Major Lower Limb Amputations: Experience of a Tertiary Care Hospital in Sri Lanka.

OBJECTIVE: To determine the epidemiology and conditions frequently seen in major lower extremity amputation. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Teaching Hospital Karapitiya, Sri Lanka, from October 2013 to September 2014. METHODOLOGY: Major lower limb amputations were identified according to ICD-10 criteria. Data was retrospectively collected. Type of the amputation, indication for the amputation, gender and age of the patients, and mortality were noted. RESULTS: Eighty-five cases of major lower limb amputations were analyzed, including 43 above-knee amputations, 40 below-knee amputations, and 2 through-knee amputations. Most of the patients were in their 7th (38.8%, n=33) and the 8th (21%, n=18) decade of life. Female to male ratio was 1:1.7. Indications of lower extremity amputation were diabetic foot ulcer (37.6%, n=32), peripheral vascular disease (31.7%, n=27), followed by trauma (n=6), acute limb ischemia and infections (n=5 each), chronic osteomyelitis (n=4), tumors (n=3), elephantiasis, pressure sore and chronic wound (n=1 each). Overall diabetes frequency was 52.9% (n=45). In-hospital mortality rate was 9.4%. Main cause of deaths was septicemia. CONCLUSION: In the study population, major lower limb amputations were more common in males compared to females, with highest incidence in the 7th and 8th decades. Diabetes mellitus contributed to more than 50% of amputations directly or indirectly, and septicemia was responsible for the most mortality.

Terminal ilial intussusception in an adult due to endometriosis.

BACKGROUND: Intussusception is invagination of a proximal segment of bowel into the distal segment in telescopic manner. Although intussusception is common among children, intussusception secondary to terminal ileal endometriosis in an adult is a very rare encounter. We present such a case of intussusception in a Sri Lankan female. CASE PRESENTATION: A 43 year old Sri Lankan female presented to the surgical casualty unit with features of a subacute intestinal obstruction. Her past surgical and medical histories were unremarkable. On examination she was haemodynamically stable with distended abdomen and there was generalized tenderness. There was no guarding or rigidity. No masses were palpable. Bowel sounds were increased. Her urine was negative for Human Chorionic Gonadotrophin hormone. Full blood count revealed an increased white blood cell count with predominant number of neutrophils. Plain abdominal X-ray film showed dilated small bowel loops with empty rectum and distal colon. Patient underwent emergency exploratory laparotomy. An annular growth at terminal ileum was noted. Proximal bowel loops were distended. There was no free fluid in the abdomen. Ileo caecal tuberculosis was suspected and right hemicolectomy was performed. Uterus and bilateral ovaries appeared normal. Post surgical recovery was uneventful. The pathologist has noted endometriosis of terminal ileum contributing to the stricture formation and intussusception at the site. Following recovery patient was referred to a Gynaecologist for management of endometriosis. CONCLUSION: Though terminal ileal endometriosis is a very rare cause of intussusception it is important to consider the possibility of it, especially when a female patient of reproductive age presents with symptoms and signs of intestinal obstruction.