unusual cause of pain in the right hypochondrium

Choledochal cyst is an uncommon anomaly of the biliary system. It manifests by cystic dilation of the extra or intrahepatic biliary tract or both. Three cases of choledochal cysts are reported, who had presented with pain in right hypochondrium. All the three patients presented in one Surgical Unit of a Teaching Hospital within a span of three months. The first patient was initially managed as obstructive jaundice, second as acute pancreatitis and third patient as a case of pancreatic pseudocyst. However, after investigations, the final diagnosis in all three of them was the same i.e. choledochal cyst which was managed by Roux-en-Y hepatico-jejunostomy

Practicality of modified Alvarado score in the diagnosis of acute appendicitis

To evaluate the practicality of Modified Alvarado Scoring System [MASS] in the diagnosis of acute appendicitis in our set up. Prospective, quasi-experimental study from July 2005 to December 2005. Surgical Unit II, Rawalpindi General Hospital, Rawalpindi. All patients, aged 15 years or above, who were operated for Acute Appendicitis during the study period. All patients were evaluated using the Modified Alvarado Score [MAS] once decision of surgery has been made by a consultant surgeon. The MAS was correlated with the operative and histopathological findings. Out of the total 82 patients, 49 were male [60%] and 33 female [40%]. Their age range was from 15 to 60 years with peak incidence in the 2nd and 3rd decade of life. The overall sensitivity of MAS was 89%. There were 4% negative appendicectomies with MAS between 6-9, 12% with MAS between 4-5 and 50% where MAS was < 4. MASS cannot be fully relied upon to make the decision to operate in acute appendicitis, and that the decision remains clinical

Management of retroperitoneal haematoma

To find out the frequency of different visceral injuries and morbidity and mortality related to different zones in retro peritoneal haematoma due to trauma. D.H.Q Teaching Hospital Rawalpindi. Prospective study. June 1998 to May 1999. There were total 45 patients with retro peritoneal haematoma. The policy for exploration of retro peritoneal haematoma included mandatory exploration of Zone I and selective exploration of Zone II and III. Out of total 45 patients, 40 had associated intra peritoneal injuries and Zone I was most commonly involved [n=21] followed by Zone II [n=13] and Zone III [n=11]. Vascular, genitourinary and pelvic fracture injuries were the common injuries. Overall mortality was 6.5% mainly due to irreversible shock in patients with Zone I vascular injuries. Mandatory exploration of Zone I and selective exploration of Zone II and III is a valid policy in the management of retro peritoneal haematomas. Penetrating Zone I trauma causing vascular injuries is most common of all. Shock is the most common presentation, complication and cause of mortality

Can we afford to operate on patients without HB sag screening?

In this prospective study, out of 100 patients screened for hepatitis B surface antigen [HBsAg] 28 were found positive in a surgical unit of the Rawalpindi Medical College. Of these, 3 [10.71%] patients had a past history of jaundice, 10 [35.71%] of blood transfusion and 9 [32.14%] of previous operations, whereas 15 [53.57%] patients did not give any history of blood transfusion, operation or jaundice. In our hospitals with a history of jaundice are screened for HBsAg and precautions are taken against positive cases; hence 25 seropositive patients in our series would have been operated upon unknowingly. Thus, history alone cannot be relied upon for HBsAg screening. With the enormous pool of asymptomatic hepatitis B virus [HBV] carriers in our population, screening for HBsAg before surgery should be mandatory to reduce at least one important mode of dissemination of HBV infection

Malacoplakia of omentum and mesentery simulating tuberculosis of abdomen: a diagnostic dilemma

Malakoplakia is a rare granulomatous disease of unknown aetiology. It can involve any organ and can occur in any age group but is rare in children. Case of a 10 year old girl is reported whose clinical picture, peroperative diagnosis and initial management was that of tuberculous abdomen. Histological surprise came out to be malakoplakia of greater omentum and mesentery. Subsequently she improved without any medication