were found to be potential underlying risk factors of constipation.

Extrahepatic biliary tract tumors are rare and among them rhabdomyosarcoma is most common. Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor and is a very rare malignancy of the common bile duct in children. It usually presents as obstructive jaundice and/or pruritus. If there is no local invasion to the adjacent tissues, the radiological appearance of the tumor lesion is like a choledochal cyst. So the diagnosis is usually made at surgery or by preoperative biopsy. It is important to diagnose early and differentiate it from choledochal cyst and start treatment as early as possible for long time survival of the patient. This case report presented a case of a 10-year-old boy with recurrent onset of obstructive jaundice and fever preoperatively who was diagnosed as choledochal cyst and postoperatively as embryonal rhabdomyosarcoma of the common bile duct. After surgical resection and postoperative chemotherapy, the child had a good prognosis. So it is crucial to know that this rare tumor can mimic congenital choledochal cyst and it should be considered in the differential diagnosis of obstructive jaundice in children.