High velocity missile injuries of the liver

A prospective study of 15 consecutive patients admitted with high velocity missile liver injuries of the liver was done at Lacor hospital between November 1996 and May 1997. Operative findings, treatment offered and factors influencing morbidity and mortality were noted. All patients were followed up for two months postoperatively. Fourteen patients sustained gun shot wounds while one was injured by a bomb blast fragment. Ages ranged from 2 to 33 years (mean 24.4 years). Two patients sustained liver injury alone while the rest had other associated visceral injuries as well. Grade I, II and III liver injuries were seen in 7, 5 and 2 patients respectively. One patient had a bullet perforation of the liver and could not be classified on this scale. Six patients received blood transfusion. Four patients (27%) developed complications. One had a sub-hepatic abscess while the other three had wound infections. Two patients died, one of exsanguination and the other of septic shock. High velocity missile injuries of the liver are associated with high transfusion needs and morbidity both of which can be minimized by a policy of conservative surgery

Acute Bowel Obstruction in a Rural Hospital in Northern in Northern Uganda.

Background: The aim of the study is to find the aetiology and outcome of bowel obstruction treatment in St. Mary’s Hospital Lacor vis-à-vis other centres in the world. Methods: A retrospective review of patients’ files from January 2007 to December 2008 was done. The variables studied were age, sex, duration of symptoms, cause of obstruction, bowel resection, length of hospital stay, postoperative complications and mortality. Results: There were 132 patients with a mean age of 31.5years and M:F ratio of 2.2:1. Duration of symptoms ranged from 1 – 14days with a mean of 4days. The leading cause of obstruction was Hernias in 53(40.2%) patients followed by Adhesions in 27(20.5%). Gut volvulus was third in 23(17.4%) patients. Bowel resection rate was at 48.5%. Length of stay ranged from 1 – 39 days with a mean of 8 days. The commonest complication was wound sepsis ± dehiscence (50%). Morbidity rate was 24.2%. Mortality rate was 12.9% with 100% case fatality rate for neonatal intestinal atresia. Conclusion:Obstructed/strangulated hernias rather than Adhesions are still a leading cause of bowel obstruction

Sigmoid Volvulus and Ileosigmoid Knotting at St. Mary’s Hospital Lacor in Gulu, Uganda

Background : Sigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people. Little is known about this condition in our country and there is yet no literature from an environment like ours (northern Uganda) where civil war has devastated the economy with most of the populace displaced into internally displaced peoples’ camp. The main objective of this study was to determine the demographics, treatment and outcome of sigmoid Volvulus cases seen at Lacor Hospital. Methods : This was both a retrospective and prospective study of patients who presented with sigmoid volvulus at St. Mary’s Hospital Lacor over a period of 61/2 years from 1st January 2002 to 31st July 2008. Medical records of patients who underwent sigmoid surgery was stratified for the following measures; demographic characteristics, presentation to hospital (emergency or elective), operative finding and operative procedure, complication, co-ominous factors and outcome. Similar data was gathered from patients who were prospectively followed up. Data was analyzed using SPSS. Results : One hundred eighty two patients aged 10 years and above met the inclusion criteria. They had fasted 6 hours prior to the operation and undergone both general anaesthesia and surgery. Patients who had medical and surgical conditions that led to nausea and vomiting were excluded. 53% of the patients were males and 43% were females. The prevalence of PONV was 40.7% within 24 hours after surgery. Factors that were statistically significantly (p value < 0.05) associated with PONV following univariate analysis included : age group 20 to 30 years, female gender, history of PONV, intra-operative use of Pethidine, type of operation (orthopaedic surgery) and postoperative use of Pethidine. Independent predictors of PONV include; age group of 20 to 30 years, history of PONV, and the type of operation. Conclusion : Sigmoid volvulus is relatively rare in our community. It commonly affect males particularly the old. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. In viable bowel, primary resection and anastomosis of the twisted sigmoid is feasible as it may not adversely affect outcome. Nevertheless colostomy should be considered if the bowel is gangrenous or perforated. Though the disease carries a high mortality, most of the patient who die are either older and/or have co-morbid conditions