ABSTRACT
Background: Cases of self insertion of anorectal foreign objects and their extraction maneuvers had occasionally been stated in literature
Objective: To determine the presentation and management of self induced anorectal foreign bodies
Methodology: Retrospective data of anorectal foreign bodies from 1 March, 2010 to 30 September, 2015 was collected and analyzed in this cross sectional study. Atotal of 17 male patients presented with foreign bodies in lower gastrointestinal tract were included in this study. Information regarding detailed clinical history, digital rectal examination, proctoscopy, sigmoidoscopy, plain abdominal radiograph and surgical and nonsurgical treatments were collected and analyzed. Details of intraoperative or postoperative complications, observed mortality or morbidity and condition at discharge, were also noted and analyzed, by using SPSS version 20
Results: The mean age of 17 patients included in this multicentered retrospective analysis was 35 +/- 17 years. Anorectal pain was present in 17 [100%] patients while rectal bleeding was observed in 14[82.35%]. Only 7[41.17%] revealed history of foreign body insertion through anus for sexual gratification. Plain abdominal radiograph displayed foreign bodies in 10 patients. In 7[41.17%] patients, foreign bodies were extracted transanally. Ten [58.82%] patients experienced laparotomy for high lying objects. No major or minor postoperative complications were observed. There was no mortality. Mean hospital stay was 2.14 +/- .1.95 days
Conclusion: Anorectal foreign body can present invariably. Low threshold of suspicious is required for early recognition. Management should be planned according to type and best possible facilities availability
ABSTRACT
Background: Acute abdomen is a surgical emergency and sometimes portrays a challenge as its cause remains unexplained unless explored. Recently, trend of diagnostic laparoscopy in acute abdominal conditions is growing among surgeons due to its benefits of establishing diagnosis and provision of therapy with minimal invasive approach
Objective: To assess the diagnostic and therapeutic utility of laparoscopic surgery in unexplained acute abdominal conditions
Methodology: Fifty three patients, from 1st September 2014 to 30th June 2015, with unexplained acute abdominal conditions on clinical and radiological assessments were subjected to diagnostic laparoscopy. Therapeutic laparoscopic surgery was offered to all diagnosed cases. Resected specimens were directed for histopathological analysis to confirm diagnosis. All patients were followed up to 3 months. The data was entered and analysis by using SPSS version 20
Results: Accurate diagnosis was established successfully in all patients. The outcome of diagnostic laparoscopy was: uncomplicated acute appendicitis in 31[58.49%] patients, complicated acute appendicitis in 5[9.43%] patients, acute cholecystitis in 1[1.88%] patients, pancreatic necrosis in 1[1.88%] patients, mesenteric adenitis in 2[3.77%] patients, caecal mass in 2[3.77%] patients, dual pathologies in 5[9.43%] patients, and gynaecological emergencies in 6[11.32%] patients. We did not need to convert to open surgery for diagnostic or therapeutic purpose in any case. No significant intraoperative and postoperative complications were observed. All patients were discharged within 2 days after surgery except three cases. There was no mortality
Conclusion: Our initial experience showed that diagnostic laparoscopy in acute abdomen is useful in establishing diagnosis, safe to perform and achieves therapeutic goals in almost all patients
ABSTRACT
Background: in this arena of minimally invasive surgery, surgeons have been compelled to combat the pathologies through smaller incisions to lessen the toll of surgery in terms of cosmesis
Objective: to describe the outcome of buttonhole access surgery in uncomplicated acute appendicitis
Methodology: this was a quasi experimental study, conducted over a period of four years, 1[st] January 2010 to 31[st] March 2015, we performed appendectomies among 213 thin lean cases [BMI6] through buttonhole access which were attempted through a small incision of 1.5-2cm size placed usually lower down in pelvis so could be hided easily in undergarments. Data regarding demographics, clinical features, operative time, hospital stay, postoperative additional analgesic requirements and complications if any was collected and analyzed through SPSS 20
Results: the mean BMI of the patients was 18.94 +/- 0.88 kg/m[2] and the mean Alverado score at the time of admission was 8.16 +/- 1.01. Through buttonhole access, appendectomies were successfully accomplished in 205 [96.24%] patients [mean incision length 1.887 +/- 0.156 cms]. Mean operative time was 19.69 +/- 6.21minutes. No intraoperative complication was noticed. 209 [98.12%] patients were discharged within 24 hours of operation. The only postoperative complication was small seroma which developed in only 2[0.93%] cases. No scar related complications was observed over a period of six month follow up. There was no mortality
Conclusion: buttonhole access for uncomplicated acute appendicitis is feasible and safe to perform in thin lean patients where diagnosis is sure
ABSTRACT
Background: Single incision laparoscopic appendectomy [SILA] is getting popular but is expansive due to the need of special equipment. Surgeons are thrived to develop different low cost techniques in order to decrease the cost. We herein describe an early experience of our own simplified low cost single incision laparoscopic appendectomy [SILA] technique with use of conventional laparoscopic instruments and a modified suture loop technique among patients with uncomplicated acute appendicitis [UAA]
Objective: To determine the outcome of single incision laparoscopic appendectomy by an innovative suture loop technique among patients with uncomplicated acute appendicitis
Methodology: In this Quasi experimental study we performed SILA in 25 patients of all age and both sexes by using conventional non-reticulating laparoscopic instruments, 0[degree] telescope, two 10mm ports and an innovative percutaneous suture loop [named Saad's loop] to suspend appendix for essential dissection around it. Any intraoperative or postoperative complications were noted. The patients were followed at least till 6 months after surgery
Results: We successfully completed SILA with our technique [Saad's loop] in all patients. The mean number of attempts to engage the loops was 1.76 +/- 0.93 and the mean operative time was 36.72 +/- 11.23 min. Suture loop did not cause trauma to appendix in any case. The mean VAS was 0.20 +/- 0.50. All patients were discharged within two days. No intraoperative or postoperative complications were noted over a period of six months follow up
Conclusion: Our SILA technique with conventional laparoscopic instruments is simple and cost effective in patients with UAA by the use of innovative suture loop to suspend appendix. However, further randomized controlled trials with large sample size are recommended in assessing this new technique SILA to disclose its prospective benefits
Subject(s)
Humans , Male , Female , Adult , Laparoscopy , Appendicitis , Acute Disease , Non-Randomized Controlled Trials as TopicABSTRACT
Background: Usually breast cancer presents as palpable mass. Suspicion of cancer is increased when nipple discharge is also present along with palpable masses. Triple assessment i.e. clinical, radiological examination and biopsy is done to detect malignancy. However, this is expansive, operator dependent and is not readily available
Objective: To determine the sensitivity, specificity and diagnostic accuracy of positive malignant cell cytology of blood stained nipple discharge among patient with palpable breast mass for detection of breast carcinoma
Methodology: This cross- sectional study was conducted at Sir Ganga Ram Hospital, Lahore, from 1[st] July, 2011 to 31[st] July, 2013 and included 100 patients who presented with blood stained nipple discharge along with palpable breast mass. All the patients had cytology of nipple discharge which was labeled as positive [if malignant cells were found]. Diagnosis was confirmed on histopathology of surgically removed breast lump [modified radical mastectomy for positive cases and wide local excision for negative cases]. The data was entered and analyzed by using SPSS version 20
Results: Cytology of nipple discharge was positive among 30 [30%] and negative in 70 [70%] patients. Histopathology of patients with positive cytology confirmed intraductal carcinoma in all cases [100%]. Sensitivity, specificity and diagnostic accuracy of cytological examination of blood stained nipple discharge was 100% each
Conclusion: Positive cytology for malignant cells in blood stained nipple discharge among patients with palpable breast masses is highly accurate and is suggestive of malignancy in almost all the cases