Intra-intestinal mesh migration presenting with faecal fistula after incisional hernia repair

Ventral hernias are a frequent problem in our society. Incisional hernia is not an infrequent sequel of ventral abdominal hernia repair. Incisional hernias are characterized by breakdown of the scar in the abdominal wall from an incision for any previous operation. This differentiates them from recurrent hernias where a previously done hernia repair operation breaks down. Such repairs are globally done by applying meshes of different sizes and types. Despite all the documented benefits of its use, a number of complications associated with mesh are reported in many studies. This study reports the case of a man operated for an incisional hernia, repaired by a proline mesh. He developed a complication of migrating mesh after 5 years of surgery at LUMHS, Jamshoro. There are very few such mesh complications reported in the literature

Post laparoscopic cholecystectomy exploration: an audit

This study was conducted to analyse the different causes and factors for exploration and their management after laparoscopic cholecystectomy in 1000 cases of cholelithiasis. This is a prospective study conducted in the department of surgery Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, from January 2003 to December 2010. Thousand cases of cholelithiasis were operated for laparoscopic cholecystectomy in eight years and were observed for their recovery and complications postoperatively. Those patients who developed major problems were assessed clinically and by different investigations like LFT, Ultrasound, CT scan and HIDA scan to find out the cause. They were operated once absolute indication of exploration was made. All patients were included in study after getting informed consent for first operation as well as for Re-do surgery if any one required exploration. Out of 1000 cases, 58 patients [5.8%] developed unidentified complications during laparoscopic cholecystectomy who required surgery for one or other reason. The problems which required exploration were bleeding in 2.2%, biliary leak in 1.9% and obstructive jaundice in 1.0% of cases as main reasons. The cases were managed by various open surgical procedures depending upon the pathology found on exploration. Laparoscopic cholecystectomy though proved as gold standard for cholelithiasis but still is not free of complications and can land up into major problems for patients who had either difficult cholecystectomy or over looked congenital anomalies of biliary tree

Clinical spectrum and management of ovarian tumours in young girls upto 20 years of age

Ovarian tumours are one of the common malignancies all over the world affecting all age groups. This study analyses different clinical presentation and management of ovarian tumours in young girls up to 20 years. Patients up to 20 years of age admitted with the diagnosis of ovarian tumour were included. Data collected on a proforma. Variables studied included age, presenting symptoms, investigations, surgical findings, type of surgery, histopathology reports and follow-up. The patients with malignant ovarian tumour were followed by oncologist as well as gynaecologist. Data analysis was done on SPSS. The mean age was 17.27 +/- 2.46 SD years. The common symptoms included abdominal mass, abdominal pain, urinary problems, menstrual irregularities and generalized malaise. All patients were operated after preliminary investigations. Patients were advised to have follow-up post-operatively after 1 month. The follow up was done by oncologist and gynaecologist. Six patients [12.5%] died and 22 [45.83%] were lost to follow up. Ovarian tumours are quite common in young girls. Majority of patients seek medical advice once the disease becomes symptomatic, complicated or advanced disease in the case of malignancy. Histopathology of the tumours revealed that epithelial cell tumour is the commonest tumour in contrast to germ cell tumour as reported by world literature

Clinico-pathological profile of patients with breast diseases at university hospital, Jamshoro

To assess various disorders of breast regarding their frequency, presentation, pathology and management at a University Hospital. A descriptive study. Department of Surgery, Liaquat University Hospital Jamshoro - Sindh from January 1999 to December 2003. One hundred and fifty patients with different breast disorders were studied. All cases were assessed clinically by getting history on a predesigned proforma and diagnosis was confirmed with help of relevant investigations. Patients with various breast diseases were included in the study except those who were having either no definite lump or no breast pathology. The treatment given was according to type of lesion in the form of surgery or conservative. Patients with benign breast diseases were assured and followed up after surgical treatment or kept on hormone therapy where as cases with malignant disease were referred to oncologist for cancer registry purpose and chemo-radiotherapy. Among 150 cases, majority was females with female to male ratio of 24:1. All patients presented with breast lump [100%], followed by pain in the lump [53.33%] as main symptoms. Left breast was involved in 53.33% and right breast in 44.66% of cases. Majority of cases [84.67%] underwent surgery. Histopathology revealed fibro-adenoma in 30.66%, fibrocystic disease in 15.33% and carcinoma in 35.33% cases as main disorders. All six male patients had gynaecomastia. In our set up, frequency of carcinoma of breast is increasing as compared to benign lesions. However, overall benign problems are more frequent than breast cancer