ABSTRACT
Free perforation of peptic ulcer into the general peritoneal cavity is a catastrophic event. Although laparoscopic approach has been successfully used for its management, primary closure of the perforation using an omental patch [Grahm's patch] is the immediate alterative. This study was planned to analyse risk factors, which could predict releak following Grahm's patch closure. This study was carried out for five years from April 2003 to March 2008, at department of surgery Muhammad Medical College Mirpurkhas. All patients undergoing surgery for perforated duodenal ulcer were included in the study. 53 patients underwent Grahm's Patch Closure. 6 patients developed releakage post operatively. Therefore two groups were made. Patients with releak were kept in case group [n=6] and the patients with no leak [n=47] were included in control group. In this study all patients were assessed for age, pulse rate, systolic blood pressure, hemoglobin and serum Protein / albumin, total leukocyte count [TLC] on arrival, delay in arrival since sign and symptom [probable] of perforation and size of perforation on operation were also documented. Age greater than 50 years [p=0.05], pulse greater than 110/min [p=0.22], systolic blood pressure less then 90mmHg [p=0.02l], hemoglobin less than 10gm% [p=0.25], serum albumin less than 2.5gm% [p=0.018], delay in arrival for more then 36 hour [p=0.00017], and size of proportion greater then 5mm in it maximum dimension were identified as risk factor for releak. Delay in arrival was the single most significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer
Subject(s)
Humans , Adult , Middle Aged , Aged , Male , Peptic Ulcer Perforation/complications , Peptic Ulcer Perforation/etiology , Risk Factors , Time Factors , Age FactorsABSTRACT
Objective: to see the outcome of single layer extramucosal interrupted suture gut Anastomosis
Study design: prospective analytical
Setting and methods: this study was carried out in the Department of Surgery Unit-I Muhammad Medical College Mirpurkhas, from August 2004 to July 2007. A total of 72 patients were included in this study in which gut anastomosis was performed with single layer extramucosal interrupted suture. Patients of all ages and sex groups were included in whom end-to-end anastomosis was required in small and large intestine. Polyglactin [Vicryl 2/0 and 3/0] material was chosen on round body needle
Results: end-to-end anstomosis in 72 patients was done in cases of ileal perforation 37 / 72 [51.38%] and right hemicolectomy 09/72 [12.50%]. Intussusception was the cause in 11/72 [15.27%] cases, mass at recto-sigmoid junction was found in 02/72 [02.77%] strangulated inguinal hernia in 07/72 [09.72%] patients, jejunal diverticulosis in 01/72 [01.38%], caecal volvulous in 02/72 [02.77%] and sigmoid volvulous in 02/72 [02.77%] cases. Anastomosis leakage occurred in only 02/72 cases. Mortality remained 1/72 [01.38%]
Conclusion: single-layer extramucosal interrupted suture gut anastomosis is safe method of hand sewing technique. It is suitable for all anastomosis in the gastrointestinal tract
ABSTRACT
To determine the mode of presentation in intestinal tuberculosis and effectiveness of various surgical procedures adopted in our set up. A descriptive study. Liaquat University Hospital, Hyderabad from June 1996 to May 1998 and Muhammad Medical College Hospital Mirpurkhas, Sindh from April 2002 to March 2004. One hundred-twelve cases of intestinal tuberculosis were studied, which were operated and diagnosis was confirmed on biopsy. Data collection included detailed history particularly duration of symptoms, respiratory complains, dietary habits and bowel habits. At Liaquat University Hospital, 1872 patients were admitted, 386 [20.61%] were operated for abdominal complains [acute, sub-acute or chronic intestinal obstruction or perforation] and 80 [4.27%] were diagnosed as having intestinal tuberculosis. Meanwhile, 624 patients were admitted in Muhammad Medical College Hospital Mirpurkhas. Of these, one hundred-seventy [27.24%] were operated for abdominal pathology and 32 [5.12%] cases were proved as intestinal tuberculosis on histopathology. Out of total 112 cases of intestinal tuberculosis, 64 [57.20%] were male and 48 [42.80%] females. Age ranged from 8 to 55 years with majority in 2nd and 3rd decades. Resection and anastomosis of small gut, limited right hemicolectomy, right hemicolectomy, stricturoplasty, ileostomy, adhenolysis and evacuation of pus were the procedures adopted for management. Post-operative complications were seen in 30.65% of patients with wound infection on top, however, mortality remained 3.57%. The mortality of intestinal tuberculosis is high due to delay in diagnosis and under dosage or irregular anti-tuberculous treatment. In complicated cases, surgery is indicated. When multiple strictures or perforations are present, resection and end to end anastomosis is required. In case of caecal mass [fungating type], right hemicolectomy can be performed and in cases where extensive adhesions are present and there is fear of iatrogenic perforation, in attempts to mobilize right colon, limited right hemicolectomy shall be performed