Background: The presence of two hollow viscus perforations in a single patient is a rare entity and no case report is available in the literature which shows the finding of duodenal ulcer perforation and enteric perforation in the same patient. Case presentation: A 55-year-old male presented in the emergency department of East Surgical Ward of Mayo Hospital, Lahore, Pakistan, in January 2020 with complaint of abdominal pain and vomiting for the past 3 days and fever for the past 5 days. He was a chronic smoker with a history of 10 pack-years. On examination, he had tachycardia with a pulse rate of 114 beats/minutes and respiratory rate was 30/minutes and his whole abdomen was guarding with absent bowel sounds. X-ray of the chest showed free gas under the right hemidiaphragm. The patient was resuscitated and plan of exploration was made with diagnosis of perforated duodenal ulcer. We found a 0.5 × 0.5 cm perforation on the anterior surface of the first part of the duodenum along with a 1 × 1 cm perforation on antimesenteric surface of ileum that is 1 feet proximal to ileocolic junction. Graham’s patch repair was carried out for duodenal perforation, while loop ileostomy was made for ileal perforation. The patient was discharged on the 5th postoperative day. The reversal of loop ileostomy was carried out after 2 months. Conclusion: In cases of peritonitis, general inspection of the whole gastrointestinal tract plays a very important role as more than one hollow viscus perforation can be found in a single patient which can be missed and can lead to peritonitis again.

Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure. Methods: It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared. Results: Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared to the patients where abdominal binder was not used. However, there was no difference in reducing the need for reclosure in patients who use abdominal binder (P value = 0.063). Conclusion: Although abdominal binder helps in reducing the pain and improving the psychological satisfaction in patients with midline abdominal wound dehiscence yet it doesn’t help in healing of wound and reclosure of the dehisced abdominal wound is needed. doi: https://doi.org/10.12669/pjms.37.4.3671 How to cite this:Ammar AS, Naqi SA, Khattak S, Noumani AR. Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure. Pak J Med Sci. 2021;37(4):1118-1121.  doi: https://doi.org/10.12669/pjms.37.4.3671 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: The objective of this study is to compare the effect of pre-operative calcium and vitamin D supplements in terms of hypocalcemia in patients with total thyroidectomy. Study Design: Comparative study. Setting: EAST Surgical Ward, MAYO Hospital Lahore, Pakistan. Period: 1st July 2018 to 30th June 2020. Material & Methods: Sample size of 342 patients and duration of 2 years. 2 groups were created including 171 patients each. Group A patients received calcium and vitamin D supplements 1 week prior to total thyroidectomy while Group B patients didn’t receive any supplements. The results of both groups were compared. Data was collected by pre designed proforma and evaluated by SPSS 21. Results: 164 (47.9%) patients were male and 178 (52.0%) were females. Most common age group which undergone total thyroidectomy was between 31 years to 40 years. Total 140 patients (40.93%) experienced hypocalcemia. In group A, 32 (18.71%) experienced hypocalcemia while in group B 108 (63.1%) experienced hypocalcemia. The most common occurrence of hypocalcemia was noted on 1st post-operative day where 52 (37.14%) cases of hypocalcemia were reported. Conclusion: In a country with prevalent calcium and vitamin D deficiency the addition of these supplements one week prior to total thyroidectomy will lead to lesser incidence of hypocalcemia after total thyroidectomy and early discharge of the patient.