Simple repair is sufficient for most injuries to the duodenum - a case series of 23 patients

Duodenal injury is the most important hollow viscus injury in the abdomen. The study analysed the outcome of duodenal injuries at the unit. Prospectively collected data on a case series involving 23 patients over 3 years. It involved demographic details, part of duodenum injured, injury severity according to the AAST, injury-operation time lag, mode of repair, and the extent of significant associated injuries. M:F ratio was 4.75:1. Mean age 33yrs. Patients with non-perforating injury were excluded. All were operated by a senior registrar or senior. 7/23 were blunt, 13/23 firearm and 3/23 stab injuries. D2 was involved in 87%. Injury severity was graded according to AAST [American Association for Surgery of Trauma]. 17/23 were Grade II/III, 3 Grade IV and 3 Grade V injuries. Four had injury-operation lag of >18hrs. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs wer e required for 3/23 patients. Five patients died, as a result of associated insults. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Duodenum-related mortality was zero. Adverse prognostic factors towards morbidity were injury severity >GIII and injury-operation lag >18hrs. The mortality was related to associated injuries. Primary repair is sufficient for most non-resectional duodenal injuries

Colonic injuries: is primary repair a safe option?

This study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of large gut injuries. 80 patients, presenting in emergency between Jan. 2004 and December 2005, were selected out of which 63 were males and 17 were females. Colonic injuries were divided into five categories and were dealt accordingly. All colonic injuries presenting to emergency in study period except. Injuries requiring ileocolic anastomosis, repair and proximal fecal diversion and distal colonic injuries requiring Hartmann's procedure

Management of acute pancreatitis: an experience at Mayo hospital, Lahore

This is a retrospective as well as prospective study of 46 patients with acute pancreaitis who were managed in North Surgical Unit of Mayo Hospital, Lahore. This study was carried out with special emphasis on need of surgical treatment and its outcome. No age group or sex was found immune to this disease. It was more common in 3rd to 4th decade of life and female sex. The commonest etiology is gall stones [54%] followed by alcohol [8%] and idiopathic [15%]. Pain epigastrium is a constant symptom. Judicious use of serum amylase urinary amylase and ultrasonography can help in early diagnosis of the acute pancreatitis. Complications are best diagnosed on CT scan. Majority of patients were treated successfully by conservative measures [44%] but developed complications which carried high morbidity and mortality. Surgical treatment of associated gall stones has prevented recurrent attacks of acute pancreatitis. Hence cholecystectomy for associated gall stones is recommended during same admission for mild to moderate pancretitis after resolution of symptoms

Extremity vascular trauma-the continuing challenge

A retrospective study of 36 consecutive patients with extremity vascular trauma managed by the South Surgical Ward trauma team between February 1998 to January 2000. All our patients were men with a mean age of 27 years. The commonest clinical presentation.was with haemorrhage [75%] or ischemia [58.4%]. The mode of injury was gunshot wounds [75%], blunt trauma [20%] and iatrogenic injuries [5%]. The most commonly injured arteries were the superficial femoral [27.5%], the popliteal [24%] and the brachial [24%]. The techniques utilized for.repair of the arterial injuries were autogenous reverse vein grafting [51.7%], end-to-end anastomosis [27.6%].and lateral repair [3.4%]. 17.2% of the arterial injuries were ligated. 43% of the venous injuries underwent lateral venorrhaphy while 57% were ligated. Tri-compartment leg fasciotomies were carried out in 14 patients The commonest complication was vein graft thrombosis [16.7%]. Our amputation rate and mortality were both at 6.9%. Early transport of the patient to a good surgical facility, good surgical judgement and the liberal use of. vein grafts improves the outcome in vascular injuries of the extremities

Solitary cold nodule of the thyroid gland

Cold Solitary Nodule of the thyroid was found in 25% patients who had thyroidectomy over a period of three years. Goiter was the presenting symptom and solitary nodule was palpable in all the patients. Diagnosis of cold nodule was confirmed on scintigraphy. Unilateral lobectomy was the surgical procedure performed. The incidence of complications was very low. There was no the mortality in this series. Histopathologically colloid nodule was found in the majority of cases followed by adenoma, thyroid cyst, malignancy, tuberculosis, Hashimoto's Thydroiditis and pyogenic thyroiditis in descending order. The incidence of malignancy was 6.6% in this series