Stray bullet in inferior vena cava

A young boy presented in emergency with history of being hit by a stray bullet injuring the right hypochondrium. Ultrasound of abdomen showed hemoperitoneum and the radiograph showed bullet in the pelvis. Exploratory laparotomy showed injuries to liver and cystic duct with tract leading retroperitoneally into the inferior vena cava. The bullet was found wandering inside the vena caval lumen. Stray bullets are presumed to remain limited to the soft tissues. However, the trajectory, impact velocity and the involved region ultimately determine the outcome and influence management

Appendicectomy in younger females; what should be the better approach?

Females have a high negative appendicectomy rate. In this study our goal was to ascertain if there was a significant reduction in negative appendicectomy rate in our hospital with the increasing use of elective laparoscopy along with Alvarado scoring and ultrasonography in the females of childbearing age. Cross sectional study. Emergency department, Allied Hospital Faisalabad. Females of age 12-40 year with pain in right iliac fossa were studied from November 2005 to April 2006. Patients were divided into three groups on the basis of Modified Alvarado Score [MAS]: Group I: patients [score <5] discharged, Group II: patients [score 5-7] put on observation for 36 hours and elective laparoscopy was done. Group III: Patients [score 8 and 9] underwent emergency open appendicectomy and negative appendicectomy rate was calculated. In group II any complication associated with delaying appendicectomy for 2 days were identified. One hundred and thirty female patients presented with pain in right iliac fossa. 33 patients were having MAS <5 [group I], 44 patients were having MAS 5-7 [group II]. Out of these 35 patients underwent diagnostic laparoscopy. Only two patients [5.7%] in this group needed conversion to open appendicectomy due to perforation. 53 patients had MAS 8 and 9 [Group III]. Ultrasonography excluded four patients with gynecological findings and mass formation. 49 patients underwent emergency appendicectomy. Four females [8.1%] were having negative appendicectomy as proved on histopathology. Diagnosis and treatment of acute appendicitis in younger females can be improved with appropriate use of Alvarado score, ultrasonography and laparoscopy