Pakistan is an endemic area for the disease. The patients in our series were relatively younger as compared with those in other reports. Surgery is the treatment of choice for hydatid disease and has good results. Pre-op and post-op chemotherapies decrease the risk of intraoperative infection and recurrence. Chest X-ray and abdominal ultrasound should be carried out in case of even minimum clinical suspicion, especially in endemic areas.

Introduction; Appendectomy is the most common surgical emergency and negative appendectomy is a one of recognized consequence of appendectomy. Recently an increased use of radiology is seen in diagnosing appendicitis and it has significantly decreased the rate of negative appendectomy. Every effort should be made to establish an exact diagnosis. If, however, this is impossible and a suspicion of appendicitis exists, exploration is mandatory. It is far better to subject a moderate number of patients to a theoretically unnecessary operation than to let one patient suffer perforation. Aim; Recently we have seen an increased use of radiology in our department for diagnosing appendicitis. The idea of conducting this audit was to calculate our negative appendectomy rate by correlating it with use of radiology and to compare it with international figures and to set up guide lines for use of radiology in diagnosing appendicitis on basis of results of our audit . Methods; Records of all patients who underwent appendectomy in Dubai Hospital, UAE from jan 2018 to jan 2019 were retrospectively analyzed using electronic record system. Clinical diagnosis and radiological findings were compared with histopathology as gold standard for negative appendectomy rate. The sensitivity and specificity of different radiological procedures was calculated as well. Results; Total 165 patients underwent appendectomy in specified duration. Over all negative appendectomy rate was 17 % with male being 9.7 % and female rate 31% . CTSCAN was found to be 100% specific and 91.4 % sensitive in diagnosing appendicitis while clinical diagnosis was accurate in 88.5 % cases.

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.

No abstract

Introduction: Appendectomy is the most common surgical emergency and negative appendectomy is a one of recognized consequence of appendectomy. Recently an increased use of radiology is seen in diagnosing appendicitis and it has significantly decreased the rate of negative appendectomy. Every effort should be made to establish an exact diagnosis. If, however, this is impossible and a suspicion of appendicitis exists, exploration is mandatory. It is far better to subject a moderate number of patients to a theoretically unnecessary operation than to let one patient suffer perforation. Aim: Recently we have seen an increased use of radiology in our department for diagnosing appendicitis. The idea of conducting this audit was to calculate our negative appendectomy rate by correlating it with use of radiology and to compare it with international figures and to set up guidelines for use of radiology in diagnosing appendicitis on basis of results of our audit. Methods: Records of all patients who underwent appendectomy in Dubai Hospital, UAE from Jan 2018 to Jan 2019 were retrospectively analysed using electronic record system. Clinical diagnosis and radiological findings were compared with histopathology as gold standard for negative appendectomy rate. The sensitivity and specificity of different radiological procedures was calculated as well. Results: Total 165 patients underwent appendectomy in specified duration. Overall negative appendectomy rate was 17% with male being 9.7% and female rate 31%. CT scan was found to be 100% specific and 91.4% sensitive in diagnosing appendicitis while clinical diagnosis was accurate in 88.5% cases.