Background: The last century has witnessed immense evolvement of management of patients with abdominal trauma. Moreover the recent trend has shifted to selective operative management rather than exploratory laparotomy in trauma patients with suspected intraabdominal injuries and is considered more rational as well. Diagnostic laparoscopy is highly sensitive in detecting intra-abdominal injury with subsequent reduction in the rate of negative laparotomy and procedure related morbidity. Objective: The study was carried out to find the role of diagnostic laparoscopy in abdominal trauma. Methods: An observational study was carried out in the casualty block of Dhaka Medical College Hospital from 1st June 2015 to 30th March 2016. A total of 50 successive patients were assigned in this study. All of them were admitted with abdominal trauma and underwent diagnostic laparoscopy during the period of 10 months. The study was designed to find out whether laparoscopy can help in identifying intra-abdominal injuries with consequent avoidance of unnecessary operative explorations. Results: Intra-abdominal injuries other than GIT perforation were diagnosed by laparoscopy with 100% accuracy but in case of bowel injury the diagnostic accuracy was 80%. Conclusion: Diagnostic laparoscopy is the procedure of choice in doubtful intra-abdominal injuries with impressive accuracy except for bowel injury. Subsequently it reduced the need for negative laparotomies with their procedure related adverse effects. Journal of Surgical Sciences (2018) Vol. 22 (1): 47-51

Background: Acute appendicitis is one of the important causes of emergency surgeries. Diagnosis of acute appendicitis remains to be challenging with up to 30% negative exploration rates. In addition to careful clinical history and physical examination, we still need easily applicable, cheap and effective biomarker. Complete blood count is the primary investigation for any inflammatory condition. Total WBC count and neutrophil percentage are widely used biomarkers to diagnose acute appendicitis. Mean platelet volume (MPV) is an emerging biomarker that has been considered to be affected by inflammatory burden. MPV value is also estimated during complete blood count. This study may help to reveal the change of MPV in acute appendicitis. Study design: This was a prospective observational type of study. Study setting and period: The study was carried out in the Surgery In-patient Department of Dhaka Medical College Hospital, Dhaka from 15-11-2013 till 15-04-2014. Materials: A total of 150 patients of both sex aged 15-65 years who got admitted in the surgery department for acute appendicitis were selected. Pediatric patients (aged less than 14years), patients with co morbid illness like ischemic heart disease, inflammatory bowel disease, general peritonitis and the patients having lack of necessary investigations were excluded from the study. Methods: The variables like total WBC count, neutrophil percentage, platelet count and mean platelet volume (MPV) of all 150 selected patients were noted after admission by doing complete blood count and compared with normal value. The appendix samples obtained after surgery were sent for histopathological confirmation and reports were collected. Results: A total of 150 patients with the mean age of 25.72 (ranging 15-65) years were studied. Among them 93(62%) were male and 57(38%) were female. Mean MPV value was 11.7 ± 0.183 fL (p value 0.02). 122 patients have increased MPV value (81.33%). Among them 113 were eventually diagnosed as acute appendicitis. Negative exploration rate was 14%.Negative exploration was less among MPV raised patients (7.38%). Whereas negative exploration was more among normal MPV patients (21.42%).Total WBC count and neutriphil percentage are important biomarkers to diagnose acute appendicitis which is accepted. However this study revealed MPV value is an important biomarker in acute appendicitis also which is statistically significant and can reduce negative exploration. Conclusion: In this study mean platelet volume increases in acute appendicitis. MPV can be used as a biomarker in diagnosis of acute appendicitis. Journal of Surgical Sciences (2018) Vol. 22 (2) : 83-88

Background: Peptic ulcer perforation management is still an enigma. Though the overall incidence has been reduced worldwide due to wide use of anti-ulcerants, still it is not uncommon. But there is a debate regarding its conservative management over surgical management. Objective: To determine whether surgery could be avoided in selected patients with perforated peptic ulcer disease Methods: This study was conducted in the department of Surgery of Sir Salimullah Medical College and Mitford Hospital during the period from 1st March 2016 to 31st August 2016. After approval from the institutional ethics committee, 30 patients of suspected perforated peptic ulcer disease were successively assigned in this study on clinical and radiological basis. All were given non-operative regimen up to 24 hours. Then they were closely monitored to see improvement of clinical condition or development of any complication. Non-operative treatment was abandoned if the patient failed to improve or deteriorated within 24 hours of non-operative treatment. The data were collected by active participation of patients’ interview in preformed data collection sheet. Results: The data analysis of 30 patients yielded that most of them (86.67%) recovered well after receiving non-operative management, whereas only 4 patients (13.33%) showed no progression and were treated by laparotomy. 73.08% patients with uneventful outcome left the hospital within 10 days of admission and the others were a little late to leave. Conclusion: Patients with perforated peptic ulcer disease can be effectively treated by conservative approach in properly selected cases by proper monitoring under strict supervision of an experienced consultant. Journal of Surgical Sciences (2018) Vol. 22 (2) : 95-98

No abstract

Burst Abdomen is a preventable condition in which many risk factors play their role and lead to life threatening complications. This study was carried out to find out various risk factors of burst abdomen following emergency laparotomy, to find out the high risk group of patients for burst abdomen, to determine the predictors of burst abdomen, to prevent the rate of burst abdomen & find out morbidity and mortality of burst abdomen. This cross sectional study was done among 100 cases of burst abdomen occurring in Sir Salimullah Medical College & Mitford Hospital, Dhaka and Dhaka Medical college,Dhaka during the period of July,2011 to December,2011. The patients were admitted for various surgical problems and underwent emergency laparotomy. Burst abdomen was taken into account. Another group of 100 patients who undergone emergency laparotomy but did not develop burst abdomen were also taken into account to make a comparison with the burst group. Patients who undergone elective laparotomy,paediatric age group,patients undergone exploration through mini laparotomy or transverse incision,patients with pregnancy were excluded from the study populations.Patients were assessed by history taking, examination and appropriate investigation before surgery and observed post operatively for any complication. The results were prepared on 100 patients underwent emergency laparotomy in SSMCMH & DMCH. Burst abdomen following emergency laparotomy results from multifactorial causes. The main outcome measure found significant as the risk factors of burst abdomen in this study were peritonitis (95%),anaemia (26%),malnutrition (18%), in the preoperative period; inadequate peritoneal toileting and faulty surgical techniques in the per operative period; and wound infection (62%), postoperative cough (28%), abdominal distension (22%). The result also shows that the rate of burst abdomen is still very high in SSMCMH & DMCH and most of them occur in operations done by trainee surgeons (86%) and in those patients who has 3 or more of the risk factors (44%). We hope this study will arouse awareness and concern about this problem, so that more active steps will be taken for its prevention by identifying the high risk groups. This will certainly reduce the incidence of burst abdomen. Bangladesh Med J. 2017 May; 46 (2): 38-42