ABSTRACT
Typhoid perforation is the most important surgical complication of typhoid enteritis and is associated with a significant morbidity and mortality. To determine the factors affecting morbidity and mortality in patients with typhoid intestinal perforation, the complete medical records of a pool of patients from two major teaching hospitals of Lahore were reviewed. A total of 39 patients diagnosed to have typhoid Heal perforation at operation included 27 patients operated in the emergency of South Surgical Ward. Mayo Hospital Lahore from January 1998 to Dec 2000, and 12 consecutive patients operated by the surgical team of Surgical Unit II. Shaikh Zayed Medical Complex. Lahore between December 2000 to May 2005. The average age was 26 years, the male-to-female ratio 4/1. The mean interval from admission to operation was 09 hours [range 05 hours - 03 days]. Eight patients had more than one perforation at the time of operation. Primary repair of the perforation was performed in 22% of the patients, ileostomy [primary repair and proximal loop ileostomy or exteriorization of perforation as a loop ileostomy] in 46%. and resection with end ileostomy and mucous fistula in 32%. No primary end-to-end anastomosis after resection was performed. Postoperative complications occurred more commonly in patients with delayed admission and/or severe peritonitis. Hospitalization was shorter and the postoperative complication rate lower in patients who underwent ileostomy. Three patients developed an enter cutaneous fistula requiring re-operation. The four deaths [10.25% mortality] resulted from overwhelming sepsis. The most significant factors affecting morbidity were prolongation of perforation-operation interval and severe peritonitis. No single operative procedure is best in all cases: therapy should be individualized and tailor made for every patient. Ileostomy appears to be an effective and safe procedure, particularly in patients with severe abdominal contamination and delayed presentation. Early diagnosis, aggressive resuscitates tion with fluid and electrolyte optimization and prompt operation may result in improved survival in these seriously ill patients
ABSTRACT
The problem of full-thickness rectal prolapse is formidable, with no clear predominant treatment of choice. Several operations have been proposed to correct rectal prolapse which can be divided into transabdominal and perineal procedures. Delorme operation is a suitable procedure for elderly and/or medically unfit patients with rectal prolapse. However, good results have also been demonstrated for younger patients, suggesting that the operation may have wider application. From January 2001 to September 2003, 07 young adult patients underwent the Delorme repair of rectal prolapse in our unit with good results. The main outcomes measured were method of anesthesia, morbidity, mortality, recurrence rates, length of follow-up, and incontinence. In the 07 patients, the mean age of the patients was 24 years. The mean operating time was 55 minutes. Four patients were administered general anesthesia and 03 were administered spinal anesthesia. The mean postoperative stay was 05 days. No patients died as a result of th e procedure. Patients were followed up for 3 - 33 months. Preoperative incontinence was present in 02 patients, both of whom improved after the procedure. Postoperative incontinence was seen in only one of these patients but that too seemed to improve with time. No recurrent postoperative prolapse has yet been seen. None of the patients had complications that required operative intervention in the postoperative period. Although, the best operation for rectal prolapse remains a controversial subject, we believe that the Delorme Operation offers a promising option for the treatment of rectal prolapse even in young adults