Biomedical subjects
Publications and source records attributed to D A Watters.
A case of cholangitis secondary to chronic pancreatitis is reported. A liver abscess ruptured into the chest and the patient presented coughing bile. Symptoms were cured by a choledochojejunostomy, providing drainage for the obstructed common bile duct. To our knowledge this is the first reported case of a bronchobiliary fistula developing as a result of chronic pancreatitis. The principles of treatment are discussed.
A case is reported in which an anastomotic leak following the Swenson procedure for Hirschsprung's disease was complicated by the development of a pelvic abscess that communicated freely with the epidural space. The child presented with signs and symptoms of an epidural abscess, but his myelogram was normal. The diagnosis was made by urografin enema. The child was treated by defunctioning colostomy and drainage of the pelvic abscess by enlarging the defect at the anastomosis site digitally. The epidural space drained freely to the pelvis and therefore laminectomy was not required. The possible etiology of such a communication is discussed.
Over a one year period, 2270 sports injuries were seen in the Accident and Emergency Department at the Royal Infirmary, Edinburgh. This represented 3.9% of the total new patients seen in that year. Football and rugby were the most frequent sports responsible for injury. Seventy-eight per cent of injured persons were 26 or under and 88.7% of injuries occurred in men. The two months with the most sports injuries were September and February; 74% (1683) patients stated they trained at least once a week and 85% (1895) played the sport in which they were injured at least once a week. Players who did not train were less likely to incur a severe injury than those who did. Fourteen per cent of the injuries were the result of foul play, but again foul play was less likely to cause a serious injury; 41% of injuries were to the lower limb; 45% of injuries were fractures, dislocations, lacerations and head injuries; 7% of patients required admission to hospital and 22% were referred to a clinic. Seventy-seven per cent of the referrals were to the orthopaedic department. The relevance of these figures to the accident and emergency workload is discussed.
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In a prospective trial of 103 patients undergoing appendicectomy, one group of patients had the appendix stump treated by ligation alone and the other group underwent ligation and invagination. The two groups of patients were similar with respect to age, sex, incision and degree of inflammation of the appendix. Perforated appendices were excluded and in neither group were drains used or antibiotics given. No significant difference between the two methods of treatment of the appendix stump was noted, either with respect to wound infection or postoperative stay in hospital.
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BACKGROUND: Trauma is responsible for about 30% of surgical admissions in Port Moresby. Vascular injuries are frequently missed due to inadequate assessment by primary health care workers and often present late with large aneurysms which are difficult to manage. The aim of this study was to identify the patterns of morbidity associated with traumatic false aneurysms complicating vascular injuries in Port Moresby General Hospital from January 1995 to July 1999. METHODS: A surgical database with 11,004 records was used to identify patients with a diagnosis of false aneurysm. Charts of patients with gunshot wounds, knife wounds and compound fractures were also reviewed to identify further cases with vascular injury. RESULTS: 51 patients were found to have had documented evidence of vascular injury requiring surgical repair within the study period. 21 patients with traumatic false aneurysm presented to Port Moresby General Hospital. 17 of the 21 patients were aged 11 to 40 years. There was only one female patient. Stab wounds (50%) were the commonest mode of injury followed by lacerations (23%) and fish bites (14%). The calf (42%), forearm (13%) and the head (13%) were the commonest sites involved. The time from insult to admission varied from 4 days to 11 years with the modal time being 14 days. Most patients presented with hard signs of false aneurysms (94%) and 81% of the patients were treated within five days. Ligation (67%) was the commonest operation, followed by excision (43%) and vascular repair (19%). There were no deaths or amputations in any of the patients with false aneurysms. CONCLUSION: False aneurysms are a not infrequent complication of vascular injuries. Greater awareness of the possibility of vascular injury is needed. Patients in Port Moresby often present after considerable delay. However, the diagnosis can be made clinically and the results of surgical exploration are good. Although colour Doppler ultrasound is a useful investigation it sometimes fails to identify the aneurysm because it requires blood flow to be present in the aneurysm.
BACKGROUND: Trauma is the commonest cause of surgical admission in Papua New Guinea, accounting for around 30% of cases in Port Moresby and over 40% in the highlands. The abdomen is traumatized in about 10-15% of trauma cases. In malarial endemic areas the enlarged spleen is particularly prone to rupture although earlier studies showed that this injury can often be managed conservatively. AIM: To determine the pattern and outcome of abdominal injury in the two largest cities, Port Moresby and Lae, in the 1990s. METHODS: A retrospective study of 213 adult admissions for abdominal trauma in Port Moresby and a prospective study of 98 adult abdominal trauma patients in Lae. In both centres malaria is endemic. Statistical analysis where appropriate was made using the chi2 test. RESULTS: Abdominal trauma was more likely to affect men outside the home and women in the home. Assault was responsible for 72% of cases of abdominal trauma. Women were assaulted by their husbands in two-thirds of cases. The spleen was the most likely organ to be injured, particularly in blunt trauma. Road traffic accidents caused only 10% of admissions with abdominal trauma. Most patients were admitted with a single injury. Splenic injury was managed nonoperatively in over 60% of cases. The negative laparotomy rate was 7% in Port Moresby and 20% in Lae, but negative laparotomy did not cause any deaths or extra morbidity. 17 patients (5.5%) died, the highest case fatality rate being 29% in a group of 31 patients with an injury severity score of 25 or greater. CONCLUSION: The pattern of abdominal trauma reflects the culture of Papua New Guinea and the different spectrum of risks to men and women. Once patients reach hospital they tend to do reasonably well although there is room for improvement, particularly with early assessment of the extent of the injury. The enlarged spleen is prone to injury and in those cases requiring laparotomy it is difficult to conserve. Many cases of ruptured spleen can be treated nonoperatively.
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