Laparostomy: three year experience in a tertiary-care unit

Laparostomy is a temporary measure to avoid abdominal compartment syndrome as well as allow repeated and ready access to abdomen for lavage. This study was conducted to identify the indications and analyze the outcome of laparostomy in a tertiary care surgical ward. This prospective study was conducted on laparostomy cases between March 2008 and February 2011. Data was analyzed for the indication, clinical course and final outcome. Results were expressed as frequency-percentage, means, procedural morbidity and overall mortality. A total of 16 laparostomies were performed during the study period. All 16 patients were operated in emergency. Burst abdomen with impending intra-abdominal hypertension was the most common indication followed by "grossly edematous bowel" which made primary closure impossible. A delayed deep tension closure was possible only in eight patients. Four patients died in the postoperative period. Persistent wound sepsis was the most common morbidity. Laparostomy is often necessitated by the desperate situations encountered in emergency surgery

Early laparoscopic cholecystectomy for acute calculous cholecystitis: what is the optimal timing?

To assess the outcome of optimal timing of early laparoscopic cholecystectomy in cases of acute calculous cholecystitis. Descriptive case series. Shaukat Omer Memorial [Fauji Foundation] Hospital and Hill-Park General Hospital Karachi, from April 2010 to November 2011. Clinical records of 164 patients who underwent early laparoscopic cholecystectomy in acute calculous cholecystitis were retrieved and categorized into two groups according to the timing of surgery from the onset of symptoms [A, who had laparoscopic cholecystectomy within 72 hours; B, who had laparoscopic cholecystectomy after 72 hours]. Outcome of interests were conversion to open procedure, postoperative complications and length of hospital stay. The SPSS version 11 was utilized for data analyses. Chi-square test was used to assess qualitative and unpaired Student t test was employed for quantitative data. A value of p < 0.05 was considered statistically significant. The mean [+SD] age was 40.42 +12.42 year. There were 21 [12.8%] males and 143 [87.2%] females with male to female ratio being 1:6.8. Comparing the two groups, the conversion rates [2.9% versus 13.6%, p=0.012], postoperative complications [1.9% versus 10.2%, p=0.026], and length of hospital stay [2.34 versus 3.93 days, p<0.001] were significantly reduced in group A. The early laparoscopic cholecystectomy within 72 hours minimizes the conversion rates and postoperative complications, and shortens the length of hospital stay in cases of acute calculous cholecystitis

Nail mine in stomach

Ingestion of foreign bodies is a common clinical scenario in any emergency department. Presence of thousands of ingested foreign bodies inside stomach is a rare scene. However, only a few such cases have been reported. Here we present a case of young adult man with known psychiatric disorder, having 2562 nails in his stomach leading to gastric outlet obstruction. Gastrotomy was employed to relieve the stomach of this mine of nails. Later psychiatric care was also provided

Malacoplakia of rectum

Colorectal malacoplakia with ulcerative colitis is a rare clinical entity. This is a case report of a woman, 35 years of age, who presented with bleeding per rectum, lower abdominal pain and painful defecation for 02 months duration. A tender circumferential mass was found on digital rectal examination and incisional biopsy showed malacoplakia. CT scan revealed rectal mass extending up to rectosigmoid junction; infiltrating the pelvic wall and encasing the right lower ureter, though her CEA level was normal. DJ stenting was done for ureteric obstruction and quinolone therapy was instituted. Despite this, surgical debulking [abdominoperineal resection] was carried out for aggravation of her symptoms. The histopathology report revealed it to be a malacoplakia with ulcerative colitis

Primary closure of common bile duct after open choledochotomy

To assess the outcome of primary closure of common bile duct after open choledochotomy. Descriptive case series. Department of surgery, unit II, III and VI, Dow University of Health Sciences and Civil Hospital Karachi from June 2005 to May 2009. Clinical records of all the patients who underwent bile duct exploration followed by primary closure were reviewed. Main outcome measures were operating time, duration of hospital stay and postoperative complication; including bile leakage, subphrenic abscess, biliary peritonitis and postoperative jaundice. The SPSS version 11 was applied to the data for analysis. A total of 38 patients were found from clinical records having male to female ratio of 1:6.6. Mean [ +/- SD] operating time was 95 [ +/- 7] minutes. The overall complication rate was 10.52%. Bile leak was encountered in three [7.89%] patients whereas small subphrenic collection was noticed in one [2.63%] patient who was treated conservatively. None of the patients experienced postoperative jaundice and biliary peritonitis. Mean [ +/- SD] duration of hospital stay was 7.63 [ +/- 1.63] days. Primary repair of common bile duct after open choledochotomy is safe and associated with low complication rate

Surgical audit of unit ii, department of surgery abbasi Shaheed Hospital, Karachi

To report the experience of one year audit of general surgical procedures and comparison of results with other audit data. This study was carried out from January 2005 to December 2005 in the Department of Surgery, unit II, of Abbasi Shaheed Hospital, Karachi. Total numbers of patients were 881, majority of them were between 16 to 50 years of age group [73.4%]. Elective surgeries were performed in 449 [50.9%] cases whereas 315 [35.7%] cases underwent emergency surgical procedures. Rest of the patients were managed conservatively i.e. 117 [13.2%] cases. The most frequent region was gastrointestinal tract [36.1%], in which appendiceal pathologies were commonly encountered. Average duration of stay was 12 days. There was an overall mortality of 1.2% and a complication rate 5.9%. We conclude that audit is essential for better health practice and should be perform yearly. Moreover, there should be proper audit program and committse for this purpose