Multimodality Imaging Approach For The Early Diagnosis Boerhaave Syndrome.

Boerhaave's syndrome is a spontaneous transmural rupture or perforation of the oesophagus or post-emesis oesophageal rupture. Boerhaave's syndrome has a high risk of morbidity and mortality, and early, definitive diagnosis leading to prompt management improves outcomes. Definitive diagnosis of this syndrome is made with imaging, including x-ray, USG and computed tomography Scan. This is a case of a 50-year male with history of sudden onset of epigastric pain after an episode of forceful emesis was referred for Ultrasound (USG) abdomen. His USG examination demonstrated fluid collection with internal free floating and linear echoes in left pleural cavity consistent with hemo-pneumothorax his further imaging workup was done with suspicious of Boerhaave's Syndrome which conformed the suspected diagnosis.

MORBIDITY OF SURGERY IN PREVIOUSLY UNDIAGNOSED CIRRHOTIC PATIENTS.

BACKGROUND: Undiagnosed cirrhotic patients are frequently encountered during routine and emergency surgery. These patients have a higher incidence of blood loss & wound infection, resulting in prolonged hospital stay. This study was conducted to highlight the possible complications which result in prolonged hospital stay in these patients. METHODS: A total of 38 patients were incidentally found to have cirrhosis out of a total of 1560 patients who underwent abdominal operation. Diagnosis was confirmed on per-operative liver biopsy and was suspected preoperatively in patient having abnormal liver function test. Per-operative bleeding, postoperative wound infection and hospital stay was compared in cirrhotic and non-cirrhotic patients. RESULTS: The mean blood loss was 310 ml in cirrhotic patients as compared to 205 ml in non-cirrhotic patients which was statistically significant (p-value 0.008). Post-operative infection rate was 21% in cirrhotic patients compared to non-cirrhotic patients 5%. Significance was tested using Pearson Chi square test (0.042). The Average hospital stay was 10 days in cirrhotic patients and 7.5 days in non-cirrhotic patients respectively which was statistically significant (p-value 0.006). CONCLUSION: There is statistically significant difference in per-operative bleeding, wound infection and hospital stay in cirrhotic and non-cirrhotic patients.

PATTERN OF INJURIES SEEN IN MASS CASUALTIES IN TERRORIST ATTACKS IN BALUCHISTAN, PAKISTAN--A THREE YEARS EXPERIENCE.

BACKGROUND: As a front line state in war against terror, Pakistan has been a victim of terrorism, for the last many years & Baluchistan has been the hub of all such terror activities. The objective of this study was to determine the incidence and type of injuries in mass casualties in terrorist activities in Baluchistan. METHODS: The study was done by the review of the record of all patients of terrorist attacks who were admitted in Combined Military Hospital (CMH) Quetta from 27th Aug 2012 to 31st Jul 2015. The final injuries sustained by the victims were documented in the patient charts after repeated examination. The data was collected from these patient charts. Data was analysed using SPSS-21. Frequency & percentages of different injuries was calculated to determine the injury pattern. RESULTS: A total of 3034 patients reported to the hospital (n-3034), 2228 were admitted (73.4%). Out of the injured, 1720 (56.69%) were patients of multi system trauma, whereas 1314 (43.3%) had a single site injury. Out of these 537 patients had fractures of long bones (17.6%), those with head & spinal injuries with neurological deficit were 455 (14.9%), 266 had abdominal injuries requiring surgical intervention (8.7%), 75 (2.47%) had thoracic injuries were whereas 25 (0.82%) were vascular injuries, requiring emergent limb saving surgeries. Sex ratio was M/F=5.7: 1 Mean hospital stay was 6.31 days. CONCLUSION: Majority of the injured had multisystem injuries; therefore the hospital should have a well-trained multi-disciplinary team of surgeons. In addition to general surgery, the subspecialties' should include orthopaedics, vascular, thoracic and neurosurgery.

Abdominal wall endometriosis.

Abdominal wall endometriosis is a rare condition, which usually develops in a surgical scar of abdominal hysterectomy or Caesarean section. A 38-year-old lady presented in the surgical out patient department complaining of painful swelling in the lower abdomen, at the left edge of the scar of caesarean section. Computerized tomographic (CT) scanning of the pelvis with contrast revealed an enhancing mass in the abdominal wall extending from the skin to the muscle layer. A diagnosis of a tumour or an inflammatory mass was suggested and fine needle aspiration cytology (FNAC) of the lesion was advised to ascertain the nature of the lesion. The mass was removed completely and histopathology of the surgical specimen revealed endometriosis.

Congenital cystic adenomatoid malformation.

This case report presents the clinical picture, diagnostic methodology and surgical treatment of a female child who presented with chronic cough and dyspnoea due to congenital malformation of lung. A discussion of diagnosis and management is presented at the end.

Repair of retrohepatic inferior vena cava injury.

A 10 years old child was brought to the Emergency Department of Combined Military Hospital (CMH), Lahore with a history of trivial injury due to fall from a bicycle. He was found to be having severe intraperitoneal hemorrhage. Immediate resuscitation in the emergency department could not revive his vital parameters. He was operated upon in emergency and found to be having grade V hepatic injury extending into retrohepatic inferior vena cava. Child was operated under general anesthesia and recovered well postoperatively without any residual complication.