Extended islanded reverse sural artery flap for staged reconstruction of foot defects proximal to toes

Objective: To assess the outcome of extended delayed reverse sural artery flap for reconstruction of foot defects proximal to toes in terms of flap survival, complication and extended area

Study Design: Case series

Place and Duration of Study: Jinnah Burn and Reconstructive Surgery Centre, Lahore, from February 2015 to April 2017

Methodology: Cases who underwent delayed sural artery flap were inducted. Preoperative hand-held doppler was done to confirm the location of perforator. Two suitable perforators were chosen to raise the extended flap by crossing the proximal limit in all cases. The pedicle was kept minimum 3 cm wide and perfusion was assessed. Flap was delayed for one week and vaccum-assisted closure [VAC] dressing was applied over wound. The second surgery was performed after one week. Proximal perforator was clamped and ligated after checking adequate perfusion of flap. Flap was insetted into defect

Results: Thirty-two patients were reconstructed with delayed reverse sural artery flap. The mean age of the patients was 26.5 +12.2 years. Twenty-four [75%] patients were males and 8 [25%] were females. Twenty-two [68.7%] cases were degloving wounds after road traffic accidents [RTA], 6 [18.7%] were diabetic foot wounds, 4 [12.5%] sustained injury after falling from height and 7 [21.8%] patients had fracture of metatarsals. Twenty-eight flaps were transferred after one week delay, and only in 4 cases, flap were transferred after two weeks. All flaps survived completely. Complications of infection noted in 3 [9.3%] flaps, 3 [9.3%] flaps showed tip necrosis, 2 [6.2%] flaps undergone epidermolysis and only 2 [6.2%] showed venous congestion

Conclusion: Delayed islanded reverse sural artery perforator flap is a reliable and versatile option for resurfacing soft tissue defects of lower limb proximal to the toes with lesser complications and extended coverage area

Endoscopic intervention in the management of bile leak after cholecystectomy: a 10-year experience at a tertiary centre

Objectives: To determine the outcome of endoscopic intervention in the control of post-cholecystectomy bile leak

Design: Retrospective study

Setting: Department of Surgery, College of Medicine, King Saud University, Saudi Arabia Subjects: This study included all consecutive patients with bile leak after cholecystectomy who were managed in the department of Surgery at King Saud Medical City from July 1, 2005 till June 30, 2015

Intervention: Medical records of all the patients were reviewed and the data were collected retrospectively

Main outcome measures: Bile leak was confirmed by endoscopic retrograde cholangiopancreatography [ERCP] in all patients. Endoscopic sphincterotomy [ES] with bile duct stenting was performed in the same setting

Results: A total of 121 patients were managed with bile leak after cholecystectomy. All patients underwent ES and stent insertion. Bile leak was successfully controlled in 88 [73%] patients; 79 patients with type A, 3 with type C, and 6 with type D injury. Endoscopic management was not definitive in 33 [27%] patients. These patients included 3 type C, 5 type D and 25 type E injuries. Twelve ERCPrelated complications [4%] were reported; mild pancreatitis [n = 7], cholangitis [n = 2], bleeding [n = 2], and duodenum perforation [n = 1]

Conclusions: Two-third of bile leaks after cholecystectomy was due to lesser bile duct injuries and was amenable to definitive endoscopic therapy. One-third of patients had major biliary injury that required surgical intervention. Endoscopic intervention is recommended as the preferred and safe primary modality for the diagnosis and treatment of post-cholecystectomy bile leak

Quantification and further refinements of dorsal metacarpal artery perforator flap for reconstruction of wounds of fingers up to distal interphalangeal joints

Objective: to assess the outcome of dorsal metacarpal artery perforator flap for coverage of finger defects extending up to distal interphalangeal joint [DIPJ]

Study Design: case series

Place and Duration of Study: Jinnah Burn and Reconstructive Surgery Centre, Lahore, from March 2015 to May 2017

Methodology: our study was carried out in two parts. 1st part of study was to measure average flap length in our population. Five hundred cases were enrolled to measure flap length, from pivot point of the flap to the distal border of extensor retinaculum. This length was traced to fingers to determine its coverage area. This was followed by clinical study in 35 cases. All patients with wounds over dorsal surface of fingers up to distal interphalangeal joint and volar surface of fingers up to mid of middle phalanx, single or multiple finger defects with exposed tendon joints or bones were included in the study. Patients with history of trauma to the dorsum of hand, metacarpal head or neck fracture and patients with history of diabetes or peripheral vascular disease were excluded

Results: flap length decreased from radial to ulnar side of hand. Average length of flap based on the second metacarpal artery was 7cm while of the third was 6.6 cm and the fourth was 6.1 cm. This flap length covered up to mid of middle phalanx in border digits while up to PIPJ in central digits. This data was confirmed in 35 patients in whom 36 flaps were raised to cover finger defects. Thirty-four flaps survived completely while tip necrosis was seen in 2 cases

Conclusion: the dorsal metacarpal artery perforator flap is a thin, pliable flap, which has minimal donor-site morbidity. It can reliably cover soft tissue defects of dorsum of fingers up to mid of middle phalanx in border digits and up to PIPJ in central digits

Ocular complications of silicone oil

Objective: silicone oil [SO] is an invaluable tool in the management of complex retinal detachments [RDs]. Injection of silicone oil is associated with a variety of ocular complications specially when it is kept for a long time and its removal is endangering retinal re-detachment. The objective of this study was to determine the frequencies of different ocular complications associated with silicone oil injection in our setup

Study Design: case series

Place and Duration of Study: this study was conducted at Vitreo-retina division of Al-Shifa Trust Eye Hospital, Rawalpindi from January 2014 to June 2014

Material and Methods: a total of 30 patients were included in the study who underwent pars-planavitrectomy [PPV] with silicone oil injection for complex retinal detachments. The patients who had reached between 3 months and 6 months of their postoperative period and were presenting with some complications related to silicone oil injection were included in the study. Their records were reviewed and pre-operative data were collected regarding state of the eye preoperatively. Then the post-operative complications were noted. The descriptive and analytical statistics of different variables were measured using SPSS-17.0 software

Results: out of thirty patients included in our study 23 [76.7%] were male and 7 [23.3%] were female. The mean age was 21.53 +/- 16.004 years and range was 66 years. The mean pre-operative intra-ocular pressure [IOP] was 14.0 +/- 2.150 mmHg and range 8 mmHg and the mean post-operative IOP was 24.93 +/- 13.889 mmHg and range 45 mmHg [p=0.001. The pre-operative PVR grade-C was absent in 12 [40%] patients and was present in 18 [60%] patients and post-operative PVR grade-C was absent in 24 [80%] patients and was present in 6 [20%] patients [p=0.004; McNemar test]. Band keratopathy was seen in 8 [26.7%] and corneal decompensation in 2 [6.7%] patients. Emulsification of silicone oil was seen in 14 [46.7%] patients. Rubeosisiridis was present in 2 [6.7%] patients

Conclusion: apart from other complications, raised intraocular pressure is a significant postoperative complication of eyes with silicone oil injection, so should be kept in mind because if not addressed properly it may lead to irreversible blindness in these cases

Effect of body mass index on accuracy of doppler ultrasonographic detection of dominant perforator of deep inferior epigastric artery perforator flap

Objective: The objective of this study is to find the frequency of correct identification of the dominant perforators by pre-operative Doppler ultrasonography in deep inferior epigastric artery perforator flap in relation to increasing body mass index [BMI]

Study Design: Descriptive cross-sectional study

Place and Duration of Study: This study was carried out in Jinnah Burn and Reconstructive Surgery Centre, Lahore from 4[th] June 2013 to 4[th] June 2015

Materials and Methods: A total of 46 patients fulfilling the inclusion criteria were enrolled from Jinnah Burn and Reconstructive Surgery Centre, Lahore. An informed consent was taken for color Doppler ultrasonography, operation and to gather information for study purpose. Pre operative BMI was calculated by dividing weight in kilogram [Kg] by height in meter square [m[2]] and placed into two group ; group 1 with BMI <30 [normal to overweight] had 33 patients [71.74%] and group 2 BMI >30 [obese], 13 patients [28.26%] reoperative Doppler USG was done for localization of dominant perforator in periumbilical region of Deep inferior epigastric artery and distance from umbilicus was measured in centimeters [cm]. Per operative distance of dominant perforator confirmed and measured in centimeters along the radius of umbilicus

Results: Forty six patients aged between 32-46 years with mean 39.3 +/- 3.5 years were included. In group 1 all 33 [76.7%] had correctly identified dominant perforators, whereas all the 3 [100%] patients whom the per operative perforator location fall out of 1cm range of pre-operative Doppler localization fell in group 2 [obese patients] showing clinically significant p- value 0.004

Conclusion: It is concluded that Color Doppler USG is a safe and reliable imaging technique but increasing BMI effects the accuracy of pre-operative mapping of dominant perforator of DIEP flap

Outcome of hand function after extensor indices proprius opponensplasty

Objective: To assess the functional improvement in the hand after Opponensplasty

Study Design: Descriptive study

Place and Duration of Study: This study was conducted at Plastic Surgery Department Jinnah Hospital, Lahore from October, 2005 to March, 2015

Materials and Methods: A total of 40 patients with loss of opposition of thumb were included in the study. Their opposition was lost either due to median nerve or both median and ulnar nerve injury or directly damaged thenar muscles. Patients in whom there is restricted range of thumb motion or scarring in the route of tendon transfer were excluded from the study. After taking informed consent Extensor Indices Proprius tendon transfer was done. Post- operatively cast was given for 4 weeks and protective splintage was applied for another 2 weeks. Improvement in the hand function was recorded at conclusion of study

Results: Four patients lost follow-up. Out of 36 patients, 26 [72%] patients showed good results, 6 [17%] showed fair results and 4 [11%] showed poor results. 25 patients [69%] had good Kapandji score, while 7 [20%] had fair and 4 [11%] had poor score. Mean DASH score was 24. Overall patient's satisfaction was very good. Most of the patients hand function improved significantly

Conclusion: Our study results strongly suggest Opponensplasty with Extensor Indices Proprius is an excellent procedure for restoring opposition in patients with median or both median and ulnar nerve injury at wrist

Diagnostic yield of conventional trans-bronchial needle aspiration [TBNA] for subcarinal and right paratracheal nodes

Objective: to observe the diagnostic yield of conventional TBNA with EBUS-TBNA for right paratracheal and subcarinal nodes

Study Design: Observational / descriptive study

Place and Duration of study: This Study was conducted in Pulmonology Department of Services Institute of Medical Sciences [SIMS] Lahore from January 2013 to March 2015 after approval from ethical review committee

Materials and Methods: We prospectively enrolled patients with right Mediastinal and sub carinal lymph nodes for bronchoscopy and TBNA. Patients of both gender with significant [>1.5 cm] subcarinal and right paratracheal nodes or mass lesions were included in the study. All patients had conventional TBNA done with Smooth shot needle no.19 F via video bronchoscope under light sedation. Adequacy of the sample and definitive diagnosis either by Histopathology or cytology was noted

Results: Sixty patients including 27 male [45%] and 33 [55%] female had TBNA for Subcarinal or paratracheal nodes or mass lesions. Mean age was 50.31 + 14.3. Fifty four [90%] patients had the diagnosis on histopathology, cytology or tissue culture while 6 [10%] patients had non-diagnostic/inadequate samples. Leading diagnosis was Sarcoidosis 24 [44.4%] followed by NSCCA 11[20.3%], Tuberculosis 10 [18.5%], SCCA 7 [12.9%], and Endocrine Tumor 2 [3.7%]. Minor hemorrhage 6 [10 %] was managed by topical adrenaline

Conclusion: Conventional TBNA is useful easily available, cheap and safe diagnostic tool in patients with Sub- carinal and right Para-tracheal lymph nodes/mass lesions of >1.5 cm size

rural trauma team development course in Pakistan - potential for improving trauma care

To determine the feasibility, acceptability and potential for improving trauma care in Pakistan through the Rural Trauma Team Development Course [RTTDC]. Mixed method approach. Pre and post test, Questionnaire based survey. The course was held at the College of Physicians and Surgeons Pakistan in Karachi over a 2-day period in year 2012. Input from participants in one RTTDC instructor course and one provider course conducted in Pakistan was reviewed. On the first day a course for instructors who trained providers on the second day, was conducted. t-test was used to compare pre and post MCQ scores of both instructors and participants. A 5-point Likert scale was used to assess the educational value of the course based on a 16 item questionnaire. Relevance and applicability of the Performance Improvement and Patient Safety [PIPS], Communication and Scenario Modules were also assessed through questionnaires. General Comments on the applicability and potential for trauma care improvement in Pakistan through the program were solicited and analyzed. Mean percent scores in the MCQs improved for both instructors and participants but both pre and post RTTDC scores were higher in the instructor group [p=.006]. On 5-point Likert scale 75% faculty and 100% participants strongly agreed/agreed that the course educational content was relevant to their needs. PIPS was graded "very relevant" by 100% faculty and 35% participants with 65% student grading PIPS as "relevant". Communication module was rated "very relevant" by 100% faculty and 68% participants. Scenarios were "very relevant" to 100% faculty and 50% participants. Both faculty and providers recommended widespread promulgation of RTTDC training in Pakistan to improve trauma outcome. Assessment showed improvement in knowledge and a very positive attitude towards the program

Changes in macular thickness and visual acuity after intravitreal bevacizumab injfection in patients with retinal vein occlusion

To evaluate the effect of singel Intravitreal Bevacizumab [Avastin] injection on visual acuity [VA] and central retinal thickness [CRT] in patients with macular edema secondary to branch retinal vein occlusion [BRVO] or central retinal vein occlusion [CRVO]. Prospective, non-randomized, interventional case series. This study was conducted at Al-Shifa Trust Eye Hospital Rawalpindi from March 2012 to February 2013. Twenty three patients with macular edema attributable to vein occlusion received intravitreal injection of Bevacizumab 1.25 mg. Nine patients had central retinal vein occlusion [CRVO] and 14 patients had branch retinal vein occlusion [BRVO]. Complete ophthalmic examination including best corrected visual acuity [BCVA] and optical coherence tomography [OCT] was done at base line and follow up visits. At base line mean visual acuity was Log MAR 0.73 and showed improvement to mean Log MAR 0.39 at 12 weeks after intravitreal Bevacizumab [IVB] injection. Mean CRT was 527 micro m at baseline that decreased to 274 micro m after 12 weeks of IVB treatment. Intravitreal Bevacizumab appears to result in significant short term improvement of VA and macular edema secondary to vein occlusion

Need for chest tube after video assisted thoracoscopic [VATS] lung biopsy

To observe the effects of early removal of chest tube drain after video assisted thoracoscopic [VATS] lung biopsy. We prospectively evaluated the removal of chest tube drain at six hours or 24 hours after the VATS-lung biopsy in fifty consecutive patients with no evidence of air leak after the lung biopsy. Our results show that removal of chest tube drain at 6 hours was not associated with complications such pneumothorax, atelectasis or pleural effusion as compared to the 24 hours removal of the drain[p>0.05]. Early removal of chest tube drain is safe in patients where air leak has been documented to be absent. Since it was a non-randomized evaluation, further randomized study in our population is needed to confirm these findings

Musculoskeletal injuries by bone setters

To highlight, evaluate and analyze the complications associated with the treatment of fractures, joint dislocations and limb deformities by bone setters in a suburban population of district Kasoor. Prospective descriptive study. This study was conducted at the Department of Trauma and Orthopaedics, Central Park. Medical College based at Bhatti International Teaching Hospital, Kasoor. This was a six month prospective study involving eighty six [86] consecutive patients presenting with complications related to treatment of their musculoskeletal injuries by bone setters. Eighty six patients with complications associated with previous treatment by bone setters were seen 62.7 [%] were male while 37.2 [%] were female. The age range from 4 months to 76 years [mean 34 years]. out of eighty six patients, 15 [17.4%] patients had non union, 21 [24.4%] had malunion, 9 [10.4%] had avascular necrosis, 15[17.4%] had chronic osteomyelitis, 4[4.6%] patients had gangrene, 8[9.3%] had contractures, 2[2.3%] had persistent dislocations, 4[4.6%] had Leg ulcers and 8[9.3%] had wound infections. The major reasons for going to bone setters were the perceived low cost of treatment [45%], pressure and advice from the elders and friends [38%], fear of surgery [5%] and assumption of faster healing by the bone setters [12%]. The methods used by the bone setters include splintage, bandage, plaster, stretching, massage and suturing. Bone setters create very difficult problems for orthopaedic surgeons. Many patients develop complications and loose their limbs due to inappropriate treatments. Awareness programs regarding inadequate treatment given by bone setters are necessary and their Patronization should be discouraged to avoid these types of complications

Bilateral adductor abcess following grion injury

Pubic pain is a common symptom in athletes and in soccer players.Its cause can be difficult to determine. We report a case in a 14-year-old boy who presented with bilateral adductor muscle abcesses following a trivial injury to the groin. The etiology, radiological findings and treatment, along with literature review are discussed. The main causes of pubic pain after sports are thought to be sports related microtrauma to the pubic rami or symphysis and lesions of the oblique, rectus or adductor muscles or their tendons1, 2. Osteitis pubis refers to a painful inflammation of the periosteum, bone, cartilage and ligamentous structures of the anterior half of the pelvis. Pubic osteomyelitis is an uncommon entity, accounting for less than 1% of all cases of Heamatogenous osteomyelitis. We report a case of bilateral adductor muscle abcess six week after a trivial injury in sports

Indications and complications of intestinal stomas -a tertiary care hospital experience

An intestinal stoma is an opening of intestine on the anterior abdominal wall made surgically. The commonly performed procedures include colostomy and ileostomy. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it. An observational study was carried out in Services Hospital Lahore, over a period of two years from Feb. 2007 - 09. A total of 85 patients needing intestinal stomas, ileostomy or colostomy, were included in the study. Patients under 12 years, with enterocutaneous fistula and urinary conduits were excluded from study. Indications, immediate and late complications of stomas were recorded. Reversal of stoma usually performed after 12 weeks and complications of reversal were also recorded. Majority [73%] of patients were males. There were 36 ileostomies and 49 cases of colostomy making a total of 85 patients. Main indications of Ileostomy were intestinal tuberculosis [58%], enteric perforation [31%] and penetrating injuries [5.5%]. Colostomy was mostly required in penetrating injuries [33%], blunt trauma [23%] and intestinal obstruction [28%]. In a total 0/35 stomas local complications appeared in 54 [41.77%]. General problems included anxiety, psychological and social isolation. Skin excoriation and ulceration were the most common [25%]; they were worse in ileostomy than colostomy. In laparotomy wound infection [9.4%], stoma diarrhea [7%], stoma retraction [6%] and prolapse [6%] were other notable comp-lications. A mortality rate of 1.6% was found in cases of ileostomy. Hospital admission ranged from 10 - 62 days. 62 stomas including 25 ileostomies and 37 colostomies were closed on an average of 3 months after primary operation. There were 9 cases of wound infection, three anastamotic leakages and a single mortality [1.6%] in the stoma reversal group. Common indications for intestinal stomas were abdominal trauma, intestinal tuberculosis and enteric perforation. Main complications included local skin problems, stoma diarhoea, prolapse and retraction. Early identification and treatment of tuberculosis and enteric fever can reduce stoma formation and its associated complications

Hemisoleus muscle flap, a better option for coverage of open fractures involving middle third of tibia

Local reconstructive options for middle third of leg make good use of Soleus muscle flap. Soleus being the prime ankle planter flexor and stabiliser of the ankle in ambulation cannot be sacrificed without significant morbidity. Soleus is a bipennate muscle with independent blood supply of each half. Using one half retains its important function, increases arc of rotation, and makes it easy to orientate for coverage of defect of any shape thus obviating the need for use of whole Soleus muscle flap. Due to this geometrical advantage, it is a superior option than the whole Soleus. We conducted a study to evaluate the reliability of the medial hemisoleus muscle flap for coverage of middle third tibial defects. This descriptive study was conducted at department of plastic surgery, Jinnah Hospital, Lahore from August 2008 to May 2009. Ten patients with middle third tibial defects were included in the study. All the patients were provided soft tissue coverage with proximally based medial hemisoleus muscle flap with split thickness skin graft on it. All the flaps survived with primary healing of the wound except one patient who developed wound infection which settled after wound drainage and irrigation. Hemisoleus muscle flap is a valuable local option for soft tissue coverage of middle third of lower leg. It does not sacrifice the whole function of the Soleus muscle. Due to its longer arc of rotation, this flap can cover the defects of different size and shape in middle third of leg

Scalp as a donor site for split thickness skin grafts

Use of scalp as a donor site was reported for the first time in 1964. Since then, authors have described scalp as a donor site, which heals rapidly and re-growth of hair conceals the donor site. This study was aimed at evaluation of scalp as donor site by calculating the healing time, and frequency of post-operative complications. This was a descriptive study and was conducted at Plastic Surgery Department Jinnah Hospital, Lahore, from October, 2006 to December 2007. Thirty patients requiring split skin grafting for small to moderate sized defects [requiring up to 4 sheets] were included in this study. After taking informed consent skin graft were taken from the scalp using Zimmer Electric Dermatome. Donor site was covered with occlusive dressing. Donor site healing time and complications were recorded. Patients having scalp lesions were excluded from the study. All the patients in this study achieved healing of the donor site. None of them required grafting. 26 [86.67%] patients achieved healing by 6th post-op day.3 [10.0%] patients achieved healing by 10th postop day and the remaining 1 [3.33%] patients achieved healing by 20 days. Complications noted were folliculitis in 2 patients and scab formation in 1 patient. Alopecia, hair transplant to recipient site and hypertrophic scarring was not encountered in our study. Patients were discharged by 6th post operative day and complications were managed on outpatient basis. Overall patients' compliance and satisfaction was excellent. scalp is an excellent donor site for taking split skin graft. It has shown to be very useful in terms of quick healing, convenient post-op care and negligible complications. It should be given preference when donor site for taking skin graft is to be selected

Para-umbilical perforator based abdominal flap for forearm/hand resurfacing

A prospective study was carried out from October 1999 to December 2005 including 38 patients. The objective of the study has been to evaluate paraumblical perforator based abdominal flap for large forearm and hand defects. Prospective, interventional study. Methodology: 38 patients were evaluated for a period of six years and two months by filling a Performa which was entered in a database and different variables were evaluated. paraumblical perforator based abdominal flap is very useful for resurfacing large hand and forearm defects

Spectrum of general surgical problems in the developmentally disabled adults

This study highlights the spectrum of general surgical problems necessitating admission on intellectually disabled adult patients. Problems encountered in the management and the ways to overcome various difficulties are highlighted. Prospective collection of data on 63 consecutive developmentally disabled adult patients admitted to the Department of General Surgery, Riyadh Medical Complex [RMC], Riyadh, Kingdom of Saudi Arabia for various indications from January 2000 through December 2004. Demographic details, clinical presentation, diagnostic modalities, associated physical and neurological disabilities, coexisting medical condition, treatment options, morbidity and mortality were analyzed. Various difficulties encountered during the management and mean to overcome these problems are addressed. Sixty-three patients accounted for 71 admissions. Mean age was 26.7 years with a male preponderance [4.25:1]. Fifty-four patients were admitted for various emergency conditions. History of pica could be obtained in 33% of the cases. Twenty-seven patients were admitted for acute abdomen. Volvulus of the colon [22.2%] and pseudo-obstruction [18.5%] were the most common causes of acute abdomen. Twenty-one patients were admitted with upper gastrointestinal bleeding. Reflux esophagitis was the most common cause of bleeding [62%]. Overall morbidity was 41% for emergency admissions and 22% for elective surgery. Hospital mortality was 21.4% for emergency surgery. There was no death in elective cases. Developmentally disabled patients comprise a special class of patients with peculiar management problems. The treating clinician should be aware of various unexpected conditions not found as frequently in the normal patient population. Apparent lack of pain does not exclude an acute emergency. Possible surgical condition should be suspected if there is vomiting, abdominal distension, fever, increased irritability of recent onset. Male gender and history of pica are added risk factors

Castleman disease presenting as obstructive jaundice

A 48-year-old Saudi male was admitted with features of obstructive jaundice. Endoscopic retrograde cholangiopancreatography showed stricture in distal common bile duct CBD. Computed tomography scan revealed lymphadenopathy along CBD and in porta hepatis. Cholangiocarcinoma, lymphoma or metastatic deposits were suspected but no definite preoperative diagnosis could be established. Laparotomy disclosed lymph node enlargement in porta hepatis and along the CBD and lesser curvature of the stomach. Triple bypass procedure was performed to relieve the obstruction. Pathological examination of the lymph nodes showed Castleman disease of hyaline vascular type

Acute small bowel obstruction due to bilharziasis

Schistosomiasis remains a major world health problem. The disease presents with protean manifestations in the endemic areas. Small bowel schistosomiasis leading to acute intestinal obstruction is an extremely rare clinical presentation. The disease may mimic peritoneal tuberculosis or carcinomatosis intra-operatively. Small bowel bilharziasis leading to obstruction has not been reported in the recent indexed English literature. This report describes a 50-year-old Yemeni male presenting with acute small bowel obstruction due to schistosomiasis. We review the pathological changes in the intestine following schistosomal infection and discuss diagnosis and treatment. We emphasize the importance of histopathology on all surgical specimens

Primary actinomycosis of the abdominal wall

Primary actinomycosis of the abdominal wall is a rare clinical entity. Only 7 adequately described cases have been reported in the English literature. We report a case of isolated abdominal wall actinomycosis involving the left lower quadrant of the abdominal wall in a 32-year-old diabetic male. The diagnosis was confirmed by histopathological examination. Surgical drainage of the abscess followed by long-term administration of penicillin resulted in cure. The clinicopathological spectrum of actinomycosis is reviewed and isolated involvement of the abdominal wall is characterized in light of the knowledge acquired from the available literature on this rare clinical presentation. The significance of obtaining tissues for culture and histopathology in all inflammatory lesions is emphasized