Risk factors for surgical site infection in clean surgeries in Abbasi Shaheed Hospital

To assess the risk of surgical site infection in clean surgeries associated with age, sex and duration of surgery in Abbasi Shaheed Hospital. This study is a Case control study and was conducted in surgical Unit-1, Abbasi Shaheed Hospital, Karachi from January 2006 to December 2008. Its sample size is Non-probability, convenience and 150 patients were taken for this study in which 100 patients with healthy surgical site were taken as control while 50 patients with infected surgical site were taken as the cases. All male and female patients of age between 18 to 55 years were included in this study. For ail diabetic and non-diabetic patients who were admitted in ward for elective clean surgery, same method of skin preparation was under taken with povidone iodine and spirit. Control were patients without surgical site infection while cases were patients with surgical site infection. All patients received three doses of prophylactic antibiotic first generation cephalosporin 500 mg i/v Shourly preoperatively. SPSS version 10 was used to analyze the data. The ages of the patients were between 18-55 years with increased risk of surgical site infection with increasing age. Out of 50 patients with surgical site infection, 28 [56%] were diabetic and 22 [44%] were non-diabetic. It was seen that 24 patients [16%] had surgery of duration 46-60 minutes and 12 of them [50%] had surgical site infection as compared to 36% in surgery of less than 30 min. Odd ratio of infection for diabetes, duration of surgery, age and gender were 10.3, 6.5, 3.1 and 1.3 respectively. Significant association was found between type, duration of surgery and ASA score. Adjusted analysis revealed a significant relation between age, ASA class, diabetes mellitus, uncontrolled postoperative blood glucose level, duration of surgery and surgical site infection. Mastectomy was significantly associated with surgical site infections along with longer duration and ASA class III

Desmoid tumour of lower abdomen

A desmoid tumour is slow growing fibromatosis with aggressive infiltration of adjacent tissue and extremely unusual systemic metastases. We report a case of a female patient aged 25 years who had a mass in lower abdomen for 2 years. There was no previous history of any surgical intervention. Preoperative evaluation included ultrasound and computed tomography. Patient underwent primary resection with wide margins. Histology revealed a desmoid tumour

Bilobed gallbaldder

We report a rare case of duplication anomaly of gallbladder in a female aged 17 years, who presented with right hypochondrial pain for 3 months. Ultrasound findings suggested multiple stones in gallbladder and per-operatively she was found to have bilobed gallbladder. This case emphasizes the need for complete removal of both gallbladders during initial surgery, as a failure of this may result in recurrence of symptoms and stones and a need for re-exploration

Proportion of bile micro-organisms and their culture and sensitivity to various antibiotics in patients with gallstones

To provide scientific basis for selecting a prophylactic antibiotic in the cases of elective cholecystectomy, according to our local conditions. Descriptive Study. General Surgery department of Abbasi Shaheed Hospital Karachi from 1st Jan, 2004 to 31st Dec 2004. Fifty patients with chronic cholecystitis ranged between 20 to 65 years were admitted through outpatient department. These patients also included high risk patients with diabetes mellitus, ischaemic heart diseases, hypertension and immunocompromised patients. Patients with acute cholecystitis, empyema, obstructive jaundice, common bile duct stone, carcinoma of gallbladder or biliary tree, cirrhosis and patients having septic foci elsewhere were excluded. Patients were selected according to convenient sampling. During cholecystectomy bile was sent for culture and sensitivity. For analysis of data SPSS-10 was used. In this study positive bile culture was found in 44 percent of cases and most prevelant organisms were E.coli and Klebsiella. With regard to antibiotic sensitivity. Amikacin, quinolone, imipiname and piperacillin has shown almost 90% sensitivity. Prophylactive antibiotic should be used in all cases of elective cholecystectomy

Complications of colostomy in Abbasi Shaheed hospital

To describe the different complications of colostomy that developed after its construction either in emergency or elective surgery in Abbasi Shaheed Hospital Karachi. Descriptive study from January 2006 to Dec. 2007 during which fifty patients who were above 12 years of age were admitted in Surgical Unit-I, of Abbasi Shaheed Hospital, Karachi, through emergency and out patient department. Information of patients including history, clinical examination, investigations, and indication of surgery, operative procedure and operative findings were collected. Gut preparation was done in elective cases only. Detail about stoma, its type, complications and treatment were observed carefully. Emergency colostomies were performed in emergency theatre while elective cases were done in main theatre. Patients were followed up from the construction of colostomy to the fourth post operative week to analyze the complications associated with stoma formation. Reversal of colostomy was done after 8th to 12th post operative period. Among them 40 patients 80% were males and 20% were females. Students, labors and old age were mostly affected class. Most of them were victims of terrorism. Intestinal trauma due to gun shots and stab were the leading cause while the intestinal pathology like tuberculosis, carcinoma, volvulus, intestinal obstruction were found to be the less common causes of stoma formation. 40 patients [80%] were operated in emergency theatre while 10 patients [20%] under went elective faecal diversion. Majority of Colostomies were temporary loop colostomies, formed only for diversion and decompression of distal segment. Out of fifty patients, none of the patients had any major post operative complications like necrosis, prolapsed, parastomal hernia and fistula formations. Only twelve patients [24%] developed complications. Abdominal wall infection in two patients [4%] and skin excoriation in 3 patients [6%] around the stoma were found the commonest local complications. Retraction in 2 patients [4%], stenosis in two patients [4%] with stoma obstruction in 1 [2%] and detachment in 1 [2%] were found. All these cases required refashioning of Colostomy. Stoma bleeding and pain was also observed and treated in 2 patients [4%]. The psychological trauma of having colostomy with a bag on the belly was a considerable problem which patient had during the period, which was reduced and post operative counseling and training was given. Stoma surgery has a wide range of clinical implication. It is relatively a save procedure either to reduce leakage of distal colonic repair or to provide sufficient time for the healing of intraperitonial trauma. The complications occurred in only 24% patients among which skin excoriation and skin infection occured in a few patients. Having an artificial anus was a mental torture for patients

Results of ultrasound findings in cases of pure cystic scrotal swellings in patients of all ages in ash

To describe the results of ultrasound findings in pure cystic scrotal swellings in patients of all ages in ASH. It was a descriptive case series carriedout from Jan 2003 to Dec 2005 in SOPD and Surgical unit-1, Abbasi Shaheed Hospital and KMDC, Karachi. A total of 100 patients were taken who had pure scrotal swellings which were cystic in nature clinical examinations. These patients were treated in this hospital during this period. All patients [n=100] attending SOPD of Abbasi Shaheed Hospital with presenting complain of pure scrotal swellings were clinically examined with especial attention to get above the swelling, fluctuation and transillumination test and their size of the swelling also noted by an inch tape. An inform consent was taken and ultrasound of scrotum was done in ultrasound department to confirm the cystic swelling of scrotum and also to measure the size of the swelling. These patients were then divided into three groups according to the size of the scrotal swelling in which Group A [n=22] patients had size <5cm in diameter, Group B [n=51] had size 05-10cm in diameter and Group C [n=27] had size >10cm in diameter. All patients were admitted for surgery [exploration of the scrotal swelling]. On exploration of the scrotum [n=100], about 39% [n=39] of patients had < 50 ml of fluid, 32% [n=32] of patients had 50-100 ml of fluid while 29% [n=29] of patients had >100 ml of fluid in the sac. About 77% [n=77] of patients had clear amber coloured fluid, about 13% [n=13] had serous fluid with calcifications, about 07% [n=07] had pussy fluid and only 03% [n=03] had bloody fluid in the sac. Therefore about 90% of the patients had hydrocele [n=90], about 07% had pyocele [n=07] and only 03% of patients had haematocele [n=03]. No malignancy was found in this study. Most of the patients coming in this hospital with pure cystic scrotal swellings had hydroceles [90%], some of the patients had pyoceles [07%] while few had haematoceles [03%]. All most all cystic scrotal swellings were benign in nature and no malignancy was found in this study

Intestinal tuberculosis - a common cause of intestinal obstruction

To assess the prevalence and presentation of intestinal tuberculosis in cases of mechanical bowel obstruction. Retrospective study from Oct. 1999 to Sept. 2005. Surgical Unit I, Abbasi Shaheed Hospital, Karachi. All patients [> 10 years of age] presenting with mechanical bowel obstruction. The data and files of all the cases of dynamic bowel obstruction was retrieved and analyzed with reference to age, sex, symptomatology and examination findings, investigations, aetiology, surgical procedures performed and outcome. A total of 163 patients were admitted with mechanical bowel obstruction over a period of six years. The ages of the patients varied between 10-74 years, maximum cases being seen between 30-40 years, with a male preponderance [60.1%]. Abdominal pain [40.5%], vomiting [20.2%] and constipation[16. 0%] were the prominent modes of presentation. Intestinal Tuberculosis [70.6%] was the most common cause of intestinal obstruction, followed by irreducible inguinal hernias [17.2%] and malignancies [7.4%]. Less than half [46.0%] the tuberculous patients were already on anti-tuberculous treatment at the time of presentation. About 9% of the tuberculous cases were managed conservatively, while the rest were operated upon; right hemicolectomy being the most frequent [47.6%] procedure performed. Histopathology was positive for tuberculosis in all the cases. Five patients of intestinal Tuberculosis died due to Tuberculous peritonitis. Intestinal Tuberculosis is the leading cause of mechanical bowel obstruction in our part of the world. Many patients of abdominal tuberculosis, managed conservatively on anti-tuberculous treatment, develop signs and symptoms of acute obstruction. Hence early surgical intervention is recommended to improve the morbidity and mortality of such patients