Sliding Amyand's hernia

Amyand's hernia is defined as appendix inside the inguinal hernia sac. It is a rare pathology and literature present over it comprises of case reports or small case series. Diagnosis is difficult and mostly made intraoperatively after opening of the hernial sac, and treatment relies upon the condition of appendix. In this report we share our experience of a case where the caecum and inflamed vermiform appendix were part of boundary of the sac, thus leading us to name it a sliding amyand's hernia

Malacoplakia of rectum

Colorectal malacoplakia with ulcerative colitis is a rare clinical entity. This is a case report of a woman, 35 years of age, who presented with bleeding per rectum, lower abdominal pain and painful defecation for 02 months duration. A tender circumferential mass was found on digital rectal examination and incisional biopsy showed malacoplakia. CT scan revealed rectal mass extending up to rectosigmoid junction; infiltrating the pelvic wall and encasing the right lower ureter, though her CEA level was normal. DJ stenting was done for ureteric obstruction and quinolone therapy was instituted. Despite this, surgical debulking [abdominoperineal resection] was carried out for aggravation of her symptoms. The histopathology report revealed it to be a malacoplakia with ulcerative colitis

Chest trauma management: good outcomes possible in a general surgical unit

To determine the predominant pattern of injuries following chest trauma and assess the adequacy of the management strategies employed in a general surgical unit of a trauma care hospital. This Case Series study with prospective data collection was conducted in Surgical Unit-Il ft Unit-VI of Civil Hospital Karachi, from September 2007 to February 2009. One hundred and three consecutive patients with thoracic trauma presenting in emergency department were evaluated. Patients above 12 years of age, who presented with chest trauma either alone or associated with multiple trauma were included. A total of 103 patients were studied for various chest injuries during eighteen months period. As a whole 58% of patients had blunt chest injury as compared to 42% who had penetrating injuries. Thirty patients [29%] had chest wall injuries [rib fracture, mild lung contusion] without haemothorax or pneumothorax, who were managed conservatively. Chest intubation was required in 64 patients [62%] having hemothorax I pneumothorax. Thoracotomy was required in nine patients [9%], in which only two were emergency thoracotomy and seven were elective. Over all mortality rate was 8%.Penetrating injury of chest is rising with time due to gunshot injuries although blunt trauma is still more common. Majority of chest trauma patients can be managed in a general surgical unit satisfactorily and few patients need major operative management

Bile duct injuries during open and laproscopic cholecystectomy:management and outcome

To evaluate the management of twenty two patients, with bile duct injuries during open and laproscopic cholecystectomy who were referred to the tertiary center. It is a prospective cohort study conducted at Department of Surgery, Sindh Government Lyari General Hospital, affiliated with Dow University of Health Science Karachi. Patients who sustained bile duct injuries following open cholecystectomy and laproscopic cholecystectomy were included. Time between cholecystectomy and recognition of injury, method of repair and post operative outcome was recorded. Strassburg classification was used to delineate the type of bile duct injury. Twenty two patients of bile duct injuries following open cholecystectomy and laproscopic cholecystectomy were managed. Mean age of patients was forty six [thirty four - fifty six] years. Injury was sustained in fifteen patients during laproscopic cholecystectomy and in seven patients during open cholecystectomy. Overall fourteen patients had Strassburg E1 and E2 and eight patients had E3 and E4 injuries. In nineteen patients, Roux-en-Yhepaticojejunostomy was done, while three patients underwent lateral choledochorraphy with T-tube drainage. One patient died of septicemia, while one patient was re-explored for revision of hepaticojejunostomy for stenosis of bilioenteric anastomosis. Other minor complications were treated conservatively. Bile duct injury after open and laproscopic cholecystectomy can be successfully managed in a tertiary center by hepatobiliary surgeon. Principles of management include anatomic definition of injury, control of sepsis, staged approach involving interventional radiology and refined operative technique

Acute postoperative pain management by a surgical team in a tertiary care hospital: patients satisfaction

To assess the acute postoperative pain management by a surgical team and patient satisfaction in a tertiary care teaching hospital. 105 patients, ASA I and II, both sexes, mean age of 35.1 +/- 14.6 years, scheduled for general surgery under routine practice conditions, were included in the study. All patients were assessed 12 and 24 hours postoperatively by two numerical visual analogue scale [VAS 0-10], related to rest and dynamic pain. Patients were also requested to indicate their satisfaction level with the help of VAS. Data was analyzed by SPSS version 10. Student t test was applied to find significant differences between the groups. At 12 hours postoperatively mean rest and dynamic pain scores were 3.85 +/- 2.45 and 5.32 +/- 2.61 respectively. At 24 hours postoperatively mean rest and dynamic pain scores were 2.84 +/- 1.86 and 4.65 +/- 2.47 respectively. Overall, female patients experienced more pain but there was no statistically significant difference apart from rest pain at 24 hours. Forty-seven [44.8%] patients were very satisfied, 42 [40%] moderately satisfied and 16 [15.2%] patients were mildly satisfied with the pain management. Overall management of acute postoperative pain by surgical team in a tertiary care hospital was satisfactory. Most of patients were moderately to very satisfied by the care provided

Parotid gland tumours: a six years experience

To find out the different types of Parotid tumours in out setup and their prevalence in different age groups. Observational cross sectional study from Dec. 1994 to Dec. 2001. Department of Surgery, Peoples Medical College and Hospital, Nawabshah. All patients admitted with Parotid swellings, irrespective of age and sex. The detailed data of the patients was collected and analyzed. A total of 27 patients, I5 males and 12 females, with ages ranging from 15 to 65 years were included in the study. Most of the patients were in the 31-50 years of age group. Pleomorphic adenoma was the commonest benign tumour with an incidence of 66.6%, while Mucoepidermoid Carcinoma with an incidence of 11.11% was the most common malignant tumour. Parotid gland is the principal site of salivary gland tumours. Males are affected more and Pleomorphic adenoma is the most common benign and Mucoepidermoid carcinoma the most common malignant tumour

Prevalance of helicobacter pylori in dyspeptic patients at Lyari General Hospital

To find out the frequency of Helicobacter Pylori among patients having dyspepsia. Observational, cross sectional study from Jan. 2005 to Oct. 2005. Department of Surgery at Sindh Govt. Lyari General Hospital, Karachi. Patients presenting with dyspepsia, irrespective of age and sex were included in the study. Complete history of all the patiens was taken and thorough examination done. Upper G.I.Endoscopy was performed, biopsies taken and the specimen sent for histopathology. A total number of 63 patients were studied, out of which 31 were males and 32 females, with ages ranging from 12-68 years. Majority of the patients were in the third and fourth decades of life, and presented with upper abdominal pain and retrosternal burning. Other symptoms seen included regurgitation, dyspepsia, water brash, nausea, vomiting and hematemesis in some cases. Histopathology of gastric biopsy showed Helicobacter pylori associated gastritis in 30 [47.62%] patients, while 33 [52.38%] patients had gastritis which was not associated with Helicobacter pylori infection. The incidence of Helicobacter pylori associated gastritis and gastritis not associated with Helicobacter pylori is more or less equal in dyspeptic patients

Role of modified Alvarado score in acute appendicitis

To evaluate the efficacy of Modified Alvarado Score in Acute Appendicitis, and to correlation it with the operative and histopathological findings. Observational, cross sectional study carried out in two phases, 2000-2001 at Nawahshah and 2002-2003 at Karachi. Nawabshah Medical College Hospital and Sindh Govt. Lyari General Hospital, Karachi. All patients admitted with the diagnosis of Acute Appendicitis during the study period. After collecting the basic and clinical data, the patients were divided into three groups according to the Alvarado Score. Group-7 [Score 1-4] patients were put on conservative treatment and sent home, while Group III [Score 8-10] patients were operated after necessary preparations. Group-II [Score 5-7] cases were admitted, put on conservative treatment and, re-assessed and re-scored after few hours. Those settling down were discharged, while those deteriorting with increase in their Alvarado Score were operated. Modified Alvarado Score was then correlated with the operative and histopathological findings. A total of 254 patients, 140 males and 114 females were included in the study. Majority [62.19%] of them were teenagers or in their twenties. Amongst them 174 patients, 110 of Group-Ill and 64 from Group-II, underwent appendicectomy. Out of these 20 [11.49%] cases had a normal appendix. Modified Alvarado Score is effective, cheap and easy to apply Hence it helps in improving the diagnosis in cases of Acme Appendicitis

Colorectal carcinoma: a six years experience at a tertiary care hospital of Sindh

To find out the frequency of colorectal carcinoma in our population. Case Series. All patients with colorectal carcinoma admitted in surgical department of People's Medical College Hospital, Nawabshah Sindh - Pakistan from September 1996 to September 2001 were included in the study. Total fifty-six patients with age range of 14 to 70 years; thirty males and twenty six females were studied. Most of the patients were in fifth and sixth decades of their life. Only ten patients with colorectal carcinoma were in twenty-one to thirty years age group while two patients were below the age of twenty years. Common sites involved were rectum [46.43%] followed by sigmoid colon [28.57%]. Bleeding per rectum [62.05%] and altered bowel habits [35.71%] were the commonest symptoms. Histo-pathologically, twenty patients had well differentiated adenocarcinoma [35.72%] where as eighteen patients had anaplastic tumour [32.14%] and mucinous adenocarcinoma was found in five patients [8.92%]. Colorectal carcinoma is affecting even the younger age group in our set up. Bleeding per rectum and altered bowel habits are the main symptoms and these symptoms irrespective of the age should be thoroughly investigated

Outcome of surgery for pilonidal sinus: karydakis versis open procedure

To compare and analyze the outcome of Karydaki's procedure with Open excision technique for Pilonidal sinus especially in term of recovery time, period off work, complications and recurrence. Prospective, randomized and comparative study from April 2004 to Sept. 2006. Dept. of Surgery [Unit-I], Sindh Government Lyari General Hospital, Karachi. Twenty six patients with Pilonidal sinus of the natal cleft were included in the study. Biodata, symptoms and signs of all the patients were recorded and appropriate investigations performed. They were randomized into two groups. Group-K underwent Karydaki's procedure in which a wedge of tissue including the simus and its ramifications were excised with primary asymmetrical closure of the wound. In Group-O patients, wide excision of the Pilonidal sinus tract was done and the wound was left open. Amongst the 26 patients included in the study, majority [25] were males in the third decade of life [52.85%]. Their mean duration of symptoms was 8.53 months. The mean operating time for K-Group [45 +/- 10 mins.] cases a bit longer than the O-Group patients [25 +/- 5 mins.] however the former group was associated with fewer postoperative complications, lesser recovery period [2.46 weeks], lesser period off-work [3.53 weeks] and low recurrence rate [7.69%]. In contradiction, amongst the O-Group patients the mean recovery period was 6.69 weeks, mean period off-work was 8.15 weeks and recurrence was seen in 15.38% patients. The Karydakis procedure is superior to Open excision in terms of post-operative morbidity, recurrence rate and recovery period, though it takes a big longer to perform

Pattern of gall bladder disease at Nawabshah: an analysis of 260 patients

To find out the pattern of gall bladder disease at Nawabshah. A observational cross sectional study from Nov. 1998 to Oct. 2001. Setting: Dept. of Surgery, Peoples Medical College Hospital, Nawabshah. Patients of either sex who had gall bladder disease and were operated. The detailed data of all the patients was collected and analyzed. A total of 260 patients were operated for gall bladder disease during the study period. Amongst them 215 were females and 45 males, with ages ranging from 13 to 79 years. Most [175] patients presented with pain in the right hypochondrium, where as 130 patients suffered from flatulent dyspepsia, 120 from fullness after eating, and 56 from nausea and vomiting; 30 gave history of jaundice. Majority of the patients had chronic cholecystitis, while 16 had adenocarcinoma of the gall bladder on histopathology. Gall bladder disease is common at Nawabshah and occurs at a relatively early age as compared with the western countries

Varicocelectomy

To find out the age incidence of varicocele in our population, and to compare the results of high versus low ligation for varicocele. An analytical study from August 2001 to July 2005. Surgical Unit I, Sindh Govt. Lyari General Hospital, Karachi. This study was carried out in 22 patients who presented with varicocele. The biodata and clinical features of all these patients were noted. Half of the patients i.e. 11 underwent high and the remaining half low ligation. The post-operative complications were recoeded and the results of the study were analyzed statistically. Out of the 22 patients, 21 [95.45%] had varicocele on the left and one [4.54%] on the right side. One case [4.54%] presented in Grade-I, while 14 [63.64%] presented in Grade-II and seven [31.82%] in Grade-Ill. Postoperative hanging of testis and persistence of pain were major complaints in high ligation, while scrotal haematoma and postoperative hydrocele were more commonly seen in low ligation. In our study there were less post-operative complications in high ligation; furthermore they were less time consuming and the patients were mobilized earlier

Role of laparoscopic cholecystectomy in the management of acute cholecystitis

To evaluate the safe technique of surgery in patients with acute cholecystitis and to highlight the better method in which patient can be prevented from complications. A descriptive study. This study was conducted at Larkana, Sindh from February 2002 to August 2004. A total of 504 patients underwent laparoscopic cholecystectomy. Out of these, 398 patients were treated by elective laparoscopic cholecystectomy and 106 patients underwent emergency laparoscopic cholecystectomy for acute cholecystectitis. Among 106 patients, females were double [73.1%] than males and most of these patients were received within 24 hours of the onset of symptoms. In 56 [52.83%] patients, ultrasound revealed odematous gall bladder, mucocele, empyma, contracted, perforated and gangrenous gall bladder. Per-operative complication was encountered in 71 [66.98%] patients including bleeding, minor injury to common bile duct [CBD] and liver, adhesions of gall bladder with omentum, stomach, colon, CBD, and distorted anatomy of Calot's triangle. The minimum time taken during the procedure was 50 minutes. In 5 [4.72%] patients, the laparoscopic procedure was converted to open and reasons for conversion were bleeding, tight, dense adhesions and perforated gallbladder leading to biliary peritonitis. Emergency cholecystectomy is reliable and safe modality in the management of acute cholecystitis. Certain factors are responsible for the conversion, which include delayed arrival of patient, patients with perforated gall bladder, bleeding and adhesions. Hence, emergency laparoscopic cholecystectomy seems to be safe, cost effective, and timely surgery with modern conception. This timely surgery prevents the complications associated with acute cholecystitis

Carcinoma of rectum

To document our experience of management of carcinoma of rectum. Design: Descriptive study. Place and Duration Chandka Medical College Hospital, of five years duration. Subject And The Study spread over a period of 5 years from 1998 to 2003. The data was recorded on a structured Performa. Fifty patients of rectal carcinoma were diagnosed and managed at Chandka Medical College Teaching Hospital Larkana over a period of 5 years. The male to female ratio was 3.2:1, 80% patients presented with bleeding per rectum. On digital rectal examination [DRE], in 70% the tumor was at lower rectum, 20% at middle rectum and 10% at upper rectum. On histopathology, 90% cases were reported as adenocarcinoma. According to Duke's classification, 50% were in stage-III. 60% [30 patients] were managed with abdomino-perineal resection. The mortality was 4%. We conclude that carcinoma of rectum can be diagnosed at early stage in patients presenting with symptoms of ano-rectal conditions when examined properly including DRE, proctoscopy and biopsy of suspected lesions