Acute appendicitis mimics pelvic disease clinically in women of reproductive age

To analyze the clinical behaviour of acute appendicitis and pelvic disease in the women of reproductive age with special reference to ruptured right ovarian cyst/ectopic pregnancy. Study Observational. West Surgical Ward, Mayo Hospital Lahore. Duration: January-June 2006. All the women >12 years of age with the physical signs of acute appendicitis were included in the study. Age ranged from 13-44 years with the mean of 21 [median 18] years. Anorexia and shifting of pain were hallmark of acute appendicitis while sudden severe localized pain in right iliac fossa and tachycardia without fever were more specific to ruptured ovarian cyst/ectopic pregnancy. Tenderness and rebound tenderness were common with varying in intensity in each of the two diseases. Appendicectomy was done in all patients by making Gridiron incision in 150[75%], muscle cutting in 31[15.5%] and Lanz's incision in 19[9.5%] patients. Retrocaecal appendix was found in 150[75%] and pelvic in 42[21%] patients. Ruptured right ovarian cyst was present in 11[5.5%], ruptured right ectopic pregnancy in 6[3%] and ovulation bleeding in 4[2%] patients. Morbidity observed in the study was 9.5% with no mortality. In the context of limited available medical imaging modalities, detailed history and good clinical performance are the main diagnostic tools with no increase in the rate of negative appendicectomy in developing countries

Urological injuries

To find out the mechanism of injury and urological organ involved. Prospective study. two years [from 1996 to 1998] West Surgical Ward Mayo Hospital Lahore. A total numbers of 30 patients were included in the study. All the patients above the age of 12 years having injury to kidney, ureters, bladder, and combination were included. Penetrating injuries due to firearms were the dominant cause i.e. in kidneys and ureters [100%] and in urinary bladder [50%]. Kidney was the most common urological organ injured [56.66%] followed by the ureters [20%] and Urinary bladder [13.33%]. Urological injuries account for 10% of abdomen injuries. The vast majority are penetrating injuries due to firearms. The injuries may better be prevented than treated by strict maintenance of law and order

Role of barium enema preceding colostomy closure in trauma patients is limited and challangeable

The prospective study comprising 50 cases was conducted in West Surgical Ward, Mayo Hospital, Lahore from January 2000 to December 2001. Majority of the patients 45[90%] were male and 5[10%] patients were female. Cause of colostomy in 28[56%] patients was firearm, stab injury in 13[26%], blunt trauma in 4[8%], rectal impalement in 3[6%] and iatrogenic injuries in 2[4%] patients. Barium enema preceding colostomy closure was advised in all patients with 98%[49 patients] negative results and 2%[1 patient] false positive results which were found negative o n further evaluation by proctoscopy/sigmoidoscopy. Gut was prepared pre-operatively by both chemical and mechanical methods. Colostomy closure was performed in 43[86%] and resection and end t o end anastomosis in 7[14%] patients. Skin was left open in all cases. Post-operative complications observed in the series were interloop abscesses in 1[2%], anastomosis narrowing in 1[2%] and urinary tract infection in 1[2%] patient. All complications were managed according to their own protocol and priority. No mortality was recorded in the study

Acute appendicitis - incidence of perforated appendicitis

The prospective study was carried out in West Surgical Ward, Mayo Hospital, Lahore during the year 2003 consisting of 200 patients. There was slight preponderance of males 102[51%] to females 98[49%]. Age ranged from 13-75 years with the mean of 28.2 years. Appendicectomy was done in all patients by making gridiron incision in 165[82.5%], muscle cutting in 15[7.5%], Lanz`s incision in 16[8%] and right Para-median in 4[2%] patients. Regarding position of the appendix, retroceacal was the most common, found in 160[80%] and pelvic position in 31[15.5%] patients. Perforated appendix was delivered in 10[5%] patients with male to female ratio 4:1. Postoperative complications observed in the series were wound infection in 11[5.5%], prolonged ileus in 2[1%] and gastritis in 2[1%] patients. All the complications were managed according to their own protocol. No mortality was recorded in the series