Appendecectomy (1)

Pt name: IQRA Age/ Sex: 22years/ Female

Reg number: 81947 Date of adm: 19-08-2015

Mode of admission: Emergency Status: Observer

Diagnosis: Acute appendicitis Surgeon: Dr.Sana

22 years old Female presented in emergency with complaint of Right iliac fossa for last
1 day. Pain was sudden in onset, severe in intensity, non-radiating, with no aggravating
factors and relieved only by I/v pain killers. Pain is associated with nausea nut no
vomiting, anorexia, low grade fever.

No history of Diarrhea, Constipation, burning micturition and foul smelling P/v discharge.
Pt LMP was 20 days back with regular menstrual cycle of 7/28 days.

On Examination: PR-92/min; BP-110/70; Temp-100oF; RR-18

On abdominal Examination: abdomen was non distended, soft, with tenderness and
rebound tenderness at Mc Burneys point, Bowel sounds audible.

Investigations revealed TLC-12600/cmm;

USG abdomen revealed no pelvic pathology

Patient was diagnosed as ACUTE APPENDICITIS and underwent Open appendectomy

with perop findings of Inflammed appendix containing faecolith .

Procedure:

After aseptic measures, gridiron incision made, Subcutaneous tissue dissected,

External oblique aponeurosis was cut in the direction of line of incision, internal oblique
and transversusabdominus muscles retracted, peritoneum was cut. Appendix identified
and delivered, appendix found inflammed ,mesoappendix ligated and cut, appendix
ligated at its base, appendesectomy done. Haemostasis secured. Wound closed in
reverse order , skin stitched with prolene 2/0. ASD done

Patient was shifted to the ward. Post operative recovery was uneventful. Patient started
taking orally after 8 hours of the procedure. Patient was discharged on 2 ndpost operative
day, and was called for the follow up.
Appendecectomy (2)
Pt name: Hafiz Bilal Age/ Sex: 18years/ male

Reg number: 84520 Date of adm: 26-08-2015

Mode of admission: Emergency Status: Observer

Diagnosis: Acute appendicitis Surgeon: Dr. SAAD

18 years old male presented in emergency with complaint of Right iliac fossa for last 2
days. Pain was sudden in onset, severe in intensity, non-radiating, with no aggravating
factors and relieved only by I/v pain killers. Pain was aassociated with nausea nut no
vomiting, anorexia, low grade fever.

No History of Diarrhea, Constipation or burning micturition.

On examination : PR-98/min; BP-110/70; Temp-100oF; RR-18

On abdominal: abdomen was non distended, soft, with tenderness and rebound
tenderness at Mc Burneys point, Bowel sounds audible.

Inverstigations revealed TLC-14300/cmm;

USG abdomen revealed no pelvic pathology

Patient was diagnosed as ACUTE APPENDICITIS and underwent Open appendectomy.

Procedure:

After aseptic measures, gridiron incision made, sub cutaneoustissue dissected, External
oblique aponeurosis was cut in the direction of line of incision, internal oblique and
transversusabdominus muscles retracted, peritoneum was cut. Appendix identified and
delivered, appendix found inflammed ,mesoappendix ligated, cut, appendix ligated at its
base, appendesectomy done. Haemostasis secured. Wound closed in reverse order ,
skin stitched with prolene 2/0. ASD done

Per OP findings: Highly Inflammed appendix containing faecolith

Patient was shifted to the ward. Post operative recovery was uneventful. Patient started
oral intake after 8 hours of the procedure. Patient was discharged on 2 ndpost operative
day, and was called for the follow up.
Inguinal Hernia (1)
Patient Name: Sharjeel Age/sex: 35 years/ male

Reg number: 77908 Date of admission: 9/8/2015

Surgeon: DrAFIFAMode of admission: Out Patient department

Status: Observer

Patient known smoker for last 12 years presented with complaint of Right sided inguino
scrotal swelling for last 3 years. Swelling was associated with dragging type of pain
which gets worse as the day passes. Swelling use to disappear on lying down. There
was no history of constipation, vomiting. There is no history of obstructive and irritative
urinary symptoms.

On examination: Right sided Inguino-scrotal swelling with positive cough impulse

reaching upto the bottom of the scrotum, with upper limit not reachable, reducible, non
tender, On occlusion of the deep inguinal ring swelling didnt appear.

USG abdomen/pelvis revealed no ascites,, no visceromegaly, no abdominal mass, post

voiding residual urine volume was nill.

Patient was diagnosed as having Right sided, reducible, complete Indirect Inguinal
Hernia.

Under Spinal anaesthesia, area surgically prepared and drapped, supra inguinal
transverse incision made about 2cm above ingunal ligament, sub cutaneous tissue
dissected uptil external oblique aponeurosis, external oblique aponeurosis was cut in
the lines of the incision including superficial inguinal ring, contents of the cannal along
with sac lifted, sac separated from the contents of the cannal, Sac opened transfixation
of the sac done at the level of the deep inguinal ring, polypropylene mesh 15*8cm
placed and fixed with prolene 2/0 for posterior wall reinforcement, haemostasis secured,
external oblique aponeurosis closed by absorbable suture , skin stitched with prolene
2/0, aseptic dressing applied.
Patient underwent uneventful recovery and was discharged on first post operative day
with no evidence of scrotal edema. Patient was advised for wound care and avoidance
of carrying heavy loads, cessation of smoking, and prevention of constipation and
cough. Patient was called for follow up after 7 days.

Inguinal Hernia (2)

Patient Name: GhulamDastageer Age/sex: 40 years/ male

Reg number: 88523 Date of admission: 6/9/2015

Surgeon: Dr. YASEENMode of admission: OPD

Status: Observer

Patient presented with complaint of Right sided inguino-scrotal swelling for last 2 years.
Swelling was associated with dragging type of pain. Swelling use to disappear on lying
down. There was no history of constipation, vomiting. There is no history of obstructive
and irritative urinary symptoms.

On examination: Right sided Inguino-scrotal swelling with positive cough impulse, not
reaching upto the bottom of the scrotum, with upper limit not reachable, reducible, non
tender, On occlusion of the deep inguinal ring swelling didnt appear.

USG abdomen/pelvis revealed no ascites,, no visceromegaly, no abdominal mass, post

voiding residual urine volume was nill.

Patient was diagnosed as having Right sided, reducible, Incomplete Indirect Inguinal
Hernia.
Under Spinal anaesthesia, area surgically prepared and drapped, supra inguinal
transverse incision made about 2cm above ingunal ligament, sub cutaneous tissue
dissected uptil external oblique aponeurosis, external oblique aponeurosis was cut in
the lines of the incision including superficial inguinal ring, contents of the cannal along
with sac lifted, sac separated from the contents of the cannal, Sac opened transfixation
of the sac done at the level of the deep inguinal ring, polypropylene mesh 15*8cm
placed and fixed with prolene 2/0 for posterior wall reinforcement, haemostasis secured,
external oblique aponeurosis closed by absorbable suture , skin stitched with prolene
2/0, aseptic dressing applied.

Patient underwent uneventful recovery and was discharged on first post operative day
with no evidence of scrotal edema. Patient was advised for wound care and avoidance
of carrying heavy loads, cessation of smoking, and prevention of constipation and
cough. Patient was called for follow up after 7 days.

Perforated Duodenal Ulcer (1)

Pt name: Noor Muhammad Age/sex: 50years/male

Reg number: 86122 Date of admission: 2/9/2015

Mode of adm: Emergency Surgeon: Dr MUNEEZA

Status: Observer

Patient presented in accident and emergency department with complaint of severe

abdominal pain for last 2 days, sudden in onset, pain started in epigastrium later on
became generalized for last 1 day, pain aggaravated while movements and only
relieved by injectable painkillers. Abdominal pain was also associated with abdominal
distension for last 2days, also sudden in onset after start of pain, distension
progressively increased, not relieved by medicine at home.

No history of cough, diarrhea, constipation

Patient had history of painkillers intake for last 5 years for joint pains along with some
herbal remedies for pain relief.

On examination: pulse 110/min, BP: 100/70mmhg, Temp: 100F, Resp. rate: 20/min

Abdominal examination revealed distended abdomen with generalized tenderness with

maximum tenderness in epigastrium.

Investigations revealed TLC-18500/cmm;

X ray abdomen erect film revealed gas under Right Diaphram.

Patient diagnosed as Peritonitis and planned Exploratory Laparatomy under general

anaesthesia.

After aseptic measures abdomen opened by an upper midline incision. Skin and
subcutaneoustissues are incised. Linea alba is incised in the same line. The surgical
peritoneum is lifted up in-betweentwo pairs of hemostatic forceps and incised in-
between the pairs of hemostatic forceps. Theperitoneum incision is then extended up
and down. As soon as the peritoneum is incised,gas and bile stained peritoneal fluid
escape. The peritoneal fluid is aspirated and the site of perforation is localized. The liver
is retractedby a Deavers retractor and the stomach is drawn downward by the assistant
using a moist sponge. The distal stomach and the duodenum is inspected. Four
interrupted vicrylsutures are insertedalong the axis of the gut around perforation. The
central stitch traverses through the center of the perforation. Tag of omentum was
placed over the site of perforation and the sutures are tiedover the omentum.After
closure of the perforation the meticulous peritoneal toilet is done. The
subphrenicpaces,paracolic gutters and the pelvis are cleared of all turbid fluid and these
areas are irrigatedwith normal saline and the lavage fluid aspirated back. A drain is
placed in the Pelvis. The peritoneum and the lineaalba is closed with a continuous no. 1
polypropylene sutures. Skin stitched with prolene 2/0. Aseptic dressing applied.
Patient shifted to inpatient department and underwent uneventful recovery. Patient
started taking orally on 4th post-operative day. Patient was discharged on 5th post-
operative day. Patient was advised for wound care, avoidance of smoking, and
meticulous usage of painkillers. Patient was given H-pylori eradication therapy and was
called for follow up after 7 days.
Perforated Duodenal Ulcer (2)
Pt name: Shoaib Age/sex: 62years/male

Reg number: 97889 Date of admission: 30/9/2015

Mode of adm: Emergency Surgeon: Dr. yaseen

Status: Observer

Patient presented in A&E department with complaint of severe abdominal pain for last 3
days, sudden in onset, pain started in epigastrium and became generalized for last 2
days, pain aggaravated while movements and only relieved by injectable painkillers.
Abdominal pain was also associated with abdominal distension for last 2 days,
distension progressively increased, not relieved by medicine at home.

No history of cough, diarrhea,but patient complained of constipation since start of

abdominal pain.

Patient had history of medicine intake for last 5 years for joint pains, and swelling of
joints (record not available at admission) along with some herbal remedies for pain relief.

On examination: pulse 120/min, BP: 100/60mmhg, Temp: 101F, Resp. rate: 20/min

Abdominal examination revealed distended abdomen witheverted umbilicus and

generalized tenderness on superficial and deep palpation with maximum tenderness in
epigastrium. There was no shifting dullness or fluid thrill.

Investigations revealed TLC-20000/cmm;

X ray abdomen erect film revealed gas under Right Diaphram.

Patient diagnosed as Peritonitis and planned Exploratory Laparatomy under general

anaesthesia.

After aseptic measures abdomen opened by an upper midline incision. Skin and
subcutaneous tissues are incised. Linea alba is incised in the same line. The surgical
peritoneum is lifted up in-between two pairs of hemostatic forceps and incised in-
between the pairs of hemostatic forceps. The peritoneum incision is then extended up
and down. As soon as the peritoneum is incised, gas and bile stained peritoneal fluid
escape. The peritoneal fluid is aspirated and the site of perforation is localized. The liver
is retracted by a Deavers retractor and the stomach is drawn downward by the
assistant using a moist sponge. The distal stomach and the duodenum is inspected.
Four interrupted vicryl sutures are inserted along the axis of the gut around perforation.
The central stitch traverses through the center of the perforation. Tag of omentum was
placed over the site of perforation and the sutures are tied over the omentum. After
closure of the perforation the meticulous peritoneal toilet is done. The subphrenic paces,
paracolic gutters and the pelvis are cleared of all turbid fluid and these areas are
irrigated with normal saline and the lavage fluid aspirated back. A drain is placed in the
Pelvis. The peritoneum and the lineaalba is closed with a continuous no. 1
polypropylene sutures. Skin stitched with prolene 2/0. Aseptic dressing applied.
Patient shifted to inpatient department and underwent uneventful recovery. Patient
started taking orally on 5th post-operative day. Patient was discharged on 6th post-
operative day. Patient was advised for wound care, avoidance of smoking, and
meticulous usage of painkillers. Patient was given H-pylori eradication therapy and was
called for follow up after 7 days.

Below know amputation (1)

Pt name:MuhammadMunneer Age/sex: 38 years/male

Reg number: 93082 Date of admission: 16/9/2015

Mode of adm: Emergency Surgeon: Dr SANA

Status: Observer

38 years old male known diabetic presented in emergency with history of blackening of left forefoot for
last 15 days. Colour change was gradual in onset, painless, initially started from left big toe then involved
all fingers. Colour change was also associated with foul smell from left foot.

O/E: BP-130/90mmhg, Pulse-86/min regular, Temp-99F, R/R: 16/min

Local examination: local examination of left lower limb revealed dry gangrene of left
forefoot ,dorsalispaedis and posterior tibial artery were not palpable. Popliteal artery and femoral artery
were palpable. No crepts palpable.

Doppler studies of left lower limb revealed Biphasic flow below left popliteal artery

Diagnosis of Grade V diabetic foot was made

Patient was planned Below Knee amputation.

After spinal anaesthesia, incision marked, area surgically prepared and drapped, long posterior flap
incision made, incision joined posteriorly, incision deepened down to tibia anteriorly,
periosteum of tibia elevated 1cm proximal to incision, tibia divided with giglisaw,further dissection
done, fibula was cut 1cm proximally, posterior tibial and peroneal vessels identified and
ligated,posteriortibial nerve divided and allowed to retract, distal limb separated,haemostasis secured,
bones covered by muscle flap. Drain placed, stump made, stump closed, skin stitched with prolene
number 2/0. Aseptic dressing applied.

Patient shifted to the ward.

Patient was discharged on the second post operative day and was referred to rehabilitation unit.

PARA UMBILICAL HERNIA (1)

Pt name: ShahidaParveen Age/sex: 48 years/Female

Reg number: 77750 Date of admission: 10/8/2015

Mode of adm: Out-Patient Department Surgeon: Dr SULTAN

Status: Observer

48 years old female patient presented in OPD with complaint of swelling around the
umbilicus for last three years. The swelling was initially small in size at the onset but for
last three years the swelling is gradually increasing in size and attained the present size.
The swelling increases in size during walking and during strenuous activities and
reduces in size on lying down. Complains of dull aching pain over the swelling for last 6
months.
No history of vomiting, abdominal pain, constipation etc.
No history of previous surgery, gynecological history revealed G3P3 , with all
spontaneous vaginal deliveries.
Vitals: Pulse:80/min: BP: 120/70 mmhg: Temp:98F : Respiratory rate: 16/min
On examination: On local examination, there is a swelling in the umbilical region. The
whole umbilicus is stretched and thinned out. The swelling shows expansile impulse on
cough. The swelling is reducible on lying down position and with slight manipulation of
the contents. There is gurgling sound during reduction of the contents of the swelling. A
gap of about 3 cm is palpable in the lineaalba. Rest of abdominal examination was
unremarkable.
Patient was planned for OnlayHernioplasty.
After aseptic measures area surgically prepared and drapped. Transverse elliptical
incision is made around the umbilicus. The skin and the subcutaneous tissue is
dissected off from the rectus sheath to expose theneck of the sac. Findings confirmed.
The hernial sac is opened at the neck and the contents are returned into the abdomen.
The redundant sac is excised and rent closed with prolene #1. A polypropylene mesh is
placed with prolene 2/0 over the anterior rectus sheath covering about4 cm, area all
around the gap. The mesh is fixed to the anterior rectus sheath by interrupted sutures.
A suction drain is kept in the subcutaneous space. The skin is closed with prolene 2/0
by interrupted ,matress sutures. Aseptic dressing applied.
Findings: Hernial sac containing omentum. Rent in of about 3cm in lineaalba 2 cm
above umbilicus
Patient was shifted to the ward. Patient underwent uneventful recovery and was
discharged on 2ndpost operative day and was called for follow up after 7 days.

ANAL FISSURE (1)

Pt name: Ashraf Age/sex: 48 years/male

Reg number: 92843 Date of admission: 16/09/2015

Mode of adm: Out-Patient Department Surgeon: Dr AFFIFA

Status: Observer

28 years old male, presented in surgical OPD with complaint of pain during defecation
for last 2 months. Pain was sudden in onset, severe in intensity, lasted for 3 days then
decreased in intensity after use of medicine by a general practitioner, pain aggravated
while passing stool. Pain was also associated with bleeding per rectum for last 2
months, also sudden in onset, started after the onset of the pain, with a streak of blood
around stool.

Patient has history of on and off chronic constipation for last 2 years. No complaint of
fever, diarrhea, abdominal pain, or burning micturition etc. Patient has history of
medicine intake both oral and local applicants for last 2 months for this pain from a GP,
record not available on admission.

Vitals: BP-120/80mmHg, Pulse-78/min, Temp-98F, R/R-16/min

On examination: Abdomen was soft and non-tender. No visceromegaly.

DRE: Patient didnt allow due to pain.

Baseline laboratory investigations were done and Lateral Sphincterotomy was planned
for the patient on elective list.

Patient was put in lithotomy position. After aseptic measures area was surgically
prepared and drapped. Manual dilatation of anal cannal done, DRE was done,
proctoscopy was done, findings were confirmed, transverse incision made at 3o clock
position, internal anal sphincter localized, sphincterotomy done, haemostasis secured,
aseptic dressing applied.
Patient was shifted to the ward. Post Op recovery remained uneventful. Patient started
taking orally 6 hours after procedure and was discharged on the first post-operative day
and called for follow up after 5 days.

I/V line maintainenance:

Pt name: Age/sex:

Reg number: Date of admission:

Mode of adm: A&E Surgeon: performed independently

Patient admitted in surgical emergency with history and findings suggestive of peritonitis.
For pre-operative preparation patients Intravenous line was taken. Patient was
explained that an intravenous line is to be set up for which a needle is required to be
punctured through his skin into the vein.

A tourniquet applied above the elbow and the patient asked to close and open the fist
few times to make the veins visible. The selected site is cleaned with an alcohol swab.
The cannula number 18 is opened from the sterile pack and held with two wings
together with the bevel of the needle pointing upward. The vein is steadied and the skin
and subcutaneous tissue is punctured with the cannula keeping the cannula at about 15
degrees to the skin.The needle is further advanced few millimeter inside the vein. The
needle is withdrawn slightly, intravenous position of cannula confirmed by flow of bood
through cannula and the plastic cannula is advanced into the vein over the metal needle.
The metal needle and the tourniquet are removed.The cannula is secured in place by a
sterile dressing and adhesive tape. I/V fluid attached to cannula.
Insertion of nasogastric tube

Pt name: Age/sex:

Reg number: Date of admission:

Mode of adm: A&E Surgeon: performed independently

Patient admitted in surgical emergency with history and findings suggestive of Intestinal
obstruction. Nasogastric decompression via nasogastric tube was planned to be
inserted.The patient was explained that a tube needs to be inserted through his nose.
Patient has to swallow the tube and there may be some cough during insertion of the
tube. Ryles tube no.16 Fr was lubricated with 2% xylocaine gel.Ryles tube inserted
horizontally through the left nostril. The tube is then slowly advanced as the patient is
asked to swallow the tube. The tube is further advanced till the second ring in thetube
lies at the level of nostril. Patency of the tube in stomach confirmed by spontaneous
gastric contents drainage due to distended stomach. The tube is secured to the nose
with an adhesive tape. The tube is then connected to a plastic drainage bag to drain out
the stomach contents.

FOLEYs CATHETERIZATION (1)

Pt name: Age/sex:

Reg number: Date of admission:

Mode of adm: A&E Surgeon: performed independently

-------years old male admitted in A&E with history and findings suggestive of Peritonitis
due to gut perforation. Patient was optimized for surgery. For monitoring of input and
output record Foleys catheterization planned. Patient was explained the nature of
procedure. After aseptic measures, area drapped, 20 mL of 2% xylocaine taken in the
syringe and introduced through the external urethral meatus into the urethra and the
external urethral meatus pressed to prevent the jelly spilling out. The undersurface of
the penis was massaged to allow the jelly to go further down. After 5 minutes wait, the
lubricated Foley's catheter is then pushed gently through the external urethral meatus
and gradually advanced till it reached the bladder. The catheter is advanced a little
further. About 1520 mL of water is introduced through the side channel of the catheter
to inflate the balloon. After the balloon is inflated the catheter was pulled outward to
confirm that the balloon is properly inflated. The catheter was then connected to an
urobag.

ARTERIAL BLOOD GAS SAMPLING

Pt name: Age/sex:

Reg number: Date of admission:

Mode of adm: A&E Surgeon: performed independently

Patient admitted in inpatient department with history and findings suggestive of Acute
Pancreatitis. Arterial blood gas analysis was planned to evaluate the severity of
pancreatitis. Patient was explained about the procedure and consent was taken. Right
radial artery puncture planned. With supinated right forearm the area cleaned with an
alcohol swab and the radial artery is palpated. 0.1 mL of heparin is drawn into a 2 mL
syringe. The radial pulse is felt with the index and the middle fingers. Inbetween the
index and the middle fingers the right radial artery is punctured by a vertically held 23
gauge needle on a 2 mL syringe.About 1.5ml of blood withdrawn.The needle is
withdrawn and firm pressure was applied over the puncture site for about 3minutes and
a dressing applied over the puncture site. The Syringe sealed with a plastic cap and
placed over ice. Sample sent to the laboratory immediately.

Rays amputation (1)

Pt name: Age/sex:

Reg number: Date of admission:

Mode of adm: A&E Surgeon: Dr. Yaseen / Observer

Cricothyridotomy:
Pt name: Age/sex: 30/F

Reg number: 11817 Date of admission: 10-02-2016

Mode of adm: A&E Surgeon: Cricothyroidotomy

30 years old female admitted in surgical emergency with history of accidental flame
burn while cooking in the kitchen 3 hours back. Examination revealed total burn surface
area of approximately 45% along with signs and symptoms suggestive of inhalational
burn injury of upper respiratory tract. Emergency cricothyroidotomy was planned.
Informed consent taken.
After aseptic measures patients positioned supine with neck extended and shoulders
elevated on a small roll. Area surgically prepared and draped. Local anaesthesia
infiltrated. Horizontal incision made along cricothyroid membrane upto 3 cm long.
Subcutaneous tissue dissected. Cricothyroid membrane approached and punctured,
dilatation done, tracheostomy tube inserted, stylet removed, cuff of tube inflated,
tracheostomy tube attached with oxygen tube, tracheostomy tube secured with skin
sutures by silk no. 1. Incision wound closed with prolene 2/0. Aseptic dressing done.
Patient was admitted to the ward.

Fistulla InAno:
Pt name: Age/sex: 45/ M

Reg number: 4195 Date of admission: 13-01-2016

Mode of adm: Opd Surgeon:

Status: Assistant

Patient admitted from surgical Opd with complaint of discharge from an opening near
perianal region for last 2 months. Patient had history of perianal abscess 3 months back
for which he undergone incision and drainage. Discharge was gradual in onset, painless,
blood stained, without any aggravating and relieving factors. There was no history of
trauma, constipation, diarrhea, or bleeding per rectum.

On Digital rectal examination: External opening was found at 1 O clock position about
1.5 cm from anal verge. Area of induration was palpable also at 1O clock position about
1cm in anal canal. Scar mark of previous incision and drainage was found at 2 to 4O
clock position.

Patient was admitted in the ward and Fistulectomy was planned.

Procedure: After aseptic measures patient was given saddle block anaecthesia. Patient
was put in lithotomy position, area was surgically prepared and drapped. Digital rectal
examination done, Proctoscopy done, Findings confirmed. Incision made around the
external opening, tract dissected and excised, biopsy of excised tract made.
Haemostasis secured, wound left open, aseptic dressing applied.

Per op findings: External opening was found at 1 O clock position about 1.5 cm from
anal verge in perianal region. Internal opening was found at 1O clock position about 1
cm from anal verge in anal cannal.
Patient was shifted to the inpatient facility. Post op recovery remained uneventful and
patient was discharged on the first post operative day.

Carbuncle excision:
Pt name: Age/sex: 38/ Female

Reg number: 128902 Date of admission: 28-12-2015

Mode of adm: A&E Surgeon:

Status:

38 years old female diabetic patient admitted in surgical emergency ward with history
and examination findings suggestive of carbuncle at the back of left shoulder. Patient
was resuscitated and investigated. Carbuncle excision planned in emergency operation
theatre and patient was prepared.

Patient was given general anaesthesia. After aseptic measures area surgically prepared
and drapped. Cruciate incision made, all necrotic tissue removed. Haemostasis secured.
Wound washed with normal saline. Aseptic dressing was applied. Patient was shifted to
the ward. Patient was discharged on the 3rdpost operative day with followup in
outpatient department.

Sebaceous cyst:
Pt name: Age/sex: 25/ Female

Reg number: 101730 Date of admission: 10-10-2015

Mode of adm: A&E Surgeon:

Status:
Patient presented with complains of a slowly growing swelling on the back of the left
shoulder for last 2 years. The swelling was growing slowly in size since last 1 year.
Patient complained of occasional discharge of grayish-white material from the swelling,
which had offensive smell. There was no other swelling in other parts of the body.On
examination: A globular soft cystic swelling 4 cm in diameter was found on the back of
the left shoulder. Surface was smooth,margins are well defined. There wass a punctum
on the surface of the swelling and the skin was fixed to the swelling. Transillumination
was negative. Clinical diagnosis as sebaceous cyst was made and excision biopsy
planned on elective list.
After aseptic measures , area drapped, local anaesthetic infiltrated, an elliptical incision
made around punctum of the swelling, sharp dissection done over the capsule of the
swelling and lump dissected from the surrounding tissue care was taken not to rupture
the capsule. Lump excised, haemostasis secured. Wound closed with prolene 2/0.
Aseptic dressing applied. Lump sent for histopathology. Per op findings revealed a
cystic swelling of 4 cm.
Patient was discharged on the same day with advised about wound care, and follow up
after 10 days.

Venous cut-down: (1)

Pt name: Age/sex: 26/ F

Reg number: 1273 Date of admission: 06-01-2016

Mode of adm: A&E Surgeon:

26 years old female patient admitted in surgical emergency with history of Flame burn 2 hours
back. At presentation patient was in the state of shock. For resuscitation peripheral venous line
and central venous lines attempt failed. Right great saphenous vein cut-down planned.

After aseptic measures, area surgically prepared and drapped. Local anaesthesia infiltrated.
Incision made 2cm above right medial maleolus. Subcutaneous tissue dissected, vein exposed, 2
ligatures passed at proximal and distal end. A curve needle passed through half diameter of the
vein. Anterior surface at the needle incised. No 6 fr feeding tube inserted. Cut-down done.
Intravenous fluid attached to the catheter. Both ligatures tied by looking at the flow point of drip
set. Wound stitched with prolene no 1. Aseptic dressing applied

Venous cut-down: (2)

Pt name: Age/sex: 16/ M
Reg number: 30310 Date of admission: 06-04-2016

Mode of adm: A&E Surgeon:

16 years old male patient admitted in surgical emergency with history of road traffic accicent 1
hour back. At presentation patient was in the state of shock. For resuscitation peripheral venous
and central venous line attempts failed. Right great saphenous vein cut-down planned.

After aseptic measures, area surgically prepared and drapped. Local anaesthesia infiltrated.
Incision made 2cm above right medial maleolus. Subcutaneous tissue dissected, vein exposed, 2
ligatures passed at proximal and distal end. A curve needle passed through half diameter of the
vein. Anterior surface at the needle incised. No 6 fr feeding tube inserted. Cut-down done.
Intravenous fluid attached to the catheter. Both ligatures tied by looking at the flow point of drip
set. Wound stitched with prolene no 1. Aseptic dressing applied

TYPHOID PERFORATION: (open close abd)

Pt name: Age/sex: 38/ M

Reg number: 30290 Date of admission: 06-04-2016

Mode of adm: A&E Surgeon:

38 years old female admitted in surgical emergency with history, and examination
findings suggestive of peritonitis. Patient was resuscitated, investigated, and optimized
for surgery. Nasogastric intubation done for decompression. Folleys catheterization
done. Patient and attendants were explained about condition of the patient and
informed consent for exploratory laparatomy was taken. Exploratory laparatomy with
loop ileostomy was done in surgical emergency. Per operative findings revealed 1) 2
liters of gut contents in peritoneal cavity. 2) 1*0.5cm perforation at anti mesenteric side
of terminal ileum about 1 and half feet proximal to IC junction. 3) Enlarged multiple
mesenteric lymphnodes. Lymph node biopsy was taken and sample was sent to
pathology department for histopathology.

Patient was shifted to the ward. Post operative recovery remained uneventful. Patient
started taking orally at 4th post operative day.. Patient was discharged at 5th post
operative day and was called for follow-up in outpatient department.
 Intestinal obstruction: (adhesion)
Pt name: Age/sex: 45/ M

Reg number: 45457 Date of admission: 11-05-2016

Mode of adm: A&E Surgeon:

45 years old male was admitted in surgical emergency with history and examination
findings suggestive of acute intestinal obstruction. Patient had history of exploratory
laparatomy for blunt abdominal trauma due to RTA, in which resection of half feet
portion of terminal ileum 2 feet proximal to IC junction was done and ileostomy was
done. Patient was resuscitated, investigated and provisional diagnosis was adhesion
obstruction. Nasogastric decompression and folleys catheterization was done. Patient
and attendants were explained about condition of the patient and informed consent for
exploratory laparatomy was taken. Exploratory laparatomy with adhesiolysis was done
in surgical emergency. Per operative findings revealed 1) Collapsed caecum. 2) densely
adherent gut loops with each other and to abdominal wall. 3) adhesion causing
obstruction of gut about 1 and half feet proximal to IC junction, with dilated gut
proximally and collapsed distally.

Patient was shifted to the ward. Post op recovery remained uneventful. Patient started
taking orally on 3rd post operative day. Patient was discharged on 4th post operative day
and was called for followup in surgical outpatient department.

FIRE ARM INJURY OF THE ABDOMEN:

Pt name: Age/sex: 29/ M

Reg number: 39701 Date of admission: 06-04-2016

Mode of adm: A&E Surgeon:

24 years old male patient admitted in surgical emergency with history of fire arm injury to the
abdomen. On examination there was a 1*0.5 cm puncture wound at umbilical region. Patient was
resuscitated, blood transfusions given. Patient was investigated and optimized for surgery.
Exploratory laparatomy with resection anastomosis of half foot terminal ileum plus loop
ileostomy was done . Per operative findings revealed 1) 1.5 liters of blood in peritoneal cavity 2)
3*2cm horizontal tear of mesentery of terminal ileum with half foot area of doubtful viability
about 2feet proximal to IC junction. 3) 2*1cm perforation of terminal ileum about 2 feet
proximal to IC junction.

Patient was shifted to the ward. Post operative recovery remained uneventful. Ileostomy stomy
started draining on 3rd post operative day. Patient started taking orally on 4th post operative day.
Patient was discharged on 5th post operative day and was called for followup in out-patient
department.

BLUNT ABDOMINAL TRAUMA: (open close abd)

Pt name: Age/sex: 29/ M

Reg number: 42867 Date of admission: 14-05-2016

Mode of adm: A&E Surgeon:

29 years old male admitted in surgical emergency with history of fall from motorbike in a
road traffic accident. Patient was resuscitated, examined, investigated, and diagnosed
to have blunt abdominal trauma. Patient and attendants were explained about condition
of the patient and informed consent for exploratory laparatomy was taken. Exploratory
laparatomy was done with intraoperative findings revealed 1): 500ml of blood in
peritoneal cavity with minimal contamination of gut contents 2): 2*3cm perforation of
terminal ileum about 2 feet from IC junction. Peritoneal lavarge was done and primary
resection anastomosis of terminal ileum was done, abdomen was closed in a reverse
order.

Patient was shifted to the ward. Post operative recovery remained uneventful. Patient
started taking orally on 5th post operative day. Patient was discharged on 6th post
operative day and was called in out patient department for follow-up.
 Debridement for Fournier gangrene:
Pt name: Age/sex: 60/ M

Reg number: 125490 Date of admission: 26-12-2015

Mode of adm: emergency Surgeon:

Diagnosis: Fournier gangrene

Status: Assistant

60 years old male admitted in surgical emergency with history and findings suggestive of
Fournier gangrene. Patient was resuscitated, investigated and planned for debridement in surgical
emergency. Informed consent was taken regarding extensive debridement. Patient was optimized
and prepared for debridement in spinal anaesthesia.

Patient was given spinal anaesthesia. Lithotomy position was made. After aseptic measures area
was surgically prepared and drapped. Incision was made around scrotum at surrounding normal
skin, all necrotic tissue was debrided, testes exposed, wound washed with normal saline,
haemostasis secured. Aseptic dressing applied.

Patient was shifted to the ward. Daily dressing was done. Sitz bath advised. Patient was
discharged on 1st post operative day. Patient was called for follow-up in surgical OPD after 5
days.

CERVICAL LYMPH NODE BIOPSY:

Pt name: Age/sex: 16/ F

Reg number: 17199 Date of admission: 27-02-2016

Mode of adm: OPD Surgeon:

Diagnosis: Right cervical lymphadenopathy

Status: Assistant

16 years old female admitted in inpatient department with history and findings suggestive of
right cervical lymphadenopathy. Patient was investigated and for diagnosis cervical lymph node
biopsy planned on elective list.
After aseptic measures, area surgically prepared and drapped, local anaesthetic infiltrated.
Horizontal incision made along the prominent part of swollen lymphnode at right side of neck.
Subcutaneous tissue dissected and lymphnode exposed. Base of lymphnode tied with vicryl 2/0.
Lymphnodeescised. Haemostasis secured. Wound closed in reverse order.Biopsy made and sent
to the pathology department for histopathology.

Patient was discharged on 1st post operative day and was called for followup on OPD basis.

Haemorrhoids: (Proctoscopy): (1)

Pt name: Age/sex: 52/ M

Reg number: 109127 Date of admission: 08-11-2015

Mode of adm: OPD Surgeon:

Diagnosis: Second degree Haemorrhoids

Status: Assistant

52 years old male admitted from surgical opd with history of bleeding per rectum for last 1 year
and something coming out of anal cannal on defecation for last 6 months. Patient planned for
proctoscopy on elective list.

Proctoscopy was done on elective list in local anaesthetic, with finding revealed second degree
haemorrhoids at 3 and 7 O clock positions. Band ligation was done at 3 and 7 O clock position.
Patient was discharged on the same day.

Haemorrhoids: (Proctoscopy): (2)

Pt name: Age/sex: 46/ M

Reg number: 15003 Date of admission: 17-02-2016

Mode of adm: OPD Surgeon:

Diagnosis: Third degree Haemorrhoids

Status: Assistant

46 years old male admitted from surgical opd with history of bleeding per rectum for last 1 year
and something coming out of anal cannal on defecation which needed manual reduction for last 6
months. Patient planned for proctoscopy, and proceed accordingly on elective list.

Spinal anaesthesia was given. Patient was positioned. Proctoscopy was done with findings
revealed third degree haemorrhoids at 3 and 11 O clock positions. Haemorrhoidectomy was
done at 3 and 11 O clock position. Patient was discharged on the first post operative day.

Hydrocele: (1)
Pt name: Age/sex: 31/ M

Reg number: 2140 Date of admission: 09-01-2016

Mode of adm: OPD Surgeon:

Diagnosis: Right Hydrocele

Status: Assistant

31years old male admitted from out-patient department with history and findings suggestive of
right sided Hydrocele. Patient was examined, investigated, and operated with Jabouleys
procedure. Patient was discharged on first post operative day.

Hydrocele: (2)
Pt name: Age/sex: 45/ M

Reg number: 31905 Date of admission: 06-04-2016

Mode of adm: OPD Surgeon:

Diagnosis: Left Hydrocele

Status: Assistant

45 years old male admitted from surgical out-patient department with history and findings
suggestive of left sided Hydrocele. Patient was examined and investigated. Jabouleys procedure
was done on elective list. Patient was discharged on the first post operative day.

Chest intubation(2)
Pt name: Age/sex: 28/ M

Reg number: 1904 Date of admission: 06-01-2016

Mode of adm: A&E Surgeon:

Diagnosis: Right Pneumothorax

Status: Assistant

28 years old male presented in surgical emergency with history of accidental fall from motorbike 2 hours
back, with complaint of Shortness of breath and right side chest pain. Vitals revealed: Pulse-110/min,
Blood pressure-90/70, Respiratory rate-30/min. Trachea was deviated to left on clinical examination. No
surgical emphysema. On Auscultation breath sounds were absent at Right chest and percussion note
was resonant over Right lobe.

Diagnosis of tension pneumothorax was made and needle decompression of right pleural space was
done followed by chest intubation.

After Aseptic measures, local anaesthetic infiltrated in Right 5th Intercostal space anterior to mid-
axillary line. 3cm long Incision made, subcutaneous tissue and muscles dissected uptil intercostal space.
Parietal pleura punctured by inserting a hemostat along the upper border of the lower rib of 5th
intercostals space. Gush of air came out on insertion of chest tube. Chest tube attached with the
underwater seal. Air column movements seen. Chest tube fixed, Aseptic dressing applied.

Post Intubation X-ray chest done to confirm the position of the Chest tube. Patient was shifted to ward.
Chest physiotherapy done, Incentive spirometer use was encouraged. On 3rd post admission day
bilateral equal air entry noted on auscultation with fully expanded lungs on chest X-ray. Extubation was
done on 3rd post admission day. Patient was discharged.
 Obstructed inguinal hernia: (1)
Pt name: Age/sex: 37/ Male

Reg number: 126517 Date of admission: 19-12-2015

Mode of adm: A & E Surgeon:

Diagnosis: Obstructed right inguinal hernia

Status: Assistant

37 years old male admitted in surgical emergency department with complaint of severe
pain in right inguinoscrotal region for last 2 hours and irreducible inguinoscrotal swelling
for last 3 hours. Painn was also associated with 3 to 4 episodes of vomiting. Patient was
admitted, resuscitated, investigated and diagnosed to have obstructed right inguinal
hernia. Emergency herniotomy planned. Informed consent was taken.

Patient was given general anaesthesia. After aseptic measures area surgically prepared
and drapped. Right supra-inguinal incision made and extended upto scrotum.
Subcutaneous tissue dissected, superficial inguinal ring identified, sac opened in the
scrotum, viable loop of ileum found in the sac, external oblique aponeurosis was cut.
Contents were reduced, spermatic cord was lifted, hernia sac was separated from cord
contents, anatomical closure of the sac was done, posterior was was reinforced by
prolene 2/0. Wound was closed in reverse order. Skin was stitched with prolene 2/0.
Aseptic dressing was applied.

Patient was shifted to the ward for post operative care. Patient started taking orally on
2nd post operative day and was discharged.

Obstructed inguinal hernia: (2)

Pt name: Age/sex: 48/ Male

Reg number: Date of admission: 23-04-2016

Mode of adm: A & E Surgeon:

Diagnosis: Obstructed right inguinal hernia

Status: Assistant

48 years old male admitted in surgical emergency department with complaint of severe
pain in right inguinoscrotal region for last 8 hours and irreducible inguinoscrotal swelling
for last 6 hours. Pain was also associated with multiple episodes of vomiting. Patient
was admitted, resuscitated, investigated and diagnosed to have obstructed right
inguinal hernia. Emergency herniotomy planned. Informed consent was taken.

Patient was given general anaesthesia. After aseptic measures area surgically prepared
and draped. Right supra-inguinal incision made and extended up to scrotum.
Subcutaneous tissue dissected, superficial inguinal ring identified, sac opened in the
scrotum, 1 feet loop of small bowel (ileum) was found as contents of the hernia sac
which was gangrenous, external oblique aponeurosis was cut. Gut was delivered both
proximally and distally up to viable points, resection of the gangrenous portion of the gut
was done and end to end anastomosis of the proximal and distal gut was done.
Contents were reduced, spermatic cord was lifted, hernia sac was separated from cord
contents, anatomical closure of the sac was done, posterior was reinforced by prolene
2/0. Wound was closed in reverse order. Skin was stitched with prolene 2/0. Aseptic
dressing was applied.

Patient was shifted to the ward for post operative care. Patient started taking orally on
4th post operative day and was discharged.

Appendicitis: (3)
Pt name: Age/sex:

Reg number: Date of admission: 14-10-2015

Mode of adm: A & E Surgeon:

Diagnosis:

Status: Assistant

.. years old male presented in emergency with complaint of pain in Right iliac fossa
for last 8 hours. Pain was sudden in onset, severe in intensity, non-radiating, without
any aggravating factors or relieving factors. Pain was associated with nausea but no
vomiting. Patient was resuscitated, examined and investigated. Patient was diagnosed
as ACUTE APPENDICITIS and underwent Open appendectomy.

After aseptic measures, grid-iron incision made, subcutaneous tissue was dissected,
External oblique aponeurosis was cut in the direction of line of incision, internal oblique
and transverses abdominus muscles retracted, peritoneum was cut. Appendix identified
and delivered, appendix found inflamed, mesoappendix ligated, appendix ligated at its
base, appendesectomy was done. Haemostasis secured. Wound closed in reverse
order, skin stitched with prolene 2/0. ASD done

Per OP findings: Highly Inflammed appendix containing faecolith

Patient was shifted to the ward. Post operative recovery was uneventful. Patient started
oral intake after 8 hours of the procedure. Patient was discharged on 2 ndpost operative
day, and was called for the follow up.

Appendicitis: (4)

Pt name: Age/sex:

Reg number: Date of admission: 05-12-2015

Mode of adm: A & E Surgeon:

Diagnosis:

Status: Assistant

Patient presented in emergency with complaint of pain in right iliac fossa for last 10
hours. Pain was sudden in onset, severe in intensity, non-radiating, without any
aggravating factors or relieving factors. Pain was associated 4 to 4 episodes of vomiting.
Patient was resuscitated, examined and investigated. Patient was diagnosed as having
ACUTE APPENDICITIS and Open appendectomy planned in emergency..

Patient was given general anaesthesia. After aseptic measures, grid-iron incision made,
subcutaneous tissue was dissected, External oblique aponeurosis was cut in the
direction of line of incision, internal oblique and transverses abdominus muscles
retracted, peritoneum was cut. Appendix identified and delivered, appendix found
inflamed, mesoappendix ligated, appendix ligated at its base, appendesectomy was
done. Haemostasis secured. Wound closed in reverse order, skin stitched with prolene
2/0. ASD done

Per OP findings: Highly Inflammed appendix containing faecolith

Patient was shifted to the ward. Post operative recovery was uneventful. Patient started
oral intake after 12 hours of the procedure. Patient was discharged on 2ndpost operative
day, and was called for the follow up.

Perforated Appendicitis: (5)

Pt name: Age/sex:

Reg number: Date of admission: 17-02-2016

Mode of adm: A & E Surgeon:

Diagnosis:

Status: Assistant

Patient presented in emergency with complaint of right iliac fossa pain for last 14 hours.
Pain was sudden in onset, severe in intensity, shifted to umbilical area, without any
aggravating factors or relieving factors. Pain was associated 4 to 4 episodes of vomiting.
Patient was resuscitated, examined and investigated. Patient was diagnosed as having
ACUTE APPENDICITIS and Open appendectomy planned in emergency..

Patient was given general anaesthesia. After aseptic measures, grid-iron incision made,
subcutaneous tissue was dissected, External oblique aponeurosis was cut in the
direction of line of incision, internal oblique and transverses abdominus muscles
retracted, peritoneum was cut. About 50ml of pus was drained from right iliac fossa.
Appendix identified and delivered, appendix found inflamed and perforated its apex.
Mesoappendix was ligated, appendix ligated at its base, appendesectomy was done.
Dry mopping was done. Haemostasis secured. Wound closed in reverse order, skin
stitched with prolene 2/0. ASD done
Per OP findings: Highly Inflammed appendix with perforation at its apex. 50 ml of pus in
peritoneal cavity in right iliac fossa.

Patient was shifted to the ward. Post operative recovery was uneventful. Patient started
oral intake after 24 hours of the procedure. Patient was discharged on 3rd post operative
day, and was called for the follow up in outpatient department.