Objectives: To determine the prevalence, seasonal presentation, and management of Ludwig's angina in Northwest Nigerian Tertiary Health Facility. Patients and Methods: Cases of Ludwig's angina that presented and managed by the Dental and Maxillofacial Surgery Unit of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between 2013 and 2015 were retrieved. Data were stored and analyzed using IBM SPSS (IBM Corp., Armonk, NY, USA) Statistics for windows version 20. Results: Over the review period, 36 patients presented with clinical features of Ludwig's angina. Only 28 cases were analyzed and 8 cases had incomplete data and were excluded from the analysis. Of the 28 patients, 23 (82.1%) were males while 5 (17.9%) were females with a male: female ratio of 4.6:1. The mean age of the sample was 32.3 ΁ 11.6, range 18-60 years. A majority of the patients were in low socioeconomic group with 11 (39.3%) patients being peasant farmers. Odontogenic infection was responsible for the disease in 27 (96.4%) cases while only 1 (3.6%) case was idiopathic. Of those with odontogenic etiology, 18 (64.3%) were due to sequelae of caries. Microbiology, culture, and sensitivity in few cases revealed Streptococcus species, Pseudomonas aeruginosa, and Staphylococcus aureus. Most of the cases recorded no bacterial growth after 24 h incubation period. Twenty-five patients (89.3%) survived the disease while 3 (10.7%) died. Conclusions: Management of Ludwig's angina in a resource- and personnel-scarce setting can be very challenging. Early surgical decompression, aggressive empirical antibiotics, and nutritional support have contributed to the low mortality in our series.

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Introduction: Perforation is defined as an abnormal opening in a hollow organ or viscus. Gastrointestinal perforation is one of the common surgical emergencies in developing countries. The diagnosis is mainly clinical and is aided by radiological investigations. The present study was conducted to highlight the spectrum of hollow viscus perforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgical treatment, postoperative complications, and mortality encountered at SMS Medical College and Hospital, Jaipur, India. Materials and Methods: The study was a hospital-based prospective observational study conducted from April 2012 to October 2013 in the Department of General Surgery. During the study period, a total of 442 patients underwent surgery for secondary peritonitis. The patients included in the study were patients (>12 years) presenting with gastrointestinal perforation and undergoing emergency laparotomy. Results: Out of 442 patients, 91.2% (403) were males, with male-to-female ratio being 10.33:1. The mean age was 39.13 years. About 79.2% of the patients were below 50 years. Free gas under diaphragm on chest X-ray was noted in 86.2% cases. Duodenum was the most common site of perforation in 158 patients. The most common etiology for perforation was acid peptic disease (41.4%). Simple closure was the most common surgical procedure being performed in 63.8%. Overall morbidity and mortality recorded in this study were 42.8% and 14.7%, respectively. Conclusion: Early diagnosis, resuscitation with fluids, and timely surgical intervention are the most important factors deciding the fate of the patient with perforation peritonitis.

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Context and Aims: Pneumatic reduction has a higher success rate and lower incidence of complications compared to barium enema and hydrostatic reductions. What is deterrent to its common use is the cumbersome technique. Our technique is simple that can be used in any hospital with locally available facilities. Settings and Design: This was a prospective study. Subjects and Methods: A total of 25 children were enrolled in the study between September 2015 and June 2016 at our institute. Patients were given air enema under US guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 100 mmHg. A total of three attempts of 3 min each were allowed. Statistical Analysis Used: We just used simple statistic to calculate average. Results: There were 17 males and 8 females. The average age of the patients was 8.5 months. Twenty-two (88%) of the cases were reduced successfully while 3 (12%) failed to reduce. A majority of those that did not reduced had symptoms for at least 4 days. No bowel perforation occurred in our study. All cases of the intussusception have length <5 cm were reduced with pneumatic reduction in our study. Conclusions: The technique described is easy to assemble, safe, and effective. We recommend it for regular use in pneumatic reduction of intussusception, especially in the center have limited resources.

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Objective: The effectiveness of teaching operative notes in surgical resident training program at King Abdulaziz University Hospital, Jeddah was studied. Materials and Methods: This was a prospective study done at Department of Surgery, King Abdulaziz University Hospital to evaluate the effect of teaching the surgical residents how to write operative notes. Twenty-one residents were asked to write operative notes of appendicectomy. Their operative notes were evaluated for medical record number (MRN), date and time of the operation, preoperative and postoperative diagnosis, names of surgeon, assistant, and anesthetist, name of the operation, incision, findings, closure, hemostasis, estimated blood loss, whether histopathology specimen was sent to the pathology department or not, postoperative orders, whether the patient went to the recovery room in a satisfactory condition or not, and signature of the operating surgeon. Two months of effective teaching of operative notes was given to them. They were again asked to write operative notes of appendicectomy. Notes were collected and studied and comparison was made with previous notes. Legibility of the operative notes was also studied. Results: In our study, we found that there was improvement of 29-39.9% in recording MRN and the date of operation by our residents after they were taught the art of writing operation notes. There was marginal improvement (4.7%) in stating whether it was elective or emergency operation. Documentation of surgeon's name, assistant's name, and anesthetist's name improved to 12.4-32.8%. Writing the name of the procedure and pre- and postoperative diagnosis improved to 31%. Details of the procedure such as position of patient and incision improved marginally to 5.9%. Mentioning the findings and description of the procedure showed no improvement, as it was 100% before teaching. Documenting hemostasis, estimated blood loss, and transfer to recovery room improved to 58.4%; however, there was no improvement in writing post-op orders and histopathology sent to the pathology department.Improvement of signature was only 9%. Conclusion: Effective teaching of how to write operative notes helps in the training of surgical residents.

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Cecal volvulus as an uncommon cause of acute intestinal obstruction is due to axial twist of the cecum and terminal ileum around their mesentery. Cecal volvulus is a surgical emergency requiring urgent laparotomy. Resection and anastomosis is the proposed choice of the operation depending on the general condition of the patient. In addition, to its rarity, lack of familiarity causes diagnostic doubt and consequently delays in treatment. In this paper, we report a case of cecal volvulus seen in a 31-year-old Saudi male presented with vomiting, abdominal pain, and distension.

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Background: Most major hepatocellular carcinoma (HCC) staging systems recommend hepatic resection only for patients with early-stage of HCC. Still there is controversial about resection of patients with large HCC (defined as >5 cm). The aim of this retrospective study is to investigate the clinicopathological features that impacted the long-term outcomes of 1 year after hepatectomy of large HCC >5 cm in cirrhotic patients. Materials and Methods: From February 2012 to December 2015, a total of 92 patients with resection of large HCC on liver cirrhosis were reviewed retrospectively and considered for clinicopathological features that impacted the long-term outcomes. Time to recurrence (recurrence-free survival) and overall survival (OS) were determined by Kaplan-Meier analysis. Results: Twenty-nine (31.5%) patients developed tumor recurrence. The mean time until tumor recurrence was 12.4 ± 6.6 months. The cumulative 1-, 2-, and 3-year disease-free survival rates were 73%, 28%, and 18%, respectively. On multivariate analysis, male gender, α-fetoprotein >400, bilobed tumors, patients with portal hypertension, plasma transfusion, and absence of tumor capsule remained independent predictors for recurrence of HCC. The OS rates at 1, 2, and 3 years were 73%, 31%, and 16%, respectively. On multivariate analysis, α-fetoprotein >400 and plasma transfusion remained independent predictors for death. Conclusions: Liver resection is suggested in patients with large HCC and can be performed with acceptable overall and disease-free survival and morbidity rates. Identification of risk factors and close postresection follow-up with early detection are mandatory measures for prompt treatment of tumor recurrence which is reflected by a beneficial survival rate for this group of patients.

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Objective: The aim was to determine the role of laparoscopy in the management of nonspecific abdominal pain (NSAP). Background: NSAP constitutes a good proportion of surgical admissions, both in emergency and elective settings with considerable diagnostic dilemma. Patients and Methods: All patients who presented with pain abdomen with no immediate cause and were labeled as NSAP after clinical assessment and investigations and following that underwent laparoscopy to make a definitive diagnosis were included in the study. Results: A total of 88 patients were included in the study. There were 59 (67%) females and 29 (33%) males. The mean age was 26 years (range 18-58 year). The common mode of admission was out-patient department 69 (78.4%) patients. Twenty-five (28.4%) patients presented with NSAP in lower abdomen, followed by 21 (23.8%) with right lower abdominal pain and 19 (21.5%) with central pain radiating to right lower abdomen. Diagnosis was established in 75 (85.2%) patients. In 13 (14.7%) no pathology was found. The most common diagnosis was pathology of appendix in 29 (32.9%) patients followed by pelvic pathology in 18 (20.4%) and abdominal tuberculosis in 14 (15.9%) patients. Most 37 (42%) of the patients stayed in the hospital for 24 h. There was no readmission and no major postoperative complications. Conclusions: Laparoscopy has a definitive role in diagnostic dilemma associated with NSAP. It has at the same time role in treatment of the condition; hence laparoscopy has a diagnostic and a therapeutic implication in management of NSAP.

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Objective: The aim was to study the prophylactic effect of tamsulosin on postoperative urinary retention in benign anorectal surgeries. Background: Acute urinary retention (AUR) after anorectal surgeries is essentially a type of postoperative urinary retention (POUR). It is the most common complication of the procedure. Use of tamsulosin, a super selective alpha 1a adrenergic blocker has been found to reduce the risk of POUR. Patients and Methods: Patients who underwent anorectal surgeries for benign anorectal conditions were included in this study. Patients were randomly assigned into two groups. In one, group (cases), patients were given 0.4 mg of oral tamsulosin only 6 h preoperative and 6-8 h postoperatively. Inability/difficulty to pass urine, which necessitated catheterization after following patient for 24 h was labeled as POUR. Results: A total of 626 patients who underwent surgery for benign anorectal condition were included in the study and grouped into two groups with 313 patients in each group, control and case group. In the control group, 56 patients (17.9%) had inability to pass urine and required catheterization and in the case group, only eight patients (2.5%) needed catheterization following POUR. The difference in the requirement of catheterization following POUR was statistically significant (P = 0.04). Hemorrhoidectomy was the most common anorectal surgery associated with POUR. Conclusion: The use of tamsulosin in preoperative and postoperative period has been found effective to reduce the incidence of POUR following surgeries for benign anorectal pathologies.

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Objectives: An endeavor to look for cost effective method for dressing wounds to minimize loss of working hours. Three percent citric acid solution (CA) was used for dressing acute lower limb ulcers with the object of pH modulation of wounds at an early stage and to evaluate its effects on wound healing. This solution was compared with Edinburgh University solution of lime (Eusol) in a randomized double-blinded study. Appearance of healthy granulation was the end point of the study. Materials and Methods: An unicentric randomized double blinded study with a parallel design was used to compare patients treated with 3% CA and Eusol solutions, respectively. The results were analyzed using Chi-square and P value using Microsoft Excel and SPSS 22. Patients having fever, altered consciousness, high initial random blood sugar >350 mg%, positive urinary ketones, hypoproteinemia, signs of septicemia and vascular diseases were excluded. Results: Twenty patients were known diabetic out of which 11 were in the CA group, and the rest were in the Eusol group. It was observed that the average total stay in diabetic patients was 16.36 days in CA group and 31 days in Eusol group whereas it was 15.78 and 24.75 days respectively in the nondiabetic group. The ulcer granulation interval showed that the mean stay in CA group was 10.56 days while it was 20.04 days in the Eusol group. The cost of stay was less in CA group. Conclusions: It is concluded that 3% CA solution forms a good alternative for wound dressings that acts by modulating the wound pH to acidic levels thereby contributing to wound healing by increased fibroblast proliferation and probably increasing local oxygen concentration and reducing microbial growth and virulence.

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H-type rectourethral fistula in males is a rare congenital anorectal malformation. It is associated with anal stenosis at normal site which generally delays diagnosis. We describe a case of a 6-month-old male child who presented with intermittent passage of fecal matter in urine along with ribbon-shaped stools through anal orifice, on straining. Investigations revealed an H-shaped rectourethral fistula with anal stenosis. Minimal sagittal anorectoplasty with fistula ligation was done.

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Objective: The aim of this study is to describe the computed tomography (CT) features of primary and secondary omental infarction. Materials and Methods: Five cases of primary and seven cases of secondary omental infarction are described with emphasis on CT features. The etiology and clinical features are described with the ultimate clinical outcome. Results: In this case series of 12 patients, five omental infarcts (42%) were classified as primary. Seven cases (58%) were postoperative with four infarcts following cesarean section, one following a total abdominal hysterectomy, one occurring after a laparoscopic ovarian cystectomy, and one occurring after laparoscopic hemicolectomy. Of the seven secondary omental infarctions, one was associated with secondary thickening of the transverse colon and one patient developed an abscess. Three patients from the secondary group and one patient from the primary group underwent omentectomy. Primary infarcts showed an ill-defined fat attenuation lesion with thin stranding located in the right upper quadrant in three and left lower quadrant in two patients. The postoperative omental infarcts showed more pronounced inflammatory change and soft tissue attenuation foci interspersed with fat density foci. They were located in the right lower quadrant in four patients, in the right upper quadrant in two patients, and in the left lower quadrant in one patient. The patients were followed to clinical resolution. Conclusion: It is possible to distinguish primary and secondary omental infarcts on the basis of CT features. Even though, a nonsurgical cause of acute abdomen, surgical management may become necessary in patients with secondary omental infarction and secondary infection who fail to respond to antibiotics and percutaneous drainage. The majority of the secondary cases followed cesarean section in our series.

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Background and Objective: Surgical residents are at high risk of sustaining sharp injuries. Our aim is to identify predisposing factors of sustaining sharp injuries in operating rooms among surgical residents and their attitudes and behaviors in dealing with sharp injuries. Methods: In this cross-sectional study, a random sampling technique was adopted to recruit a representative sample of surgical residents who were involved in operative procedures in King Abdulaziz University Hospital. Data were collected between September and December 2016 by completing a self-administered questionnaire on attitude toward the most recent sharp injuries, predisposing factors for sharp injuries, and practice of universal precautions during the surgical procedures. Results: Among the 78 recruited residents, 46 (58.9%) had sharp injuries during surgical procedures. Most of the injuries (60%) were self-induced, and (72.9%) of the injuries took place while suturing. Twenty (43.5%) of those who had injuries did not report any injury, 15 (32.6%) reported some, and 11 (23.9%) claim that they reported all their sharp injuries. 44.9% of the participants are fully aware of sharp injuries local policy and procedures in the hospital. Most of the injured participants during surgeries did not follow each step of the local sharp injury policy. The perceived causes of sharp injuries among the participants were due to rushed (61.1%), fatigue (43%), lack of skills (19.4%), lack of assistance (15.3%), lack of sleep (13.9%) and (16.7%) though it is not preventable. 55.1% of all participants have never participated in any sharp-related safety training. 10.2% practiced all three universal precautions of double-gloving, face shields, and hands-free technique. Conclusions: Sharp injuries are common among the surgical residents but are not reported by most of them. Target training about sharp injuries during residency may improve their attitude and behavior toward prevention of sharp injuries in the operative room.

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Background: Post operative ileus (POI) is the transient absence of gut motility without any mechanical obstruction, commonly occuring after abdominal surgery. It is reported to occur in 25% patients. Although it may resolve spontaneously with two-three days there have been many studies which have evaluated the role of early feeding in recovery from postoperative ileus. The study was conducted to evaluate the role of chewing gum for early recovery of postoperative ileus. Materials and Methods: This prospective comparative study was conducted from March, 2017 to September, 2017 on patients who underwent exploratory laparotomy and any kind of intestinal anastomosis either during emergency or elective surgeries. The patients were divided into 2 groups each group having 25 patients. Patients in study group (n=25) were asked to chew one stick of chewing gum for 30 min four times a day until passing flatus while the control group (n=25) patients were kept nil per orally until the passage of flatus. A probability value of less than 5% (P < 0.05) was considered significant. The Chi-square test was used to check for differences between proportions. Results: Total male patients were 33 and 17 were female. There was no significant difference in the appearance of bowel sounds, mean time of passage of flatus, stool passage and feeling of hunger between study and control group. In all these variables the mean time was shorter in study group. The patients were discharged early in study group with a statistically significant difference. Conclusion: Based on the results it can be concluded that the chewing gum does not seem to be significant to reduce the duration of post operative ileus. Although it was seen that the duration of overall recovery of bowel movements in form of appearance of bowel sound, passing flatus and motion and feeling of hunger, occurred early in patients chewing gum but was not significant statistically.

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Importance: Nonpsychiatric physicians often encounter body dysmorphic disorder (BDD) which is a common psychiatric disorder. In the general population, BDD is estimated to affect 1%–2%. In esthetic specialties, however, rates are markedly higher. Objective: This study aims to quantify the prevalence of BDD among people seeking facial plastic surgeries in Saudi Arabia because the literature is sparse in this field. Design: This is a cross-sectional study, conducted in 2018 (October–December). Setting: A self-administered web-based questionnaire was administered on 453 individuals, aged 18 years and older, of Saudi residence. Participants: A total of 453 individuals, aged 18 years and older, of Saudi residence, were enrolled in the study. Main Outcome(s) and Measure(s): The study has three main measures which are: (1) sociodemographic data, (2) previous and future plastic surgeries, and (3) the Body Dysmorphic Disorder Questionnaire. Results: A total of 453 individuals were enrolled in this study. Of the total sample, 34.2% reported their desire to go for a facioplastic surgery in future, of which 14.19% fulfilled the criteria of BDD. Twenty-two individuals who fulfilled the criteria were all females (100%). All were relatively young, with 54.5% aging between 18 and 24 years of age, followed by 45.5% aging between 25 and 34 years of age. The majority were married 54.5%, with the rest being single. The majority of individuals (59.1%) live in cities, followed by 36.4% living in villages and 4.5% living in outskirts. Nearly 68.2% hold a college degree, followed by 27.3% holding a high school degree. The vast majority reported the desire to undergo a rhinoplasty (54.5%), followed by facial implants (9.1%), facelift (4.5%), eyebrow lift (4.5%), and cheek/jaw contouring (4.5%). Conclusion: We report a prevalence of 14.19% among people seeking facial plastic surgery. This prevalence is warring, requiring special attention by facioplastic surgeons, plastic surgeons, and dermatologists, when dealing with patients. We recommend the screening of all patients to be a standard practice to ensure the best outcome possible.

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Objective: The objective was to assess the prevalence and risk factors of abdominal aorta aneurysms (AAAs) in the general population. Materials and Methods: We carried out a prospective, interventional study with patients aged over 60 years screened in the Asir Central Hospital Vascular Department from March 2017 to March 2018. Ultrasound was used to AAA screening. The maximal anteroposterior (AP) and transverse (LL) diameters of the suprarenal and infrarenal aorta were measured in each patient. AAA was defined as aortic dilatation >29 mm in the AP or LL plane. All cases with an aortic diameter >25 mm were included in the study. Results: Our study included 701 patients (531 male, 170 female; age 60–102 years). Most were Saudi nationals (87.6%). There were some smokers (1.3%), 277 (39.5%) had diabetes mellitus, and 233 (31.8%) had hypertension. Fifty-one percent of patient had ischemic heart disease (7.3%), and 13.4% had hypercholesterolemia. Patients were classified into three groups: normal aortic size of 657 patients (93.7%); aortic ectasia 26–29 mm of 24 patients (3.4%); and AAA ≥30 mm of 20 patients (2.9%). The overall prevalence of AAA was ≥30 mm (2.9%) and there is significant relation with hypertension (P < 0.05). Conclusion: Asymptomatic AAA is prevalent in our area. We may need to implement a regular screening program for men aged >60 years, especially high-risk patients to reduce AAA rupture, emergency AAA repair, and mortality.

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Background: With the introduction of mesh for repair of inguinal hernia, the focus of surgeons has shifted to postoperative pain and quality of life (QOL). As compared to open procedures, laparoscopic procedures have been found to be associated with less pain and faster recovery. The present study was designed to assess whether this holds true when open Lichtenstein repair is done using lightweight mesh (LWM) because, in previous studies where laparoscopic inguinal hernia repair is compared to open Lichtenstein repair, heavyweight mesh (HWM) was used for both techniques. HWM was used for total extraperitoneal (TEP) in the current study because of higher recurrence associated with LWM. Materials and Methods: This prospective randomized study was done on 60 patients divided into two groups: the Lichtenstein group and the TEP group. Patients were followed at 1 week, 1 month, and 6 months for any postoperative complication. QOL was assessed using hernia-specific Carolinas Comfort Scale. Results: No statistically significant difference was observed between the two groups with regard to various postoperative complications. Only one recurrence was detected at 1 month in TEP group. The mean groin pain was significantly less in TEP group at 24 h, 1 week, and 1 month (P < 0.05). The sensation of mesh was significantly less in Lichtenstein group at 24 h and 1 week (P ≤ 0.001) but comparable to TEP at 1 month and 6 months. The difference in movement limitation was not significant at any time between the two groups. Conclusion: Except for less pain in the early postoperative period TEP does not offer any advantage and Lichtenstein repair using LWM can still be considered as the best option for inguinal hernia repair, especially in countries where resources are limited.

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Glomus tumors (GT) are cutaneous and soft tissue mesenchymal neoplasms. The malignant variant that is, glomangiosarcomas (GS) are rare and account for <1% of all GT. GS are usually seen in adults with a wide age range of 20-89 years. GS usually have an indolent course with local aggressiveness. The treatment is complete surgical excision with excellent prognosis though metastasis workup is advised. Herein, we report an unusually large GS de novo in a 6-year-old girl. Complete surgical excision was performed. There was no evidence of recurrence or metastasis over the last 15 months of follow-up postoperatively. GS should be considered as one of the differential diagnosis of cutaneous and soft tissue neoplasms.

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Multiple intestinal atresia (MIA) associated with colonic atresia is very rare, especially with almost normal bowel length. This report deals with a case of multiple jejunoileal atresia associated with descending colon atresia, which was managed by multiple resection and primary anastomoses without use of stents and with total parenteral nutrition. Literature on the genesis, management and survival of MIA is reviewed.

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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.

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Background: Oral cancer is one of the common cancers in India with dismal survival in advanced stages. Most of the patients present in advanced stages with borderline operability and such patients may be helped by chemotherapy to render them operable. It is well known that tumor growth is angiogenesis-dependent and thus vascular endothelial growth factor (VEGF) may be a surrogate marker of growth and angiogenesis. At present, there is a scarcity of predictive markers for oral cancer. In this prospective study, we studied VEGF expression and its role as a predictive marker in oral cancer. Materials and Methods: Patients with locally advanced oral cancer having borderline operability or unfit to undergo surgery in the primary setting were included in the study. VEGF expression of the cancerous tissue was studied in all patients. Three cycles of neoadjuvant chemotherapy (NACT) was administered before definitive treatment in locally advanced cases and response is assessed. VEGF levels were analyzed in cancer tissue and compared with normal surrounding mucosa. The response to chemotherapy was then correlated with VEGF score in patients receiving NACT to evaluate it as a predictive marker. Results: All forty patients were VEGF-positive and had a mean score of 1023 with 63% patients having Grade 3 expressions, whereas the normal surrounding mucosa had a VEGF score of 30. It was seen that in patients showing no response to treatment, the mean total VEGF score was significantly higher as compared to those showing complete or partial response. VEGF score correlated inversely with chemotherapy response, but no significant association was seen between VEGF grade and chemotherapy response. Conclusion: We can conclude from this study that VEGF is significantly overexpressed in cancer mucosa as compared to normal mucosa and overexpression of VEGF was found to be associated with chemoresistance and thus may serve as a negative predictive marker.

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Aims and Objectives: This study is aimed at determining the frequency and histopathological patterns including grading and staging of bladder tumors as seen in University of Benin Teaching Hospital, Benin City, Nigeria and to compare with similar research works elsewhere. Materials and Methods: A retrospective study of all data of surgical excision and cystoscopic bladder biopsies received over a 10-year period (2003-2012) at the Department of Histopathology, University of Benin Teaching Hospital, Benin City, Nigeria. Histological criteria published by the World Health Organization/International Society of Urological Pathology were used for the diagnosis and grading of these tumors. Results: A total of 75 bladder lesions were received in the Pathology Department. Of these, 64% were males and 36% were females giving a male to female ratio of 1.7:1.0. The peak and mean age incidence of urothelial bladder lesions was 60-69 years and 54.9 years ± 8.6 standard deviation, respectively. Bladder tumors accounted for 74.7% of all bladder lesions. Fifty-one (68%) cases out of 75 lesions were malignant tumors. Transitional cell carcinoma (TCC) was the most commonly encountered histological pattern accounting for 64.7% of bladder cancer. High grade papillary urothelial carcinoma was the most common tumor grade accounting for 51.4%. Only 40.6% cases were urothelial confined carcinoma (PTa) while 29.7% each accounted for lamina propria (PT1) and muscle (PT2) invasive carcinoma. Conclusion: Bladder tumors are more commonly encountered in males with the majority of cases occurring in the 7 ^th decade. Both high-grade TCC in stage (PT2) and low-grade carcinomas stage (PTa) were relatively common patterns seen in this study.

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Introduction: Delayed presentation of patients with posterior urethral valve (PUV) is common in our country and is usually associated with complications and morbidities. Objective: To determine the pattern of presentation of PUVs and its complications and outcomes in these patients with respect to decrease or resolution of vesico-ureteric reflux (VUR) and/or requirement of additional operative procedures. Materials and Methods: A retrospective study was conducted, and 30 children of PUV were analyzed with respect to the pattern of presentation, duration of symptoms, age at primary fulguration, grade of VUR and its outcome. Results: Patients with early presentation were diagnosed early, had their PUV fulgurated early and had lesser grades and better resolution of their VUR and good outcome. The reverse was seen in those patients who presented late and already had some form of renal impairment such as higher and bilateral grades of VUR and higher serum creatinine levels. Some of them also required additional procedures which added to their morbidity. Discussion: Delayed presentation of PUV is common in our country and is associated with an increased incidence and a higher grade of VUR which does not decrease or resolve on follow-up and usually requires additional operative interventions adding to the morbidity of both the parents and the child. On the other hand, early presentation leads to early diagnosis and early relief of obstruction and is associated with lesser VUR, which resolves over time. Conclusion: With early presentation, diagnosis and treatment, the outcome of patients with PUVs is expected to improve. Efforts at improving awareness and early diagnosis and referral among the health team should be encouraged.

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Introduction: The established success of damage control surgery (DCS) in trauma of torso motivates surgeon to apply similar concept in managing complicated intra-abdominal sepsis. The main objective of this study is to audit our new practice of such in nontrauma emergency abdominal surgery. Materials and Methods: We retrospectively reviewed all emergency abdominal surgeries (nontrauma) done from February 2013 to February 2014. All patients who had damage control procedures done for complicated intra-abdominal sepsis were analyzed. Results: A total of 60 patients were operated within that period. Six patients (10%) had undergone DCS with or without laparostomy. All were male with mean age of 48.5-year-old (26-61-years-old). Most were in ASA 3 (83%, 5 patients) with only one in ASA 4. Primary indications were ischemic bowel with mesenteric vein thrombosis (3 patients, 50%), abdominal compartment syndrome (ACS), bleeding post near total splenectomy for splenic abscess and gangrenous proctitis with purulent peritonitis. Nearly, all patients (5 patients, 83.3%) were severely acidotic with pH <7.2 intra-operatively, which triggered the DCS. Nevertheless, only 3 patients (50%) benefited from laparostomy and all of them achieved complete fascial closure within 2.6 days (mean). Their mean total Intensive Care Unit (ICU) stay was 15 days (9-32 days). Overall predicted mean Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity mortality rate was 51%. However, the observed (actual) mortality rate was only 33% (2 patients). Conclusion: The result of the practice of DCS in the septic abdomen is very encouraging. It appears able to reduce the mortality by 35%. A comparative analysis with larger series is therefore warranted to further confirm the findings.

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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.

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Solid pseudopapillary tumors of the pancreas are rare tumors commonly found in females. Surgery is the primary treatment and the role of adjuvant chemotherapy or radiation is not well defined. Although they are mostly benign, they have the potential for late metastasis, thereby defining the need for long-term surveillance for such patients. This review article describes these tumors in detail and in addition, focuses on the management of the resected tumors and the need and indications for adjuvant treatment in selective cases.

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