Stercolith Perforation

A 62-year-old diabetic bed ridden woman, presented to the emergency department with symptoms suggestive of peritonitis. She had been taking oral laxatives and enemas to relieve her chronic constipation for last 6 years. Hard impacted stools and pelvic tenderness were found on digital rectal examination. Her X-ray abdomen showed soft tissue shadows in the colon but there was no gas under the diaphragm on chest X-ray. Sonography found free fluid in pelvis. She was resuscitated, and her hyperglycemia was controlled by use of regular insulin as per sliding scale. Operative findings revealed free fluid in pelvis and very hard faecalomas lying free in peritoneal cavity. There was a 2 x 3 cm perforation at the anterior wall of the recto-sigmoid junction. Peritoneal toilet was carried out followed by Hartmann's procedure. Histopathology of perforation side showed no evidence of malignancy

Comparison of oral misoprostol with vaginal misoprostol for cervical ripening

To determine the efficacy and safety of stepwise oral misoprostol with vaginal misoprostol for cervical ripening for induction of labour. Interventional Quasi - Experimental study. The study was of 15 months [April to 30 June] duration conducted at Obstetrics and Gynaecology department Military Hospital Rawalpindi. 100 females between 37-42 weeks of gestation were randomly divided into two groups 1and 2. Patients in group -1 assigned to the stepwise oral misoprostol arm received 50 micro g initially followed by 100 micro g every 04 hours upto maximum 04 doses ; group-2 assigned to the vaginal misoprostol arm received 25 micro g every 04 hours up to maximum 04 doses. Subsequent doses of misoprostol were withheld if adequate uterine activity [>/= 3 contractions in 10 minutes] or a Bishop score >/= 8 had been achieved, or active labour had begun. The main outcomes were the interval from first misoprostol dose to delivery and mode of delivery. Patients were also monitored for adverse events. There was no difference in the average interval from the first dose of misoprostol to delivery in the oral [21.1 +/- 7.9 hrs] and vaginal [21.5 +/- 11.0 hrs, p = NS] misoprostol groups. 9 patients in the oral group [18%] and 16 patients in the vaginal group [32%] underwent caesarean section [p<0.05]. There were no significant differences in the occurrence of tachysystole, hypertonus, hyperstimulation or neonatal outcome between two groups. Oral misoprostol appears to be as effective as vaginal misoprostol for cervical ripening with a low incidence of hyperstimulation, no increase in side effects, and is associated with a lower cesarean section rate

Ultrasonography; diagnostic accuracy in female appendicitis

Acute appendicitis is a diagnostic dilemma in young female patients. Ultrasonography has an important role in making preoperative diagnosis and ruling out other gynecological pathologies in women. [1] To determine the diagnostic accuracy of ultrasonography for acute appendicitis. [2] To compare it with impression, in female patients. Cross-sectional comparative study. Female Surgical department. Combined Hospital, Rawalpindi. Mar 2006-Jun 2008. 214 consecutive female patients presenting with pain right lower abdomen were enrolled. The patients were assessed clinically. Blood complete picture and urine analysis was carried out in all patients. Ultrasonography was performed by radiologist with 7.5 MMz short-focused high-resolution probes. Patients were operated upon and appendicectomy was done. Specimens were sent for histopathology to confirm appendicitis. Ultrasound supported the diagnosis of acute appendicitis in 163 [76.2%] patients. In ultrasound with positive findings, patients 161 [98.8%] had inflamed appendices on histopathology and 2 [1.2%] had normal appendices. The over all sensitivity of ultrasonography was 81.3% and specificity was 87.5%. Diagnostic accuracy of ultrasonography was 81.8%. The over all sensitivity of surgeon's clinical impression remained 81.8% and specificity was 62.5%. Diagnostic accuracy of ultrasonography was 81.8%. Ultrasound should be the initial diagnostic modality in females presenting with right lower abdominal pain. It is highly specific, effectively rules out other pathologies and helps in minimizing the avoidable surgical trauma

Single and simple antibiotic prophylaxis for elective cholecystectomy

To determine the postoperative infection result after use of a single and simple antibiotics for prophylaxis in open elective cholecystectomy. Descriptive [quasi-experimental] study. Place and Duration of Study: This study was conducted in Military Hospital, Rawalpindi from December 2006 to January 2008. One hundred and sixteen patients requiring elective open cholecystectomy were included. Patients with acute cholecystitis, jaundice and choledocholithiasis were excluded. Only two doses of Gentamycin were used as prophylactic antibiotic for operation. Special precautions were taken for maintaining sterilization during surgery. Out of 116 cases, 111 [95.7%] patients had smooth postoperative recovery and only 5 [4.3%] patients developed surgical site infection. Culture sensitivity of these 5 patients revealed E. coli in 2 [40%] cases, 01 [20%] patient had Klebsiella, while 2 [40%] had mixed growth. Single antibiotic prophylaxis for elective cholecystectomy is recommended provided strict aseptic measures are taken during surgery along with good surgical technique