ObjectivesThis study aimed to determine the change in anatomical location of appendix in full-term pregnancy.Study designThis was a descriptive cross-sectional study.Place and duration of studyLiaquat National University Hospital, Karachi, Pakistan, Department of General Surgery, January 01 to July 31, 2010.Patients and methodsFull-term pregnant women undergoing caesarean section were enrolled. The anatomical position of the appendix was noted by visual inspection with reference to the transtubercular plane (TTP). SPSS-10 was used for analysis.ResultsSeventy-seven full-term pregnant female patients who underwent caesarean section were included in the study. Their mean age was 29 years, the mean height was 5.3 feet, and mean gestational age was 38 weeks. Appendix was found at the normal anatomical location in 63 out of 77 patients (81.8%), while it was located above the TTP in 14 patients (18.2%).ConclusionAppendix does not migrate up with increasing gestational age in the majority of pregnant women. In most full-term pregnant female patients, appendix is located at the normal anatomical position.

Background: Hematological malignancies present with gastrointestinal manifestations in the form of typhlitis, colitis and bowel perforation. Prompt diagnosis and appropriate treatment of these entities is essential because they are associated with high morbidity and mortality. Case report: We present a case report of a young female patient who was diagnosed with acute lymphoblastic leukemia and while being on induction chemotherapy started having fever, pneumonia, positive blood culture and was started for that on broad spectrum antibiotics after which she developed abdominal pain and loose motion and was found to have clostridial difficile a toxin positive in blood. Surgical consult was taken for non-settling abdominal pain. It was a challenging diagnosis as patient was having loose motion with positive clostridial difficile further more ct scan abdomen done with contrast showed only bowel thickening which was in favor of colitis along with ascites. She was initially managed conservatively and ascitic diagnostic tap also was done which showed serous fluid. However, her persistent abdominal pain which was not settling led her to go another ct scan abdomen after 3 days of initial ct scan and showed specks of free air around cecum based on which she was taken to operation theatre and was found to have big cecal perforation with fecal peritonitis, she ended up having right hemicolectomy and ileo transverse stoma formation. She had prolonged Intensive Care Unit (ICU) stay but eventually recovered fully and was shifted to general ward where after wound healing was taken over by hematology department for continuation of her chemotherapy. Final histopathology of right hemicolectomy specimen showed focal marked mucosal ulcerations/erosions with patchy submucosal neutrophilic abscesses with fibrinosuppurative necrosis, and marked serositis with dense acute (fibrinopurulent) inflammation, all bowel layers mucosa, sub mucosa, muscularis and serosa showed neutrophilic infiltrates, there was no evidence of pseudomembranous colitis, granuloma or malignancy. Conclusion: Patients on chemotherapy for hematological malignancies are neutropenic and are at high risk of bowel ischemia and perforation emanating to there primary disease, immunocompromised status and direct and indirect side effects of chemotherapeutic agents. A high index of suspicion is needed to diagnose these cases accurately and treat accordingly to prevent mortality.

Introduction and Background: Thyroidectomy is one of the common endocrine surgery performed. Hypocalcemia is one of the most common complication post thyroidectomy. Incidence varies between 6.4-20.5% for transient and 1.5 to 2.69 for permanent hypocalcemia. Meticulous surgical technique is the key for preservation of blood supply to parathyroid gland and hence decreasing the incidence of post op hypocalcemia. Once identified should be treated with multidisciplinary approach with proper follow up. Objective: To determine the incidence of transient and perminant hypocalcemia in patients undergoing thyroidectomy in our institute for various reasons. Methods: Records of 120 patients who underwent thyroidectomy from Jan 2017 till July 2020 were retrospectively reviewed. Calcium levels were checked at 6 hours post operatively to find the incidence of transient hypocalcemia and at 6-8 months interval to calculate for permanent hypocalcemia. All patients were followed till 2 years post operatively and treatment started for those with hypocalcemia and repeated calcium levels were checked and treatment was tapered and gradually stopped once normal serum calcium levels reached normal. Results: The incidence of transient hypocalcemia in our study is 4.1 % while only 0.8 % patients had permanent hypocalcemia . Conclusion: Hypocalcemia being one of the most common complication of thyroidectomy, the incidence can be reduced by paying attention to meticulous surgical techniques. It is seen mostly in patients undergoing total thyroidectomy and advanced and prolonged surgery for malignancy.

Introduction: Undescended testis (UDT) or cryptorchidism is a common childhood condition in which a boy is born without having one or both testes in their scrotum. It is a very frequent clinical finding in boys, with a prevalence of about 2-4%. The inguinoscrotal phase of testicular descent normally takes place in the last trimester of pregnancy. The regulation of prenatal testicular descent in humans is not fully understood, but numerous genetic and endocrinal factors are thought to have been involved. Preterm boys have been described to have a higher rate of UDT. The classification of UDT is performed according to palpable or nonpalpable testis. If the testis is located inside the normal path of descent, the testis is called ’intra-abdominal’, for those located in the abdomen is called ’intracanalicular’, for those located between the internal and external rings or ’suprascrotal’, for those located between the entrance of the scrotum and the external ring. This study was conducted to determine the frequency of anatomical location of undescended testis in pediatric patients undergoing orchidopexy as well as to compare the mean size of undescended testis at different anatomical location in pediatric patients undergoing orchidopexy as a secondary objective. Methods: It’s a cross sectional study of 94 patients with total 110 testes as per inclusion criteria. Study was performed at pediatric surgery department of Liaquat National university hospital Karachi, Pakistan for a duration of eight months. Orchidopexy was performed under general anesthesia as a surgical day care procedure. At orchiopexy, the outcome variables i.e. location and size of the testis was noted. The size of the testis was measured in anteroposterior and mediolateral dimensions vernier caliper, graduated in mm. The size of testis was calculated by modified Lambert’s formula (0.71xlengthxwidth2). All the collected data were entered into the proforma attached at the end. Results: Mean±SD of age was 4.29±2.19 with C.I (3.38…….4.74) years. Mean±SD of size of testis was 425.68±244.43 with C.I. (375.89……..475.47) mm. In location of testis 4 (4.2%) was located at intra-abdominal, 15 (16%) at intracanalicular and 75 (79.8%) was located at distal to superficial ring. Mean size of testis in intra-abdominal location was 276.29±145.47, intra-canalicular 367.89±196.15, distal to superficial ring was 442.27±54.08 and non-significant P-value was found i.e. (p=0.264). Conclusion: No significant difference was found between mean size of testis and location of undescended testis. The most common location was distal to superficial ring. Keyword: Testes; Undescended; Anatomical Location; Orchidopexy; Anatomical Location

Background: Primary thyroid lymphoma are seen occasionally accounting for 5% among thyroid tumors. Commonest of these lymphomas is diffuse large B cell type. Case report: A 66 years old female presented to our Department with rapidly enlarging thyroid mass having difficulty in swallowing as well as breathing. She underwent left hemithyroidectomy 30 years ago for a benign disease. Clinicallly it was a large mass 20 × 20 cm hard inconsistency and clinically attached to sternocleidomastoid muscles with no skin and lymph node involvement. Computed Tomography (CT) scan of neck with contrast showed large ill-defined mass noted arising from the right lobe of the thyroid gland encasing the common carotid with loss of fat planes between the mass and the right jugular vein, sternocleidomastoid, trachea, esophagus suggesting involvement. She underwent incisional biopsy of mass which showed Diffuse Large B Cell Lymphoma (DLBCL). Discussion: Most of thyroid lymphomas originate from B cells. Fine Needle Aspiration Cytology (FNAC) can diagnose 80-85% of cases but definitive diagnosis can be made by biopsy only. Surgery has a limited role in treatment and main modality is chemoradiotherapy. Conclusion: A rapidly enlarged thyroid swelling should be suspected of having lymphoma specially on the background of lymphocytic thyroiditis and multidisciplinary team approach should be used for management.