Situs inversus totalis with liver abscess

A case of multiple liver abscesses in a patient with situs inversus totalis is presented. Initially the patient was treated conservatively and remained symptom free for 4 days of hospital stay. On a follow up visit after 1 week the patient had high grade spiking fever and ultrasonography showed expanding multiple abscesses. The patient was restarted on intravenous antibiotics which resolved the disease

Laparoscopic Cholecystectomy: An early experience at Ayub Teaching Hospital Abbottabad

Laparoscopic Cholecystectomy first introduced in 1987, is becoming more and more popular and now it has become gold standard in symptomatic gallstone disease. The current descriptive study is carried out in Department of General Surgery, Ayub Teaching hospital, Abbottabad to evaluate the result of Laparoscopic Cholecystectomy in symptomatic gallstones disease in our set up with special emphasis on complication rate, morbidity and mortality. The data of all patients who underwent Laparoscopic Cholecystectomy form January to December 2007 was entered in standardized proforma and analysed on SPSS 10. Out of 60 patients, 51 [85%] were female and 9 [15%] were males; the age range from 17 to 65 years mean age being 40.30 years, majority were in age 30-40 years group. Two [3.3%] patients had bile leak, 1 [1.3%] patient developed port site wound infection 1 [1.3%] patient developed collection in pouch of Morrison and in 1 [1.3%] patient stone were recovered from the epigastric port site wound. There was no bile duct or colonic injuries. The conversion rate was 5%. There was no mortality. Laparoscopic cholecystectomy is a safe and effective treatment for gall stone disease and is up to the accepted standard in our set up as compared to national and international data

Conservative management of mesh site infection in ventral hernia repair

Mesh Hernioplasty is the preferred surgical procedure for abdominal wall hernias and infection remains one of the most common complications of this technique. In some patients the mesh may need removal to overcome infection, where as others may be salvaged by conservative treatment. This study was conducted to assess the outcome of conservative management for mesh site infection in abdominal wall hernia repairs. This study was carried out in Ayub Teaching Hospital Abbottabad Pakistan from Jan 2006 to Dec 2007. Thirteen consecutive cases were included, who developed mesh site infection after abdominal wall hernia repair. Pus or purulent fluid was sent for culture and sensitivity. All patients were treated by intravenous antibiotics and local wound care. Treatment was taken as successful when there was complete resolution of infection and healing of the wound. There were 7 inguinal [53.84%], 4 para-umbilical [30.76%] and 2 incisional hernias [15.38%]. Eight patients were males [61.53%] and 5 females [38.46%]. Median age of the patients was 40 years [range 28 to 52 years]. Staphylococcus aureus was the most commonly found organism causing infection in 8 patients, [76.9%]. Mean hospital stay was 22 days [range 18-26 days]. All cases were effectively treated conservatively without removing the mesh. Polypropylene mesh was used in all of these cases. Conservative management is likely to be successful in mesh site infection in abdominal wall hernia repairs

Experience with splenic trauma in Ayub Teaching Hospital, Abbottabad

This study was carried out to estimate the prevalence, severity and mode of splenic trauma and management technique from amongst the abdominal trauma cases admitted in Ayub Teaching Hospital The study was carried out at Surgery units of Ayub Teaching Hospital, Abbottabad, the only referral hospital for major trauma cases, from July 2001 to Dec. 2002. One hundred consecutive abdominal trauma patients admitted to all surgical units which were followed up through complete documentation were included in the study. Their injuries were classified, treatment strategies outlined and complications were documented. Out of the 100 patients presenting in emergency, 25% presented with blunt and 75% with penetrating trauma. 97 patients underwent laparotomy and 03 treated conservatively. Mean age was 27.26 [range 19-49] years. Out of these cases 19 patients had splenic injury, 6 [31.57%] with Type-I and II while 13 [68.42%] with Type-III and IV. 11[57.89%] of the splenic injuries were due to blunt abdominal trauma and 8 [42.10%] due to penetrating abdominal injuries. 14 [83.6%] of the patients with splenic injury underwent splenectomy and 5[26.3%] splenorrhaphy. The commonest cause of splenic injury was blunt abdominal trauma; Assessment of the severity of splenic injuries at the time of laparotomy resulted in splenic salvage procedures in some cases. Splenorraphy was associated with fewer complications

Cancelled elective general surgical operations in Ayub teaching hospital

Cancellation of operations in hospitals is a significant problem with far reaching consequences. This study was planned to evaluate reasons for cancellation of elective surgical operation on the day of surgery in Ayub Teaching Hospital, Abbottabad. From July 2006 to June 2007 the medical records of all the patients who had their operations cancelled on the day of surgery in all the three General Surgical units of Ayub Teaching Hospital, Abbottabad were audited prospectively. The number of operation cancelled and reasons for cancellations were documented. 3756 patients were scheduled for surgery during the study period. 2820[75%] patients were operated upon. 936 [25%] operations were cancelled out of which 338[36%] were cancelled due to shortage of time, 296[31.6%] were cancelled due to medical reasons, 152[16.2%] were cancelled due to shortage of beds while 55[5.8%] were cancelled due to shortage of anaesthetists. Three operation lists were lost completely. The Anaesthetist cancelled 43%, Surgeon 39% while 18% of operations were cancelled due organizational reasons. Cancellation of patients on operation lists occupy a substantial population [25%] of cases. Majority of cancellation were due to reasons other than patients medical conditions. Better management could have avoided most of these cancellations

Role of ultrasound in acute appendicitis

Misdiagnosis of acute appendicitis is a common and crucial problem in general surgery. Graded compression ultrasonography is one of the new diagnostic technique that is reported to have improve the diagnostic accuracy and clinical outcome. The aim of current study is to assess the role of this diagnostic modality in the management of acute appendicitis. This is a cohort observational study comparing the adverse outcome in two different groups of patients admitted with suspected acute appendicitis at two different hospitals in two different countries. The first group of 200 patients at Ayub Teaching Hospital Abbottabad, Pakistan, was managed without preoperative ultrasonography. In the second group of 200 patients admitted at Najran General Hospital Najran Saudi Arabia, graded compression abdominal ultrasonography was routinely performed preoperatively. Diagnostic accuracy of the protocol in each group was measured statistically and rates of negative appendicectomy and perforation were determined. Addition of routine ultrasonography in clinical assessment for acute appendicitis decreases the sensitivity but significantly increases the specificity of the protocol thereby reducing the false positive rate translating into decreased negative appendicectomy rate. Rate of negative appendicectomy was 22.5% in group one and 4.7% in group two.Perforation rate was 15.6% in group 1 and 15% in group two. Proper clinical assessment is the mainstay of diagnosis in acute appendicitis and addition of routine ultrasound by graded compression technique can improve the diagnostic accuracy and adverse outcome

Parathyroid carcinoma

Parathyroid carcinoma is a very rare cause of primary hyperparathyroidism and these tumors are usually hyper-functioning as compared to other malignant endocrine tumors. Surgery is the only effective primary treatment. We report a patient, who presented with pathological fracture of femur, hypercalcemia, bilateral renal stones, markedly raised Parathormone levels and palpable mass in the neck. Parathyroid adenoma was initially diagnosed and localized at left lower gland by Sestamibi scan and ultrasonography. She underwent surgery and enlarged parathyroid gland was removed. Intra operatively there was no evidence of local invasion or lymph nodes involvement but biopsy report suggested malignancy

Dextrocardia associated with left hemidiaphragmatic eventration

A rare case of dextrcardia in association with eventration of left hemidiaphragm who failed to thrive is presented. Growth retardation could not be attributed to these congenital anomalies