Short term donor outcomes after hepatectomy in living donor liver transplantation

Objective: to determine the outcome of living-donor liver transplant [LDLT] donors from the first liver transplant program in Pakistan

Study Design: cohort study

Place and Duration of Study: shifa International Hospital, Islamabad, from April 2012 to August 2014

Methodology: a total of 100 live donors who underwent hepatectomy were included. Demographics, etiologies, graft characteristics and operative variables were retrospectively assessed. Outcome was assessed based on morbidity and mortality

Results: median donor age was 28 [17 - 45] years and median body mass index [BMI] was 24 kg/m[2] [15 - 36]. Male to female ratio was 1.5:1. Hepatitis B and C were the most common underlying etiologies and accounted for 79/100 [79%] of LDLT's. Overall, 93/100 [93%] donors donated a right lobe graft. Median estimated graft weight to recipient body weight [GW/BW] ratio was 1.03 [0.78 - 2]. Standard arterial anatomy was present in 56% donors. The 90-day morbidity was 13/100 [13%] and overall morbidity was 17/100 [17%]. Bile leak was encountered in 3 [3%] patients. There was no donor Mortality

Conclusion: acceptable short-term donor outcomes were achieved in an LDLT program in Pakistan with careful donor selection and planning

Paediatric living donor liver transplantation: a single centre experience from Pakistan

Objective: To determine the outcomes of paediatric living donor liver transplantation [LDLT] recipients from Pakistan in terms of 90-day morbidity and mortality

Study Design: Cohort study

Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, between April 2012 and April 2015

Methodology: All patients in paediatric age group [17 years] who underwent LDLT with a minimum follow-up of 3 months, were included. All grade 2 and above complications on Clavien-Dindo system were included as morbidity. The main outcome measure was 90-day morbidity and mortality

Results: Fourteen paediatric LDLTs were performed. Median age of the recipients was 8.5 years ranging between 6 months and 17 years. Wilson's disease and cryptogenic cirrhosis were the most common etiologies [28.6% each]. Acute liver failure was present in 5 [35.7%] patients. Overall 90-day morbidity and mortality was 71.4% and 14.2%; both were attributable to pulmonary infection. No difference was observed in morbidity [21.3% vs. 42.8%, p=0.3] and mortality rates [20% vs. 11%, p=1.0] between patients with acute and chronic liver failure. Estimated 3-year survival was 85%

Conclusion: Paediatric LDLT offers a promising treatment option for acute and chronic liver failure. Mortality was attributable to post-transplant pulmonary infections

Adrenal angiomyolipoma

Adrenal angiomyolipoma is a rare tumour arising from the mesenchymal tissue containing fat cells. A 72 years old lady presented with right upper quadrant pain. She underwent laparotomy after relevant imaging and investigations and was found to have a right sided adrenal angiomyolipoma confirmed on histopathology, which was encasing the inferior vena cava and renal veins. Due to its diagnostic difficulty, potential to achieve large size and possible complications; surgeons and pathologists should keep angiomyolipoma in mind when dealing with an adrenal mass

Left paraduodenal hernia: a rare cause of large bowel obstruction and gangrene

Internal hernias are a rare cause of intestinal obstruction. Paraduodenal hernias are the most common type of internal hernias. Although small bowel obstruction is associated with internal hernias, large bowel obstruction is unique. The authors here report a case of left para duodenal hernia with simultaneous small and large bowel obstruction and gangrene. The patient underwent emergency laparotomy and generous resection of gangrenous small and large bowel was carried out and stoma was created. Postoperatively, the patient had a smooth recovery and was discharged after a few days. Reversal of stoma was carried out after 2 months

Flexible sigmoidoscopic findings in patients with fresh rectal bleeding

Flexible sigmoidoscopy can diagnose majority of pathologies in patients with rectal bleeding and is less demanding than colonoscopy. Frequency of different findings in patients with rectal bleeding on flexible sigmoidoscopy was considered. Out of a total of 215 patients, 133 [61.9%] were males and 82 [38.1%] were females. The most common findings were hemorrhoids in 49 patients [22.8%] and polyps in 37 [17.2%] patients. The mean duration of bleeding was 57.4 +51.8 months. Seventeen [7.1%] were found to have malignancy on sigmoidoscopic biopsy. Flexible sigmoidoscopy was able to determine the cause of bleeding in majority of patients with rectal bleeding

Diagnosis of Proximal Biliary Strictures: Role of serum bilirubin, alkaline phosphatase and abdominal ultrasound

To determine the role of serum bilirubin, alkaline phosphatase and abdominal ultrasound in the diagnosis of proximal biliary strictures. Cross sectional Place and Duration: Surgical Unit IV, Civil Hospital Karachi, from Jan 2007 to August 2008. A total of 407 patients with obstruction of the biliary tree on ultrasound and raised serum levels of alkaline phosphatase had ERCP performed on them. Serum bilirubin and alkaline phosphatase levels were recorded prior to the procedure. A total of 75 patients with strictures on ERCP were included in the study. Jaundice and abdominal pain were present in 68 [90.6%] and 41 [54.6%] of the total 75 patients respectively. A statistically significant difference was present in the mean bilirubin levels of different stricture groups [p=.024]]. Receiver Operator Curve analysis of serum bilirubin level of 19.2gm/dl showed a sensitivity of 43% and specificity of 77% with area under curve= 0.6. Abdominal ultrasound was found to be 31.8% sensitive and 79.2% specific in predicting the presence of proximal biliary strictures. Serum levels of total bilirubin and alkaline phosphatase and abdominal ultrasound have minor role in the diagnosis of proximal biliary strictures

Endometriosis in caesarian section scar

Endometriosis is a very common benign gynecological condition, It is the presence of functional endometrial tissue outside the uterine cavity. Though it can involve most parts of the body, scar endometriosis is an infrequent condition. The wide array of clinical presentations makes it difficult to diagnose preoperatively. Here, we report two cases of caesarian section endometriosis. One presented as a painful swelling and the other as an area of induration in the scar. Only one of the patients had been on medical treatment with Danazol. Despite that both patients remained symptom free after excision of their lesions