Assessment of diagnostic laproscopy in chronic abdominal pain at tertiary care hospital

Objective: The objective of this study was to find out the diagnosis of diagnostic laparoscopy in patients having chronic abdominal pain

Study Design: Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at the Surgery Department of PMC hospital and PUMHS Nawabshah from February 2014 to March 2015

Materials and Methods: All the undiagnosed cases of chronic abdominal pain [by conventional methods and investigations such as clinical examination, urine examination, US abdomen etc], abdominal pain more than 3 months, cases age more than 18 years either gender and clinically diagnosed as chronic were selected in this study, while all the cases with known cause of pain, Acute inflammatory disease, cases having acute intestinal obstruction, coagulation abnormalities, critical illness, severe/decompensated cardiopulmonary failure and medically unfit for anaesthesia and surgery were not selected in this study. Diagnostic laparoscopy was performed in all selected cases and findings were entered in proforma

Results: Total 45 patients underwent diagnostic laparoscopy majority of the young patients was found. Female were found in the majority 60% as compare to males 40%. 13 [28.88%] patients had pain in right iliac fossa, 08 [17.78%] patients had hypogastrium pain, 10 [22.22%] cases were found with whole abdominal pain, 10 [22.22%] patients had pain in left iliac fossa and 04 [8.89%] patients were noted with pain at right hypochondrium. According to laparoscopy findings, appendicitis and adhesions were most common 14[31.11%] and 10[22.22%] respectively, following by Abdominal tuberculosis, Hernia, Mesenteric lymphadenopathy, Ovarian cyst and Dense adhesions + Thickened gall bladder wall with percentage of 06[13.33], 03[6.67%], 02[4.44%], 04[8.89%] and 02[4.44%] respectively, while 04[8.88%] cases were noted without any disease

Conclusion: Diagnostic laparoscopy in good tool for diagnosis of chronic abdominal pain, according to the assessment the commonest basis of chronic recurrent abdominal pain in this study was appendicitis followed by abdominal tuberculosis and adhesions

Presentation and outcome of surgical management of strangulated inguinal hernia at Liaquat university hospital Hyderabad

The objectives of the study are to determine the incidence of strangulated inguinal hernia in patients presenting with irreducibility and obstruction, evaluate the age and sex incidence, see the duration of hospital stay in our setup and see the post operative morbidity and mortality. Experimental Study. This study was carried out in Surgical Unit-IV, Liaquat University Hospital Jamshoro, from 2007 to 2009. 100 cases of obstructed hernia were selected out of which 85 with strangulation were included in this study. These patients were admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro/Hyderabad. All these patients were admitted in emergency. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 140 patients presenting with obstructed hernia were selected of which 85 were found to have strangulated hernia. There was wide variation of age ranging from a minimum 15 to 70 years with the mean age 42 years. 55 patients had Right sided hernia 64.7% and 30 patients had Left sided hernia 35,2% and no patient with bilateral strangulated inguinal hernia reported 0%. During surgery of 60 patients [70.5%] had gangrenous omentum while 23 cases [27%] ileum was non viable so we had to resort to resection and anastmosis, two cases [2.3%] Ileum was so much contaminated so we had to resort to Ileostomy and two case [2.3%] sigmoid colon was involved so we had to resort to colostomy. Postoperatively majority of them developed wound infection 14 [16,4%] followed by chest infections 10 [11.7%] Haematoma formation was reported in 5 [5.8%] and retention of urine in 3 patient [3.5%]. Good pre-operation assessment and early management will decrease the morbidity and mortality in strangulated inguinal hernia

Outcome of early appendicectomy in appendicular mass versus conservative approach

The objectives of the study are to compare the outcome of early appendicectomy in appendicular mass versus conservative approach. Experimental Study. This study was carried out in Surgical Unit-IV, Liaquat University Hospital Hyderabad, from January 2008 to December 2009. This study consisted of hundred patients were divided in two groups. Group A for early appendicectomy and group B traditional conservative treatment, each group consist of 50 patients admitted through the outpatient department, as well as from casualty department of Liaquat University Hospital Jamshoro/Hyderabad. Data was analyzed through SPSS software. In conservative management [CM] group 36[72%] were male and 14[28%] female. Ratio male:female ratio of 2.25:1. In immediate surgery [IS] group 34[68%] were male and 16[32%] female with male:female ratio of 2.1:1. There was wide variation of age ranging from a minimum of 10 year to 50 year in both group. The mean age was 22.3 +/- 3.30 years for CM group and 23.4 +/- 3.50 years for IS group. Pain in right iliac fossa were found in all patients in both groups, vomiting was seen 42[84%] patients in CM group and 43[86%] patients in IS group, nausea was seen 17[34%] patients in CM group and 18[36%] patients in IS group, fever was 42[84%] patients in CM group and 44[88%] patients in IS group, diarrhea was 4[8%] patients in both groups, anorexia was seen 35[70%] patients in CM group and 37[74%] patients in IS group, constipation were 9[18%] patients in both groups and urinary complains was 8[16%] patients in CM group and 9[18%] patients in IS group. Ultrasound findings revealed was inflamed appendix with omentum adherent in 10[20%] patients of CM group and 9 [18%] patients of IS group where as inflamed appendix with omentum and abscess formation in 17[34%] patients of CM group and 19 [38%] patients of IS group, and edematous appendix with fecolith and omentum adherent in 23[46%] patients of CM group and 22[44%] patients of IS group. Operative time in both groups was recorded. Operative time range 30 minutes to 90 minutes in both groups. The mean time in CM group was 60.10 +/- 11.90 minutes and IS group was 45.30 +/- 7.96 minutes. The early appendectomy in appendicular mass is a safe alternate to conventional way of managing this problem. Hence, it obviates the need of a second admission and provides curative treatment during the index admission whereby minimizing total expenses