Bile duct injury: management and outcome

To describe the management and outcome of bile duct injury. Descriptive case series. Surgical Unit II Civil Hospital, Dow University of Health Sciences Karachi, from July 2008 to June 2011. Patients who sustained bile duct injury were included in this study. Mode of admission, type of injury, procedures for reconstruction and outcome were recorded. There were sixteen patients with bile duct injury. Twelve [75%] patients were females and four [25%] males. Mean age was 40 year. In six [37.5%] patients injury occurred in our unit during surgery while four [25%] patients were referred from other tertiary care hospitals. Three [18.75%] patients were sent from district hospitals, one [6.25%] patient from taluka hospital and two [12.5%] from other private hospitals. Nine [56.25%] patients sustained injury during open cholecystectomy and in five [31.25%] during laparoscopic cholecystectomy. Ten patients [62.5%] underwent end to end repair over T-Tube. Two patients [12.5%] underwent hepaticojejunostomy. Morbidity noted in 37.5% [n=6] and mortality was 18.75% [n=3]. Bile duct injury occurred more with open cholecystectomy and end to end repair over T tube was most frequently used procedure. Mortality remained significant

Atypical presentation of appendicitis: diagnosis and management

To identify the patients with atypical features of acute appendicitis and to describe their management so as to avoid unnecessary delay in surgery. Descriptive study. Surgical Unit V, Civil Hospital and two private hospitals at Karachi, from July 2005 to June 2007. All patients who presented with right sided lower abdominal pain in whom provisional diagnosis of acute appendicitis made, were admitted for observation and further workup. The presenting symptoms, physical findings and total white count were entered on a proforma. Ultrasound, CT scan and laparoscopy were performed in atypical cases where available. A total of 318 patients were managed of whom 217 presented with classical features of appendicitis and 101 patients had atypical presentation. Diagnostic accuracy of ultrasound was 85%, CT scan 91% and laparoscopy 100%. One hundred and eighty patients had appendectomy in classical group and 80 patients in atypical group. Laparoscopic appendectomy was done in 26 patients. Nine patients required laparotomy. Ultrasound, CT scan and laparoscopy play an important role in diagnosis and management of atypical cases of appendicitis

Complications and management of unsafe abortion

To determine the frequency of unsafe abortion and its morbidity and mortality in patients presenting at Civil Hospital Karachi Descriptive study. Department of Obstetrics and Gynecology, Unit III Civil Hospital Karachi, from 1st January 2001 to 31st December 2005 All patients with history of induced abortion were admitted. The particulars related to each case like age, marital status, parity, reason for requesting abortion, place and expertise of person carrying out the procedure and outcome were recorded. Once patient arrived in our unit detailed examination was done and relevant investigations sent. After primary resuscitation and optimization, the patients were managed according to their complications in collaboration with general surgical department Fifty nine mostly young ladies with age range of 17 to 47 years and mean age of 30.76 years, presented with complications of induced abortion. Fifty four patients were married and 5 were single mothers. Fourteen patients [24%] were nullipara and remaining 45 [76%] were having 5 or more children. Only 7 out of 59 patients were booked cases, who underwent elective therapeutic medical termination of pregnancy [for foetal congenital anomalies in 5 cases and maternal grade III cardiac disease in 2 cases] They had no complication. Fifty two patients presented with induced and unsafe abortion. They were referred cases, and had multiple complications. Two patiens were brought dead and one patient died during pre-operative resuscitation. Out of remaining 49 patients, five [10%] were managed conservatively, 25 [51%] had re-evacuation and 19 [39%] underwent exploratory laparotomy. Ileal perforation was found in 5 cases. These were treated by primary repair and resection and anastomosis [2 cases each] and ileostomy in 1 case. Sigmoid perforation was found in 3 cases and managed by colostomy. Repair of uterine perforation only was done in 4 cases. Hysterectomy was performed in 4 patients. In three patients peritoneal toilet was also done. Overall mortality was 9.6% [n-5] Our data shows high morbidity and mortality associated with induced unsafe abortion in the form of prolonged hospital stay, multiple blood transfusions, laparotomies, hysterectomies that compromises the obstetrical future of young patients

Management of obstructive jaundice: experience in a tertiary care surgical unit

To evaluate the presentation, clinical features and treatment of Obstructive Jaundice cases. Prospective observational study from Jan. 2003 to Dec. 2004. Surgical Unit IV, Civil Hospital, Karachi. All patients who were admitted and treated for Obstructive Jaundice. The patients were evaluated clinically and by investigations. After appropriate preparations surgery was carried out; the procedure depending upon the nature of the lesion. Intra and post-operative complications, and the outcome of the patient was noted and the whole data analyzed. This study comprises of 24 cases of Obstructive Jaundice. Their ages varied from 25-65 years [mean age being 41.12 years]; 10 were males and 12 females. Amongst these 13 [54.17%] patients had jaundice due to malignancy, 9 [37.5%] had stones in the common bile duct [CBD] and the remaining 2 [8.33%] patients had amoebic liver abscesses. In the malignant group five patients had Carcinoma Head of the Pancreas [two treated by pancreatoduodenectomy and three by cholecystojejunostomy], three had Cholangiocarcinoma [treated by hepatojejunostomy], three had Carcinoma Gall bladder [one treated by hepatojejunostomy, two inoperable] and two patients with malignant nodes at the porta hepatis who refused surgery and were referred for endoprostheses. All patients with stones in the CBD were treated by cholecystectomy and choledocholithotomy, whereas those with amoebic liver abscess underwent drainage/aspiration. Early diagnosis of the cause of obstruction is very important especially in malignant cases, as resection is only possible at that stage

Abdominal tuberculosis: Clinical presentation and outcome

To study the clinical presentation and outcome of cases of Abdominal Tuberculosis. Prospective cross-sectional study from January 2005 to December 2006. Surgical Unit II and V, Civil Hospital, Karachi. Fifty four patients of Abdominal Tuberculosis were seen during the study period Four patients were lost to follow-up, which were excluded. Detailed information of all the patients including age, sex, symptoms, signs, investigations and management was recorded, analyzed and compared with local and international data. Out of the 50 patients with Abdominal Tuberculosis, 31 were females and 19 males. Their ages ranged from 17 to 63 years, with a mean age 425.1 years. Thirty five cases were admitted through Emergency and 15 through Outpatients departments. Abdominal pain was the most common symptom found in 44 [88%] patients followed by vomiting in 33 [66%]. Abdominal tenderness was seen in 22 [44%] patients, while 16 [32%] patients had rigidity and other features of peritonitis. Surgery was performed in all these patients, limited right hemicolectomy in 17 [34%], segmental resection and anastomosis in 12 [24%], ileostomy and strictureplasty in six [12%] each, repair of perforation in five [10%] and adhesiolysis in four [8%] patients. Overall mortality was 8% due to septicaemia and multiorgan Abdominal Tuberculosis is a significant clinical entity with lethal complications in neglected cases. It affects a younger age group and is more common in females. Clinical features are rather non-specific but vague ill health, low grade fever, weight loss and anorexia may help to diagnose the case

Subfertility: experience in a tertiary care hospital

To determine the frequency of different causes responsible for subfertility in our setup. Prospective cross-sectional study from March 2005 to March 2006. Oupatients Dept. [OPD] of Gynaecology and Obstetrics [Unit 111], Civil Hospital, Karachi. All patients who were diagnosed as subfertile. Amongst the 156 women included in the study, 85 [54.5%] had primary and 71 [45.6%] secondary subfertility. Majority [59%] of cases were between 21-30 years of age; 78 [50%] complained of subfertility only, while 26 [17%] had history of vaginal discharge, 34 [21%] menstrual disorders and 12 [8%] weight gain. Nineteen [14%] cases had family history of subfertility, 18 [12%] of congenital anomaly and 3[2%] of genetic disorders. Abnormal hormonal profile was seen in 37 [27%] patients, whereas 63 [40.3%] had positive findings on pelvic ultrasound and 43 [27%] patients tubal blockage on hysterosalphinography. Out of 156 women, 27 [17.3%] had Ovarian factor in the form of anovulation, polycystic ovarian syndrome and premature ovarian failure and 51 [32.7%] had Tubo-Ovarian factor in the form of tubal blockage, endometriosis, endometritis and uterine fibroid; in 19 [12.2%] cases both the partners had abnormality, in 40 [25.6%] the male partners had semen abnormality [25.6%], while in 19 [12.2%] no cause could be found. A significant number of patients had secondary subfertility, mostly due to previous surgical interventions, and were suffering from anaemia and vaginal infection. Tubal blockage and male factors were the predominant causes of subfertility

Pattern of abscesses at civil hospital, Karachi

To study the pattern of abscesses at Civil Hospital, Karachi. Descriptive study from March 2003 to August 2004.Emergency Operation Theatre, Civil Hospital, Karachi.The data of all patients who presented with abscesses was collected and analyzed.Out of 537 patients who underwent drainage of abscesses, 327 were males and 210 females, with a male to female ratio of 1.56:1. Their ages ranged from 1 to 80 years with a mean age of 33.08 years. Diabetes mellitus was found in 75[13.96%] patients with a male to female ratio of 2.57:1. The most common site of abscess was the hand [17.31%] followed by breast [16.38%], anorectal region [13.96%] and foot [12.84%]. The common presenting complaints were pain, swelling and fever. All were treated by drainage with satisfactory outcome.Abscesses are the 2nd most common cause of emergency surgery at Civil Hospital, Karachi, the commonest cause being appendicitis