Background:The gold standard of quick and definitive treatment of Abdominal compartment syndrome (ACS) is surgical decompression by opening the abdomen and leaving it open until intra-abdominal pressure decreases. Temporary abdominal closure techniques are used to postpone definite closure until predisposing factors causing pathologic elevation of intra-abdominal pressure are resolved.This study aim to analyze feasibility of Bogota Bag placement as a way of temporary abdominal closure. Methods:Cases admitted in the period of eight years that were diagnosed to have or at risk to develop ACS and managed with 'Bogota Bag', irrespective of primary diagnosis were reviewed retrospectively. Cause of ACS, reasons to place Bogota bag, its complications and final outcome in terms of mortality related or not related with Bogota Bag placement were assessed. Results:Total of ten patients had placement of Bogota Bag in the period of eight years. Laparotomy for bowel perforation with peritonitis was the most common primary condition contributing to ACS. Bogota bag was placed in two cases after emergency decompression as a therapeutic measure whereas others were done as prophylactic measure. There were two mortalities (20%) which were not directly related to abdominal compartment syndrome. Conclusions:Abdomen closure with Bogota Bag for patients with ACS or likely to develop ACS is a feasible technique with minimal procedure related morbidities.

Fecalith is a concretion of dry compact feces or hard stony mass of faeces in the intestinal tract. Thoughappendicular fecoliths are commonly encountered, caecal fecoliths are rare entities. Fecoliths areamenable to conservative management with laxatives and enemas but surgical management preventsrecurrence. We present a case of 27 years old male who was diagnosed with acute appendicitis withperitonitis. He was intraoperatively diagnosed as gangrenous and perforated retrocaecal appendixwith multiple small fecaliths and a large fecalith on cecum with perforation. Appendectomy andprimary repair of caecal perforation done. Histological examination of perforated margin confirmedas an inflammatory lesion.

Introductions: Cases of colic of the vermiform appendix have been rarely described or diagnosed. Appendicoliths cause acute appendicitis and appendicular perforation. It is still not clear whether appendicoliths cause appendicular colic in the absence of acute appendicitis. Methods: A cross sectional study that included appendectomy done for recurrent appendicitis or chronic right iliac fossa pain. Histology reports were reviewed. The presence of an appendicolith in the report was noted. Results: Thirty-two cases of recurrent appendicitis and chronic right iliac fossa pain were included. Twenty-four patients (75%) had fecoliths in the histology specimens. Eight patients (25%) who presented with appendicular colic without signs of appendicitis were further evaluated. Conclusions: Majority of patients with chronic or colicky right iliac fossa pain had appendicoliths.

Abstract

Background: Emergency appendectomy is the commonest emergency surgical procedure being performed for many years. Till now, the dictum is that it should be done as soon as possible from the onset of attack. Objectives: To evaluate immediate surgical outcome in cases undergone appendectomy after hospital delay of more than 12 hours duration compared with appendectomy done immediately within 12 hours of presentation. Methods: This is a retrospective study of 118 patients on whom appendectomies were done between 1 st June 2008 to 31 st August 2010. These patients were divided into two groups on the basis whether the appendectomy was done ≤ 12 hours or >12 hours from the time of presentation in the hospital and intergroup comparison was made regarding length of hospital stay, rate of perforation and post operative complications. Results: A total of 118 patients were included in the study. Out of which 71(60.2%) were male and 47(39.8%) were female. Mean age of patients was 30.97 ± 12 years. Mean duration of hospital stay was 4.35 ± 1.75 days. In comparison of two groups of ≤ 12 hours or >12 hours from the time of presentation in the hospital, there were no statistically signifi cant difference in length of hospital stay (4.29 vs 4.4 days, p=0.7), rate of perforation of appendix (9.25% vs 10.93%, p=0.3) and post-operative wound infection (16.66% vs 17.18%, p = 0.9). Conclusion: Delaying an appendectomy for a valid reason can be considered. Prospective trials are required to establish fi ndings of this study.

Introduction Hydatid cyst is a common disease in Asian subcontinent produced by the larval stage of Echinococcus granulosus. The most common site of involvement is the liver. The mode of presentation can vary. The management of hydatid cyst includes medical treatment with albendazole, ultrasound guided aspiration and instillation of scolicidal agents as well as surgical treatment. Surgery can be perfomed by open or laparoscopic approach. The aim of this study is to analyze the cases of hydatid cyst of liver managed in our set up. MethodsThis is a retrospective study of 45 patients with hydatid cyst managed in Kathmandu Model Hospital over the last five years. Data were collected from the patients hospital records. Demographic parameters, chief complains, radiological findings, anti echinococcal immunglobulin findings, mode of management,complications of surgery were evaluated. ResultsMajority of our patients were female (66.7%). Mean age of the patients were 39±17.2 years (16 to 89 years).Most common symptom of presentation was pain in right upper quadrant of abdomen.Most common site of involvement was liver (93.33%)followed by spleen (4.4%). There was one case of ruptured pulmonary hydatid cyst which was referred.Operative management was done in patients (17.77%) out of which five patients (62.5%) underwent laparoscopic partial pericystectomy and omentoplasty.No major complications were encountered in any of the cases managed surgically. ConclusionMajority of cases occured in liver. Most cases were managed conservatively. Laparoscopic management of hydatid cyst is effective.