Stercolith Perforation

A 62-year-old diabetic bed ridden woman, presented to the emergency department with symptoms suggestive of peritonitis. She had been taking oral laxatives and enemas to relieve her chronic constipation for last 6 years. Hard impacted stools and pelvic tenderness were found on digital rectal examination. Her X-ray abdomen showed soft tissue shadows in the colon but there was no gas under the diaphragm on chest X-ray. Sonography found free fluid in pelvis. She was resuscitated, and her hyperglycemia was controlled by use of regular insulin as per sliding scale. Operative findings revealed free fluid in pelvis and very hard faecalomas lying free in peritoneal cavity. There was a 2 x 3 cm perforation at the anterior wall of the recto-sigmoid junction. Peritoneal toilet was carried out followed by Hartmann's procedure. Histopathology of perforation side showed no evidence of malignancy

Accuracy of modified alvarado score in diagnosis of acute appendicitis in adults

To measure the accuracy of Modified Alvarado Score [MAS] in diagnosing suspected patients of acute appendicitis having MAS of 7 or above. Validation study. Surgical Departments of Combined Military Hospital [CMH] and Military Hospital [MH] Rawalpindi from April 2006 April 2007. This study involved 100 patients who were operated with provisional diagnosis of acute appendicitis. Preoperatively MAS of each patient was calculated. Postoperatively appendices of all the patients were sent for histopathological examination of their results regarding presence of absence of acute appendicitis were then compared with MAS of there patients. The data was analyzed by using SPSS version 10.0. Statistical analysis showed that MAS of 7 or more has sensitivity of 88.885, specificity of 71.42%, Positive Predictive Value 88.88% and Negative Predictive Value 71.4%. Accuracy of MAS was 84%. MAS 7 or above is a reliable indicator of acute appendicitis clinically in adults. The number of negative appendicectomies can be reduced by using MAS in clinical practice

Earthquake 2005: experience with mass casualties at military hospital, Rawalpindi

A massive earthquake struck North of Pakistan on 8th October 2005. The objective of this study was to evaluate the type of injuries and procedures carried out on the admitted casualties. Descriptive study. Military Hospital, Rawalpindi from 8 Oct to 7 Dec 2006. All the causalities were received at the emergency department. All the patients who needed admission for treatment were included. Patients who had minor injuries not requiring indoor treatment and those, brought in dead, were excluded from this study. The files of admitted patients were analyzed for type of injuries, procedures carried out, complications and causes of death. The data was entered in a computer, and results presented in tabular form in numbers and percentages. The total number of patients received was 1698, out of which 862 [50.8%] were admitted. Within the first three months 651[75.5%] cases were discharged after full treatment. A total of 2268 operations were performed. Out of these, 1025 [45.2%] were major surgeries. 323 [31.5%] plastic surgery procedures, needing colostomies 230 [22.4%] orthopaedic operations, 21[2.0%] patients underwent spinal surgery for blunt abdominal injuries 14 [1.6%] and laparotomies were done with 4 [0.4%]. Sixteen [1.5%] amputations had to be done. Seveteen [2%] patients died in the hospital during admission, while 76 were brought in dead

Single and simple antibiotic prophylaxis for elective cholecystectomy

To determine the postoperative infection result after use of a single and simple antibiotics for prophylaxis in open elective cholecystectomy. Descriptive [quasi-experimental] study. Place and Duration of Study: This study was conducted in Military Hospital, Rawalpindi from December 2006 to January 2008. One hundred and sixteen patients requiring elective open cholecystectomy were included. Patients with acute cholecystitis, jaundice and choledocholithiasis were excluded. Only two doses of Gentamycin were used as prophylactic antibiotic for operation. Special precautions were taken for maintaining sterilization during surgery. Out of 116 cases, 111 [95.7%] patients had smooth postoperative recovery and only 5 [4.3%] patients developed surgical site infection. Culture sensitivity of these 5 patients revealed E. coli in 2 [40%] cases, 01 [20%] patient had Klebsiella, while 2 [40%] had mixed growth. Single antibiotic prophylaxis for elective cholecystectomy is recommended provided strict aseptic measures are taken during surgery along with good surgical technique

Deep vein thrombosis in pelvic and femoral fractures in earth quake victims

The aim of this prospective cum descriptive study was to determine the frequency of deep vein thrombosis using Duplex ultrasound scan, in a group of earth quake victims of 08 October, 2005. All these patients belonged to the high mountain northern areas of Pakistan and were admitted in Combined Military Hospital Rawalpindi with pelvic and/ or femoral fractures without additional risk factors for DVT. None of the patients had prior thromboprophylaxis. Study was conducted in thirty female patients admitted in Family wing of Combined Military Hospital Rawalpindi from Oct 2005 to Feb 2006. Although we managed about 75 such cases, only 30 could be assessed for DVT by duplex ultrasound scan partly due to excessive work load on part of Ultrasound department but also because of early post operative mobilization of the patients as per policy, thus offering little chance of having positive results. Out of thirty patients studied, DVT was found in 01[3.3%] patient, who belonged to Balakot and had pelvic fracture. Clinically she was asymptomatic and had no signs of DVT, but her duplex scan revealed calf veins involvement on the right side, with extension of the thrombus in to the femoral veins as well. Another patient with bilateral upper femoral fractures had painful swelling of both thighs, but her duplex scan for DVT was normal. The percentage of DVT observed in patients belonging to the northern areas is low in comparison to both our urban population research data as well the internationally conducted studies. Factors responsible might be dietary, racial or geographical, either alone or in combination, which need to be determined in focused, prolonged studies