Fissurectomy with posterior midline sphincterotomy for management of chronic anal fissure

To determine the efficacy and safety of fissurectomy with posterior midline Sphincterotomy in the management of chronic anal fissure in terms of symptomatic relief, complications and recurrence. Observational case-series. Department of Surgery, Liaquat University Hospital, Jamshoro/Hyderabad, for a period of 3 years from January 2005 to December 2007. A total of 136 patients with chronic anal fissure were recruited for this study. All subjects underwent elective fissurectomy and posterior Sphincterotomy. Surgery was performed either under spinal or general anaesthesia. Symptomatic relief and early postoperative complications were recorded. The patients were followed for 18 months. Follow-up included assessment for complications such as pain, incontinence, keyhole deformity, and recurrence. All patients presented with pain during and after defaecation. Forty [29.4%] patients presented with bleeding per rectum. One hundred and sixteen [85%] patients complained of perianal swelling while 8 [5.9%] patients complained of perianal itching. Retention of urine was the most common postoperative complication, seen in 10 [7.4%] cases. It occurred within the first 24 hours after operation and all cases required catheterization. Six [4.4%] patients complained of moderate to severe postoperative pain in the first 24 hours, requiring narcotic analgesics. Transient incontinence of flatus and faeces occurred in 5 [3.7%] and 3 [2.2%] cases respectively. One patient presented with a recurrent anal fissure after 8 months but responded to conservative treatment. Given the low rate of complications and almost negligible rate of recurrence, fissurectomy with posterior midline Sphincterotomy is still a treatment of choice for the management of chronic anal fissure

Pattern of acute pancreatitis: the Liaquat University hospital experience

To determine the aetiological factors, presentation and management of acute pancreatitis and to assess the outcome of different forms of management in our set up. A case series. Liaquat University Hospital, Jamshoro/Hyderabad - Sindh from January 2002 to December 2004. The data of 45 consecutive patients admitted with acute pancreatitis was collected through a proforma and assessed with reference to aetiological factors, clinical presentation and management in each case. Majority [60%] of the patients belonged to 30-40 years of age. Thirty-six [80%] patients presented in emergency. The most common aetiological factor for acute pancreatitis was gallstones and the pain, nausea and vomiting were the main symptoms. Serum amylase [>3 x normal] was seen in 36[80%] patients. Prediction of severity was identified through Ranson score. It was <3 in 27[60%], 3 in 13[28.9%] and 4 in 5[11.1%] patients. The mortality was 13.33% but the morbidity remained high with the sequelae of resolution in >50% cases. Acute pancreatitis in our set up shows a lower frequency of this disease when compared to the world literature. However, when compared with aetiology and presentation, the pattern remains the same. Meanwhile, due to adoptation of Western way of life, the incidence seems to be increasing. Due to patient's delayed arrival, the diagnosis depending upon the level of serum amylase seems to be misleading

Carcinoma of caecum presenting as mega intussusception and rectal mass

Carcinoma of colon and rectum are second commonest cancer cause of death in United Kingdom. Because, right colon has a large caliber, a thin and distensible wall and faecal content is fluid, so, carcinoma of right colon may attain a large size before it gives specific symptoms. Any complication like acute appendicitis or intussusception may draw early attention, when curative resection is possible. In this report, an unusual presentation of carcinoma of caecum is reported