Prevalence, evaluation and management of preoperative anaemia in the elective general surgical patients.

BACKGROUND: Anaemia is the commonest haematological problem in the preoperative patients. Often it is a sign of underlying disease or associated co-morbid condition. A low haemoglobin level is associated with an excess risk in surgical procedure and its outcome. Therefore an understanding of any cause, evaluation and any potential treatment is crucial in the preoperative setting. Our objective was to determine prevalence, evaluation and management of preoperative anaemia in the elective general surgical patients. METHODS: Prospective observational study in Surgical Unit-II, Liaquat University Hospital Jamshoro from July 2008 to June 2009. One hundred and twenty-five anaemic cases were included in the study, with haemoglobin level < 10 g/dl. Their age ranged from 13 to 70 years. They were evaluated for preoperative anaemia in relation to surgical problems and associated any co-morbid conditions. RESULTS: Out of 830 patients during the study period, 125 patients were anaemic with haemoglobin level 2.1-9.9 g/dl. Fifty-six (44.8%) were male and 69 (55.2%) were female, and 68.5% patients were from rural areas. Hypochromic microcytic was seen in 101 (80.8%) cases. Commonest surgical problem associated with anaemia was malignancies (27.2%) followed by haemorrhoids (20%) and tuberculosis of abdomen (14.4%). Majority of patients (52%) were managed on oral iron supplements while 48% received blood transfusions.

Giant trichobezoar mimicking gastric tumour.

We present a case of giant gastric trichobezoar retrieved through a long gastrotomy in a 40 years old married women from rural Sindh with unreported psychological disturbance. Trichobezoar almost exclusively occur in females with an underlying psychiatric disorder. It has an insidious development of symptoms which accounts for its delayed presentation and large size at the time of diagnosis. They are associated with trichophagia (habit of compulsive hair eating) and are usually diagnosed on CT Scans or upper GI Endoscopy. They can give rise to complications like gastroduodenal ulceration, haemorrhage, perforation, peritonitis or obstruction with a high rate of mortality. The treatment is endoscopic, laparoscopic or surgical removal and usually followed by psychiatric opinion.

Extra osseous primary Ewing's sarcoma.

The case of 20 years old boy with an extra osseous Ewing's sarcoma is described. He was initially diagnosed as a case of infiltrative malignant tumour of left suprarenal gland on the basis of preoperative workup but postoperative biopsy of surgically excised specimen confirmed Extra-osseous Ewing's Sarcoma (EES) suprarenal gland with no evidence of malignancy on skeletal scintiscan, bone marrow aspirate and histopathology Suprarenal location of primary EES is unknown and probably has not been reported in literature. We report a unique case of EES.

Open cholecystectomy without intraperitoneal drainage.

BACKGROUND: Cholecystectomy through laparotomy with or without intra-peritoneal drain has been the standard operation for the gall bladder disease for the last 100 years. It implies removal of gall bladder and is performed mainly for symptomatic gall stones. The Objectives was to analyse the outcome of open cholecystectomy without drain in term of complications. METHODS: Patients who underwent open cholecystectomy without drainage from January 2005 to December 2008, at Department of Surgery, Liaquat University Hospital, Jamshoro, Pakistan were included in the study. This was a 4 years prospective analysis of open cholecystectomy performed without drainage on 212 patients. Patients were randomly allocated for the procedure who presented with uncomplicated Cholelithiasis. Exclusion Criteria included carcinoma gall bladder, empyema gall bladder, Choledocholithiasis and porcelain gall bladder. All these patients underwent open cholecystectomy under general anaesthesia through various incisions. Operative time, post operative complications and hospital stay were recorded on a performa and analysed using SPSS-13. RESULTS: Two hundred and twelve patients, 199 females (93.9%) and 13 males (6.13%), age range 15 to 70 years, underwent open cholecystectomy without drainage for uncomplicated cholelithiasis. The most common complication observed includes seroma (5.66%), followed by surgical site infection both superficial and deep (3.30%) and bile leakage (1.14%). However biliary peritonitis, sub hepatic abscess and Wattman Walter's syndrome were not observed in any case. Mean operating time was 35 minutes. Mean hospital stay was 1.5 days with no mortality during the period of hospitalisation. The overall complications rate and hospital stay was significantly less when compared to open cholecystectomy with intra-peritoneal drain. CONCLUSION: In selected cases with a dry gall bladder bed, routine use of intra peritoneal drainage is unnecessary.