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

Strangulated obturator hernia - an unusual presentation of intestinal obstruction

An 81-year-old Caucasian emaciated female presented with 3 days history of colicky abdominal pain nausea, projectile vomiting and abdominal distension. A pre-operative diagnosis of mechanical bowel obstruction was made. The absence of characteristic clinical signs in this thin elderly woman with a small bowel obstruction failed to provide a pre-operative diagnosis. She underwent a midline laparotomy and resection and anastomosis of small bowel and repair of the strangulated right obturator hernia. The high mortality rate associated with this type of abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and prompt surgical intervention if the survival rate is to be improved