Experience of spontaneous small bowel perforations at the Mayo Hospital

Hospital record of 84 consecutive cases of spontaneous small bowel perforation managed by one surgical unit of mayo hospital over a period of two years was examined. Fifty eight male and 26 female cases were dealt with. Age ranged from 15-70 years. Perforations were caused by enteric fever in 50% cases tuberculosis 31%, adhesive bowel disease and non-specific in 9%. Eighty one percent cases had only one, 12% cases had two and 7% cases more than 2 perforations. Primary repair of perforation was done in 60% cases, resection and anastomosis in another 23% and in 13% cases the perforation was exteriorized. In 2% cases simple tube drainage of the coelomic cavity was done. Twenty One cases had postoperative complications out of these 5 patients expired

Selective expolratory protocol, a possibility in penetrating neck trauma

A four year [1993-96] prospective study of penetrating neck trauma was carried out at a surgical unit of a major teaching hospital. The study comprises of 48 patients. Age ranged from 16-72 years with a male to female ratio of 9:1. Thirty two [66.6%] merited early exploration while 16 [33.3%] were initially treated conservatively. Two of the later group underwent delayed exploration for infected hematoma. Firearm was the commonest mode of injury [43.7%] and cervical vasculature was the most commonly injured[25.4%]. Exsanguination and respiratory paralysis following cord damage were responsible for the mortality in 5 cases

Penetrating abdominal trauma

Audit of 73 consecutive patients with penetrating abdominal trauma managed from June 94 to June 95 is presented. Victims were predominantly young males. Age ranged from 14-85 years. Mode of injury was firearm in 58 cases [79.4%] and stab in 15 [20.5%], twenty six [35.6%] cases had associated extra-abdominal injuries. In this series 70 cases underwent exploratory laparotomy, of which 63 [90%] were therapeutic and in 7 cases [10%] non- therapeutic. Twenty seven [37%] patients had postoperative complications and 15 [20%] patients expired during this study period, including 3 [4%] intraoperative deaths. Suggestions to reduce such a high rate of morbidity and mortality include, a strict control on firearms, enforcement of ban on their display and development of fully equipped regional centers for managements of such patients