Volume 06, issue 4

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1066/thumbnail.jp

Ultrasonography and atypical sites of endometriosis

In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in “atypical” sites, in all the cases where “typical” clinical findings are present

Ultrasonography and atypical sites of endometriosis

In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in "atypical" sites, in all the cases where "typical" clinical findings are present

A Retrospective Analytical study on Pattern of Intestinal Obstruction

INTRODUCTION: Acute intestinal obstruction is an enigma with its versatile presentation and wide spectrum of management options available. It presents a constant challenge to the surgeon both in diagnosis and in judgment as regards the line of management for that specific patient, for those specific parameters and for that specific moment in the course of the disease. Intestinal obstruction is a dynamic condition where the parameters are changing as the clock ticks on. ‘Time’ means everything in intestinal obstruction and a delay in diagnosis or management increases the mortality. With a wide range of conditions known to cause obstruction, the surgeon should be aware of the commonest causes in the geographical region of presentation. Keeping with these principles, this study hopes to discuss the various causes and clinical presentations, sift out the reliable signs and symptoms and the most common causes. Diagnostic modalities have reached new heights in present times, but our study focuses on using the available basic modalities to further the diagnosis. Different treatment modalities and their outcome in terms of death/morbidity have been tabulated. OBJECTIVES: 1. To identify the cause of acute intestinal obstruction, 2. To discuss the various clinical presentation, 3. To discuss the various diagnostic modalities, 4. Various modalities of management of acute intestinal obstruction, 5. To study the outcome of patients with acute intestinal obstruction. MATERIALS AND METHODS: This is a retrospective study of 40 patients with acute intestinal obstruction admitted in the Department of General Surgery at the Government Stanley medical college and hospital. From the time of presentation the cases were followed up till the time of discharge / death. X ray abdomen erect was routinely taken for all patients. The details of symptoms at presentation, the diagnosis entertained, investigations reports, type of surgery and outcome have all been recorded and tabulated in a master chart for reference and comparison. The final outcome has been sub grouped based on the degree of incapacitation to deat. The observations were compared with the current literature on acute intestinal obstruction and conclusions were drawn. RESULTS: In our setup there is higher incidence of intestinal obstruction among males. 28 – males, 12 – females. As far as age distribution is concerned the age range was14- 72 YRS., Most common occurrence between 30 to 60 years. Most common cause of intestinal obstruction was band/adhesion. followed by irreducible hernias (inguinal/umblical/incisional/epigastric)/malignancy etc,. Commonest symptom in our study was pain followed by vomiting, distension, constipation. Abdominal tenderness, tachycardia, with hyper dynamic or absent bowel sounds were the commonest signs. CONCLUSION: As far as age distribution is concerned the age range was 14 – 72 years., most common occurrence between 30 to 60 years, Abdominal pain is the most common presenting symptom (100%) followed by vomiting (96%) and distention of abdomen (94%). The most common sign was tachycardia (96%), tenderness which was present in (96%) of the cases, followed by guarding (84%) & rigidity which was present in (82%) of patients. Of the 40 cases the commonest cause of acute intestinal obstruction is adhesions/bands (14 cases). Hernias were present in 10 cases, and is the second commonest cause

Comparitive study of onlay and preperitoneal mesh repair in the management of ventral hernia

BRIEF RESUME OF INTENDED WORK: Ventral hernia in the anterior abdominal wall includes both spontaneous and, most commonly, incisional hernias after an abdominal operation. . Hernia recurrence is distressing to patient and embarrassing to surgeons. Mesh repair can be pre- peritoneal or onlay. Controversy exists among the surgeons regarding the use of type of either meshoplasty, due to differences in ease in performing the surgery, time of surgery, complications occurring in the post operative period and the recurrence. Only few institution do preperitoneal mesh repair due to the need of skilled surgeon, so we are comparing onlay and preperitoneal mesh repair. AIMS AND OBJECTIVES OF THE STUDY: To compare outcome of onlay and preperitoneal mesh repair in the management of ventral hernia. MATERIALS AND METHODS: METHOD OF COLLECTION OF DATA Patient admitted with ventral hernia are included in the study with details of cases, clinical examination and symptoms are included in the study after confirming the diagnosis by ultrasonography and are divided randomly into onlay and preperitoneal group with 25 patient in each group. Patient are followed for six months to study the outcome reccurence. PERIOD OF STUDY : November 2014 to April 2015 TYPE OF STUDY : Randomized control study. SOURCE OF DATA : Patient diagnosed as ventral hernia in department of general surgery, Royapettah hospital and kilpauk medical college hospital. 50 of them are to be selected on basis of non probability (purposive) sampling method. INCLUSION CRITERIA : Patient with ventral hernia including • Umbilical hernia, • Paraumblical hernia, • Epigastric hernia • Incisional hernia. EXCLUSION CRITERIA : Patient admitted with • Groin hernia , • Divarication of recti, • Recurrent hernia, • Patient medically unfit for surgery, • Obstructed and strangulated hernias. CONCLUSION : By analyzing the outcome of seroma, wound infection, flap necrosis and recurrence in both groups the final result will be submitted in my dissertation

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

The morbid physiology of intestinal obstruction: with special reference to low obstruction and to strangulation of the bowel

The original work presented here is almost wholly experimental, but all experimental surgery must find birth in clinical observation, and no con- clusions drawn from experiment are clinically appli- cable unless the disease in the experimental animal is constantly compared with the disease in man. A chapter has accordingly been devoted to the clinical varieties and features of intestinal obstruction, and a chapter to its morbid anatomy.The main substance of the thesis is concerned with low intestinal obstruction and with strangulation of the bowel, but no consideration of these would be complete without an understanding of the chemical changes which occur in high intestinal obstruction, and an account of this condition is given in the fourth chapter. In chapter seventeen, Presentation is made of a scheme of treatment based on recent experimental and clinical observations. The great as jority of the measures suggested are generally accepted already as good surgical practice, but the statements in this chapter are advisedly general, since certain of the forms of treatment considered are based on the conclusions drawn by a single observer, and have not yet been practically applied to man