No abstract

Objective: To compare the senior and junior surgeons in terms of the outcome of the open appendectomies. Study Design: Comparative Cross Sectional study. Setting: Holy Family Hospital, Rawalpindi. Period: January 2019 to April 2019. Material & Methods: Patients of 16 years and above who underwent emergency open appendectomies for suspected appendicitis were included while elective appendectomies and those done for gynecological indications were excluded from the study. After informed consent, 65 appendectomies were included in the study. SPSS v23.0 was used for data entry and analysis. Frequencies, percentages, means and standard deviations were calculated. Chi-square, t-test and Kruskall-Wallis tests were applied to test the significance of the results. Results were then presented in the form of tables. Outcome variables of the study were duration of the symptoms, Alvorado score, WBCs count, duration of surgery, per-operative findings, post-operative antibiotic, home treatment prescription, post-operative hospital stay and complications. Results: Out of total 65 appendectomies, 35 (53.8%) were done by junior surgeons, out of which 16 (45.71%) were males. Out of 30 appendectomies done at the hands of senior surgeons, 16 (53.3%) were done by males. There was no significant difference between the senior and junior surgeons except for Alvorado score (higher mean score for senior surgeons), per-operative findings (more complicated appendicitis in case of senior surgeons) and post-operative hospital stay (prolonged for senior surgeons’ appendectomies), p values are <0.000, 0.001, and <0.000, respectively. Conclusion: This study concludes that junior surgeons can safely perform open appendectomies with no difference in the incidence of complications as compared to senior surgeons.

Amyand hernia is defined as hernia containing appendix as content which can range from being normal or inflamed to being gangrenous and perforated. Its occurrence is three times commoner in infants and it occurs more frequently on right side. Exact surgery to be performed in such cases is subject to the type of amyands hernia present ranging from herniorraphy and hernioplasty to laparotomy. Herein, we report the unusual case of a 70years old man who presented with left sided amyands hernia. Conclusion: Hernia is defined as protrusion of a viscus or part of viscus through an abnormal opening in the wall of its containing cavity. Inguinal hernia is the most commonly occurring variety usually containing gut or omentum. Amyand’s hernia is a rare variety of inguinal hernia comprising 1% of all presentations.1 Its defined by presence of appendix as its content which can be either normal or inflamed.2 Its three times commoner in infants and occurs more on right side.3 Here we report a unique case of left sided Amyand’s hernia diagnosed per operative in seventy year old man.

INTRODUCTION: Appendicitis remains one of the most common causes of acute abdomen worldwide. It presents as a spectrum of disease ranging from an acutely inflamed appendix to a perforated one. where acutely inflamed can be managed conservatively, a perforated appendix always needs surgery to prevent complications like pelvic abscesses. Bedside diagnosis remains relevant in our setup. AIMS AND OBJECTIVES: To determine whether history, clinical examination, and basic laboratory investigations can help in confident bedside diagnosis of perforated appendicitis especially in the absence of sophisticated diagnostic modalities. MATERIALS AND METHODS: A retrospective case-control study was conducted. Hospital records of patients who underwent open appendectomy in the year 2016 were reviewed. Two groups of 100 patients each were made based on per operative findings. Appendices having macroscopic holes in the base or tip were labeled as perforated. Group A had acutely inflamed appendix and group b had perforated appendix. The patient's demographic details were taken from hospital admission tickets. Findings of history and examination were retrieved from treating resident and operating surgeon's notes. Data were analyzed through SPSS. RESULTS: Out of 200 patients the total number of males was 102 (51%) and females were 98 (49%). Mean age was 24.13+9.73 in males and 18.7+ 6.4 in females of group A and 26.0+10.1 in males and 20.56+7.53 in females of Group B. Group B showed a significant delay in presentation to emergency after the onset of pain (P = 0.022). Upon history and clinical examination, the presence of anorexia, malaise, generalized abdominal pain, guarding, mass in right iliac fossa were significantly associated with perforation. Whereas gender, fever, vomiting, and dysuria showed no association with perforation. CONCLUSION: Bedside conventional methods of history taking and examination remain a useful tool in anticipating perforated appendicitis. This helps surgeons in planning incisions and prioritizing patients on heavy operating lists. This remains especially relevant in resource-constrained setups where sophisticated modalities like CT scans are largely unavailable. KEYWORDS: Perforated appendicitis, Acute appendicitis

Incidence of adenoid cystic carcinoma of breast ranges from 0.1% to 1%. Its rare occurrence makes its surgical management options debatable. However rarity of metastasis contributes to an encouraging prognosis inspite of its triple negative receptor status. Herein, we report the case of a 60 year old woman who presented with a breast lump that turned out to be adenoid cystic carcinoma.