Predicting factors favouring surgery or endoprosthesis in the palliation of pancreatic head and ampullary carcinoma

Acute abdominal pain is one of the most common surgical condition which calls for prompt diagnosis and treatment. Diagnostic error on the initial assessment may lead to unnecessary surgical intervention, and at most to death of the patient, or a protracted clinical illness due to development of complications which could be avoided by earlier surgical intervention.The study was carried out on 897 cases during a retrospective period from 1/1/2003 to 30/12/2003 and 1196 cases during a prospective period from 1/1/2004 to 1/1/2005 admitted to contingencies Hospital of Zagazig University.The age ranged from 3-80 years with a mean age of (38) years. 1085 cases were females (51.8%) and 1008 cases were males (48.2%).The aetiology of acute abdomen was as fallow:Acute appendicitis, intestinal obstruction, peritonitis, acute cholycystitis, gyneacological, causes and unsettled diagnosis (query appendicitis).In this study the clinical examination, laboratory and radiological investigations helped in the evaluation of management and outcome of the patients with acute abdomen.The study revealed that, the clinical picture and total leukocytic count have an important role in the diagnosis of acute appendicitis.Regarding the outcome of acute appendicitis: 1145 patients (91.6%) underwent appendectomy with uneventful recovery. Fifty-six cases (4.4%) developed postoperative wound sepsis. Twenty cases (1.7%) developed postoperative paralytic ileus. Twenty-eight cases (2.2%) developed chest infection.