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1.
PAFMJ-Pakistan Armed Forces Medical Journal. 2016; 66 (2): 185-189
in English | IMEMR | ID: emr-179008

ABSTRACT

Objective: To report on our experience of cholecystectomy associated bile duct injuries and observe factors influencing outcomes


Study Design: Simple descriptive study


Place and Duration of Study: Surgical unit IV, Military Hospital [MH] Rawalpindi, over a period of seven years from 01-01-2005 to 1-12-2012


Material and Methods: Eighty eight patients who underwent repair of bile duct injuries during this period were included in this study. Patients referred from class 'W and 'C' hospitals to our institute were also included


Results: Fifteen immediate repairs [0-72 hours] post cholecystectomy, forty eight intermediate repairs [72hrs-6wks] and twenty five late repairs [> 6 wks] were performed [table-1]. Short term morbidity was higher in patients with upper biliary tract injury [p=.04].The most common long-term complication was biliary stricture, which occurred in 28 patients [31.8%]. Patients with bile duct injuries [BDIs] repaired in intermediate period were more prone to develop stricture of biliary tree than those repaired in immediate or late period [p=.03] [table 3]. Long term morbidity was also higher in patients who presented with bile contamination of peritoneum [p=.03] and had sustained complex biliary tract injuries [E4/E5] [p=.03].The overall morbidity and mortality rate was 31% and 3% respectively


Conclusion: We observed that complex hilar injury, presence of intra-abdominal bile and timing of BDI repair is an important predictor of long-term outcome. Injuries repaired in early [0-72hrs] or late period [>6wks] were less likely to develop biliary stricture as compared to injuries repaired in intermediate period [72hrs-6wks]. Moreover complex hilar injuries and intra-abdominal bile at presentation increases the possibility for development of late biliary stricture


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cholecystectomy , Postoperative Complications , Morbidity , Retrospective Studies
2.
JCPSP-Journal of the College of Physicians and Surgeons Pakistan. 2014; 24 (12): 894-897
in English | IMEMR | ID: emr-154005

ABSTRACT

To determine the usefulness of RIPASA score for the diagnosis of acute appendicitis using histopathology as a gold standard. Cross-sectional study. Department of General Surgery, Combined Military Hospital, Kohat, from September 2011 to March 2012. A total of 267 patients were included in this study. RIPASA score was assessed. The diagnosis of appendicitis was made clinically aided by routine sonography of abdomen. After appendicectomies, resected appendices were sent for histopathological examination. The 15 parameters and the scores generated were age [less than 40 years = 1 point; greater than 40 years = 0.5 point], gender [male = 1 point; female = 0.5 point], Right Iliac Fossa [RIF] pain [0.5 point], migration of pain to RIF [0.5 point], nausea and vomiting [1 point], anorexia [1 point], duration of symptoms [less than 48 hours = 1 point; more than 48 hours = 0.5 point], RIF tenderness [1 point], guarding [2 points], rebound tenderness [1 point], Rovsing's sign [2 points], fever [1 point], raised white cell count [1 point], negative urinalysis [1 point] and foreign national registration identity card [1 point]. The optimal cut-off threshold score from the ROC was 7.5. Sensitivity analysis was done. Out of 267 patients, 156 [58.4%] were male while remaining 111 patients [41.6%] were female with mean age of 23.5 +/- 9.1 years. Sensitivity of RIPASA score was 96.7%, specificity 93.0%, diagnostic accuracy was 95.1%, positive predictive value was 94.8% and negative predictive value was 95.54%. RIPASA score at a cut-off total score of 7.5 was a useful tool to diagnose appendicitis, in equivocal cases of pain


Subject(s)
Humans , Male , Female , Appendicitis/epidemiology , Cross-Sectional Studies , Appendix , Appendectomy , Acute Disease
3.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 64 (4): 639-641
in English | IMEMR | ID: emr-167584

ABSTRACT

Gallstone ileus is a rare disease and accounts for 1-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We present a case report of a 55 year old lady diagnosed as having gall stone ileus and was treated with emergent laparotomy and enterolithotomy with fistula repair at a later stage


Subject(s)
Humans , Female , Ileus , Intestinal Obstruction/etiology , Laparotomy
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