ABSTRACT
BACKGROUND: Perforation peritonitis is the most common surgical emergency encountered by the surgeons all over the world as well in Pakistan. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counter part. This study was conducted at Dow University of health sciences and Civil Hospital Karachi (DUHS & CHK) Pakistan, designed to highlight the spectrum of perforation peritonitis in the East and to improve its outcome. METHODS: A prospective study includes three hundred consecutive patients of perforation peritonitis studied in terms of clinical presentations, Causes, site of perforation, surgical treatment, post operative complications and mortality, at (DUHS&CHK) Pakistan, from 1st September 2005 - 1st March 2008, over a period of two and half years. All patients were resuscitated underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. RESULTS: The most common cause of perforation peritonitis noticed in our series was acid peptic disease 45%, perforated duodenal ulcer (43.6%) and gastric ulcer 1.3%. followed by small bowel tuberculosis (21%) and typhoid (17%). large bowel perforation due to tuberculosis 5%, malignancy 2.6% and volvulus 0.3%. Perforation due to acute appendicitis (5%). Highest number of perforations has seen in the duodenum 43.6%, ileum37.6%, and colon 8%, appendix 5%, jejunum 3.3%, and stomach 2.3%. Overall mortality was (10.6%). CONCLUSION: The spectrum of perforation peritonitis in Pakistan continuously differs from western country. Highest number of perforations noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. Most common cause of perforation peritonitis is perforated duodenal ulcer, followed by small bowel tuberculosis and typhoid perforation. Majority of the large bowel perforations are also tubercular. Malignant perforations are least common in our setup.
ABSTRACT
OBJECTIVE: To evaluate the result of surgical procedures adopted for repair of iatrogenic injuries of extrahepatic biliary tract over T-tube. METHODS: An interventional study conducted at Surgical Unit 1 of Abbasi Shaheed Hospital, Karachi; and private hospitals in Karachi, from 1974 to 2004 (30 years). All the iatrogenic injuries of extrahepatic biliary tract during open cholecystectomies were recorded. The records included age and sex of patients, site and extent of injury, method of repair and post-operative complications, if any. All primary repairs were done over T-tube. For injuries at the confluence, the T-tube was converted into a Y-tube, and its short limbs were introduced into the lumen of right and left hepatic ducts. Follow up was done in the outpatient department weekly for a month after discharge, and then annually for maximum 5 years. RESULTS: A total number of 5,000 open cholecystectomies were performed during the study period. Eleven patients (0.22%) had intraoperative extrahepatic biliary tract injury: 6 out of 11 had injury of common bile duct (CBD), 2 had common hepatic duct (CHD) and 3 had injury at the confluence. One patient was lost to follow up after a year. One patient died of myocardial infarction after two years. Nine patients were clinically and biochemically well at five years follow up after primary repair of the injuries. CONCLUSION: Primary repair of extrahepatic duct injuries, situated at CBD, CHD or at the confluence, over the T-tubes is safe. In case of injury at the confluence the T-tube may be shaped like a Y-tube for secure anastomosis of all the three cut ends.
