Prostate cancer (PCa) is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide with an estimated 899,000 new cases and 258,000 new deaths in 2008. Out of this 72% of the cases and 53% of the deaths were found in developed countries representing <20% of the world population. Prostate cancer incidence rates varied 24-fold worldwide in 2008 with the highest estimated rates in Australia/ New Zealand, western Europe, North America, and the Caribbean and the lowest in south central Asia, northern Africa, and eastern Asia (Ferlay et al., 2010).Screening for prostate cancer aims to decrease mortality and morbidity from the disease by increasing the chances of successful treatment through early detection (Rabah and Arafa, 2010 Digital rectal examination (DRE) was conducted by trained professionals after collecting blood for assessment of serum prostatic specific antigen (PSA). Trucut biopsies were performed for all individuals with abnormal PSA/DRE findings. Results: A total of 1,521 males more than 50 years of age were assessed and screened after meeting the inclusion criteria. The vast majority of individuals, 1,452 (96.2%), had PSA ≤4.0 ng/ml. Abnormal PSA (>4 ng/ml) was found in 58 (3.8%). Abnormal DRE was found in 26 (1.72%). DRE and PSA were both abnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals were subjected to digitally guided trucut biopsy. Biopsy report revealed benign prostatic hyperplasia in 47 (3.11%) and adenocarcinoma prostate in 11 (0.73%). The specificity of DRE was 66.0%with a sensitivity of 90.9% and a positive predictive value of 38.5%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostate was 100% and the positive predictive value for serum PSA was 19.0% Conclusions: The overall cancer detection rate in this study was 0.73% and those detected were locally advanced. Larger community-based studies are highly warranted specially among high-risk groups.

Background: Patients who undergo emergency colorectal cancer surgery has poor outcome compared to elective surgery, both in terms of morbidity and mortality. Approximately 15 to 30% of colorectal cancers present as an emergency, most often as obstruction or perforation. Objective: To compare surgical outcome and clinical profiles of emergency and elective cases for colorectal cancer. Methods: Retrospective analysis of 34 cases who underwent surgery for colorectal cancer between December 2011 to January 2013was carried out and their surgical outcomes, clinical presentation, demographic profile were analyzed. Results: The total numbers of patients included in this study were 34. Out of which 52.94 %( n=18) were emergency cases and 47.05 %( n=16) were elective. Male female ratio was 3:1 in emergency cases and 2.6:1 in elective cases. Per rectal bleeding (56%) and altered bowel habit (31.25%) was predominant clinical presentation in elective cases whereas intestinal obstruction (55.55%) and peritonitis (22.22%) were predominant clinical presentation in emergency cases. In emergency cases most of the tumors were located in left side (77.77%) and in elective cases rectum was common site (37.5%). Left hemicolectomy was the commonest surgery performed (72.22%) in emergency set up. In elective cases, right hemicolectomy, left hemicolectomy, APR and LAR was done in 31.25%, 31.25%, 25% and 25% cases respectively. In the emergency group 11.11% (n=2) developed enterocutaneous fistula and early mortality within 30 days was observed in 5% (n=1) of emergency cases only. Conclusion: In emergency conditions, colorectal cancer presented with intestinal obstruction where as elective cases presented with per rectal bleeding and altered bowel habits. Compared with the elective patients, the emergency patients had higher rate of morbidity and mortality. Because of higher incidence of colorectal cancer in our institution, in all emergency cases who presents with features of intestinal obstruction and peritonitis, we have to rule out colorectal cancer especially if the patients are elderly. Therefore, we should encourage screening programme for early detection of colorectal cancers for better outcome of surgery. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 25-30 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9684

IntroductionMeckel’s Diverticulum is the most common congenital disease and seen in 2% of population. It is difficult to diagnose preoperative, mostly seen during operation with its various presentation.Material and Methods This is a retrospective study in which all the cases diagnosed as Meckel’s diverticulum with its complication diagnosed while doing operation were included. Demographic data, clinical presentation, preoperative diagnosis, intraoperative findings, surgical procedure performed, histopathological report and postoperative follow up of patients were recorded and statistically analyzed. The aim of this study was to assess various presentation of Meckel’s diverticulum in 8 years of duration in college of medical sciences, Bharatpur Nepal. ResultsOut of 32 cases, there were 20 male and 12 female with M:F ratio1.66:1. The mean age was 8.34 ± 3.98 years. All together sixteen (50%) patients had features intestinal obstruction. Perforation was seen in 28.1% patients, intussusception in 21.8%, diverticulitis in 15.6%, small bowel volvulus around fibrous band in 18.8%, internal herniation in 9.4% and massive bleeding in 6.3% patients. The average distance from ileocecal junction was 40-60 cm. All cases underwent emergency laparotomy, presence of Meckel’s diverticulum was incidental intraoperative finding. Three cases had superficial wound infection. Small intestine mucosa followed by gastric, pancreatic and colonic mucosa were most common histological finding. The average duration of hospital stay was 5 to 8 days.ConclusionMeckel's Diverticulum is a true diverticular anomaly that may remain clinically silent for lifetime, or it may have life-threatening complications. Due to nonspecific features in case of acute abdomen, Meckel’s diverticulum and its complications should be kept as an important differential diagnosis.Keywords: intestinal obstruction; meckel’s diverticulum; volvulus.

Introduction: Perforations of the gastrointestinal tract are frequently encountered surgical emergencies associated with high morbidity and mortality. This study was conducted to evaluate different spectrum of gastrointestinal tract perforations, their presentations, mode of surgery, complications and factors associated with mortality.   Methods: This was an analytical cross-sectional study conducted in the Surgical Gastroenterology Department at College of Medical Sciences, Bharatpur, Chitwan, Nepal from October 1st 2021 to October 31st 2022. Patients undergoing emergency laparotomy for GI tract perforations were included in this study. Patients demographics, comorbidities, preoperative investigation, site and cause of perforation, type of surgery and postoperative complications were recorded.   Results: A total 100 patients with gastrointestinal perforations were analyzed. The mean age was 46.55 years. Male predominance with M:F=1.56:1 was seen. Almost 54% patients presented after 24 hrs of onset of pain. Peptic ulcer disease as a cause of perforation was seen in 26%, trauma in 23% cases, appendicular perforation in 20%, malignant perforation in 8%, tubercular perforation in 7% and foreign body perforation in 3% cases. Duodenal, appendicular and colorectal perforations were seen in 28%, 20% and 17% cases respectively. Total morbidity was 54% and mortality was 13%. Increasing age, delayed presentation, presence of comorbidities, systolic blood pressure less than 100 mm Hg, oliguria, presence of malignancy were significantly associated with high mortality.   Conclusion: Perforations of duodenum, appendix and colorectum are commonly encountered. Acid peptic disease, trauma and infections are the leading causes of perforations. Increasing age, delay in presentation, comorbidities, oliguria and hypotension are the factors associated with high mortality.

Background & Objectives: Though abdominal surgery has been practiced for many centuries, the optimal technique for anastomosis of small bowel and large bowel remains controversial. This study was conducted with objective to compare the outcome of stapled and handsewn technique of anastomosis of the lower gastrointestinal tract.Materials & Methods: This prospective study was done in the Department of General Surgery and Surgical Gastroenterology, College of Medical Sciences, Bharatpur in the period between 1st October 2014 to 30th September 2015. A total of 50 patients who underwent resection and anastomosis for various conditions of small bowel and large bowel were alternatively placed in handsewn and stapled group. Both the groups were compared in terms of mean time required to perform the intestinal anastomosis, mean operating time, postoperative complications like anastomotic leak rate and wound infection rate, and the time of postoperative hospital stay.Results: The mean duration to perform the intestinal anastomosis was 32.04±4.51 minutes in the handsewn group and 11.00±1.91 minutes in the stapled group(p<0.001).The mean operative time was 147.12±20.91 minutes in the handsewn group versus 132.52 ± 15.71 minutes in the stapled group(p<0.05). The mean duration of postoperative hospital stay was 9.04±2.77 days in the handsewn group versus 8.44 ± 2.32 days in the stapled group (p>0.05). There was no significant difference in the anastomotic leak rate and surgical site infection rate among the two groups.Conclusion: Stapling technique can significantly reduce the time for the anastomotic procedure and also the duration of the operation. However, there was no difference in the rate of anastomotic leak and wound infection between the handsewn and stapled anastomosis. Therefore, stapled anastomosis can be considered a better option over handsewn bowel anastomosis.