RESUMO
Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. The mortality rate of severe acute pancreatitis exceeds 20%, and some patients diagnosed as mild to moderate acute pancreatitis at the onset of the disease may progress to a severe, life-threatening illness within 2-3 days1. A study was conducted in RGH [Now BBH]. January, 1997 to January, 2001. All patients with abdominal pain and having a serum amylase level of five times the normal range, were included in the study. 72 patients were admitted. 29 [40.2%] were males and 42 [59.7%] were females. Male to female ratio was 2:3. The age of the patients ranged from 7 years to 85 years [average age 40 years]. Disease severity was assessed according to Ranson's criteria. They were managed in a general surgical ward or intensive care unit when indicated. Development of complications and their management done were recorded. Patients stayed in the hospital from 1-21 days with an average period of 8.59 days. 32 [44.44%] recovered uneventfully without any complication while 40 [55.55%] patients developed either local or systemic complications. Overall 10 [13.88%] patients died early in the course of disease i.e. within one week. All of them were above 55 years of age, 6 of them were females and 4 of them were males, mortality ratio for female to male was 3:2. [1] To study the morbidity and mortality in patients of acute pancreatitis. [2] To evaluate the management of acute pancreatitis in a general surgical unit. Management of mild acute pancreatitis is simple, it needs only supportive treatment. However, the management of severe acute pancreatitis is complex. Mortality is high and the treatment requires individualized approach regarding timing of surgery and choice of technique
RESUMO
To evaluate the selective management of enteric typhoid perforation, according to the time of presentation, in terms of morbidity and mortality. Descriptive case series. Surgical unit of DHQ teaching hospital, Rawalpindi, from April 2004 to April 2011. A total of 84 patients were included, and divided into two groups. Forty patients, who presented early [within 48 hours] constituted group A, were managed by primary closure. of perforation while patients who presented late were put in group B and stoma was made. The age range was 10 to 40 years. Seventy five patients were males and 9 females. Forty four patients presented with features of systemic toxicity. All group A patients were managed by primary closure of perforation. In group B, ileostomy was performed in 20 patients after bowel resection, and the perforation was exteriorized in 22 patients with single perforation. Two patients had primary anastomosis. Overall mortality was 11.9%. Primary closure should be reserved for selective patients who present early, without gross peritoneal contamination. Patients who present late, or are severely ill, should be managed by ileostomy