Pseudomyxoma peritonei: a review of 17 cases

To evaluate the various presentations, causes and management of Pseudomyxoma Peritonei [PMP], and to create awareness among young surgeons regarding its importance. Retrospective study from Jan. 1999 to Dec. 2005. Surgical Unit of Khyber Teaching Hospital, Peshawar and Gynaecology and Obstetrics Unit, Hayatabad Medical Complex, Peshawar. All patients who had Pseudomyxoma Peritonei during the study period. The clinical records of all patients undergoing laparotomy for various causes were reviewed and cases of PMP separated. Their biodata, clinical presentation, clinical diagnosis, investigation results, operative findings, histopathology report and outcome were recorded. Out of 23,573 cases that underwent laparotomy 17 cases of PMP were on record. All were diagnosed incidentally per-operatively. Most [47.05%] cases were seen in the age group of 30-40 years and 58.82% patients were females. Abdominal pain, mass, abdominal distension and intestinal obstruction were the common presenting features. Ultrasound and CT scan reported three cases as ovarian cysts, three as multiple encysted fluid collections with thin cyst walls, two as ascites, two as ascites with peritoneal thickening, but none as PMP. Surgery was the mainstay of treatment. Appendicectomy with clearing of mucin in 11[64.70%], oophorechtomy and appendicectomy in 3[17.64%], bilateral oophorechtomy and hysterectomy in 2[11.76%], right hemi-colectomy in 1[5.88%] and second look surgery for complications were done in 2[11.76%] cases. Mortality was 11.76% and due to complication including one due to intestinal obstruction and another due to septicemia following second look surgery. Histopathological tissue diagnosis was available in only 13 cases and included mucinous adenoma appendix in five, mucinous cystadenoma ovary in three, mucinous epithelial cells of unknown origin in four and mucinous cystadenoma of borderline malignancy in one case. PMP is under reported in our setup. Pre-operative diagnosis is difficult and incidental findings usually go unnoticed due to lack of awareness and standard management protocol. There is a need to create awareness among surgeons, radiologists, pathologist and oncologist regarding this condition for the better outcome

Management of penile fracture

To document the clinical presentations, diagnostic methods and therapeutic approach for the patients presenting with penile fracture and out comes of the treatment. Prospective observational study Surgical 'C' and 'B' Ward of Khyber Teaching Hospital Peshawar, Pakistan, from January 2001 to December 2004. 17 patients presenting with fracture of the penis during this period were included in the study after approval from the Hospital Ethics' Committee. Age, marital status, activity leading to the injury, symptoms and signs, management and outcome were recorded on a proforma designed for the purpose. The common age group was 30-50 years with 13 [76.47%] patients in this group, 14 were married and 3 were students. Eleven [64.70%] cases of fractures occurred during sexual intercourse and 6 cases due to non-coital causes including masturbation and manipulation. Fifteen patients recalled a popping sound, immediate detumescence and deviation were present in all, penile swelling and hematoma in 15 while the tunical defect was easily felt in 2 patients. Diagnosis was made clinically and was confirmed on surgical exploration. Repair of tunical defect was done with vicryle 2/0. No urethral injury was encountered. Out come was excellent and all patients regained complete penile function at 3 months follow up. Mild penile curvature was seen in 5 patients but it did not interfere with erection or sexual activity. Penile fracture is an entity with typical clinical signs and no further investigations is usually needed. Management is surgical and immediate to avoid complications related to erectile dysfunction