Thoracic trauma: one year surgical audit at Arar Central Hospital, Saudi Arabia

Background: Thoracic trauma is increasingly encountered now a days in emergency room

Objective: To determine the pattern and management outcome of thoracic trauma patients at area central Hospital Saudi Arabia

Methodology: Study Design: Crosssectional study. Place and Duration of Study: This study was conducted on 104 patients at the ER, ICU and Surgical floor of Arar Central Hospital, Northern Border Region, Saudi Arabia from 1 January to 31 December 2015. Information consisting of patients particulars, pattern and modes of injuries and hospital stay were recorded. Complications and deaths were analyzed by database to determine the morbidity and mortality. Patients irrespective of their age and gender were included in our study. The data was entered and analyzed by using SPSS version 11

Results: Sample size of 104 patients was included. Male to female ratio was 4:1. Patients age raised from 4 years to 82 years, mean age was 29.6 years. Blunt Trauma was most prevalent [72.11%], followed by Penetrating injuries [19.23%] and combined injuries [8.65%]. Extra thoracic injuries included orthopedic injuries in 35[33.65%] patients, 28[26.92%] patients has neurological injuries whereas in 23[22.11%] patients blunt abdominal trauma was noted. Most frequent injury pattern seen was Fracture Ribs 70 [67.30%] patients with underlying haemothorax in 27[25.96%]patients. Most of the patients treated either conservatively or with tube thoracostomy 53.84% and 43.27% respectively. Complications were encountered in 35 [33.65%] patients. 10 [9%]patients has Chest tube site infection whereas 7[6.73%] developed atelectasis treated successfully by Bronchoscopy. Overall 6 [5.76%] deaths were recorded during study duration

Conclusion: Thoracic injuries remain major trauma related issues in this part of country. Highest priority must be given to the chest injured patients in order to decrease the morbidity and mortality. Moreover surgical audit should be expanded to other facilities also in order to improve the health care facilities provided to patients

Tuberculous intestinal perforation: a nightmare for the surgeons

Introduction: The incidence of abdominal tuberculosis has been steadily increasing over the past 20 years. The situation is worse in underdeveloped countries like Pakistan where poverty, overcrowding, unhygienic environment and recent outbreaks of multidrug resistant tuberculosis [MDR-TB] have posed more challenges for the management of abdominal tuberculosis. Tuberculous intestinal perforation is an even bigger challenge for the surgeons

Objectives: To reduce the morbidity and mortality related to tuberculous intestinal perforation vide application of Modified New Scoring system based upon simple pre-operative and intraoperative criterias

Patients and Methods: This descriptive study was conducted at surgical ward II, SZMC/Hospital, Rahimyar Khan, from 1[st] March 2009 to 31[st] August 2010 and 13 patients of tuberculous intestinal perforation were included in this study. Based on Modified New Scoring system, patients were divided into three groups. Group I were managed with primary closure, Group II with ileostomy, Group IIIA with peritoneal tube drainage and Group III B with tube enterostomy

Results: Overall, 12 [92%] patients developed wound infections, 2 [15.3%] presented with fecal fistula after surgery and were re-explored, and 3 [23%] patients developed burst abdomen due to fecal fistula or severe sepsis. The overall mortality was 2[15.3%] in this study which is less than other national/international studies

Conclusion: Modified new scoring system is practical to categorize the patients on the scale of severity of disease and to offer precise guideline to the surgeons for damage control with minimum injury and with good initial promising results

Sutureless tension free Lichtenstein repair: a safe option for indirect inguinal hernia

Background: lichtenstein technique is a widely used surgical procedure for inguinal hernia repair

Objective: this study aims to evaluate the efficacy of suture less mesh placement in open, tension-free inguinal repair

Methods: this was a prospective and interventional study in which 90 adult male patients with indirect inguinal hernia underwent suture less mesh repair from April 2007 to April 2008

Results: out of the total 90 repairs, 83 [92.2%] were for primary hernias and 7 [7.8%] were for recurrent hernias. Postoperative complications included; scrotal hematoma 2.2%, seromas 5.5%, neuralgia 3.3% and wound infections 3.3%. There were no recurrences observed

Conclusion: suture less tension free Lichtenstein repair has proved to be quite satisfactory and provides high patient comfort in primary or recurrent indirect inguinal hernias encountered in surgical practice