Demographic and surgical evaluation of typhoid ileal perforation.

BACKGROUND: Typhoid perforation of small intestine is one of the most common causes of bowel perforation in the developing countries. The purpose of this study was to determine the prevalence, factors affecting prognosis, and optimal surgical management for typhoid perforation in Sindh. METHOD: One hundred and thirty patients with typhoid perforation were included in the study from July 2005 to June 2007 in the Department of Surgery, Liaquat University Hospital, Hyderabad. Patients were admitted as cases of acute abdomen. Detailed history, clinical examination and relevant investigations were carried out. Double layer primary closure, primary loop ileostomy and segmental resection with end-to-end anastomosis were performed according to the operative findings and condition of the patients. Attention was paid to postoperative complications and course of the morbid condition. RESULTS: Majority of patients belonged to deserted areas of district Umerkot (n = 35, 26.93%), and Mithi (n=20, 15.38%) followed by Dadu (n = 17.13.08%), Badin (n = 5, 11.54%), Jamshoro (n= 11, 8.46%), Hyderabad (n = 10, 7.69%), Thatta (n = 9, 6.92%), Mirpurkhas (n = 7, 5.38%) and Sanghar (n = 6, 4.62%). Double layer primary closure of single perforation was done in 50 (38.46%) patients, primary loop ileostomy was performed in 68 (52.30%) patients and primary resection and end-to-end anastomosis was performed in 12 (9.23%) patients. Postoperative complications were observed in 79 (60.76%) patients. Wound infection was the commonest complication seen in 70 (53.84%) patients followed by wound dehiscence in 10 (7.69%), faecal fistula in 9 (6.92%), septicaemia in 8 (6.15%), postoperative chest infection in 25 (19.23%), and intra abdominal abscess in 15 (11.53%) patients. Ten (7.69%) patients died due to septicaemia and other reasons. CONCLUSION: Typhoid perforation remains a frequently fatal illness with high prevalence in remote areas of Sindh. Primary loop illeostomy is the single most successful and life saving surgical procedure in terms of overall morbidity and mortality.

Helicobacter pylori infection in patients with calcular cholecystitis: a hospital based study.

BACKGROUND: Helicobacter pylori, a gram negative bacillus has been recognised as a public health problem and approximately half of the world population has H. pylori infection causes chronic gastritis, peptic ulcer disease and gastric malignancies. Objective of this study was to determine the frequency of H. pylori infection in patients of chronic calcular cholecystitis. METHODS: This cross-sectional descriptive study was conducted at Liaquat University Hospital, Hyderabad, Pakistan from April 2010 to September 2010. All patients with history of gallstone presented with acute abdominal pain, dyspepsia, bloating and epigastric discomfort and diagnosed as calcular cholecystitis were further evaluated for the detection of H. pylori by serology and histopathology. Frequency and percentage of H. pylori infection in patients with calcular cholecystitis was calculated. RESULT: Total 100 patients of cholelithiasis underwent laparoscopic cholecystectomy were recruited. The pain in upper right part of the abdomen was observed in all 100 patients, fever in 75%, nausea and vomiting in 68%, loss of appetite in 45%, feeling of tiredness or weakness in 22%, headache in 38%, chills in 52%, backache in 58%, pain under the right shoulder in 45%, heartburn in 67%, belching in 54%, indigestion in 80%, dyspepsia in 90%, bloating in 88%, and epigastric discomfort in 85% patients. Eighty-two percent patients had family history of gallstones. The mean age of overall study population was 48.72 +/- 8.78 years and mean age of H. pylori infected calcular cholecystitis patients was 47.98 +/- 5.43 years in male and 48.76 +/- 6.68 years in females. The H. pylori infection was identified in 55% patients with calcular cholecystitis, of which 32.7% were males and 67.3% were females (p=0.03, statistically significant). Majority of females (60%) had > or = 40 U/ml antibody titre (p=0.917, non-significant). CONCLUSION: A possible relationship was identified between Helicobacter pylori and calcular cholecystitis.