Abdominal tuberculosis with massive jejunal haemorrhage

Jejunum is a rare site of involvement in intestinal tuberculosis [TB] and massive lower gastrointestinal haemorrhage is an even rare reported condition. The authors report a 15-year-old female student, who presented with fever, anaemia, hypoalbunemia and developed massive lower gastrointestinal haemorrhage during hospital stay. The diagnosis of abdominal TB was established on tissue biopsy; tissue culture was positive for Mycobacterium TB. Optimal outcome was achieved with aggressive resuscitation, repeated mesenteric angio-embolization and anti-tuberculosis chemotherapy

Abdominal angina - a rare cause of chronic abdominal pain

We report here a case of chronic postprandial abdominal pain and weight loss of more than one year duration. He was diagnosed to have abdominal angina [chronic mesenteric ischemia] on CT angiography. Open surgical revascularization procedure-right common iliac mesenteric polytetrafluoroethylene [PTFE] bypass graft achieved positive short and long-term outcome with follow-up of twenty two months

Biliary cystadenoma: a case report with review of literature

A rare case of mucinous biliary cystadenoma presented as an upper abdominal mass and progressively increasing jaundice in a 45 years old female. A free lying component of the cystadenoma producing obstruction was present in the common bile duct. Marsupialization of outer cyst with electro-coagulation of its epithelium and excision of inner cysts was performed as a palliative procedure. Diagnosis was confirmed on histopathology with positive estrogen receptors. Postoperative treatment with 20 mg Tamoxifen produced good results without any evidence of recurrence or progression even 30 months after the surgery

Rhizopus necrotizing fasciitis of cesarean wound - a rare life threatening condition

Mucormycosis is a rare cause of necrotizing fasciitis in immunocompromised patients. We report a young female, who developed rhizopus necrotizing fasciitis of caesarean wound. The lady died secondary to non-responding sepsis and irreversible multi-organ failure. High index of suspicion can lead to early diagnosis by frozen section of histopathology and fungal culture technique. Aggresive surgical debridement and intravenous anti-fungal medication is the main stay of treatment. A delay in diagnosis and treatment may cause multi-organ failure leading to high mortality

Non-traumatic right hepatic artery pseudoaneurysm: an unusual cause of hemobilia and obstructive jaundice

Most hepatic artery pseudoaneurysms [HAPA] are post traumatic, and non-traumatic pseudoaneurysm is rarely reported. It is a potentially life threatening vascular disorder and difficult to diagnose before rupture. Early diagnosis and prompt nonoperative intervention of this lesion could be life saving. The authors report the case of a patient with hemobilia caused by ruptured right hepatic artery pseudoaneurysm and subsequently developed right hepatic duct stricture, which has not been reported previously. This patient was successfully treated with endovascular stent graft of pseudoaneurysm and endoscopic stenting of right hepatic duct stricture

Splenic abscess: outcome and prognostic factors

To determine the spectrum of presentation, treatment outcome and prognostic factors of splenic abscess in a tertiary care hospital. Study Design: Case-series. Place and Duration of Study: Department of General Surgery, the Aga Khan University Hospital, Karachi, from July 1988 to July 2007. Methodology: The records of 27 patients with splenic abscess, diagnosed from 1988 to 2007, were retrieved through ICD-10 coding system. The demographic data, physical and radiological findings, treatment modalities, bacteriology reports, morbidity and mortality were collected on a proforma. There were 12 males and 15 females with a mean age of 43.52 +/- 17.49 years. Common symptoms were fever [92.6%], abdominal pain [55.6%] and malaise [29.6%]. Majority of patients [89%] had leukocytosis and 63% patients had associated diseases with which they were admitted. The most common pathogenic organism was Staphylococcus species and gram-negative rods. Ultrasound was used as a preliminary diagnostic modality, which was often followed by CT scan. Thirteen patients were treated with intravenous antibiotics, 8 underwent percutaneous drainage and 6 patients required splenectomy with respective survival rates of 84%, 87.5% and 83%. Mortality rate was 14.81% but no statistically significant difference between 3 treatment groups was manifested. There was significant difference between treatment groups regarding the size of the abscess [p=0.01] and hospital stay [p=0.04]. Splenectomy was done when abscess size was >10 cm and hospital stay were increased in the radiological drainage group. Splenic abscess is an uncommon surgical entity. High index of suspicion and liberal use of radiological studies is essential for timely diagnosis. Most of the patients could be cured with non-operative treatment. Splenectomy is a safe procedure for patients with abscess size more than 10 cm and patients not responding to non-operative treatment

Non-iatrogenic extra-hepatic biliary injuries

This prospective study was carried out in the Department of Surgery at District Headquarter Hospital, Gujranwala between January 1999 to December 2003. The study was designed to assess the nature of biliary injuries in different kinds of non-surgical trauma and to assess the results of the treatment. The nature of associated injuries was also recorded. Out of 23 patients encountered, 14 [60.87%] had gall bladder, 7 [30.43%] bile duct and 2 [8.70%] both gall bladder and bile duct injuries. Cholecystectomy was the treatment of choice in the gall bladder injuries. Bile duct injuries were managed by bilioenteric anastomosis using Roux loop of jejunum in five patients and primary repair in two patients. Pancreatico-duodenectomy was performed in one patient and cholecystojejunostomy in another. Most of the complications that occured, were due to associated injuries

Pattern of mechanical bowel obstruction-a review of 111 cases

A retrospective evaluation of the causes of mechanical bowel obstruction encountered in East surgical unit Mayo Hospital, Lahore, over a period of three years is presented. The records of 111 patients with operative diagnosis of mechanical bowel obstruction were reviewed. Adhesions and external hernias were the commonest causes of mechanical intestinal obstruction, followed by volvulus and colorectal carcionomas. Tuberculous strictures and adhesions constitute an infrequent cause. External hernias should be managed more effectively by early elective surgery. Such studies should be carried out periodically to identify the pattern of mechanical bowel obstruction