Background : Urinary retention is a common problem in the elderly. The incidence increases with age so that a man in his 70s has a 10% chance and a man in his 80s has more than 30% chance of having an episode of acute urinary retention. Inadequate management of the condition can lead to unnecessary morbidity and occasionally mortality. Increasing knowledge over the years of its pathophysiology has greatly improved the management. Thus, the objective of this study is to review the current concepts in the management of urinary retention in men. Materials and Methods: Current literature on the pathophysiology and management of urinary retention in men was reviewed. The PubMed database was searched using the key words; pathophysiology, management, urinary retention, and men. Results: Urinary retention is a common problem in the elderly worldwide; the incidence rises with age, and by the 9th decade of life, a man has more than 30% chance of an episode of retention. There are three main pathophysiologic mechanisms: Increased urethral resistance secondary to bladder outlet obstruction, impaired bladder contractility, and loss of normal bladder sensory or motor innervations. It may be acute, acute-on-chronic, or chronic. It is now generally agreed from urodynamic studies that the traditional slow decompression of the bladder in chronic retention does not serve its aim of gradual reduction of vesical pressure; thus, the current practice is immediate and complete decompression and managing anticipated complications of postobstructive diuresis or hematuria whenever they occur. Conclusion: Advanced age and bladder outlet obstruction secondary to benign prostatic hyperplasia remain the commonest risk factors for urinary retention. Secondary bladder dysfunction in bladder outlet obstruction, detrusor myogenic dysfunction, and alteration of bladder innervations are the major mechanisms. Immediate and complete decompression in both types of retention is the current practice.

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Background: Cholecystitis is a common indication for major abdominal surgeries. It may occur with or without obstruction of common bile duct. Obstruction leads to secondary bacterial infection of bile. Bactibilia is an important predisposing factor for post-operative complications. Hence, this study was designed to determine the prevalence of bacteria in bile samples of cholecystitis patients and to correlate bactibilia and post-operative wound infection. Materials and Methods: Bile samples collected intra-operatively were subjected to gram stain, culture, and antibiotic sensitivity testing. The patients were followed-up for post-operative complications. If post-operative wound infection was found, cultures were done and correlated with bacteria isolated from bile samples. Results: Bactibilia was found in 27/50 (52%) of patients. Polymicrobial flora was found in 10% of bile samples. Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis were the predominant organisms isolated. None of the anaerobes were isolated. Extended spectrum β-lactamase and AmpC β-lactamase (AmpC) production was seen in 47% and 31.5% of Enterobacteriaceae isolates respectively. Post-operative wound infection was found in six (12%) patients who had bactibilia. Combination of piperacillin-tazobactam and amikacin was most effective in prophylactic regimen. Conclusion: The organisms responsible for bactibilia were found to cause post-operative infections in the same patient warranting the use of prophylactic antibiotics in every patient undergoing cholecystectomy. All patients undergoing open cholecystectomy should receive prophylactic antibiotics to prevent post-operative wound infections.

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Background: Patients with anorectal malformation (ARM) frequently suffer from fecal incontinence after surgery because they do not have many of the normal mechanisms of continence. The objectibe of this study was to determine the effects of bulking agent for improving the continence in patients with ARM by correcting the high pressure zone during the toilet training process. Materials and Methods: From December 2008 to June 2011, 16 cases of mid to high ARM that had posterior sagital anorectoplasty were studied prospectively after perianal injection of a bulking agent (Vantris, Promedon/Argentina) into the submucosal layer in high pressure zone of the anal canal about 5 mm from the dentate line, before the start of toilet training. All patients were followed 3 months and 6 months later by manometery, modified defecation pattern scoring and physical examination for complications. They received metronidazole (10 mg/kg/q8h) for 7 days. Result: Eleven male (68.75) and five female (31.25%) included; age range from 1 year to 2 years (mean 3 ± 1.96); Six patients (37.5%) had high type ARM and the remaining were mid type ARM. Internal sphincter pressure ranged from 19.6 ± 6.7 mmHg before intervention to 27.5 ± 6.5 mmHg, after injection until 28.4 ± 8.3 mmHg 6-months after injection ( P < 0.0001). Defecation pattern score on this study changed from 7.4 ± 1.9 to 6.1 ± 1.4, 6 month after study ( P = 0.002). Conclusion: The bulking agent injection could be a cornerstone of post-operative management in patients with ARM.

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Familial adenomatous polyposis (FAP) coli is an autosomal dominant syndrome characterized by germline mutation of adenomatous polyposis coli (APC) gene resulting in intestinal adenomatous polyposis and a very high incidence of transformation to colorectal adenocarcinoma. A 57-year-old male presented with watery diarrhea, pain abdomen and weight loss since 2 years. A clinical diagnosis of malabsorption syndrome was made. Upper gastrointestinal endoscopy did not reveal any lesions. Colonoscopy showed numerous polyps throughout the colon without any evidence of malignancy. Total proctocolectomy with ileostomy was done. Excised specimen showed APC with two foci of invasive adenocarcinoma in the transverse and descending colon. Studies indicate that FAP coli can transform to adenocarcinoma and hence we go by the fact that same is the scenario in our case. We present this interesting case with clinical and pathological findings.

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Acute gastric dilatation is commonly due to abdominal surgery, anorexia and bulimia nervosa, psychogenic polyphagia, trauma, diabetes mellitus, pneumonia, staphylococci. It is very rarely associated with typhoid or superior mesenteric artery syndrome and much rarely associated with both. A young thin female had been operated for signs of sub-acute intestinal obstruction and found to have very hugely dilated stomach reaching up to the pelvis along with dilated 1^st and 2^nd part of duodenum. But lumen was patent and no sign of obstruction was found. Later, she found to be typhoid positive. But she did not improved. CT scan revealed signs of superior mesenteric artery syndrome. Division of ligament of trietz with duodenojejunostomy done, after which she improved. It is be concluded that superior mesenteric artery compression may present as acute gastric dilatation. Typhoid may be associated with superior mesenteric artery syndrome.

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Background: Fournier's gangrene (FG) refers to necrotizing fasciitis affecting the perineal, rectal or genital areas. This can have a fulminant presentation, and its clinical course is unpredictable. It can be fatal unless there is prompt recognition and aggressive surgical treatment. We report our experience and results in the management of FG. Materials and Methods: We conducted a prospective analysis of cases of FG presenting to our institute from April 2007 to September 2009. All patients with signs and symptoms of FG were admitted and evaluated. A policy of aggressive surgical debridement under the cover of broad spectrum antibiotics was adopted, often in multiple sittings. Supportive therapy was also provided. Skin grafting and thigh pouch implantation were undertaken where indicated. Results: There were a total of 18 patients. Seven patients were in the age group of 50-59 years. There was delay of 11-15 days in reporting after onset of symptoms in 44.4% of cases. The main pre-disposing risk factors were age above 50 years (61.1%) and diabetes mellitus (33.3%). The route of infection was mostly cutaneous (27.7%). All infections were polymicrobial aerobic infections, and the commonest organisms were Escherichia coli and Klebsiella species. Aggressive surgical debridements were done, often in multiple sittings. The average number of procedures per patient was 3.27 with a range of 2-4. Conclusion: Early and aggressive surgical management are essential to ensure a successful outcome in FG.

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Background: Many different treatment modalities have been advocated by different authors from time to time for lumbar spondylolisthesis. The principle underlying surgery includes stabilization of the slipping vertebrae. Various operative methods encompassing this principle include posterior interbody fusion, posterior stabilization, facet joint fusion, posterolateral fusion, excision of loose segment, and anterior interbody fusion. The objective of this study was to compare Moss-Miami pedicle screw system with Hartshill rectangle in the management of isthmic and degenerative lumbar spondylolisthesis. Materials and Methods: A prospective study was carried out to compare clinical and radiological outcomes between Moss-Miami pedicle screw fixation with facet joint fusion and Hartshill rectangle fixation with facet joint fusion after adequate decompression for Isthmic and Degenerative Lumbar spondylolisthesis. All patients of spondylolisthesis as per inclusion criteria admitted undergoing decompression, posterior stabilization, and facet fusion during the period 2009-2011 in D.Y. Patil Medical College, Pimpri, Pune were included in the study. Results: A total of twenty patients were included with mean age 47.15 years. Fifteen were females and five males. Seven females and three males underwent Moss-Miami pedicular fixation and eight females and two males underwent Hartshill fixation. Oswestry disability scoring (ODS) scores of the two groups was 4.25 and 4.23 respectively at the end of 12 months. Patients in both the groups improved significantly as assessed by the ODS system. Conclusions: Our results show that both the Moss-Miami Pedicle screw fixation and Hartshill rectangle fixation were of similar benefit as regards the stabilization of the lumbar spine.

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Background: Lymphangiomas are hamartomas of lymphatic vessels commonly arising in the head, neck, and axilla. Intra-abdominal cystic lymphangiomas are rare and are located in the retroperitoneum, the mesentery, omentum, or visceral organs. Radiological imaging in the form of ultrasound and computed tomography (CT) scan helps in preoperative diagnosis. The objective of this study is to present the management of children with intra-abdominal cystic lymphangioma in our institution. Materials and Methods: Six cases of intra-abdominal cystic lymphangiomas comprising three males and three females, which presented over 15 months, were studied. Clinical presentation, location, mode of surgical intervention, and outcome were studied. Results: The site of origin was retroperitoneum, omentum, and the mesentery, with two cases of each. Age of presentation ranged from 5 days to 7 years. Abdominal lump was the most common presenting feature. All the patients underwent complete surgical resection - four had open excision, one had a laparoscopy converted to open excision, and one had a complete laparoscopic excision. Postoperative recovery was uneventful in all of them, with no recurrence at 6 months follow-up. Conclusion: Intra-abdominal cystic lymphangiomas in children are usually symptomatic. CT scan is more accurate than ultrasound to diagnose the lesion. Complete excision of the lesion with or without intestinal resection provides symptomatic relief and prevents recurrence.

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Background: Abdominal ultrasound has assumed a major role in the management of blunt abdominal trauma. The aim of the study is to evaluate the role and vile of the use of ultrasonography in screening for blunt abdominal trauma in an emergency setting of a tertiary hospital in Nigeria. Materials and Methods: It is a retrospective study at a university hospital Zaria. All patients who presented with blunt abdominal trauma from 2008 to 2010 were reviewed retrospectively, using patients' case notes, ultrasonographic findings, operating theatre log books, and surgical audit data. Abdomino-pelvic ultrasound findings of all the patients were noted and compared with actual findings at operation followed by the analysis of the sensitivity and specificity of the ultrasound including positive predictive value and negative predictive value. The grade and experience of the principal Ultrasonographer were also noted. Results: In a total of 107 patients, 94 (87.8%) were males and 13 (12.14%) were females. The mean age was 33.4 ± 17.42 year (range 2-69). With the ultrasound, positive findings were present in 44 (41.1%) patients while negative findings in 2 (1.9%). Of these positive ultrasound findings, 18 (16.8%) had free intra-abdominal fluid only, 13 (12.1%) had both free intra-abdominal fluid and intra-abdominal organ injury, and 13 (12.1%) had intra-abdominal organ injury only. The major organs with injury included liver 18 (5.2%), spleen 16 (4.7%), stomach or bowel injury 6 (1.7%), and kidney or urinary bladder 3 (0.9%). The sensitivity of ultrasonography was 95.7%, while its specificity was 92%. The positive predictive value was 90% and the negative predictive value was 96.7%. Conclusion: Ultrasonography is an accurate and safe method for managing patients with blunt abdominal trauma.

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Background: Rectal prolapse is a chronic disease that commonly affects elderly women in which the rectum partially or fully intussuscepts and comes out through anal canal. Management of this condition is challenging and there are different surgical approaches to this disease. The objective of this study was to evaluate and compare different surgical treatment modalities in the treatment of rectal prolapse. Materials and Methods: Literature review of all articles concerned with management of rectal prolapse which were published in PubMed was done between the periods from January 1990 to July 2012. Different surgical options for rectal prolapse repair were reviewed and the outcome of these procedures in terms of the recurrence rate and the complications were evaluated. Results: Surgical options in management of rectal prolapse are abdominal, perineal, laparoscopic, and robotic approaches. Conclusion: The choice of treatment in rectal prolapse is determined by several factors including the patient age, sex, general condition of the patients, and institutional capabilities. Perineal procedures are less invasive and are the ideal choice for elderly debilitated women and young male patients' consideration, but it is associated with higher rate of recurrence. The open abdominal approach is beneficial to patients with long redundant sigmoid colon and has less recurrence rate, but it is associated with prolonged recovery period and higher morbidities. Laparoscopic and robotic approaches are less invasive and provide the low recurrence rate of the abdominal approach with a recovery period that is more like the perineal approach.

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