Effectiveness of gastrografin in resolving small bowel obstruction

Objectives: To determine the effectiveness of Gastrografin in resolving intestinal obstruction

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted in the Department of Surgery, Shaikh Zayed Hospital, Lahore from 02-10-2013 to 02-04-2014

Materials and Methods: One hundred thirty five patients who having small bowel obstruction were admitted through out-patient, accident and emergency departments. Every participant was explained about both procedures and their consequences

Results: Average age was 44 +/- 70 years. 77 [57%] were males and 58 [43%] were females with a male to female ratio was 1.32:1. In 58 [43%] male patients the obstruction was resolved, but in 19 [14%] male patients obstruction was not resolved. In 41 [30%] female patients the obstruction was resolved and in 17 [12%] female patients the obstruction could not be resolved. Overall, in 99 [73%] patients, the obstruction was resolved but in 36 [27%] of patients the obstruction was not resolved

Conclusion: Gastrografin is a secure and reduces the need for surgery when conservative treatment fails. It remains a leading cause of hospital admission in surgical departments

combined role of alvarado score and ultrasonography for the diagnosis of acute appendicitis

Objectives: Objective of the study was to evaluate use of Alvarado score and ultrasonography in diagnosis of acute appendicitis

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Department of Surgery along with Department of Radiology at Shaikh Zayed Hospital Lahore from 1[st] January 2013 to 31[st] August 2013

Materials and Methods: 250 patients of Alvarado Score were enrolled for the diagnosis of acute appendicitis attending out-patient, accident and emergency departments

Results: There were 184 [74%] were males and 66 [26%] were females with mean age of 35.27 +/- 12.57 years. One hundred and seventy patients had anorexia while 76 patients had no anorexia. 49.6% patients while in 50.4% were reported anorexia. Right iliac fossa was noted in all patients. 95% patients had rebound tenderness 203 patients have elevated temperature

Conclusion: Alvarado score is a simple and reliable non-invasive diagnosis modality without any extra cost and complication. It has also proved to be handy for our peripheral hospital settings where backup facilities not available. By application of Alvarado scoring system with non-invasive ultrasonography improves diagnosis accuracy by reducing negative appendicectomies hence reducing complications rate in our settings

Mesh versus non-mesh repair, eleven years experience at Shaikh Zayed Hospital, Lahore

Ventral Incisional Hernias are a well known complication after abdominal surgery with a reported incidence of 10% - 20% and a recurrence rate of 30% - 50% after open suture repair and less than 10% after open mesh repair. To compare the outcome of two different methods of open repair of VIH [i.e. Mesh versus Non-mesh or Suture Repair in terms of morbidity, complications and recurrence. 11 years period [January 2000 - December 2010]. Shaikh Zayed Hospital, Lahore. The total number of patients who underwent surgery for repair of VIH during the study period was 321.There were only 33 patients in Group A [simple suture/Keel repair] while Group B had 288 patients. The most common early postoperative complications seen in both the groups were wound seroma and infection. Post-operative respiratory insufficiency was more common in the obese. Chronic pain and feeling of foreign body was more frequently seen in the mesh group. On the other hand, recurrence rates were far greater in the suture repair group. The overall mortality in the whole series was 3 patients [0.93%]. The rates of ventral incisional hernia recurrence and complications are significantly lower after open onlay mesh repair as compared to the open suture repair. However, these results require confirmation by prospective randomized clinical trials which should also include the results of laparoscopic ventral incisional hernia repair which is a new and emerging technique in Pakistan

Retroperitoneal lymphangioma

Retroperitoneal lymphangioma is a rare benign congenital malformation of lymphatic channels. This report is of a 35 years old male who presented with 1 month history of abdominal pain and swelling due to a large retroperitoneal cystic lymphangioma. The lesion was removed surgically with complete resection

Pleomorphic rhabdomyosarcoma within a choledochal cyst; a rare cause of obstructive jaundice

Bile duct cysts are rare and of uncertain origin. Most have been reported in young females of Asian Descent. The long term complication of choledochal cysts includes malignant transformation in the epithelial lining of biliary tree. Histopathologically it is Cholangiocarcinoma in the majority of cases with poor long-term prognosis. However, Rhabdomyosarcoma associated with choledochal cyst in an adult is rarely reported before. The authors report one such case in an adult female patient who presented to us with features of obstructive jaundice

study of gynaecological emergencies presenting as Acute Appendicitis

To assess the frequency of gynaecological emergencies presenting as acute appendicitis among females of child bearing age. Descriptive analytical study. The study was conducted at the surgical unit-II of Sheikh Zayed hospital and postgraduate medical institute Lahore from January 2000 to December 2000. The study included 105 female patients aged 15-45 presented in accident and emergency department with right iliac fossa pain. Diagnosis was clinical in all cases .Investigations for leukocyte count, pregnancy test and lower abdominal ultrasound scan were used to improve diagnostic accuracy. All diagnosed patients underwent appendectomy and intra-operative findings were recorded. Patients with gynaecological disorder were dealt accordingly. Final diagnosis of acute appendicitis was made on Intra-operative findings and histopathology report. There was high frequency of gynaecological disorders simulating acute appendicitis in the age group ranging 15-25 years with mean age 23.1 and standard deviation + 0.74. Duration of pain ranges from 12 hours to 4 days. Pain and tenderness in right iliac fossa was found in all patients where as shifting of pain was present in 61% of cases. Total leukocyte count more than 11000 per cubic millimeter was present in 60% cases. Peroperatively acutely inflamed appendix was found in 71.4% ruptured ovarian cyst in 11.4%, right tubal abortion in 0.9% and pelvic inflammatory disease in 4.7% of patients. Histopathological report revealed that in 77.1% of cases appendix was acutely inflamed. Thus out of 105 study subjects who underwent appendectomy, 18[17%] were having gynaecological problems. In 3[2.8%] mesenteric lymph node biopsy was done, which turned out to be chronic nonspecific inflammation. In 9[8.5%] no positive finding could be found preoperatively. The rate of negative appendectomy in our study was 22.9%. There is considerable number of young females with gynaecological disorders presen ting in emergency as acute appendicitis. Good clinical judgment and routine use of ultrasonography is desirable to reduce the negative rate

Critical factors in determining mortality from penetrating abdominal vascular trauma: the Mayo Hospital experience

Mayo Hospital Lahore is a big and busy trauma center in Pakistan that receives a substantial number of patients with penetrating abdominal trauma. Vascular injuries in these patients are not uncommon. They are difficult to repair and are usually associated with a high mortality. The purpose of this study was to review treatment principles, complications and factors affecting the outcome variables in our setup in these cases, the main outcome variable being survival. Complete medical records of 411 patients with penetrating abdominal injuries, operated in our emergency over a four years period [January 1996 - December 1999], were reviewed. Amongst these 57[13.86%] had significant abdominal vascular injuries. The commonest afflicting agents were firearms [81%]. The overall mortality was 31.5%. The highest mortality was associated with retro-hepatic vena caval injuries [66.6%]. Very high mortality rates were seen in patients who were admitted with un-recordable blood pressure [72.2%] and in patients who had combined arterial and venous injuries i.e. more than one abdominal vascular injury [42.8%]. Mortality seems to be directly related to the site of the vascular injury [high for supra-renal / retro-hepatic vena caval injuries], the presence of shock on admission, free bleeding and the lack of retro-peritoneal tamponade at the time of surgery, and the presence of additional vascular injuries. The major cause of death in our patients was profound shock due to uncontrolled bleeding. Early diagnosis, prompt intervention and effective management could result in improved salvage rates