Background: Despite the rarity (5%) of acute perforation of first part of duodenum (D1) and the advancement in surgical, anesthetic and ancillary facilities, still there are life-threatening dimensions. A variety of surgical techniques evolved over time, but none is without drawbacks. Thus, the need arise for surgeon friendly, suitable surgical technique with better outcome. By this retrospective analysis, we aimed to compare between the Graham's omentopexy (GO) and modified Grahams' omentopexy (MGO) to find the suitable method of managing this acute catastrophe. Materials and Methods: This is a retrospective study design for the period June 2009-May 2012. All the patients with only D1 perforation admitted and treated at our institution were included. Patients with perforation other than D1 site, multiple perforations, poly-trauma and associated co-morbidity were excluded. Patients were randomly subjected for either GO or MGO. Post-operatively, all were followed-up for 3 months at out-patients department. Results: Out of the 122 patients, 112 were males and 10 were females with M:F ratio 11.2:1. MGO group had comparatively less chances of biliary fistula, burst abdomen and mortality, but, more chances of wound infections with longer hospital stay and better outcome at 3 month follow-up in contrast to GO group. The overall mortality rate was 4.09%. Conclusion: MGO is surgically suitable technique than GO for patients with D1 perforation with better post-surgical outcome.

Purpose: The purpose of the study is to find out the incidence of pyramidal lobe (PL), its position in relation to thyroid and correlation with functioning status of thyroid gland. Materials and Methods : This was a retrospective study conducted in Nuclear Medicine Section, Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan. We evaluated radionuclide thyroid scans performed with technetium-99m pertechnetate from March 2009 to May 2013. As per our departmental protocol, patients were used to swallow 100-150 cc water to wash away secreted esophageal activity and minimizing the possibility of false positive results. Patients with diagnosis of thyroiditis or history of any thyroid surgery were excluded. Presence and position of PL (arising from isthmus or either lobe of thyroid), presence or absence of cold or hot nodule (s), total thyroid uptake and thyroid function test performed within 4 weeks of thyroid scan were noted. Results: A total of 1116 thyroid scans qualified inclusion criteria of the study. PL was appreciable in 156 patients with overall incidence of 14% and an annual incidence of 3.5%/year (P < 0.05). Mean age of the population was 40 ± 12 years and female: Male was 113:43 (P < 0.05). Mean thyroid uptake was 14 ± 9% (P > 0.05). PL had origin from left thyroid lobe in 72 (46%), from the right thyroid lobe 58 (37%) and from the isthmus in 26 (17%) (P < 0.05). 135 (86.5%) patients were toxic (P < 0.05) while 15 (9.6%) euthyroid and 6 (3.8%) were hypothyroid (P > 0.05). Conclusion: We conclude that the incidence of PL on thyroid scanning was 14% with predominance for the female gender, left lobe origin and diffuse toxic goiters. An adequately performed thyroid scan would ensure completeness of thyroidectomies and avoid per-operative inconvenience to surgeons due to false positive scan results.

Objectives: To determine the prevalence, common causes, and outcome of non diagnostic amylase in acute pancreatitis. Materials and Methods: The data of 81 patients was looked at retrospectively. This was extracted from the patient's records with the diagnosis of acute pancreatitis from June 2010 to June 2012. These patients were admitted to King Abdulaziz University Hospital. The data included demographics, amylase level, causes and outcome. Two groups were devised group 1, non diagnostic amylase, and group 2, diagnostic amylase. Results: Out of 81 patients, 33(41%) were males, and 48(59%) were females. Age ranging from 24-75 years with a mean age of 49. Only 10(12%) of the patients were found to have amylase that is not raised up to the diagnostic level. Gallstones were the commonest cause in both groups, while hyperlipidemia was higher in group 1(20%), than group 2(8.5%). Idiopathic in 40% and 14% in group 1 and 2 respectively. Post ERCP acute pancreatitis was only seen in group 2(8.5%). The outcome was indicated by; pseudocyst which was not present in both groups, necrosis which was only present in group 2 in 4%, Intensive care unit (ICU) admission was seen in 20% of group 1 patients due to delay in diagnosis, and in 4% of group 2 due to necrosis, and mortality was absent in both groups. Conclusion: Prevalence of acute pancreatitis in non diagnostic amylase is found to be 10%. The most common cause after gallstones is idiopathic together with hyperlipidemia. The outcome is usually favorable provided the diagnosis is not delayed.

Omental infarction is a rare cause of an acute abdomen. Depending on the site of infarction, it can mimic conditions such as appendicitis, cholecystitis and diverticulitis. Before computed tomography, the diagnosis was made intraoperatively. We report a case of a young man who was treated conservatively following diagnosis using radiologic means, for its rarity and merits of a similar conservative approach in future cases.

This is a case report of a 32-year-old female who presented with acute intestinal obstruction. The radiological diagnostic possibilty of midgut volvulus with ileo-sigmoid knotting and obstruction of the proximal sigmoid colon and small bowel was given. The diagnosis was confirmed intra-operatively with associated gangrene of the distal jejunum and proximal ileum. Resection of the gangrenous segments of bowel and the release of ileo-sigmoid knotting was performed. The literature about the ileo-sigmoid knot was reviewed. It may be difficult to diagnose this condition before surgery. This is a surgical emergency that requires urgent resection of gangrenous bowel and untwisting of the volvulus. The aim of this short communication is to increase awareness of the pre-operative computed tomography (CT) diagnosis of this condition.

Gastric volvulus, wandering spleen and eventration of diaphragm share a common pathologic cause of absence or laxity of intraperitoneal ligaments. We hereby present a rare case of a 15-year-old male child with cerebral palsy presenting with organo-axial type of acute gastric volvulus resulting in gangrene of whole of stomach, associated with an infarcted wandering spleen, eventration of the diaphragm and cholelithiasis.