Frequency of causes of mechanical bowel obstruction

Objective: To find out the frequency of different causes of mechanical bowel obstruction

Study Design: Observational / descriptive study

Place and Duration of Study: This study was carried out the Surgical B Unit of MTI, Lady Reading Hospital Peshawar from March 2015 to December 2015 Patients and Methods: All the patients presented with signs and symptoms of bowel obstruction were included in the study while those with non mechanical bowel obstruction like paralytic ileus and peritonitis were excluded from the study. Patient's demographic features and all the data were recorded

Results: Total 50 patients were included in the study. The age range of the patient was 15-80 years with mean age was 42,98 +/- 17.60 years. Thirty seven 74% patients were male and 13 [26%] were female constituting male to female ratio of 2.84:1. Out of 50 patients operated for mechanical bowel obstruction, commonest cause of bowel obstruction was post operative adhesions which accounted for 17 [34%] followed by sigmoid volulus in 10 [20%] cases and intestinal tuberculosis in 8 [16%] patients

Conclusion: Adhesions and sigmoid volvulus were the common causes of intestinal obstruction

Although patients presenting with sub acute intestinal obstruction can be treated conservatively initially, should they develop signs and symptoms of gut ischemia, when conservative treatment fails or in most cases of acute intestinal obstruction immediate surgical exploration is still required

C-reactive protein and total leukocyte count in the diagnosis of acute appendicitis

The objective was to calculate the sensitivity and specificity of C reactive protein and Total leukocytecount by taking histopathological diagnosis of acute appendicitis as the gold standard. Observational study.This study was conducted in the Surgical Unit of Lady Reading Hospital, Peshawarfrom January 2014 to December 2014. The study included 50 adult patients of either gender with clinical diagnosis of acuteappendicitis. The patients were admitted through the emergency department. The decision to operate was made bythe senior surgeon on call, on the basis of clinical features. All the cases were operated within 12 hours' ofadmission. Blood samples for Total leukocyte count and C-reactive protein measurement were collected from all thepatients before surgery. Operative findings were recorded. Removed appendices were sent for histology. The datawas entered and processed on the SPSS 16 version. The patients included 32 males and 18 females. Male to female ratio was 1.8:1. Mean age was 24 years.Frequency of negative appendicectomy was 16%. Sensitivity, specificity and positive predictive value of Totalleukocyte count were 80.5%, 62.5% and 91.8% respectively. Sensitivity, specificity and positive predictive value ofC-reactive protein were 85.7%, 75% and 94.5% respectively. In patients with histopathologically confirmed acuteappendicitis, both the TLC and C - reactive protein were found to be statistically significant. C-reactive protein and Total Leukocyte Count supplement the clinical diagnosis of acute appendicitis

Frequency and causes of conversion of laparoscopic cholecystectomy into open cholecystectomy

To determine the frequency and causes of conversion of laparoscopic cholecystectomy into open cholecystectomy. Cross-sectional [descriptive] study. This study was carried out at Surgical Unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar for 14 months, from 1-11-2010 to 31-12-2011. A total of 126 patients of symptomatic gallstones disease fulfilling the inclusion criteria were subjected to laparoscopic cholecystectomy and were followed through out the procedure to see for any conversion and its cause. The mean age of patients was 40.65 +/- 10.35 with range of 20-65 years. The total no of cases converted to open cholecystectomy were 11 out of 126. Thus frequency of conversion was 11 equal to 8.7%, with commonest cause being adhesions 9 out of 11 converted cases followed by hemorrhage 2 out of 11 conversions. Moreover conversion was more in male patients. 20.8% as compared to 5.9% in females. Laparoscopic cholecystectomy is the gold standard treatment modality in the management of symptomatic gallstones disease. Its one disadvantage is the conversion into open procedure. But conversion should not be considered as complication of the procedure rather it is mature decision by the surgeons to avoid unnecessary lengthening the duration of surgery once they encounter any difficulty or interoperative complication

Frequency of diaphragmatic trauma in fire-arm injury of abdominal cases and outcome of its management

To determine frequency of diaphragmatic trauma in fire-arm injuries of abdomen and to determine outcome of its management. Retrospective study. This study was conducted at Department of Surgery, Unit B, Lady Reading Hospital Peshawar over a period of one year from January 2014 to January 2015. Record of all fire-arm injury cases, who presented during study period, was analyzed. Data were collected on pre-designed proforma from admitted patient record [patients charts] and operation theatre notes register. Demographic data, site and frequency of injury to diaphragm, operative findings, and outcome were the variables of study. Out of total 83 patients of fire-arm injuries, 14 [16.8%] patients had diaphragmatic trauma. Mean age of patient was 27.14 years. Male to female ratio was 4.9:1. Left dome of diaphragm was injured in 9 [64.28%] and right dome was involved in 4 [28.57%] of cases and in one patient [7.14%] patients central tendon of diaphragm was injured together with injury to pericardium that got expired. Diaphragmatic injury though not as common in abdominal fire-arm injury. There should be however very low threshold for suspicion in cases of fire-arm injury of abdomen, where bullet trajectory or mechanism of injury is suggestive, because missing such injury is not devoid of complications. The patient should be thoroughly examined and investigated for exclusion of diaphragmatic injury

Ileostomies and colostomies; common reasons and complications of construction: one year study

Background: An intestinal stoma is an opening of intestine on the anterior abdominal wall made surgically. The commonly performed procedures include colostomy and ileostomy. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it

Objective: To identify indications for commonly performed intestinal stomas and to study complications related to it

Study Design: Observational study

Setting: Department of General Surgery, Unit- B, Lady reading Hospital, Peshawar

Period: 1[st] Jan 2013, to 31[st] Dec 2013

Subjects and Method: A total of 106 patients who underwent surgery and ended up in intestinal stomas, ileostomy or colostomy, were included in the study. Indications, immediate and late complications of stomas were recorded

Results: A break up of 106 patients of different intestinal stomas. Majority [61.32%] of patients were males. There were 49 ileostomies and 57 cases of colostomy making a total of 106 patients. Main indications of Ileostomy were enteric perforation [55.10%], and intestinal tuberculosis [20.40%]. Main indications of colostomy were penetrating injuries [50.88%], and intestinal obstruction. In a total of 106 stomas local complications appeared in 23 [21.69%]. Skin excoriation, ulceration, lap and wound infection were the most common respectively. Seventy eight stomas including 36 ileostomies and 42 colostomies were closed on an average of 3 months after primary operation. There were 7 cases of wound infection, 2 anastamotic leak-ages and one mortality [1.3%] in the stoma reversal group

Conclusion: Common indications for intestinal stomas were abdominal penetrating trauma, enteric perforation, intestinal obstruction and intestinal tuberculosis. Main complications included local skin problems, wound infection and retraction