Intestinal Obstruction Changing Etiological Trends

Background: To describe clinical presentation, etiology, and management of patients presenting with intestinal obstruction. Method: From 6th September 2004 to 6 September 2005, 50 patients with provisional diagnosis of intestinal obstruction were admitted from emergency room of Rawalpindi General Hospital. All patients were initially assessed after resuscitation in emergency room. The decision, to operate or manage conservatively, was taken by a consultant. The clinical diagnosis was matched with per-operative findings and histopathology reports. Results: Of the total 50 patients, 42 were males and 8 were female. The age distribution varied from 15 years to 70 years. Mean age was 41.7 ± 13.6.Commonest symptom with which the patients presented was generalized abdominal pain. Most common sign was tachycardia, present in 49 patients. Most common etiology leading to intestinal obstruction was obstructed inguinal hernia in 22 followed by post operative adhesions in 12 patients. Conclusion: Obstructed inguinal hernia is the most common etiology of intestinal obstruction. Early diagnosis and surgical intervention is required to decrease gut ischemia leading to increased morbidity in patient

Incidental Parasitic Infestations in Surgically Removed Appendices and its Association with Inflammation

Background:. To determine the frequency andtype of parasitic infestations in surgically removedappendices based on histopathological findings andto assess its association with inflammation.Methods: In this cross-sectional study 471appendices removed were included and theirhistopathologic examination reports were observed.In cases with parasitic infestations, informationregarding gender, age and presence of inflammationwas gathered. Fisher’s exact test at 5% level ofsignificance was applied to compare presence ofinflammatory infiltrates in appendices with andwithout parasites.Results: Of the 471 appendectomies performed, 15(3.18%) specimens were found to contain parasites,all of which were Enterobius vermicularis(pinworm). In those 15 cases, age of patients rangedfrom 9 to 45 years with a mean age of 19.07 ± 9.04years. Out of those 15 patients, 11 (73.3%) werefemales and 4 (26.7%) were males (male to femaleratio was 1:2.75). Only 2 out of 15 cases (13.3%) withparasitic infestation had inflammation, whereas in456 of the remaining non-parasitic appendices, 324(71.1%) were positive for inflammation. Thisdifference was statistically significant with a p value< 0.05.Conclusion: Frequency of parasitic infestations insurgically removed appendices is low. Very fewappendices with parasitic infestation are associatedwith inflammation as compared to appendiceswithout parasites

Harmonic Scalpel Hemorrhoidectomy Vs Milligan-Morgan Hemorrhoidectomy

Background: To compare Harmonic Scalpel Hemorrhoidectomy (HSH) with classical Milligan Morgan Hemorrhoidectomy (MMH) in terms of operation time and post-operative pain to establish effectiveness of this novel procedure.Methods: A total of 62 patients planned for excision hemorrhoidecotmy were randomly selected into HSH and MMH groups. Mean operation time was calculated during surgery and pain at time of first defecation was recorded on visual analog scale (VAS).Results: Mean VAS after surgery at time of first defecation was 4.32 (SD 0.909) in HSH group and 6.97 (SD 1.426) in MMH group (p value <0.000). Mean Operation time in HSH group was 18.13 (SD 3.956) minutes and that of MMH group was 22.90 (SD 4.901) minutes (P value <0.000).Conclusion: Harmonic Scalpel Hemorrhoidectomy is better than Milligan Morgan hemorrhoidectom

Role of Gum Chewing After Small Gut Anastomosis

This study was performed to access the effectiveness of gum chewing on gut motility in early postoperative period after small gut anastomosis in patients operated for reversal of ileostomy or ileocolostomy. Methods: This prospective, randomized trial was undertaken at Surgical Unit-I, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi from March 2016 to March 2018. 90 patients were randomly divided into two equal groups. All patients underwent small gut anastomosis after reversal of ileostomy or ileocolostomy. In group A (gum chewing group), patients were advised to chew gum, whereas group B (control group) patients did not received any gum for chewing and continued standard post-operative care. Both groups were kept NPO till 2nd post-operative day. After surgery, all patients were observed for onset of bowel sounds, time after surgery when flatus and stool were passed, time required for return of appetite and discharge from hospital. Patient satisfaction with postoperative course, incidence of anastomotic leak, wound infection and mortality was also recorded in both groups. Results : Statistically, group A and group B were similar in age, gender and type of procedure. There was significant difference between both groups for onset of bowel sounds, passage of first flatus, complaints of nausea and vomiting, appetite, duration of hospital stay and patient’s satisfaction level (P < 0.05). In Group A, 35 patients were satisfied whereas in group B, only 5 patients were happy with their postoperative course (P < 0.05). There was no statistically significant difference between groups for incidence of anastomotic leak, wound infection and mortality. Conclusion: It is safe and cost effective to advise gum chewing in patients undergoing small gut anastomosis for reducing duration of postoperative ileus and improving level of patient satisfaction about their postoperative course. Keywords: Postoperative ileus, Ileostomy, Anastomotic leak, Surgical site infection &nbsp