Mahmood Ayyaz

Burnout among surgical residents in a lower-middle income country – Are we any different?

Objective To assess the presence of burnout among surgical residents working at various public sector hospitals in Pakistan. Design A survey based on MBI was used to assess the presence of burnout. Residents were grouped into Group A (Burn out) or Group B (No burn out). Pearson Test was used to see any correlation between different variables and burn out. A p value of <0.05 was taken as significant. Setting/participants A cross sectional survey of all the surgical residents at various public sector hospitals in Lahore was done. Results A total of 133 residents responded to our questionnaire. 74% respondents were male and 26% were female. All residents showed a very high level of burnout. 50.4% residents had high levels of burn out on the EE category, 49.6% in the DP category and 53.4% residents had low levels on the PA scale. When assessed for overall burn out 57.9% residents had overall burnout. Males were more prone to develop burnout. Job dissatisfaction was the most prevalent reason for burn out. Owning a smartphone was significantly associated with development of burnout. Awareness regarding the burnout syndrome and having children were two factors which had a protective effect against burnout syndrome. Marriage, working hours, financial conditions, smoking and consumption of coffee/tea had no effect on development of burnout syndrome. Conclusion There is high prevalence of burnout among the surgical residents in our hospitals. Unsatisfactory training is the number one reason for development of this syndrome.

Stone in the distal jejunum presenting as small bowel obstruction: A case report

Highlights • Gallstone impaction in the distal jejunum is rare.• Pre-operative diagnosis is a challenge as findings remain equivocal on imaging studies.• One or two stage procedure can be performed to alleviate obstruction.

Transmigration and spontaneous passage of a gossypiboma documented on contrast study

Gossypiboma or textiloma is a rare but very unfortunate complication of surgery. It refers to a retained foreign body usually forgotten within the abdominal cavity at the end of an operation. It may be a surgical sponge, gauze pad or other form of textile. We present the case of a middle aged lady who following cholecystectomy had a forgotten gauze which underwent transmural migration and was later expelled via the rectum demonstrated by radiological studies.

A case report of pneumo-retro-peritoneum: An unusual presentation of ischio-rectal abscess

Introduction Ano-rectal abscesses are common. They however usually do not present with abdominal symptoms. CT although useful is not routinely carried out. Finding of Pneumo-retro-peritoneum with ischio-rectal abscess is rare. Case presentation We present the case of a diabetic gentleman who presented with abdominal pain and distension and was found to have ischio-rectal abscess on perianal examination. Although initially suspected to have acute abdomen due to perforated viscus, CT scan revealed pneumo-retro-peritoneum which appeared to arise due to the abscess. Patient underwent incision and drainage of the abscess followed by serial debridement. He made a complete recovery. Conclusion Abdominal symptoms are rare in ischio-rectal abscess, but they must be kept in mind. Proper diagnosis may avoid a negative laparotomy.

Penetrating Neck Injury: Mandatory exploration versus conservative approach

This study is designed to investigate the outcome of patients managed on both conservative as well as operative protocols and then compare the two groups for morbidity and mortality. It is a comparative study comparing the groups of patients with operative and non operative intervention done for penetrating neck trauma at Mayo Hospital Lahore for a period of six years from September 1995 to August 2001. All patients of age more than 12 years of age presenting with penetrating cervical trauma in our emergency were included in study. In patients with multiple injuries mortality and morbidity of only cervical trauma was compared. Neck was divided in to three zones according to recognized anatomical landmarks. In conservative group 38.9% developed complications where as in other group 46.4%, developed complications This difference was not significant (p=0.05) Mean hospital stay was 10 days in the conservative group where as 4 days in other group which was statistically significant. Hence we conclude that patients with penetrating neck injuries who are clinically stable can be managed conservatively after appropriate investigations.

Hemoperitoneum Due to Warfarin Toxicity Presenting as Intestinal Obstruction.

The patients on anticoagulation therapy especially warfarin can develop gastrointestinal bleed, gum bleeding, hematuria or ecchymosis. Rarely do such patients present with hemoperitoneum producing symptoms. Hemoperitoneum can produce shock, cause compression symptoms or may even be fatal. Such patients can be managed conservatively or may need surgical exploration for ongoing bleeding or decompression. We had a patient taking warfarin who presented with hemoperitoneum producing intestinal symptoms. The patient was managed conservatively with fluid and blood product replacement and stopping warfarin. The benefits of thromboprophylaxis and the risks of bleeding should be carefully evaluated and the dose of warfarin carefully adjusted.

An Unusual Cause of Right Iliac Fossa Pain: Caecal Diverticulum Perforation

Caecal diverticulum perforation is a rare condition. It mimics acute appendicitis and is seldom suspected pre-operatively. Commonly it is discovered during exploration. Ultrasonography and computed tomography are helpful in the diagnosis of the condition. There is controversy regarding the surgical treatment. We are presenting the case of a 44-year male who underwent exploration for suspected acute appendicitis but was found to have a perforated solitary caecal diverticulum. Patient underwent diverticulectomy and made an uneventful recovery.