Prevalence of intestinal tuberculosis in cases of acute abdomen

To determine the prevalence of Intestinal Tuberculosis in cases of Acute abdomen. A randomized prospective study from April 2002 to March 2005. Surgical Unit-I, Chandka Medical College Hospital, Larkana. A total number of 200 patients with Acute Abdomen, who presented as intestinal obstruction or peritonitis. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome and histopathology was entered on a specially designed proforma, compiled and analyzed. Among the 200 patients with acute abdomen, 32 [16%] had Intestinal Tuberculosis on the basis of operative findings and histopatholoigcal reports. Age of the patients ranged between 15 to 65 years; majority [75%] were in the age group of 20 to 40 years. Male to female ratio was 1:0.45. Twelve [37.5%] patients had evidence of Pulmonary Tuberculosis as well on X-ray chest. The commonest operative findings were hyperplastic ileocaecal tuberculosis [34.3%], followed by strictures [25%], and perforations [25%]. The overall mortality in cases of acute abdomen was 6% and among tubercular patients 9.3%. Intestinal Tuberculosis is a common problem presenting to general surgical units in the developing countries, often in an acute form. A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis, in order to minimize complications

Abdominal wound dehiscence: frequency and risk factors

To determine the frequency and associated risk factors in patients with abdominal wound dehiscence. A descriptive study. Surgical Unit-I, Chandka Medical College Teaching Hospital, Larkana, between May 2002 toApril 2005. This study included patients with various etiologies of emergency and elective midline laparotomies. The patients operated with other incisionswere excluded. The data obtained was analyzed for each patient and postoperative complications were documented. Out of total 300 patients, 16 developed wound dehiscence giving an overall frequency of5.33%. Age ranged from 10-82 years with mean age of 33.5. Male to female ratio was 1:0.58. The frequency was greater in males than females with ratio 3:1. Majority of the patients had gut perforation with peritonitis. Out of twenty one patients with hypoalbuminemia, 09 develops wound dehiscence. Emergency surgery showed a higher frequency of wound dehiscence 7% [14/200] compared to elective surgery 2% [2/100]. Wound infection was a major factor to wound failure. Old age was also associated with greater frequency. The mortality rate of abdominal wound dehiscence was 25%, due to septicemia and multiple organfailure.Abdominal wound dehiscence still continues to be a major postoperative complication, with a high morbidity and mortality, and has significant impact on health care cost. The significant risk factors in this study were primary disease presented with peritonitis, emergency surgery, old age, male gender; wound injection and technique of closure. Less significant factors were jaundice, uremia, diabetes, and type of suture material used

Laparoscopic cholecystectomy experience of 100 cases at a teaching hospital of Sindh

To study the complications, conversion rate and hospital stay during the initial experience with the laparoscopic cholecystectomy. A case series. Chandka Medical College Hospital, Larkana - Sindh from March 2003 to February 2004. Total 100 patients suffering from symptomatic gallstone disease were admitted for laparoscopic cholecystectomy. Out of 100 laparoscopic cholecystectomies performed, 85 [85%] patients were females and 15 [15%] males. Age range was 25 to 70 years. Only 8 [8%] patients were converted to open surgery. Mean operative time was 60 minutes. Post-operative hospital stay was 24 to 48 hours for uncomplicated cases. Post-operative complications included biliary leakage 3% minor and 1% major, duodenal perforation 1% and port site infection 8%. Laparoscopic cholecystectomy is the ideal procedure for gallstone disease. However, the complications and conversion rate can be minimized by the appropriate training and experience

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