Perioperative morbidity and mortality in 100 cases of transhiatal esophagectomy- a single surgical unit experience of Khyber teaching hospital, Peshawar

To observe the perioperative morbidity and mortality rates of 100 transhiatal esophagectomies operated for esophageal carcinoma in a surgical unit of a tertiary care hospital. Data pertaining to all patients that had undergone transhiatal esophagectomy from Feb, 2012 to Jan, 2014 were reviewed. The study group comprised 100 patients. Indication for surgery was esophageal cancer. Perioperative morbidity and mortality i.e. morbidity and mortality during the first 30 days, were studied. Two patients died during the postoperative period in hospital. The anastomotic leakage rate was zero. No dysphagia was found during one month of postoperative period. Overall survival was 98% for the first 30 days of surgery. Transhiatal esophagectomy has been common stay and a safe rather feasible procedure. Oncological therapy has its role and better results are found in centers where the procedure is frequently performed

Small intestinal obstruction caused by a phytobezoar: a case report

Phytobezoar is a concretion formed in the stomach or intestine and composed chiefly of undigested compacted vegetable or fruit fibers. A case of Phytobezoar causing acute small intestinal obstruction in absence of prior gastric surgery or other predisposing factors is presented. The patient was managed surgically i.e., enterotomy

Aggressive angiomyxoma of scrotum presenting as an Inguinal Hernia

Aggressive Angiomyxoma [AAM] is a rare mesenchymal tumor with a locally aggressive course. The most common location is in the pelviperineal region and occurs mostly in females of childbearing age. In males, it is extremely rare and thus is apt to be mistakenly diagnosed as an inguinal hernia or hydrocele. We report a case of 45 year old man who had right sided scrotal swelling for about four years. It was diagnosed as an inguinal hernia clinically. On further investigations, it was found to be a soft tissue tumor of the scrotum. The patient underwent scrotal exploration. At surgery, a huge lobulated gelatinous mass surrounding the right testicle was found. The mass was excised including the testicle and sent for histopathological analysis. Histologic examination of the excised mass revealed a nonencapsulated lesion composed of sparse spindle-shaped cells and a myxoid stroma with a prominent vascular component. The cells showed focal and weak positivity for desmin. The findings were thus consistent with aggressive angiomyxoma of the scrotum. The margins of the specimen were clear. The patient we report has so far done well with no evidence of recurrence

Inferior lumbar hernia of petit in a patient with neurofibromatosis type-1

Lumbar hernias are rare lesions that account for less than 1.5% of total hernia incidence. Only 250-300 cases have been reported in literature. Diagnosis may be difficult because they are either asymptomatic or may present with vague complaints. Differential diagnosis includes a lipoma, a fibroma, a retroperitoneal or intra-cavitary tumor, hematoma or a chronic abscess. They may occur in association with defects of the musculoskeletal system including some syndromes. Lumbar hernia in patients with neurofibromatosis has been reported in a very few number of cases. We report a case of 40 year old female with type 1 neurofibromatosis who presented with left lumbar hernia of Petit

Management of penile fracture

To document the clinical presentations, diagnostic methods and therapeutic approach for the patients presenting with penile fracture and out comes of the treatment. Prospective observational study Surgical 'C' and 'B' Ward of Khyber Teaching Hospital Peshawar, Pakistan, from January 2001 to December 2004. 17 patients presenting with fracture of the penis during this period were included in the study after approval from the Hospital Ethics' Committee. Age, marital status, activity leading to the injury, symptoms and signs, management and outcome were recorded on a proforma designed for the purpose. The common age group was 30-50 years with 13 [76.47%] patients in this group, 14 were married and 3 were students. Eleven [64.70%] cases of fractures occurred during sexual intercourse and 6 cases due to non-coital causes including masturbation and manipulation. Fifteen patients recalled a popping sound, immediate detumescence and deviation were present in all, penile swelling and hematoma in 15 while the tunical defect was easily felt in 2 patients. Diagnosis was made clinically and was confirmed on surgical exploration. Repair of tunical defect was done with vicryle 2/0. No urethral injury was encountered. Out come was excellent and all patients regained complete penile function at 3 months follow up. Mild penile curvature was seen in 5 patients but it did not interfere with erection or sexual activity. Penile fracture is an entity with typical clinical signs and no further investigations is usually needed. Management is surgical and immediate to avoid complications related to erectile dysfunction