Metronidazole in acute non-perforated appendicitis

Objective: To compare the infective complication rate after open appendicectomy in patients with nonperforated appendicitis receiving cefazolin with metronizadole and cefazolin alone

Study design: Randomised controlled trial

Place and Duration of study: PAEC General Hospital Islamabad, from March 2015 to June 2016

Methodology: Patients with acute non-perforated appendicitis were divided into two groups. Group A patients received cefazolin with metronizadole and Group B received only cefazolin. A total of three doses were given, one preoperatively and two postoperatively in each group. Patients in both groups were followed up for 30 days postoperatively for any surgical site infections [SSI]

Results: A total of 242 patients were operated of whom 11 were excluded as they did not come for follow-up. There were 111 patients in group A and 120 in group B. Infection rate in group A patients was 7.21 % and in group B, 8.33%. There was no significant difference of wound infection in both the groups [p=0.427]

Conclusion: Addition of metronizadole in patients with non-perforated acute appendicitis did not reduce the rate of surgical site infection

Bouveret's syndrome

Gastric Outlet Obstruction [GOO] due to impaction of a gallstone in the duodenum after migration through a bilioduodenal fistula is known as Bouveret's syndrome. Its clinical symptoms are entirely vague and nonspecific. Because of its rarity, insidiousness and unpredictable symptomatology, Bouveret's syndrome is never thought of in the differential diagnosis as aetiology of gastric outlet obstruction. Recent advances in fiberoptics technology, advent of modern imaging modalities and minimally-invasive techniques like endoscopy and laparoscopy has brought a great revolution in the management of Bouveret's syndrome and have tremendously decreased morbidity and mortality associated with this rare clinical entity

Hypertrophic pyloroduodenal tuberculosis

Hypertrophic pyloroduodenal tuberculosis is a rare cause of Gastric Outlet Obstruction [GOO] often forgotten in the differential diagnosis of gastric outlet obstruction. Since laboratory and radiological investigations often prove inconclusive in reaching the diagnosis of hypertrophic pyloroduodenal tuberculosis, surgery has a key role in the management of hypertrophic pyloroduodenal tuberculosis. Postoperative anti-tuberculosis chemotherapy [ATT] becomes imperative for complete resolution of hypertrophic pyloroduodenal tuberculosis. This case report describes the condition and management in a young girl

Combined persistent Mullerian duct syndrome, transverse testicular ectopia and mosaic Klinefelter's syndrome

Persistent Mullerian Duct Syndrome [PMDS], a rare form of male pseudohermaphroditism, is characterized by the persistence of Mullerian duct structures [uterus, fallopian tubes and upper two-thirds of vagina] in otherwise normally-virilized males [Karyotype 46XY]. Patients suffering from PMDS present with cryptorchidism, inguinal hernia and infertility. Diagnosis is established when Mullerian duct structures are discovered either during ultrasonography for localization of undescended testis[s], during surgical exploration for cryptorchidism or herniorrhaphy [hernii uteri inguinalis]. Presence of both testes on one side of the scrotum is known as Transverse Testicular Ectopia [TTE]. Co-existence of PMDS and transverse testicular ectopia in a patient of mosaic Klinefelter's syndrome [Karyotype 46XY/47XXY] is a unique genetic association