Intussusceptions in adults: clinical features and operative proce

To determine the clinical presentation and treatment outcomes of adult patients with intussusceptions. Case series. The Aga Khan University Hospital, Karachi, from January 1988 to December 2008. Medical records of patients with diagnosis of intussusceptions in adults [above 15 years of age] from January 1988 to December 2008 were retrieved through ICD 9 coding system. Patients with complete records were included in the study and those with incomplete medical record or under 30 days follow-up were excluded. Data was analyzed on SPSS version 16. The treatment outcomes were hospital stay, 30 days-morbidity, mortality and recurrence of intussusceptions during follow-up period. The mean age of the 19 patients was 37 years with male predominance. Most patients presented with acute bowel obstruction. In 14 patients, small bowel were involved. CT scan diagnosed intussusception in 10 out of 12 patients. Benign lead point were found in 80% cases. Eighteen patients were treated surgically. Fourteen [70%] patients underwent resection with primary anastomosis while in 4 patients only reduction was done. In resection group, 11 patients had resection after reduction and in 3 patients only resection was done. There was no recurrence in resection group. One recurrence was noticed in the reduction group and one patient died of advanced gastrointestinal malignancy in the non-operative group. Intussusception is a rare cause of acute intestinal obstruction in adult population. CT scan is a promising diagnostic tool to establish pre-operative diagnosis. Early surgical resection could achieve optimal outcome. Small bowel intussusception could be reduced before resection if there is no doubt about bowel viability. In most of the patients the lead point could be benign disease

Impact of rural medical care in remote mountainous region of Pakistan: challenges and opportunities

To share the experience of developing rural medical care and the impact on the health indicators of the population. The clinical data was collected prospectively using ICD-9 coding and data base was developed on a desk top computer. Information about the operative procedures and outcome were separately collected on a excel work sheet. The data from January 1998 to December 2001 were retrieved and descriptive analysis was done on epi info-6. Thirty one thousand seven hundred eighty two [31,782] patients were seen during this period, 53% were medical, 24% surgical, 16% obstetric and 7% with psychiatric illness. Out of 1990 surgical operations 32% were general surgery, 31% orthopedic, 21% pediatric, 12% obstetric and 4% urological cases. There were 21 surgical mortality including 6 operative deaths, 15 non operative deaths and 89% of the mortalities were unavoidable. The crude in hospital mortality decreased significantly from 5.5% in 1992 to 1.1% in 2001 and the contributing factors were improved structure and process of care. The impact of secondary care rural medical centre [AKMC] is obvious from the clinical audit including accessibility, sustainability and quality of care. This could be a model of care in rural Pakistan where accessibility, affordability and quality of care is lacking

unique variant of intestinal tuberculosis

Duodenum is a rare site of involvement in intestinal tuberculosis. We report a 19 years old boy who presented with non-bilious vomiting and weight loss. His workup showed stricture in ascending colon, multiple liver abscesses with pneumobilia on CT scan. Upper GI endoscopy revealed stricture in 2[nd] part of duodenum distally. He was operated and duodenojejunostomy with limited right hemicolectomy [for stricture in this part of gut] were done. Biopsy report was suggestive of tuberculosis. Antituberculous treatment was started. He responded well and gained 20 kg weight at 3 months follow-up