Small bowel perforation secondary to fish bone ingestion

Two cases of small bowel perforation due to fish bone injury were seen in the last 10 years in the department of surgery, the first was in 2004 and a further one in 2010. The first case was a sixty-two year old Bahraini male who presented to the Emergency Department with acute lower abdominal pain of four hours duration. Abdominal examination revealed, generalized tenderness and distension. There was no guarding or rebound tenderness. Bowel sounds were audible. Abdominal CT scan was not helpful in diagnosis. Conservative treatment failed and the patient needed surgical intervention. The second case was a seventy-five year old Bahraini male, known to have diabetes, hypertension and senile hypertrophy of the prostate. The patient was admitted with acute generalized abdominal pain of one day duration. Abdominal examination showed generalized abdominal tenderness and guarding with absent bowel sounds. CT scan of the abdomen showed free gas under the diaphragm and free fluid but did not show the site of perforation. Both cases needed urgent laparotomy, identification of the bowel perforation, removal of the fish bone, and simple closure of the perforation. The aim of this report is to increase the awareness of fish bone as a possible cause of small bowel perforation particularly in Bahrain, and to advise early surgical intervention and simple closure of the perforation after foreign body removal

Ingestion of a fish bone is a cause of small bowel perforation: a case report and review of the literature

Sixty two-year old Bahraini man presented with history of lower abdominal pain of four hours duration, not associated with fever, vomiting, constipation or diarrhea. Patients had no urinary symptoms, no history of previous medical problems and no past history of previous abdominal surgery. Blood investigation were within normal ranges. Plain erect abdominal radiography showed dilated small bowel loops, no gas fluid levels and no gas under the right diaphragm. Abdominal computed tomography revealed no free intraperitoneal gas and abnormal small bowel loop with thickened wall and mesentery suggestive of inflammation or ischemia. Patient condition was not improving by conservative measures. Laparotomy was performed and a thickened inflamed ileal loop with a fish bone penetrating through its wall was found. There was minimal peritoneal soiling and omentum was coiled around the perforated ileal loop. The fish bone was removed and the perforation was closed. Patients had uneventful postoperative recovery and was discharged on the 12th postoperative day. Retrospectively he mentioned that he had a fish meal three days prior to the abdominal pain

Early versus late excision and grafting in the treatment of second and third degree burns

One hundred seventy eight patients with second or third degree burns who attended the emergency department in Suez Canal University Hospital in whom the total body burned surface area [TBSA] ranged between 10- 50% were included in our study. They were allocated randomly into two equal groups using simple randomization technique. [n= 89 patients]. Patients of the first group were treated by early excision of eschars and auto grafting [EEG], after a mean period of 5.39 +/- 1.47 days while patients of the second group were treated by repeated eschar excision, wound dressing and late grafting [LEG] after a mean period of 39.12 +/- 18.26 days [P<0.0001]. The mean graft take was 95.38% +/- 7.70 in the EEG group while it was 94.37% +/- 6.81 in the EEG group. The difference was statistically insignificant. Hypertrophic scars were common among patients of EEG group [41.57%] compared to [26.96%] in LEG group. It declined to 35% in EEG group compared to 30% in LEG group when burned surface area was equal or below 20% of [TBSA]. Late contracture was less common among patients of EEG group [6.74%] compared to [24.71%] in LEG group [P<0.001]. It declined to 0% in EEG group compared to 25% in LEG group when burned surface area was equal or below 20% of [TBSA]. The overall mortality was 5.06% [9 patients]. All mortalities had a burned surface area of 40-50%, it was due to septicaemia in 6 patients [3.37%], acute renal failure in 2 patients [1.12%] and DIC in one patient [0.56%]. Five of them [5.62%] were in EEG group and 4 [4.49%] were in the LEG group [NS]. The mean hospital stay was shorter in the EEG group [22.75 +/- 22.58 days] compared to [61.43 +/- 22.01 days] in the LEG group [p=0.0002]. We recommend the use of EEG in the management of second and third degree burn

Gastro-oesophageal after laparoscopic cholecystectomy: a prospective evaluation

The lower oesophageal sphincter [LOS] function was studied in 20 patients with symptomatic gall stone disease before and after laparoscopic cholecystectomy. Nine patients [45%] were still symptomatic 3 - 4 months after surgery. Seven patients [35%] had abnormal pH profile before surgery, increased to fourteen patients [70%] following cholecystectomy [P <0.002]. DeMeester acid reflux score increased from 15.2 to 34.2 post surgery [P<0.001]. The LOS function as assessed by the sphincter function index was significantly reduced in patients with abnormal pH profile [P<0.01]. The mean supine gastric alkaline shift increased from 9.2% to 17.7% [P<0.02]. The incidence of gastritis increased from 4 [20%] to 12 patients [60%]. These data suggest that laparoscopic cholecystectomy results in gastro-oesophageal reflux that appears to be related to compromised lower oesophageal sphincter competence