Clinical Profile Of Patients With Perforation Peritonitis.

Background: Peritonitis is common surgical emergency in which there occurs inflammation of peritoneum and peritoneal cavity. It is associated with increased morbidity and mortality. So the aim of the study was to evaluate the clinico-etiological profile of perforation peritonitis in our setting. Methods: This study was conducted in a tertiary care centre of Kashmir, over a period of 2 years in which 100 patients diagnosed with perforation peritonitis were serial evaluated. Results: In our study the dominant gender involved was male sex(68%). Mean age of study population was 34.12 years. The most common age group involved was 21-40 years (44%) . Abdominal pain was the commonest presenting symptoms (100%), followed by nausea and vomiting (88%). The commonest site of pathology was gastroduodenal region (50%) and peptic ulcer disease was the most common aetiology confirmed. Conclusion: Patients presenting to our emergency clinic with such clinical profile should be recognised promptly so as to rapidly develop a plan for further management and put our resources at best use.

Prolongation of QTC interval in patients with cirrhosis

Objectives: To observe the frequency of QTc [corrected QT] interval prolongation in patients with chronic liver disease in our population

Study design: A cross-sectional analytical study

Place and duration: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi from May 2009 to October 2009

Methodology: A non- probability, purposive sampling is used in already diagnosed cirrhotic patients. Patients between 25-70 years were included. These patients were divided into three groups according to their Child-Pugh [C.P.] classification [class A, class B and class C]. An electrocardiogram [ECG] of all patients was obtained and QT intervals corrected for heart rate [QTc] were calculated. Analysis of data was done by SPSS 17

Results: 121 cirrhotic patients were inducted in this study. 10 patients belonged to C.P. class A, 49 to C.P. class B, and 62 to C.P. class C. Prolonged QTc interval was observed in 48 [39.7%] patients while in 73 [60.3%] patients QTc interval was normal. Occurrence of prolonged QTc interval was greater in C.P. class-C [50%] followed by C.P. class-B [30.6%], p value 0.045 and 0.016 respectively

Conclusion: Significant number of cirrhotic patients had prolonged QTc interval and this prolongation of QTc interval was directly associated with more advanced liver disease

Frequency of common factors for post endoscopic retrograde cholangiopancreatography pancreatitis

To determine the frequency of factors leading to post endoscopic retrograde cholangiopancreatography [ERCP] pancreatitis. Case series. Department of Gastroenterology, Liaquat National Hospital, Karachi, from November 2007 to October 2008. Fifty [50] patients of diagnosed cases of post-ERCP pancreatitis were included in this study. The collected data included age, gender, previous post-ERCP pancreatitis, recurrent pancreatitis, recurrent abdominal pain, number of attempts of common bile duct [CBD] cannulation, difficult CBD cannulation, precut sphincterotomy, biliary sphincterotomy, pancreatic duct contrast injections, primary diagnosis, device used, therapeutic procedure undertaken and the pancreatic enzymes level. Results were described as frequency percentages. Out of 50 patients, 32 [64%] were females. The average age of the patients was 52.23 +/- 13.4 years. Frequency of common factors regarding post-ERCP pancreatitis were age 2 60, [n = 38, 76%] patients, female gender [n = 32, 64%], precut sphincterotomy [n = 34, 68%], pancreatic duct contrast injections [n = 27, 54%], biliary sphincterotomy [n = 25, 50%]. Higher number of attempts of CBD cannulation and difficult CBD cannulation were recognized as factors for post ERCP pancreatitis. Other factors like previous history, post-ERCP pancreatitis, recurrent pancreatitis, and recurrent abdominal pain were not found in this study. Age, female gender, precut papillotomy, pancreatic duct contrast injections and biliary sphincterotomy were common factors for post-ERCP pancreatitis. Risk stratification will allow endoscopists to better identify patients who are at risk and permit detailed informed consent in high-risk groups or to adapt the measures to prevent the complications and reduce the risk related with the procedure

Familial adenomatous polyposis

Familial adenomatous polyposis represents approximately 1% of all colorectal tumours and is caused by germline mutations in the adenomatous polyposis coli [ARC] gene. A 38-year-old lady presented with abdominal pain, diarrhoea and iron deficiency anemia. There was no history of colorectal cancer in the family Colonoscopy showed hundreds of polyps throughout the colon sparing the rectum, and an ulcerative tumour of the sigmoid colon. The diagnosis was familial adenomatous polyposis [FAR] and adenocarcinoma of the sigmoid colon. Colectomy with ileorectal anastomosis was performed and later on she was given chemotherapy and advice life long surveillance. The patient had one brother and one sister, without clinical symptoms. The brother had a single hyperplastic rectal polyp, while the sister refused colonoscopy. The patient has 2 sons, the elder son had normal colonoscopic findings, and the younger son was also diagnosed as a patient of FAR and referred for colectomy

Gastric Schwannoma in a Female Patient with Pulmonary Tuberculosis — A Clinicopathological Assessment and Diagnosis

Schwannomas, or neurinomas, are generally benign, slow-growing, asymptomatic neoplasms originating from the Schwann cells of a nerve sheath. As a part of spindle cell mesenchymal tumours, schwannomas arising from the gastrointestinal tract (GIT) are unusual; however, when they occur, the most common site involved is the stomach, which represents 0.2% of all gastric tumours. We report the case of a 35-year-old female patient with a history of pulmonary tuberculosis presenting with a large palpable abdominal mass reaching up to the peritoneal cavity. The initial clinical impression was a tuberculous abdominal mass, a cyst, or a teratoma. However, intra-operative findings during a subtotal gastrectomy revealed an exophytic gastric serosal mass, which suggested a gastrointestinal stromal tumour (GIST). Post-operative histopathological findings showed a fascicular arrangement of neoplastic spindle cells with pallisading nuclei that showed intense positivity for S-100 protein, and were negative for CD117 and desmin in immunohistochemistry studies. These results confirmed the final diagnosis of a gastric schwannoma.

giant infracranial hydatid cyst excised in toto; Case report and review of literature

Hydatid disease is caused by infestation of larvae of Taenia echinococcus [TE]. The definite hosts of TE are various carnivores [meat eaters], and dog is the most common host. Sheep, cattle, goats and swine are common intermediate hosts. Humans are infected through faeco-oral route by the ingestion of food and milk, contaminated by dog faeces containing the ova of parasite or direct contact with dogs. Eggs lose their envelop in stomach and embryos are released, which then pass through the gut wall into the portal system and are carried to the liver where most of the larvae are entrapped and encysted. Some may reach the lungs and very rarely some may pass through the capillary filter of liver and lungs and enter into systemic circulation and reach intracranial cavity. We report a case of giant intracranial, right sided, extra axial hydatid cyst [HC] extending from right frontal region to occipital region which was removed in one piece without rupture by a procedure called hydro-dissection

Emergency surgical management of a massive anterior mediastinal teratoma in a neonate

Generally an anterior mediastinal teratoma is diagnosed because of space occupying effect which produces respiratory distress and pneumonic episodes. However there have been few reports where there was the need to address the problem soon after birth [Fig. 1] because of severe respiratory compromise 2, 3. This was also the case in our patient. A full term baby who had to be transferred from 1000 Km. distance because of none availability of neonatal surgical facility there. He was transported with respiratory support after having been diagnosed on a plain x-ray and on MRI. [Fig. 2, 3, 4]. Emergency resuscitation and management resulted in successful outcome. Details of treatment are presented in this care report

DDS- syndrome: a rare side effect of dapsone in leprosy patients

A 35-year-old male suffering from mid-borderline leprosy was put on multidrug therapy. Six weeks after the commencement of therapy he developed features of DDS- syndrome. Dapsone was immediately stopped, he was put on oral steroids. The patient gradually improved and the liver functions became normal within few weeks. The steroids were gradually tapered off. Dapsone was replaced with quinolones