Introduction: Innovation of scoring systems helps to rectify personal experience based on subjective evaluation of outcome of patient treatment. Objectives: To predict the morbidity and mortality in patients presenting with acute upper gastrointestinal bleeding at Ibn-Sina Hospital using the Rockall score. Patients and methods: Prospective hospital-based study conducted from June 2007 through December 2007 at the Ibn-Sina Hospital Bleeding Centre. Demographic, data of history and physical examination and results of laboratory investigations of 238 patients were collected and allotted a Rockall score, Child-Pugh class and fed to Statistical Package of Social Sciences (SPSS) to calculate means and find the levels of statistical differences and define the predicted and observed mortality rates. Results: The mean (±SD) age 44.6 (±15.31) range (8-85) years. There were 190 (79%) males. Patients with oesophageal varices, peptic ulcer, and upper GI tumours were 215 (90.3%), 18 (7.6%), and 5 (2.1%) respectively. The mean predicted mortality was 3.8% while the actual observed mortality 3.8%. The mortality in cases of oesophageal varices was 8(3.4%), while that of bleeding peptic ulcers was one (0.4%). Conclusion: Rockall score is feasible, accurate, effective system for predicting outcome in patients with upper GI bleeding. The risk factor for mortality are Rockall score >3, age >70 and rebleeding.

Background: Laparoscopic surgery faces lots of constraints in the less developing countries The aim: To audit day-case laparoscopic cholecystectomy in our set up in Sudan. Method: Prospective collection of data for 602 consecutive laparoscopic cholecystectomies. 136 patients were discharged 10 hours after surgery. They were selected according to clinical and social criteria. Pain, nausea and vomiting, operative time, period of hospitalization and patient satisfaction were studied. Results: 136 patients operated as day case have mean (±SD) age 46.92(± 14.95) years and ASA score I (n = 122), II (n = 14) and their mean operative time (±SD) was 61.62 (±24.17) (range 25-150) min. There was no conversion or common bile duct injury. 122 patients were pleased with the day case procedure, 12 were satisfied and two thought that overnightstay could have been better. Conclusion: Success of day case laparoscopic cholecystectomy is reflected by the annual steadily increasing number of patients from 25 in 1998 to 50 in 2002. Good planning, patient selection, and encouragement of early mobilization make postoperative hospitalization unnecessary in the majority of cases.

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Background: The management of gastrointestinal fistula continues to present considerable challenge to the surgeon in general and gastrointestinal surgeon in particular. Objectives: To audit the management and report the outcome of the gastrointestinal fistula in a remote hospital. Setup: Eldamazeen Hospital is a regional hospital in the Blue Nile state, south east of Sudan. Methods: Retrospective analysis of demographic and clinical data of patients with gastrointestinal fistula admitted to the surgical department in the period from Feb 2003 through Feb 2008. Results: 10(83.3%) patients had high out-put fistula. Two fistulas were complex and 10 were simple. The small intestine was the commonest site of fistula followed by the large bowel. The commonest causes of the gastrointestinal fistula are emergency operations for stab wounds, laparotomy and caesarean section. The overall mortality rate is 2(16, 7%) patients mainly due to inter-abdominal abscesses. Conclusion: Conservative treatment with nutritional support is the corner stay for successful treatment. However, early surgical management of septic foci should be considered.

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