BackgroundAcute appendicitis remains the most common cause of lower abdominal pain leading to emergency visits. Even though the standard treatment of acute appendicitis remains appendectomy, in recent times, multiple randomized control trials and meta-analyses have deduced conservative treatment as a successful alternative treatment. During the coronavirus disease (COVID) pandemic, with a shortage of staff and resources, treatment with conservative management of uncomplicated acute appendicitis became very beneficial under certain circumstances and conditions. This study aimed to assess whether it is effective to manage patients with uncomplicated acute appendicitis with antibiotic therapy. MethodologyThis was a single hospital based retrospective, cross-sectional study from Jan 2015 to May 2020. Patients with clinical and radiological features of uncomplicated acute appendicitis with Alvarado's score >6 were included in the study. Patients were kept on antibiotics, intravenous fluids, and analgesia as part of a conservative regime. Those who failed to respond to conservative therapy were managed surgically. The follow-up period was six months. ResultsOne hundred eighty-two cases of uncomplicated acute appendicitis were included and managed conservatively, of which 52.2% were males while 47.8% were females. The median age of the patients was 26 years. Conservative treatment was successful in 26.2% of the patients, with a recurrence of 5.5% in the sixmonth follow-up period. The mean number of days of hospital stay was three days in patients treated with conservative or surgical treatment. ConclusionConservative management is gaining popularity, and many centers are inclined towards non-operative management; however, appendectomy remains the gold standard treatment for appendicitis.

The developing intestine rotates around the superior mesenteric vessels during physiological herniation from 6th to 10th weeks of embryogenesis. Intestinal malrotation leading to midgut volvulus and small bowel obstruction is a rare condition. Patients who develop this condition usually present in the first year of their life. Intestinal malrotation is characterized by right sided duodenojejunal junction, caecum in left iliac fossa and a narrow mesentery. Ladd’s procedure is the treatment of choice which is done to restore the normal anatomy. We report the case of an 18-year-old male patient, who presented with intestinal malrotation in emergency department of Nishtar Hospital, Multan. It is an uncommon age for presentation of this anomaly. The patient had fecal peritonitis due to caecal perforation. He underwent Ladd’s procedure in which ileocolostomy was made after right hemicolectomy. The patient had an uneventful recovery after the surgery and had no complaints on follow up visit one week after the discharge.

Context: Patients with liver disease are always at high risk of post-operative complications. The prediction of postoperative outcome is very crucial in the management of these patients. Various prediction models are in use to serve this purpose. Childs-Turcotte-Pugh (CTP) and Model of End-Stage Liver Disease (MELD) scoring systems are globally used to predict post-operative mortality in end stage liver disease patients. Aims: To compare the results of CTP and MELD scoring systems for predicting outcome in patients of chronic liver disease and to conclude which model is better for risk stratification, so as to enable us in better management of these patients. Settings and Design: Observational study Methods and Material: This is an Observational study that was carried out at General Surgery Department of Nishtar Medical University and Hospital from October 2019 to March 2020. We collected data from 30 patients. All the surgeries were done by the same team of consultant surgeons. All the investigations were done by the same institution. Scores of both CTP and MELD models were calculated preoperatively and post-operative outcome was compared with them to find out which model was a better predictor of mortality. Statistical analysis used: All the continuous variables were reported as mean ± standard deviation. Kaplan Meyer Survival Analysis was conducted to compare post-op survival time among patients divided on the basis of MELD score and CTP Grade. Pooled log rank test was conducted to determine if there were differences in the survival distributions for the different categories in each group. Significant results were followed-up by pair-wise log rank test, at Bonferroni adjusted α level of p <0.0167. Results: In our study the mean survival time of 71.20, 54.93, 8.40 for MELD scores of 11-20, 21-30 and >30 has a P value of <0.001. The mean survival time of 56, 54.85, 42.40 for CTP grades of A, B, and C respectively has a P value of 0.582. It shows that according to our study the MELD score has performed better in predicting the post-operative outcome of patients with liver diseases than CTP score. Conclusions: Although CTP and MELD both are widely used to predict the post-operative mortality but in our study MELD score has predicted the outcome more effectively than CTP scoring system.

No abstract

Scoring systems are essential to calibrate the severity of abdominal sepsis for adequate management. Disease specific scoring system based on easy to handle clinical parameters can help the cause. Objective: To study the role of Manheim peritonitis index scoring in predicting outcome and prognosis in patients with perforation peritonitis. Methods: This prospective study was carried out in Surgical Unit 1, Nishtar Hospital, Multan from 20th of August 2019 to 31st of December, 2019. It includes both sexes aged 20 years and above diagnosed at laparotomy after confirmation of peritonitis due to perforated viscus regardless of the etiology. Data were analyzed using SPSS version 19.0 Software. The outcome (death vs discharge) was compared separately to different predictors using Chi-square test. Fischer Exact test was used where assumptions of Chi-square were not met. Results: Advance age, female gender, colonic perforation, organ failure and fecal contamination were associated with high mortality. The mean MPI Score was 25.06 ± 4.96. The lowest score was 16 and the highest was 37. Overall, the in-hospital mortality rate was 14.3% in patients with MPI ≥26 compared to 6.4% in patients with MPI <26, implying over a twofold higher risk in the former group. For a score of 26 or greater as a predictor of mortality, the sensitivity was 75.0%, specificity was 38.2% at an accuracy of 94%. Conclusion: MPI enables us to categorize patients into different groups so as to tailor management according to individual needs