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  Citation statistics : Table of Contents
   2014| September-December  | Volume 2 | Issue 3  
    Online since December 15, 2014

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Role of laparoscopy in nonspecific abdominal pain
Mir Mujtaba Ahmad, Hanief Mohamed Dar, Malik Waseem, Hilal wani, Irfan Nazir, Asif Jeelani
September-December 2014, 2(3):71-74
Objective: The aim was to determine the role of laparoscopy in the management of nonspecific abdominal pain (NSAP). Background: NSAP constitutes a good proportion of surgical admissions, both in emergency and elective settings with considerable diagnostic dilemma. Patients and Methods: All patients who presented with pain abdomen with no immediate cause and were labeled as NSAP after clinical assessment and investigations and following that underwent laparoscopy to make a definitive diagnosis were included in the study. Results: A total of 88 patients were included in the study. There were 59 (67%) females and 29 (33%) males. The mean age was 26 years (range 18-58 year). The common mode of admission was out-patient department 69 (78.4%) patients. Twenty-five (28.4%) patients presented with NSAP in lower abdomen, followed by 21 (23.8%) with right lower abdominal pain and 19 (21.5%) with central pain radiating to right lower abdomen. Diagnosis was established in 75 (85.2%) patients. In 13 (14.7%) no pathology was found. The most common diagnosis was pathology of appendix in 29 (32.9%) patients followed by pelvic pathology in 18 (20.4%) and abdominal tuberculosis in 14 (15.9%) patients. Most 37 (42%) of the patients stayed in the hospital for 24 h. There was no readmission and no major postoperative complications. Conclusions: Laparoscopy has a definitive role in diagnostic dilemma associated with NSAP. It has at the same time role in treatment of the condition; hence laparoscopy has a diagnostic and a therapeutic implication in management of NSAP.
  3 5,751 3,762
Damage control surgery/laparostomy in nontrauma emergency abdominal surgery: A new concept of care
Asri Che Jusoh, Ong Yanzie
September-December 2014, 2(3):75-79
Introduction: The established success of damage control surgery (DCS) in trauma of torso motivates surgeon to apply similar concept in managing complicated intra-abdominal sepsis. The main objective of this study is to audit our new practice of such in nontrauma emergency abdominal surgery. Materials and Methods: We retrospectively reviewed all emergency abdominal surgeries (nontrauma) done from February 2013 to February 2014. All patients who had damage control procedures done for complicated intra-abdominal sepsis were analyzed. Results: A total of 60 patients were operated within that period. Six patients (10%) had undergone DCS with or without laparostomy. All were male with mean age of 48.5-year-old (26-61-years-old). Most were in ASA 3 (83%, 5 patients) with only one in ASA 4. Primary indications were ischemic bowel with mesenteric vein thrombosis (3 patients, 50%), abdominal compartment syndrome (ACS), bleeding post near total splenectomy for splenic abscess and gangrenous proctitis with purulent peritonitis. Nearly, all patients (5 patients, 83.3%) were severely acidotic with pH <7.2 intra-operatively, which triggered the DCS. Nevertheless, only 3 patients (50%) benefited from laparostomy and all of them achieved complete fascial closure within 2.6 days (mean). Their mean total Intensive Care Unit (ICU) stay was 15 days (9-32 days). Overall predicted mean Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity mortality rate was 51%. However, the observed (actual) mortality rate was only 33% (2 patients). Conclusion: The result of the practice of DCS in the septic abdomen is very encouraging. It appears able to reduce the mortality by 35%. A comparative analysis with larger series is therefore warranted to further confirm the findings.
  2 4,922 1,816
Paraduodenal hernia: A case report and review of the literature
M Correia, D Amonkar, P Audi, O Vaz, D Samant
September-December 2014, 2(3):96-98
We present the case of a 43-year-old woman who presented to our emergency department with progressive left sided abdominal pain of 1 day duration. She had a past history of bilateral renal calculi for which she was receiving treatment. Computed tomography scan revealed a sac-like mass of small bowel loops to the left of the ligament of Treitz, consistent with the diagnosis of a left paraduodenal hernia. At laparotomy, a left paraduodenal hernia with incarceration of small bowel loops were found, the herniated loops were reduced and the hernial orifice closed. The patient had an uneventful postoperative stay in hospital. Since the discharge from hospital, she has followed up on many occasions and there has been no recurrence of pain. With modern imaging modalities, early and correct diagnosis is possible. Due to the risk of obstruction and strangulation, surgical treatment is indicated. Early intervention increases the likelihood of a favorable outcome. Paraduodenal hernias are a rare congenital anomaly which arises from an error of the rotation of the midgut.
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Complete posterior rectus sheath and total extra-peritoneal hernioplasty
Maulana Mohammed Ansari
September-December 2014, 2(3):80-83
Introduction: Variations in rectus sheath formation have been reported with little realization of its importance to the laparoscopic surgeons doing total extra-peritoneal preperitoneal (TEPP) hernioplasty. Observation of complete rectus sheath during laparoscopic mesh hernioplasty for inguinal hernia through TEP approach and its surgical implication are presented here. Materials and Methods: Setting - Elective. Location for the study - J. N. Medical College and Hospital, A. M. U., Aligarh. Study design - Prospective with effective from April 2010 to August 2013. Study population - Adults (≥18 years). Data collection - Instant documentation and video recording. Method of analysis - All data were computed through on-line calculators (www.graphpad.com/quickcalcs/and http://epitools.ausvet.com.au/). Results: Thirty-five TEPP hernioplasties were carried out in a period of 3 years. All patients were males, with an overall mean age of 48.7 ± 13.4 years. Posterior rectus sheath (PRS) was found complete in four patients with a mean age of 47.28 ± 09.74, and was associated with significantly increased surgical difficulties during the procedure. On Visual Analog Score, endoscopic vision was 4.3 ± 0.6 (4.0-5.5), and the ease of the procedure was 4.5 ± 0.8 (4.0-6.0) that is, both were less than satisfactory. Operating time was 3.1 ± 0.7 h (3.25-4.0). Out of four patients, peritoneal injury occurred in three patients, surgical emphysema in one patient, and postoperative seroma in one patient. Conclusions: PRS was complete in 11.43% of cases studied that was associated with an increased level of surgical difficulties and a higher rate of complications.
  1 6,550 379
Emphysematous pyelonephritis: An unusual case of pneumoperitoneum and intra-abdominal wall abscess
Praveen S Padasali, K Kshirsagar, VS Shankaregowda, BR Prakash
September-December 2014, 2(3):99-102
Emphysematous pyelonephritis (EPN) is a rare gas-producing life-threatening necrotizing bacterial infection that involves the renal parenchyma and the perirenal tissue. It is encountered primarily in patients with diabetes mellitus or ureteral obstruction associated with perinephric and intrarenal gas. Causative organisms are those normally found in the urinary and gastrointestinal tracts. Multiple gas-producing organisms were the cause of the free intraperitoneal and perinephric air however anaerobic bacteria have been demonstrated in only 1% of cases. We describe a case of EPN, which presented as an acute abdomen with pneumoperitoneum in a diabetic patient. On the exploration, no visceral pathology was found, but the patient had right intra-abdominal wall abscess. Subsequent exploration revealed right pyelonephritis. Thus, presenting an unusual presentation of EPN as pneumoperitoneum and intra-abdominal wall abscess.
  - 3,437 229
Spectral domain optical coherence tomography used to view and quantify choroidal vascular congestion in new subretinal fluid following encircling scleral buckling
Mohamed Haji, Robert Gizicki, Flavio A Rezende
September-December 2014, 2(3):89-91
Known complications of scleral buckling surgery for primary rhegmatogenous retinal detachment include choroidal detachment, vortex vein compression and anterior segment ischemia. Post-operative persistent subretinal fluid following scleral buckling surgery is thought to occur in as many as 55% of cases. Likely mechanisms include impaired retinal pigment epithelium (RPE) function, altered subretinal fluid composition, choroidal ischemia, incomplete drainage of subretinal fluid and altered choroidal blood flow. Indocyanine green (ICG) angiography, laser Doppler velocimetry and scanning laser Doppler flowmetry have showed altered choroidal blood flow, pulsatile ocular blood flow and choroidal venous drainage after scleral buckling.
  - 3,785 273
A rare case of pediatric gastrointestinal stromal tumor arising from ileum
Vijay C Pujar, Shirin S Joshi
September-December 2014, 2(3):92-95
Malignant tumors arising from ileum are very rare in pediatric age group. Non-Hodgkin's lymphoma is the most common tumor. Gastrointestinal stromal tumors belong to a group of cancers called soft tissue sarcomas seen in adults are being reported even in pediatric age group. We report a rare occurrence of CD 117 marker positive Ileal tumor in a 2 year male child presenting with Abdominal mass associated with malnutrition and anemia.
  - 3,523 253
Gastrointestinal complications of multiple foreign body ingestion with malrotation of the gut
Rajeev Redkar, Parag Janardhan Karkera, Mukunda Ramachandra, Flavia D'Souza, Janani Krishnan, Varun Hathiramani
September-December 2014, 2(3):103-106
Foreign body (FB) ingestion is a common problem in the pediatric age group, and most pass spontaneously through the gastrointestinal tract. But the presence of anatomical variants like malrotation of the gut may lead to complications. Our patient, a 5-year-old male presented with pain in the abdomen and radiological imaging diagnosed a metallic FB in the small bowel with ileo-ileal intussusception. Exploratory laparotomy with removal of FBs (metallic ring and cotton fiber bezoar), intussusception reduction followed by closure of perforations was done. The patient had an uneventful recovery. This case is perhaps the first instance of small bowel perforations and intussusception following FB ingestion in a child with malrotation of the gut.
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Absolute benefit of gastrografin in adhesive small bowel obstruction: A retrospective study and review of the literature
Asri Che Jusoh, Fatimah Halwani Ismail, Ong Yanzie
September-December 2014, 2(3):84-87
Introduction: Adhesive small bowel obstruction (ASBO) is a major cause of postoperative morbidity. The objectives of the study are to evaluate the diagnostic and therapeutic properties of gastrografin (GF) in ASBO. Materials and Methods: A retrospective review of all adult patients admitted from January 2011 to January 2013 with ASBO, who undergone GF test was done. Apart from establishing its diagnostic property, therapeutic effects following the test were also determined such as reduced need for surgery and shortened the hospital stay. An undiluted GF (100 ml) was given once the patient is adequately rehydrated followed by supine abdominal X-ray 4-6 h later. If the contrast is seen in the colon, the test is considered as positive. Otherwise, a repeat X-ray is done 20 h later (24 h postGF). A positive test patient was considered as partially obstructed and selected for nonoperative management. Otherwise, if remain negative at 24 h surgery is considered. Results and Analyses: A total of 21 patients who fulfilled the criteria was analyzed. Majority were male (16 patients, 76.2%), aged between 14 and 84 years (mean 45.3). A total hospital stay was 5 days (median) with only 3 days for successful GF test. Eight patients (38.1%) developed first ASBO following open appendectomy whereas 28.5% (six patients) after colorectal surgery. Previous midline laparotomy was the most common approach seen (57.1%, 12 patients) followed by lanz incision (23.8%, five patients). A positive test was only demonstrated in 66.7%, 38.1% (eight patients), and 28.6% (six patients) at 4 h and 24 h, respectively. Surgery was required in seven patients (33.3%) with only one patient can be approached laparoscopically. We had no adhesion-related bowel gangrene or mortality. Conclusion: Our analysis demonstrated that GF test is safe and very beneficial in managing ASBO. It reduces the need for surgery and shortens hospital stay even in high adhesion risk group.
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