A retrospective review of 80 consecutive patients with different types of intestinal stomas was carried out to analyze the indications, complications and the complication rate with respect to stoma type. The most common type of stoma was found to be end sigmoid colostomy (35%) followed by transverse loop colostomy (22.5%). The most common indication for stoma construction was colorectal cancer (37.5%) followed by Hirschsprung's disease and imperforate anus (12.5% for each). A total of 64 complications were reported in 49patients for a corrected complication rate of (61.25%). Peristomal skin excoriation was the most frequently recognized complication in this study (45.3%), followed by prolapse (23.4%) which was almost exclusive to infants and children. Transverse loop colostomy was associated with the highest complication rate (72.2%) followed by end sigmoid colostomy (64.28%). End ileostomy was associated with the lowest complication rate (33.3%) of all types of stoma. Emergency stomas and stomas in children were found to be associated with higher complication rates. The morbidity of stoma seems to be related to insufficient preoperative planning, technical errors of stoma construction and poor stoma care and management.
A prospective study was conducted to assess the frequency of acute appendicitis at different phases of menstrual cycle, 508 patients presented with acute right lower abdominal pain diagnosed as acute appendicitis and submitted to appendectomies at Basrah Teaching Hospital during a two years period from October 2000 to October 2002. There were 263 females with mean age of 25 years and 245 males as a control with the mean age of 27 years. The study reveals a higher incidence of normal appendixes were removed among females 46 patients (17.5%) as compared to 12 (4.9%)in males. Most of normal appendixes occurred during follicular phase 27 patients (58.7%) as compared to other phases. There were 23 females with normal appendixes have no any associated pathology, 20 patients (86.95%) of them were occurred around the mid cycle (day 12-16). There was difference in the incidence and the severity of acute appendicitis among different phases of menstrual cycle. It appears that the frequency of acute appendicitis was highest in the luteal phase 105 patients (61.77%) compared to other phases, while most of perforated and gangrenous appendixes occurred during menstrual and follicular phases, 13 patients (36.11%), 15 patients (41.66%) respectively.
Splenic abscess is a rare clinical entity with an incidence of 0.2 to 0.7% in autopsy based studies. untreated splenic abscess is associated with nearly 100% mortality. This study aimed to clarify the risk factors and management of splenic abscess. This is a retrospective and prospective study of patients with splenic abscess treated at Al-Sader Teaching Hospital over a six-year period. Ten patients were managed. they were six males and four females aged range 11 to 31 years, duration of symptoms ranged from 2 to 30 days. the main symptoms were fever, chills, left hypochondrial pain, anorexia and weight loss and the main physical signs were; Left upper abdominal tenderness, splenomegaly, hepatomegaly and distension. Six patients were treated by antibiotics and splenectomy. Three patients were treated by antibiotics and open drainage of the abscess and one patient was treated conservatively by antibiotics. It is concluded that prompt diagnosis and treatment based on high index of suspicion will reduce the high morbidity associated with this rare disease. it is hoped that as appropriate skills and imaging techniques become more available in our country more splenic abscess could be managed by percutanous drainage specially when there is a solitary abscess cavity.
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