Abdominal cocoon [sclerosing encapsulating peritonitis]: a rare cause of intestinal obstruction

A 24 years old lady presented with classical history of acute intestinal obstruction. There was a background history of chronic abdomen for 9 years. There was asymmetrical abdominal distension. On laparotomy, the entire small intestine was cocooned and enclosed in a yellowish white thick fibrotic membrane resulting in obstruction of the small intestine. When the membrane was carefully peeled off the small intestine, the underlying small gut was found to be absolutely healthy. The histopathology report was consistent with non-specific dense fibrosis. Based on these findings, a diagnosis of abdominal cocoon or sclerosing encapsulating peritonitis was made which is an extremely rare cause of small bowel obstruction

randomized trial to compare pile suturing with hemorrhoidectomy for treatment of third and fourth degree haemorrhoids

The objective of the study was to compare the outcome of pile suturing and conventional haemorrhoidectomy in patients with third and fourth degree haemorrhoids. Quasi experimental study. This study carried out in Combined Military Hospital [CMH] Lahore from January 2007 to July 2007. A total of 60 patients having hemorrhoids were included in the study and disturbed between two equal groups. Group A for pile suturing was compared with group B for hemorrhoidectomy. Digital rectal examination [DRE], proctoscopy and sigmoidoscopy were done for assessment and planning, Chi square test was applied. Treatment response and complications were assessed over a follow up period of three weeks. In pile suturing symptomatic cure was achieved in 22[73.3%] patients [No pain, stoppage of bleeding and mucus discharge]. While in hemorrhoidectomy it was achieved in 12[40%] patients. However only mucus discharge is less in pile suturing then hemorrhoidectomy all other variables were same. The results shows that only on P-value of mucus discharge was significant therefore pile suturing is slightly better then hemorrhoidectomy. Pile suturing is a safe, effective, and swift method for treatment of prolapsed hemorrhoids. The procedure causes minimal pain and chances of complications are perceptibly less. The wound healing is quick, allowing an early return to normal activity

tertiary care hospital experience of efficacy of darn repair versus bassini repair in inguinal hernia

To compare the results of Bassini vs Darn inguinal hernia repair techniques in terms of postoperative pain, infection rate, hospital stay, resumption of duty and recurrence. A randomized controlled prospective comparative study of inguinal hernia repair was conducted in Combined Military Hospital Quetta, and Combined Military Hospital Rawalpindi from Jan 2001 till June 2004. Seventy-eight patients of both sexes between 20-60 years with primary inguinal hernia were included in the study. Patients with obstructed/strangulated and recurrent inguinal hernias were excluded. They were randomly assigned to group I having 42 [53.76%] patients treated by Bassini repair and group II, 36 [46.24%] patients repaired with Darning technique. In group I, severe post-operative pain requiring intra-muscular analgesics occurred in 24 [57.14%] patients, infection occurred in 3 [7.14%], mean hospital stay was 5 days [4- 6 days], assumption of duties took 5-6 weeks and recurrence at the end of one year was 4.76%. In group II, severe postoperative pain requiring intra-muscular analgesics occurred in 9 [25%] patients, infection occurred in one [2.8%], mean hospital stay was 4.5 days [4- 5 days], assumption of duties took 4-5 weeks and recurrence at the end of one year was 0%. Darn repair, though a difficult procedure is a better technique than simple Bassini repair with a low morbidity and recurrence rate