Acute appendicitis during pregnancy

To evaluate the incidence of appendicitis in various stage of pregnancy along with it symptomatology, physical signs, laboratory results, operative findings and rates of complications especially maternal morbidity and mortality. Setting: Liaquat Medical College, Hospital Hyderabad Sindh. Subject All patients who were admitted to Liaquat Medical College Hospital Hyderabad from January 1993 to March 1998. Total number of patients were twenty six. Incidence during pregnancy was 1 per 550 deliveries. Acute appendicitis was common in 18 to 23 years age group. It was seen commonly in women during their third or fourth pregnancy [16 cases [61%]. All patients had abdominal pain and location of pain was the right lower quadrant in 16 cases [61%]. Urine analysis, haematology and ultrasound were not helpful in diagnosis. All 26 patients underwent surgery within 24 hours after admission Acute appendicitis was found in 25 cases [96%]. One appendix was normal [4%]. Four patients developed post operative wound infection [15%] E.Coli and klebsiella were grown from the wound. Two patients were diabetic. There was one foetal loss in the first trimester, the patient had perforated appendix, but no maternal loss. The average hospital stay was 9.2 days. Early presentation of a patient, with an aggressive approach in the diagnosis and surgical management reduces the maternal and foetal morbrbidity and mortality

Management of abdominal trauma.

To evaluate emergency diagnostic methods, surgical procedures and the factors affecting morbidity and mortality of the victims of road traffic accidents and falls from height who sustained abdominal trauma. Setting: Liaquat Medical College, Hospital Jamshoro Hyderabad-Sindh. Subjects: All patients who were admitted to Liaquat Medical College Hospital for various injuries during the period March 1990 to May 1997. Main outcome measures: Morbidity and mortality relating to modes of trauma. Total number of patients was 1825, 7% sustained abdominal trauma, 6% required laparotomy, age range was 2 years to 69 years [mean 25.6 years] male patients outnumbered female patients by ratio 5.4: 1. Diagnostic peritoneal lavage yielded an accuracy of 95% with no complication, Spleen Liver [Seven] and mesentry [Twelve] were the three common injured organs. Mortality was high in liver injuries. Overall, road traffic accidents were most common cause of trauma in young. However, fall was the common cause of trauma in children. Diagnostic peritoneal lavage has proved to be of high diagnostic accuracy. Liver trauma patients had high mortality. However, overall morbidity and mortality appeared to be directly related to the extent of injury to other systems involved. These injuries are preventable by seatbelt enforcing laws, tough penalties for speed limit breakers, adequate precautions for safety during building works and by planned intensive public enlightenment and educational measures