Emergency management of sigmoid volvulus: experience of lady reading hospital Peshawar

To know the outcome of resection and end to end anastamosis with defunctioning colostomy in patients with sigmoid volvulus, operated in emergency. This study was conducted from Jan 2004 to December 2004 at surgical "C" unit Post Graduate Medical Institute Lady Reading Hospital Peshawar. Patients presenting to emergency department with clinical suspicion of sigmoid volvulus, were thoroughly examined and underwent baseline and radiological investigations before surgery. Final diagnosis was made per operatively and emergency resection and end to end anastamosis with defunctioning colostomy were performed in all patients in casualty operation theatre. During the time period, 25 diagnosed patients with sigmoid volvulus were finally selected for the study. Seventeen patients [68%] were in their 5th and 6th decades of life. Male to female ratio was 11.5:1. In 24 operated cases [96%], the gut was viable while in one case the gut was gangrenous. The average length of stay was 7-days. Mortality was 4% [one case], which was attributed to pre-operative unstable condition and gangrenous gut at the time of surgery. Resection of sigmoid colon with primary anastamosis and a proximal defunctioning colostomy is a safer procedure in inexperienced and learning hands in emergency situations

Surgical management of intestinal tuberculosis

To study the outcome of various surgical procedures performed for intestinal tuberculosis. This Study was carried out from July 2004 to June 2005 at Lady Reading Hospital, Peshawar on 30 operated patients of intestinal tuberculosis provisionally diagnosed on history, physical examination and x-ray findings. Emergency patients had a short work up including routine hamatological, biochemical and chest radiography while those admitted electively, had an ESR and upper gastrointestinal barium studies in addition to routine investigations. Final diagnosis was made after histopathology. Different operative procedures were performed according to the available facilities and preoperative condition of the patient. Study included 10 males and 20 females, ranging in age from 15-60 years with mean of 23.5 years. Twenty Seven patients [90%] were operated in emergency and 3 patients [10%] as elective cases. In 19 cases [63%],. ileum was involved while combined ileum and jejunum in 6 cases [20%]. Twenty patients [66%] had strictures in small gut. The most commonly performed procedures were resection and end to end anastamosis in the form of segmental resection [11 cases], stricturoplasty in 7 cases and loop ileostomy [5 cases]. Wound infection was the main post-operative complication [7 cases]. The average hospital stay was 10 days. Mortality was 10% [3 cases]. Resection of the diseased segment is the standard procedure to relieve obstruction but in the presence of multiple strictures and limited bowel length, stricturoplasty is a better alternative