PERFORATED DUODENAL ULCER ASSOCIATED WITH SITUS INVERSUS AND DEXTROCARDIA.

A 32 years old gentleman, presented in emergency department, with complaints of sudden onset of severe upper abdominal pain, associated with nausea and vomiting. He was a known case of acid peptic disease. His abdominal examination showed signs of peritonitis. X-ray chest showed pneumoperitoneum, with dextrocardia. Ultrasound showed situs inversus. Exploration confirmed the diagnosis of perforated ulcer and situs inversus. Grahm's patch repair of perforation was done. His postoperative recovery was smooth.

LAPAROSCOPIC CHOLECYSTECTOMY: OUTCOME OF FIRST 202 CASES IN A DISTRICT HOSPITAL IN GILGIT.

BACKGROUND: The incidence of gall stone disease is on the rise in Gilgit Baltistan. The objectives of the study were to assess the outcome of laparoscopic cholecystectomy in terms of conversion rate and postoperative morbidity, in The Aga Khan Medical Centre Gilgit. METHODS: It was descriptive case series. All patients that underwent laparoscopic cholecystectomy between June 2009 to May 2014 were included. The data was collected prospectively. Demographic features, operative time, and hospital stay were studied. Postoperative complications were documented and evaluated according to outcome measures (bile duct injuries, morbidity, mortality, conversion rates, wound infections). RESULTS: A total of 202 consecutive patients were enrolled with a mean age of 49±15 years. There were 164 (81%) female and 38(19%.) male patients. Twenty nine (15%) patients had hypertension, 51 (25%) patients had diabetes mellitus as comorbid conditions. The mean operative time was 54±21 minutes. The operative time was longer in 52 (26%) patients. Three patients (1.5%) required conversion to open cholecystectomy due to obscured anatomy in the area of Calot's triangle, and empyema gallbladder. The mean hospital stay was 2±0.7 days. No common bile duct injury, solid organ or bowel injury occurred in this study. The mean follow up duration was 30±15 months. Postoperative complications include, port site infection in 8 (2%) patient, chest infection in 5 (2.4%) patients, and one (0.5%) patient had myocardial infarction. There was no mortality reported in this group of patients. CONCLUSION: Laparoscopic cholecystectomy is a safe procedure with advantages of decreased wound infection, less pain, decreased hospital stay, and early recovery.

Dual Ectopy of Thyroid Tissue: Intratracheal and in Nasopharynx, Associated with Normally Located Thyroid.

Dual ectopic thyroid tissue associated with normally located thyroid, is a rare anomaly. We report a case of 42 years lady, who underwent left hemithyroidectomy for nodules in the left lobe of thyroid 15 years back. She presented with right side neck swelling and dyspnea for 6 months. Right hemithyroidectomy was done for multinodular goiter involving right lobe of thyroid. She developed stridor on the first postoperative day. CT scan and MRI showed intratracheal ectopic thyroid tissue. Ectopic thyroid tissue was removed by dividing cricoid cartilage, and trachea was repaired. Radio iodine scan after 6 weeks showed another ectopic thyroid tissue in nasopharynx. Patient refused for radio iodine ablation and, she was given thyroxin replacement.

Laparoscopic repair of ventral hernia.

OBJECTIVE: To determine the outcome of patients in terms of wound complications and follow-up, after laparoscopic ventral hernia repair. STUDY DESIGN: A case series study. PLACE AND DURATION OF STUDY: Department of Surgery, Dubai Hospital, Dubai, from January 2007 to December 2011. METHODOLOGY: All patients above 13 years of age, who underwent laparoscopic ventral hernia repair, were included. A proceed dual mesh was used for repair of hernia. Multiple parameters were analyzed, including demographic features, presentations, co-morbid conditions, duration of hernia, and defect size. The duration of surgery, postoperative complications, and follow-up of these patients in terms of suture site pain and recurrence of hernia were also analyzed. The data was expressed as frequency, percentages and mean ± standard deviation of values. RESULTS: There were 27 patients with mean age of 47 ± 10.3 years, including 20 female (74.07%) and 7 male (25.95%)patients. All patients presented with abdominal wall swelling. The hernia was partially reducible in 12 patients (44.44%), and completely reducible in 15 patients (55.55%). Seven patients (25.95%) had hypertension, 4 (14.81%) had ischaemic heart disease, and 4 (14.81%) had obesity as co-morbid conditions. All patients underwent laparoscopic hernia repair with proceed dual mesh. The mean defect size of the hernia was 6 cm, and mean duration of surgery was 94 minutes. Early postoperative complications included, seroma in 3 patients (11.11%), and haematoma in one patient (3.70%). The mean follow-up was 23 months. Four patients (14.81) had pain at suture site. CONCLUSION: Laparoscopic repair is an appropriate approach for ventral hernia repair. It results in good repair and low wound complications in terms of haematoma and wound infection. There was no recurrence of hernia in this study.