Amoebic liver abscess; needle aspiration after 96 hours of medical treatment

Amoebic Liver Abscess [ALA] is a serious problem in Pakistan Its management includes antimicrobial drugs, needle aspiration and surgical drainage. To determine if amoebic liver abscess can be treated conservatively or requires needle aspiration as well in selected cases. A prospective hospital based study. Nishtar Hospital Multan. 18 months. Thirty six consecutive adult patients with a right lobe liver abscess were included. All patients received metronidazole 800mg orally for 10-14 days and were clinically observed. Patients who did not show any clinical improvement in 96 hours had an ultrasound guided needle aspiration performed. Patients having an ALA less than 10cm in size respond to medical treatment. If patients continue to have toxic symptoms, needle aspiration should be performed. Most patients having ALA of >10cm will end up having a needle aspiration but should be given a trial of medical management

Comparison of incidence of injury of hollow viscus versus solid organs in blunt abdominal trauma

Fifty patients were chosen for this study who were between 13-50 years of age and had only abdominal injury; laparotomy was done in all the cases. Road side accident was the major cause in 48% patients of blunt abdominal trauma followed fall height, animal kicks, direct blow and fall of heavy objects. Most of the patients injured were males [82%]. Diagnosis was made on clinical grounds in 72% patients. Diagnostic peritoneal lavage was done in 38% cases. Its accuracy was 89.5%. Solid organs were injured more but intestine was the commonest organ [22%]. Reason for the slight disparity between the percentage of organ injury in this study and international studies is prolong transit time taken by the patients to reach the hospital. Average transit time was 18 hours. Since intestinal injuries were not immediately fatal whereas splenic and hepatic injuries were many times fatal before they reached the hospital; this explains the higher incidence of intestinal injuries in this region

Mini-cholecystectomy versus standard cholecystectomy

Gall bladder diseases are very common and their established treatment is cholecystectomy. Removal of the gall bladder can be accomplished with less amount of trauma depending upon the approach to gall bladder area [laparoscopic, mini-cholecystectomy and conventional cholecystectomy]. Study included two hundred patients who were randomized after informed consent into two groups; group-I [100 patients] and group-II [100 patients] and they were respectively subjected to mini-cholecystectomy and standard cholecystectomy. Results showed same operative time with its added advantage of lower analgesic requirements, shorter hospital stay, and early return to work and reduced early and long term complications in patients who underwent mini-cholecystectomy as compared to standard cholecystectomy. In conclusion, mini-cholecystectomy is better alternative to standard cholecystectomy where laparoscopic facilities are not available because it does not need specialized training and costly equipment along with acquisition of new skill

Abdominal wound dehiscence evaluation of the pattern of risk factors: a hospital based study

Abdominal wound dehiscence is a serious postoperative complication that concerns every abdominal surgeon. The rate of this complication reported in Nishtar Hospital Multan was 4%. To determine the pattern of risk factors for abdominal wound dehiscence. This descriptive study was carried out in Surgical Unit-II, Nishtar Hospital, Multan during the period from January 2003 to January 2004. A total of one hundred patients were included in the study. There were 100 patients, 65 males and 35 females. Male to female ratio in present study is 3:1. The most common age group involved in burst abdomen was between 45-60 years. Wound infection was found in 30 patients, while 10 patients had chest infection, ascites in 7 patients and prolonged ileus in 3 patients. The significant risk factors in this study were age more than 55 years, male gender, malignancy, wound infection, tuberculosis, typhoid, emergency surgery and technique of closure with continuous non-absorbable suture may be used to close laparotomy incision should be considered to reduce abdominal wound dehiscence

Primary torsion of the lesser sac omentum

Omentum torsion is rarely diagnosed preoperatively. Knowledge of the entity is important to the surgeon because it mimics the common causes of acute surgical abdomen. We present a case of acute abdominal pain in young lady with torsion of a segment of lesser omentum being diagnosed preoperatively as complicated peptic ulcer. Torsion of the omentum is a condition in which the organ twists on its long axis to such an extent that is vascularity is compromised. Although omental torsion is rarely diagnosed preoperatively, knowledge of the entity is important to the surgeon because it mimics the common causes of acute surgical abdomen. Torsion of omentum is known entity in medical literature but we had a case of torsion of segmental of lesser omentum that mimic peptic ulcer perforation