Teenage jejunoileal diverticulosis

Presentation of jeujunoileal diverticulosis in young age is virtually unknown. It is associated with middle or old age. It is usually asymptomatic but may present with vague abdominal pain and episodic nausea, vomiting or diarrhoea. It can lead to complications like bleeding, perforation and obstruction. We had 3 cases of jejuno-ileal diverticulosis presenting in their teens. They had resection and anastomosis resulting in improved health

Occult medullary thyroid carcinoma: an unusual presentation of carcinoma of the thyroid gland

A 33 years old male patient presented with slowly increasing painless swelling over left side of neck from 4 years, resulted in disfigurement. On examination it was a large firm, lobulated swelling extending from just left side of midline to anterior border of left trapezius, and from mandible to clavicle. It was not moving with swallowing. FNAC of the swelling was suggestive of metastatic follicular carcinoma of the thyroid gland. Serum TSH was normal. Radical lymph node dissection was done with total thyroidectomy. Histopathological examination showed it to be metastatic medullary carcinoma of the thyroid gland with microscopic primary in the left lobe of thyroid gland. All other examinations related to multiple endocrine neoplasia were normal

Damage control laparotomy for exsanguinating penetrating abdominal trauma

Damage control, defined as initial control of haemorrhage and contamination with intra-peritoneal packing and rapid closure, allows the resuscitation to normal physiology in the intensive care unit and subsequent definitive re-exploration. A case of penetrating abdominal trauma with extensive hepatic, interior vena cava and pancreatico-duodenal injuries, was managed on the principles of damage control on the first laparotomy and definitive procedure of pancreaticoduodenectomy was delayed and performed after 48 hours

Management of vascular trauma

To characterize the vascular injuries, their management and the results. Design: Descriptive study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Kharian Cantonment, between October 2000 and October 2003. Subjects and Cases of vascular injuries received at the hospital amongst the total of 3134 trauma patients were evaluated. Thirty six cases with 41 vascular lesions were evaluated, excluding the three primary amputations. Vascular injuries were then characterized by age, gender, site, mechanism, associated injuries, need and type of surgery. Penetrating trauma accounted for 94.4% of all vascular admissions. Five% of the vascular injuries developed complications. Surgical intervention was required in all cases [100%]. Reverse saphenous vein graft was used in 82.9%. The injured veins were mostly ligated except one, which was managed by saphenous vein graft. The average time lapsed between injury and intervention of patients ranged between 2 to 18 hours. No mortality or secondary haemorrhage was documented. Vascular trauma represents a small percentage of all trauma admissions. It has a high morbidity and most require surgical intervention. The operative intervention rates are higher in patients with vascular injuries than in the general trauma population but with prompt surgery, the chances of limb salvage increases and the overall complication rate reduces