Non-traumatic Perforation of the Small Bowel

Background: Non-traumatic perforation of the small bowel is an uncommon serious complication associated with high morbidity and mortality. Diseases that cause small bowel perforation vary in different areas of the world. Objective: To highlight difficulties in the diagnosis and management of non-traumatic perforation of small bowel. Material and methods: The medical records of four patients who have presented with non-traumatic perforation of the small bowel and were treated at Al-Ain Hospital during the last 5 years were studied retrospectively. Results: The presenting symptoms of all patients were similar. Erect chest X-ray has shown free air under diaphragm in 3 patients. Leukocytosis was present in only one patient. HIV was confirmed in one patient. Patients were diagnosed to have typhoid; HIV; hook worms and tuberculosis. Only the HIV patient died while the others were discharged home in a good condition. Conclusion: Clinical findings of small bowel perforation are usually non specific and diagnosis is usually reached after surgery. The Histopathological examination of the small bowel ulcer were non conclusive in three patients. We have made our management plan according to the clinical findings. Non traumatic perforation in developing countries can be due to typhoid; HIV; tuberculosis and possibly hook worms

Botulinum Toxin Treatment for Anal Fissure

Objectives: To evaluate the effectiveness of Botulinum toxin injection in the treatment of anal fissure. Methods: 38 patients (22 males; 16 females; mean age (SD) of 33.3 (8.3) years) who have presented to Surgical Outpatient Clinic at Al Ain Hospital; United Arab Emirates; with anal fissure in the period between June 2000 and September 2001 and treated with Botulinum toxin injection were retrospectively studied. They were followed up for at least 8 weeks to evaluate the effects of treatment. Results: Treatment with Botulinum toxin was effective in 89of patients with chronic uncomplicated anal fissure. Two patients experienced minor incontinence in the form of a fecal soiling which disappeared later. Conclusion: Botulinum toxin injection is an effective alternative for surgery for treatment of uncomplicated idiopathic anal fissure. Surgery should be offered to patients who do not improve with Botulinum toxin injection and to those with complicated anal fissure