South African Journal of Surgery - Volume 43, Issue 1, 2005
Volume 43, Issue 1, 2005
Source: South African Journal of Surgery 43, pp 17 –19 (2005)More Less
<I>Objective</I> To evaluate the outcome of treatment of patients with sigmoid volvulus in the Polokwane- Mankweng Hospital and to identify the best management options for these patients. <br><I>Methods.</I> A retrospective study was undertaken of 85 patients with sigmoid volvulus treated in Polokwane- Mankweng Hospital during the period July 1997 - May 2004. <br><I>Results.</I> In total, 85 patients were evaluated (77 males and 8 females, male/female ratio 9:1). The age range was 7 - 80 years (mean 42 years). Sigmoidoscopic derotation was attempted in 17 patients, and was successful in 10 patients. Laparotomy was done in 84 patients, viz. 75 emergencies and 9 electives. During laparotomy, gangrenous sigmoid colon was found in 30 patients and viable sigmoid in 54 patients. Resection with primary anastomosis was done in 44 patients. Hartmann's procedure was performed in 33 patients. Sigmoidopexy was done in 7 patients. Total hospital mortality was 6% (5 deaths). Mortality in the 84 operated cases was 5% (4 deaths). <br><I>Conclusions.</I> There was no mortality in patients undergoing elective resection and primary anastomosis after successful preoperative deflation and in patients with viable sigmoid volvulus who underwent an emergency Hartmann's procedure. There was low mortality in those patients with resection and primary anastomosis on viable sigmoid (3%, 1:39). The highest mortality (1:5) occurred in cases of resection and primary anastomosis of gangrenous sigmoid colon.
Source: South African Journal of Surgery 43, pp 20 –21 (2005)More Less
Isolated rupture of the infrarenal segment of the inferior vena cava due to blunt trauma is relatively rare. It may be missed clinically and even diagnostic peritoneal lavage may prove negative. The mainstay of diagnosis remains a high degree of clinical suspicion together with sectional imaging. If the patient is haemodynamically stable after initial resuscitation and there is no other indication for exploratory surgery, these lesions can be managed conservatively with good outcome as shown in the case described in this report.
Fluctuating pulse deficits associated with intimal arterial injury following gunshot wounds of the extremity - a sign not to be missed : case reportSource: South African Journal of Surgery 43, pp 22 –24 (2005)More Less
Gunshot wounds may result in intimal arterial injury without breach of the arterial wall integrity. Haemorrhage, haematoma and a pulse deficit are therefore not always found. We report on two cases of lower extremity gunshot wounds with temporal variations in the clinical and radiological assessment of the pedal pulses. In both cases surgical exploration revealed intact arterial vessel walls but significant intimal injury with overlying thrombus. We propose that the pulse deficits were due to distal thromboembolism. Subsequent clot lysis led to a return of the original pulse deficit. Variation in the distal pulses in patients with gunshot wounds of the extremities should alert one of the possibility of an intimal arterial injury; imaging of the vessels is therefore advised.