Laparoscopic repair of ventral hernia

To determine the outcome of patients in terms of wound complications and follow-up, after laparoscopic ventral hernia repair. A case series study. Department of Surgery, Dubai Hospital, Dubai, from January 2007 to December 2011. All patients above 13 years of age, who underwent laparoscopic ventral hernia repair, were included. A proceed dual mesh was used for repair of hernia. Multiple parameters were analyzed, including demographic features, presentations, co-morbid conditions, duration of hernia, and defect size. The duration of surgery, postoperative complications, and follow-up of these patients in terms of suture site pain and recurrence of hernia were also analyzed. The data was expressed as frequency, percentages and mean +/- standard deviation of values. There were 27 patients with mean age of 47 +/- 10.3 years, including 20 female [74.07%] and 7 male [25.95%] patients. All patients presented with abdominal wall swelling. The hernia was partially reducible in 12 patients [44.44%], and completely reducible in 15 patients [55.55%]. Seven patients [25.95%] had hypertension, 4 [14.81%] had ischaemic heart disease, and 4 [14.81%] had obesity as co-morbid conditions. All patients underwent laparoscopic hernia repair with proceed dual mesh. The mean defect size of the hernia was 6 cm, and mean duration of surgery was 94 minutes. Early postoperative complications included, seroma in 3 patients [11.11%], and haematoma in one patient [3.70%]. The mean follow-up was 23 months. Four patients [14.81] had pain at suture site. Laparoscopic repair is an appropriate approach for ventral hernia repair. It results in good repair and low wound complications in terms of haematoma and wound infection. There was no recurrence of hernia in this study

Spectrum of helicobacter pylori in hundred patients presenting with perforated duodenal ulcer

To find out the frequency of Helicobacter pylori in patients presenting with perforated duodenal ulcer. This observational study was conducted at Lady Reading Hospital Peshawar from July 2004 to January 2005 on 100 patients with confirmed diagnosis of perforated duodenal ulcer fulfilling the inclusion criteria. A semi-structured Questionnaire was designed for the study. Out of a total of 200 patients operated for perforated duodenal ulcer 100 patients were fulfilling study criteria. Among these100 patients 80 were males and 20 were females. The participants were ranging from 18 to 72 years in age with mean age of 47.02 +/- 13.42 years. Helicobacter pylori were found in 80[80%] patients on histopathology and 65 [65%] patients on rapid urease test Infection rates were maximum in the elderly and those belonging to poor socioeconomic class. All infected patients were treated with triple regimen eradication therapy comprising of clarithromycin, Proton Pump Inhibitor [PPI], and amoxicillin for 14 days. The patients were not followed to confirm eradication status. The spectrum of H. Pylori infection is very high in patients with duodenal ulcer perforation. An early and appropriate H. Pylori eradication therapy may prevent duodenal ulcer perforation

Acute mesenteric ischemia: experience in a tertiary care hospital

Acute mesenteric ischemia is an abdominal catastrophe. This has been described as a complex of diseases rather than a single clinical entity. The incidence in United States is 1 in 1000 hospital admissions. The objective of this descriptive study was to determine the clinical presentations and out come after surgery of patients with acute mesenteric ischemia. It was conducted at Dubai Hospital, Dubai, United Arab Emirates. All patients having per operative or histopathological diagnosis of acute mesenteric ischemia from 2002 to 2006 were included. There were 16 patients in all. Their mean age was 51 years, 12 were male and 4 were female. Abdominal pain was present in 16 patients, vomiting in 12 and anorexia in 9 patients. Abdominal tenderness was present in 16 patients, abdominal distension and rebound tenderness in 12 patients. Five patients had hypertension, 4 had myocardial infarction and 4 had diabetes mellitus as risk factors. X-Ray abdomen was done in 13 patients, Ultrasound in 9 and CT Scan in one patient. Resection of bowel was done in 14 patients. Post operatively 5 patients developed pneumonia, 3 had wound dehiscence, 3 had sepsis, and 3 had Lower GI bleeding. Five patients were expired after surgery in the hospital. Four patients were lost to follow up. We should have a high index of suspicion for mesenteric ischemia in patients with unexplained abdominal pain. Early diagnosis and prompt surgical intervention improves the outcome

Magnetic attraction: dual complications in a single case

A case report of a 19-years-old mentally retarded girl, presented with abdominal pain, nausea and vomiting of two days duration. Physical examination revealed abdominal tenderness with guarding and rigidity. Exploratory laparotomy revealed the presence of magnets in the jejunum with perforation of jejunum and a resultant gastro jejunal fistula. The procedure involved enterotomy for removal of magnets, resection of the segment of the bowel with fistula and perforation and end-to-end anastomosis. The association of ingested magnets, leading to dual complications, is a rare case ever reported in Dubai

Choledochal cyst associated with heterotopic pancreatic tissue

This is a case report of a 44 year old male, who presented with upper abdominal pain, vomiting, and fever for two days. On examination, he was jaundiced and febrile. His abdomen was tender in epigastrium and right hypochondrium. CT scan and MRCP revealed a cyst in the region of head of pancreas, extending toward liver. ERCP was not successful. He was operated, and cholecystectomy, excision of the cyst and biliary enteric anastomosis were done. The presence ofcholedochal cyst associated with heterotopic pancreatic tissue in the cyst is a rare association

Surgical palliation for unresectable pancreatic carcinoma

To review the results of surgical palliation for unresectable pancreatic carcinoma, and to analyze the morbidity and mortality associated with the surgical procedure. The reasons for readmission after discharge from the hospital were also analyzed. A retrospective study from 1995 to 2001 was done on 30 patients with pancreatic cancer operated with palliative intent, or those explored with curative intent but histopathology revealed positive resection margins or lymph node metastasis. Twenty-five [83.25%] patients were above 50 years of age. There were 16 [53.28%] male, and 14 [46.62%] females, 8 [26.64%] had diabetes mellitus, 2 [6.66%] chronic pancreatitis and 4 [13.32%] had smoking as risk factors. Twenty-three [76.59%] patients presented with jaundice, 18 [59.94%] with weight loss, 17 [56.61%] with epigastric pain, 15 [49.95%] with anorexia and 14 [46.62%] with vomiting. Whipple's procedure was performed in 9 [29.97%] patients, triple bypass in 13 [43.29%], choledochojejunostomy and gastrojejunostomy in 3 [9.99%] and gastrojejunostomy alone in 5 [16.65%] patients. Seven [23.31%] patients had preoperative ultrasonography, while CT Scan was done in 24 [79.92%] and ERCP in 8 [26.64%] patients. Histopathology showed positive resection margins in 9 [29.97%] patients and lymph node metastasis in 5 [16.65%] patients. Seventeen [56.61%] patients received less than 2 units of pack cells transfusion. Most of the patients remained admitted in the hospital between 20 to 30 days. Post-operatively, delayed gastric emptying was detected in 6 [19.98%] patients, cholangitis in 2 [6.66%], wound infection in 3 [9.99%], anastomotic leak in 2 [6.66%] and line sepsis in 2 [6.66%] patients. Three [9.99%] patients expired in hospital post operatively. The reasons for re-admission after discharge included abdominal pain in 9 [29.97%] patients, anemia in 3 [9.99%], intestinal obstruction in 3 [9.99%] and urinary tract infection in 2 [6.66%] patients. Follow up record was available for 22 [73.26%] patients. Six [19.98%] patients survived for 5 to 6 months and 9 [29.97%] had a survival between 7 to10 months. A single surgical procedure can palliate all three symptoms associated with unresectable pancreatic carcinoma, and can be carried out with reasonable safety in selected patients. The commonest indication for re-admission is severe abdominal pain associated with advanced malignancy, hence chemical splanchiectomy may also be considered at the time of surgical exploration

Liver cyst with inflammatory hepatic duct polyp

This is a case report of a 50 years old woman, who presented with upper abdominal pain, vomiting and two episodes of jaundice in five months. Computerised tomographic scan revealed a cyst in the 4th segment of the liver. Peroperatively it was found to be a simple liver cyst arising from the left hepatic duct. The cyst was excised. Peroperative cholangiogram revealed obstruction in the common hepatic duct. A polyp in the common hepatic duct, causing obstruction, was excised. The presence of liver cyst with hepatic duct polyp is a rare association