Small bowel perforation secondary to intestinal tuberculosis in patient with chronic idiopathic myelofibrosis

Idiopathic myelofibrosis is a clonal hematopoetic stem cell disorder due to a mutation in the signaling regulator gene Janus Kinase 2 (JAK2).The condition is widely treated with Ruxolitinib which is a JAK2 inhibitor along with prednisolone. However, these treatment despite promising has been linked with the risk of opportunistic infections and reactivation of tuberculosis.We reported a patient with chronic idiopathic myelofibrosis who developed small bowel perforations secondary to flare up of gut tuberculosis. The perforation sites were resected and double barrel stoma was created.peer-reviewe

Conversion rate and risk factors of conversion to open in laparoscopic appendicectomy

Purpose Laparoscopic appendicectomy (LA) has several advantages over conventional open appendicectomy (OA). However, about 5% to 10% of LA patients still need to be converted to open surgery. Identifying risk factors that contribute to conversion to OA allows for early identification of patients who may benefit from primary OA. This study aimed to determine the conversion rate of LA to OA and to identify its associated risk factors among patients with acute or perforated appendicitis. Methods A retrospective review of medical records was performed among patients with acute or perforated appendicitis who underwent LA between December 2015 and January 2017. With the use of multivariable logistic regression analyses, the predictors of conversion from laparoscopic to OA were investigated. Results Out of 120 patients, 33 cases were converted to OA which gives a conversion rate of 27.5%. Among 33 patients who were converted to OA, 27 patients (81.8%) had perforated appendix, while in the LA group, perforated appendix cases consisted of 34.5% (P<0.001). Histopathology of the appendix was the predictor of conversion from LA to OA (adjusted odds ratio, 8.82; 95% confidence interval, 3.13–24.91; P<0.001). Conclusion The result from our study shows that the overall conversion rate for the study period was high. Patients with perforated appendicitis had a higher risk of conversion to OA. Therefore, preoperative diagnosis of perforated appendicitis may be paramount in predicting conversion to OA