International Surgery Journal

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https://imsear.searo.who.int/handle/123456789/156148

Editor-in-Chief: Dr. Bhaven Kataria
ISSN: 2349-3305 (Print); 2349-2902 (Online)

Frequency: Quarterly

Language: English

Open Access Peer-reviewed journal

Web site: https://www.ijsurgery.com/

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Now showing 1 - 20 of 726

Assessment of the success rate of specialised female surgical clinic in tertiary care hospital
(Medip Academy, 2020-01) Gupta, Anand; Sharma, Anshuman
Background: Specialized female surgical clinics are the basic requirement in surgical department which should be addressed routinely. The management of surgical problems in female patients requires multidisciplinary approach mainly general surgery, obstetrics and gynaecology, general medicine, paediatrics, dermatology and psychiatry. If proper care is provided then this will uplift the follow up of same patients in such clinics. The objective of the study was to assess the success rate of female surgical clinics and to determine the follow up visits done by female patients once visited the female surgical clinics.Methods: Prospective educational interventional study was conducted. A total of 952 patients visiting the clinic were studied. Statistical analysis was done.Results: Out of 952 cases 944 (99.2%) cases were willing to continue visit to the clinic, while 809 (84.9%) cases revisited for follow up treatment in female surgical clinics within one year duration.Conclusions: It can be concluded that there is a requirement and need of a fully functional specialized female surgical clinic in our hospital. As the success rate for follow up visit by patients in this clinic was high.
Gender specific variation in risk factors of gallstone disease among adult patients
(Medip Academy, 2020-01) Dhamnetiya, Deepak; Goel, Manish K.; Dhiman, Balraj; Pathania, Om P.
Background: Gallstone disease (GSD) is a common gastrointestinal disease diagnosed in patients presented with abdominal pain. The present study was aimed to find the association between demographic, personal, behavioural and dietary factors and GSD by gender among adult population for suggesting specific gender wise intervention to control GSD.Methods: Case-control study was conducted in 120 cases and same number of controls. Data was collected on a self-designed pretested “interview schedule”. To measure the strength of association OR was calculated by matched pair analysis using McNemar’s test.Results: Among 120 study subjects, 83 cases were females and 37 were males. Strength of association was found to be significantly higher for family h/o GSD in females (OR=8), physical inactivity (OR=8), waist-hip ratio (OR=4.2), calorie intake more than recommended dietary allowance (RDA) (OR=2.09), and diabetes (OR=4) as compare to males OR=3, OR=2.8, OR=2.5, OR=1.43, OR=2.33 respectively.Conclusions: Family h/o GSD, physical inactivity, high waist-hip ratio, calorie and fat intake more than RDA, protein intake less than RDA, hypertension and diabetes were found to be potential risk factors for the development of GSD in females. Consumption of smokeless tobacco, physical inactivity, non-vegetarian diet and intake of fats more than RDA were risk factors for GSD in males.
Study of evaluation of Alvarado scoring system in acute appendicitis
(Medip Academy, 2020-01) Puttaraju, Shashidhara; Y., Deva Keerthana D.
Background: Acute appendicitis is one of the most common surgically correctable acute abdomen presenting at emergency department worldwide. Inspite of all advances in diagnostic modalities and surgical techniques, diagnosis remains difficult sometimes as a challenge and delayed decision making complicates this surgical disease. Alvarado scoring system is one of available scoring system for diagnosis of acute appendicitis, based on history, clinical examination, lab investigations and easy to apply, helps in clinical decision regarding planning surgery and avoid negative laparotomies. The aim of the study was to evaluate diagnostic accuracy of Alvarado scoring system in preoperative diagnosis of acute appendicitis and correlating with postoperative findings.Methods: This study was conducted in 100 cases of suspected appendicitis admitted in surgery department of Rajiv Gandhi Speciality Hospital, Agatti Island, Lakshadweep, Union territory of India, from July 2015 to June 2017 adopting Alvarado scoring system. Results were analyzed.Results: Out of 100 patients admitted with suspected acute appendicitis, number of cases operated suspecting acute appendicitis were 83 of which 80 were found to have acutely inflamed appendix. Results of Alvarado score of operated patients are as follows: 80 patients had score 7-10, and 3 patients had score 5-6, patients with Alvarado score <5 (17 pts) were managed conservatively.Conclusions: The Alvarado scoring system is a simple and useful diagnostic tool for diagnosis of acute appendicitis with acceptable sensitivity and specificity and can be used with high degree of accuracy. Our findings suggest that patients presenting with abdominal pain and Alvarado scores greater than 7 are more likely to have appendicitis.
A comparative prospective randomised controlled study for mesh fixation by cyanoacrylate glue versus prolene sutures in patients undergoing Lichtenstein hernioplasty
(Medip Academy, 2020-01) Kalwaniya, Dheer S.; Arya, Satya V.; Gupta, Sumedha; Kuppuswamy, Manigandan; Bajwa, Jaspreet S.; Paruthi, Shivani B.; Mahadevan, Ranjith; Choudhary, Rohit; R., Monish; Singla, Nipun
Background: Inguinal hernia repair is one of the most commonly performed procedures by general surgeons. Cyanoacrylate is the generic name for a family of fast acting adhesives. The aim of the present study done in Department of General Surgery, Safdarjung Hospital, New Delhi was to compare the newer emerging technique of mesh fixation.Methods: A total of sixty patients were included in the present study and were allotted in case and control group randomly by sealed envelope technique. In case (study) group, all the patients underwent mesh fixation by cyanoacrylate glue and in control group, by prolene 3-0 sutures.Results: Most frequency in age group 31-40 yrs, males:females ratio >1 and right sided inguinal hernia was more common. Bi-lateral hernia was common in elderly. Indirect: direct ratio 4.5:1. Operating time period for the patients of the case (study) group is less than control group. P value of post-operative pain in immediate post-operative period (day 1 and 2) and POD 30, 60 and 90 was not of clinical significance whereas the p-value on 6,120,150 and 180 post op day was of clinical significance. In our study, there was a case of incidental observation: a) reaction due to use of cyanoacrylate glue, b) rejection of mesh for which mesh had to be removed.Conclusions: There is no statistically significant difference between mesh fixation with cyanoacrylate glue and mesh fixation by prolene suture techniques in immediate post-operative pain. Statistically significant difference favoring mesh fixation by cyanoacrylate glue technique was seen with respect to operating time and post-operative groin pain with increasing post-operative duration.
Comparative study between assisted laparoscopic and open D2 distal gastrectomy for gastric cancer
(Medip Academy, 2020-01) Amer, Naglaa Fathy; El Shakhs, Soliman Abdelrahman; Mohamed, Moharam Abdelsamie; Shahin, Mahmoud
Background: Although laparoscopic gastrectomy has been in use for many years, there was great debate for its technical feasibility and oncological safety. However, with recent advancements of laparoscopic surgical instruments and the accumulation of operative experience, laparoscopic gastrectomy becomes more feasible, and laparoscopic D2 lymphadenectomy has been achieved. Methods: This study was prospectively conducted from April 2016 to September 2018 on 40 patients presenting with distal gastric cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study performed radical distal gastrectomy with D2 lymphadenectomy aiming for cure. The patients were divided into 2 groups: group A (20 patients operated upon with open gastrectomy (OG) technique) and group B (20 patients operated upon with the laparoscopic gastrectomy (LG) technique). Both groups were compared in this study regarding operative details, short term post-operative complications and pathological results.Results: The mean operative time in OG was shorter than LG (p value: 0.04), while there was significant difference between both groups regarding blood loss, mean blood loss in OG was 420.8±87.6 ml and in LG was 283.4±45.9ml, parenteral analgesic requirement was significantly less in LG than OG (p value: 0.04) while no significant difference regarding Intra-operative complications and pathological results.Conclusions: Assisted Laparoscopic distal gastrectomy with D2 lymphadenectomy is feasible and safe with less post-operative pain and short hospital stay.
Assessment of nutritional status, pre-operative nutrition supplementation and its’ impact on the outcome of surgery in gastrointestinal malignancies: a prospective study
(Medip Academy, 2020-01) Nirhale, Dakshayani S.; Ghalsasi, Amala A.; V., Nisarga
Background: Gastrointestinal (GI) cancers are responsible for more deaths from cancer than any other cancers. These patients are at risk for disease-related malnutrition which has been linked to an increase in post operative complications. Despite research, guidelines for preoperative nutritional assessment are lacking. The study was aimed to assess the nutritional status of patients in gastrointestinal malignancy, impact of nutritional supplementation and its impact on outcome of surgery.Methods: This cross-sectional study was conducted on patients of gastrointestinal malignancy attending Dept. of Surgery, Dr. D.Y. Patil Medical College, and Hospital, Pimpri, Pune. Institute Ethics Committee clearance was obtained before starting the study. 45 newly diagnosed patients of gastrointestinal malignancy were included in the study after informed consent.Results: At the start of this study 26.66% were well nourished, 35.55% moderately nourished, and 37.77% poorly nourished. At 6 weeks after supplementation 60 % were well nourished, 24.4 % moderately nourished, and 7 % poorly nourished. Surgical site infection (SSI) occurred in 7 patients of which 57.14% were poorly nourished, 28.57 % were moderately nourished. Anastomotic leak occurred in 3 patients of which 66.66% patients were poorly nourished. Average number of days of hospital stay for well nourished patients was 6.23 and for poorly nourished patients 14.14.Conclusions: Malnutrition is a concern in gastrointestinal malignancies. Delay in surgery upto 6 weeks is permissible to enhance patients’ nutritional status. Proper nutritional supplementation significantly improves nutritional status. Complications like SSI and anastomotic leak; hospital stay are significantly reduced after improvement in nutritional status.
Rare case of midgut volvulus with malrotation in an elderly patient
(Medip Academy, 2020-01) Raleng, Mezhuneituo; Pore, Anant Prakash; Katheria, Vickey; Khamrang, Worshim; Wungramthing, R. S.
A 70 year old male who was under treatment for lymphoma, presented with a 2 day old history of not passing stool, flatus, associated with vomiting and abdominal distension. Patient was diagnosed as subacute intestinal obstruction and put on conservative management. However since his condition worsen exploratory laparotomy was performed. On laparotomy a midgut volvulus was detected and subsequently de-rotation of small gut was done. Through this paper we would like to stress out the difficulties in diagnosis and the challenges that we faced.
Comparison of free radicals in blood in pre-operative and post-operative phases of breast malignancies: a clinicopathological study
(Medip Academy, 2020-01) Jina, Abhishek; Singh, U. C.
Background: Various factors have been identified as influencing factors of breast cancer. The free radicals can cause increased oxidative stress by negatively affecting the body’s nucleic acids, lipids and proteins leading to various illnesses including cancer. Therefore, this study was aimed at discovering the progress of treatment of breast carcinoma by exploring the connections of the disease with free radical injury.Methods: The present study was conducted among 30 breast carcinoma patients received in the surgery department of BRD Medical College Gorakhpur. Determination of the levels superoxide dismutase (SOD) (the procedure of photoluminescence), catalase (method of Cavarochi) and the lipid peroxidise was done. The results were presented as mean and standard error (SE). P value of <0.05 was considered as statistically significant.Results: Among the total participants, 73% patients had infiltrating ductal carcinoma and 27% patients had intraductal carcinoma. The dismutase levels showed an increase in the post-operative patients for both the groups. The catalase levels and the lipid peroxide levels showed a reduction in the postoperative patients (p<0.05).Conclusions: The present study result showed that the low amounts of SOD and catalase may not be sufficient to detoxify high amounts of free radicals. The administration of catalase could help in reducing the symptoms. Though, low amounts of SOD and catalase may not be sufficient to detoxify high amounts of free radicals. The administration of enzymes could help in the treatment of breast cancer patients.
Management modalities of isolated liver injury in blunt abdominal trauma
(Medip Academy, 2020-01) Mangukiya, Lalji; Astik, Hardik
Background: The liver is one of the most commonly injured organ in blunt abdominal trauma. Management of liver injury due to blunt abdominal trauma has been dramatically evolved in recent years. Dramatic change from operative management to non-operative management has improved survival in these patients, becoming the standard of care for most liver injuries.Methods: A retrospective study of the patients admitted with the diagnosis of isolated liver injury due to blunt abdominal trauma between 2013-2018. Data collected of 30 patients of isolated liver injury who either treated conservative management of operative management. Variable analyzed included demographic data, mechanism of injury, associated injury, conservative treatment, operative treatment, morbidity, mortality, and hospital stay.Results: A total of 30 patients were analyzed of isolated liver injury due to blunt abdominal trauma, 27 patient sustained minor liver injury (grade I, II and III), whereas 3 patients had major liver injury (grade IV, V and VI). 25 cases due to road traffic accident and 5 cases were due to falls from a height. 27 patients with American Association for the surgery of trauma grade I, II, III and 2 patients with grade IV, V managed conservatively, surgical intervention required in 1 patient with grade V, mortality occurred in 1 patient out of 29 who were treated conservatively.Conclusions: Isolated liver injury is common in the blunt abdominal trauma patient. Most of the patients with the liver injury with hemodynamically stable treated conservatively. Only a few of them require surgical management if they are hemodynamically unstable.
Can preoperative serum lactate dehydrogenase levels predict postoperative pulmonary complication following an emergency abdominal surgery? An observational study
(Medip Academy, 2020-01) Murugavel, Ananthakumar; Kanth, Vishnu; Palanivelu, Elamurugan Thirthar
Background: Postoperative pulmonary complications (PPC) are one of the commonest complications following gastrointestinal surgery. They lead to increase in morbidity and mortality. Lactate dehydrogenase (LDH) is an enzyme present in essentially all major organ systems. Studies have shown measurement of its activity levels and its isoenzyme pattern may provide additional information about lung and pulmonary endothelial cell injury. The objectives of the present study were to study the levels of serum LDH in patients with and without post-operative pulmonary complications following emergency abdominal surgery.Methods: The study was designed as an observational study. All patients ≥18 years of age undergoing gastrointestinal surgery, excluding those with prior lung pathology were included in the study. The demographic parameters, clinical parameters and laboratory parameters along with details of pulmonary complications were recorded. Serum LDH level were assessed on admission. Levels of serum LDH were compared between patients with and without post-operative pulmonary infections and were assessed for significance.Results: Incidence of PPC was 28% in our study. There was significant difference in the mean age in the group with and without PPC (p=<0.001). Smoking habit, serum albumin total protein and upper abdomen incision surgery were associated with increased incidence of PPC. Pleural effusion was the commonest PPC seen in patients. Serum LDH was not significantly associated with the incidence of PPC.Conclusions: Pre-operative serum LDH level is not a predictive factor for occurrence of postoperative pulmonary complication. Age, smoking, total protein, serum albumin, upper abdomen incision were found to associated with increased risk of PPCs.
Role of colour Doppler in evaluation of venous abnormalities of lower limb
(Medip Academy, 2020-01) Sharma, Dinika; D’Souza, John; Joshi, Priscilla
Background: Venous abnormalities of lower limb are a fairly common cause of morbidity. Although clinical diagnosis is the cornerstone of the diagnosis of lower limb venous disease, Colour Doppler ultrasound has become the investigation of choice to confirm the diagnosis. This study evaluated the role of Colour Doppler ultrasound in various venous pathologies of the lower limb and the sonographic findings were correlated with surgical and clinical findings.Methods: 100 patients of all age groups of either sex presenting with clinically suspected entities affecting venous system of the lower limb were selected for this study.Results: Our study showed a definite male preponderance (65%) with an incidence of 41% in the age group of 21-40 years. Isolated varicose veins had an incidence of 58% followed by isolated deep vein thrombosis (DVT) (29%), varicose veins with thrombophlebitis (5%), DVT with thrombophlebitis (5%), DVT with varicose veins (2%) and hematoma (1%). The findings correlated with surgery and gave a sensitivity of 100%.Conclusions: Colour Doppler ultrasound is unique due to its feasibility, accessibility and cost effectiveness. Its dynamism is also exploited by various maneuvers done by the patients, radiologist and the machine parameters to bring about changes in blood flow to reach the exact diagnosis.
Comparison of the role of ultrasound guided transhepatic aspiration of gallbladder versus conservative management of acute calculous cholecystitis
(Medip Academy, 2020-01) Udupi, Vivek Ramesh; Neogi, Sushanto; Garg, Anju
Background: Gall stone disease remains one of the most common medical problem leading to surgical intervention. Cholecystitis accounts for 3-10% of abdominal pain worldwide. Acute cholecystitis is the most common complication of cholelithiasis accounting for 14 to 30% of cholecystectomies performed in many countries. Symptoms in cholecystitis are due to impaction of stone and subsequent distention of gallbladder with inflammation. Study is aimed to clarify the role of ultrasound guided transhepatic gallbladder aspiration in the early management of acute calculous cholecystitis.Methods: The study was conducted in total of 40 patients presenting with acute cholecystitis. 20 patients underwent ultrasound guided transhepatic aspiration of gallbladder with antibiotics (group A) and 20 patients were given antibiotics only (group B). Data were collected before intervention and post intervention duration of stay, pain according to visual analog scale, leucocytosis and fever were recorded for analysis. No complications were related to aspiration procedure.Results: Both groups were comparable. Group A patients had better pain relief (p=0.0001 day on 2 and p=0.004 on day 3 post aspiration), percentage reduction of leucocyte count (p=0.041 on day 3) and duration of hospital stay (p=0.004) which were statistically significant.Conclusions: Ultrasound guided transhepatic aspiration of gall bladder with antibiotics in acute cholecystitis results in better pain profile, faster reduction in leucocyte count and shorter duration of hospital stay when compared to antibiotics alone.
Perforated isolated jejunal diverticulum: a rare cause of acute abdomen
(Medip Academy, 2020-01) Jha, Abhijeet; Ghuliani, Deepak; Jain, Sudhir K.; Ansari, Faiz M.
A 45-year-old female presented with pain in peri-umbilical region for past one day along with history of non-bilious vomiting and non passage of stool and flatus for past one day. On physical examination, patient was afebrile, mild dehydration was present, tachycardia of 102 beats per minute with normal blood pressure. On clinical examination, the abdomen was diffusely tender with rebound tenderness. Bowel sounds were absent. Laboratory investigations revealed leucocytosis. An erect plain chest X-ray was done, didn’t reveal any gas under the diaphragm. Contrast enhanced computed tomography abdomen was done which showed a hollow viscus perforation with intra-abdominal free air and pelvic free fluid. Patient was resuscitated with IV fluid, broad-spectrum antibiotics were started and immediately taken up for exploratory laparotomy. Three jejunal diverticula identified at mesenteric border, with pin-head perforation in one of the diverticula. Small bowel resection including the three diverticula and primary end-to-end anastomosis was performed. Post-operative period was uneventful. Patient discharged on satisfactory conditions. This case stresses the importance to consider this entity in cases of unexplained gastrointestinal symptoms because any treatment delay may lead to unsuccessful clinical outcome.
Indications and complications of colostomy in newborn: our experience
(Medip Academy, 2020-01) Chanchlani, Roshan; Shrivastava, Dhirendra
Background: The aim of the present study was to evaluate the indications, complications and outcome of colostomy in newborn patients.Methods: This is a descriptive, retrospective study carried out in the Department of Pediatric surgery, Gandhi Medical College Bhopal to evaluate acceptance and outcome of colostomy in newborn over a one year period from March 2018 to March 2019. All newborn with diagnosis of anorectal malformation, Hirshsprungs disease and other emergency conditions underwent transverse loop colostomy by expert and trained pediatric surgeon.Results: Out of 40 patients operated complications of colostomy was seen in 18 (45%) patients. Most common complication was skin excoriation in 08 patients (20%), bleeding from stoma site in 02 (05%) cases. Stoma prolapse occurred in 02 (05%) patients. Wound infection, dehiscence, stomal stenosis and parastomal hernia was seen in one patient each 2 (2.5%). 2 (0.5%) patient died due to multiple congenital anomalies.Conclusions: Colostomy in children is associated with significant morbidity in developing country. To minimize these problems, the pediatric surgeon should focus on the management and early closure of a colostomy.
Use of diclofenac suppositories in pain management in acute fissure in ano in outpatient department care
(Medip Academy, 2020-01) Deherkar, Juthikaa Abhijit
Background: Per anal diseases and the pain management in such cases have always been a problematic solution for surgeons. There are various pain management methods for per anal cases, however we wanted a cheaper yet effective way and patient friendly method for pain management where no expertise would be required, hence we opted to see results of diclofenac suppositories which were easily available, patient could insert it without anyone’s help or assistance and hence need not be hospitalized for any intravenous analgesics.Methods: A study was conducted over 2000 cases over a span of 6 years in a tertiary centre. A control group A of 1000 patients was made where, oral (tablet diclofenac) plus local analgesics (xylocaine gel) were opted for whereas the other group B of 1000 patients was treated with diclofenac suppository 100 mg twice a day with glycerin as lubricant at anal verge. The pain score was noted in both the groups. All acute fissure in ano cases, we included in this study.Results: The pain score of the group B cases was much lower than the group A cases, and also the duration of results acquired was much lesser than group A.Conclusions: Diclofenac suppository 100 mg twice a day proved to be an excellent pain management method for acute fissure in ano cases in outpatient department care.
Great saphenous vein diameter at different regions and it's relation to reflux
(Medip Academy, 2020-01) El Mallah, Said I.; Al Khateep, Yahia M.; Kamel, Kareem H.
Background: Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Standard pre-interventional assessment is required to decide the treatment modalities. GSV diameter measured at sapheno-femoral junction, proximal thigh, distal thigh, knee, proximal leg, distal leg. Analysis done to find at which diameter size the reflux expected to occur.Methods: The study involved 100 limbs from outpatient vascular clinic. GSV diameter measurement was done at the sapheno-femoral junction, at the proximal thigh, at the distal thigh, below the knee, mid leg in correlation to the reflux.Results: SFJ reflux (group I) was observed at 7.16±2.30 mm, proximal thigh (group II) at 6.60±1.89 mm, distal thigh (group III a) at 6.12±1.63 mm, knee (group III b) at 5.78±1.60 mm, proximal leg (group IV) at 4.6±1.24 mm, and mid leg (group V) at 3.59±1.16 mm.Conclusions: Measurement at six sites revealed higher sensitivity and specificity to predict reflux, GSV diameter correlates with reflux, sites to predict reflux not only at SFJ and proximal thigh but GSV measurement at knee joint can predict reflux. Measurement of GSV at knee joint can predict reflux if more than 5.5 mm.
Study on incidence of oesophageal carcinoma in patients undergoing upper gastrointestinal endoscopy for upper gastrointestinal symptoms in a secondary care hospital
(Medip Academy, 2020-01) Puttaraju, Shashidhara; Gnanakumar, Deva Keerthana Yesudian
Background: Oesophageal carcinoma is one of the leading causes of cancer related deaths worldwide and is also associated with high morbidity. Hence early diagnosis and treatment are the only effective way to improve survival and quality of life in oesophageal carcinoma patients. Early-stage oesophageal carcinoma are often asymptomatic and may also present with common upper gastrointestinal symptoms hence diagnosis of early oesophageal carcinoma is only based on detection of suspicious lesions through endoscopy and histopathological evaluation of biopsies from these suspicious lesions. The study is designed to see whether using alarming upper gastrointestinal symptoms, risk of oesophageal carcinoma in patients can be predicted.Methods: Present study comprises of 200 patients presenting with upper gastrointestinal symptoms at JSS Hospital, Chamarajanagar (both out patients and referred patients) during the period of October 2018 to December 2019, who underwent upper gastrointestinal endoscopy.Results: Out of 200 patients, 135 patients were males and 65 patients were females. According to the study, dysphagia was found to be a significant predictive factor and in contrary to the global statistics this study showed females aged more than 60 years were significantly at higher risk of developing oesophageal carcinoma.Conclusions: We recommend to do an early endoscopy for any patient presenting with upper gastrointestinal symptoms and to take multiple biopsies from any suspicious lesion especially for male gender older than 50 years and female gender older than 60 years presenting with dysphagia.
Conservative management of an iliopsoas hematoma causing walking difficulty in an elderly patient on anticoagulation therapy: a case report
(Medip Academy, 2020-01) Kisku, Deepak Kumar; Panigrahi, Sudhir Kumar; Mishra, Amaresh; Kanungo, Abinash; Moharana, Niranjan
Spontaneous iliopsoas hematoma is a rare complication in patients suffering from bleeding disorders like hemophilia, Von Willebrand’s disease or those taking blood thinners like aspirin and clopidogrel or anticoagulant medications like warfarin for atrial fibrillation or post-thrombotic status. It can present as severe pain, muscle dysfunction, difficult walking or neurological dysfunction due to compression on femoral nerve or lumbar plexus. A high index of suspicion with early blood and radiological investigations like contrast enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) of the part is immensely helpful in diagnosis and prompt management of such patients. A low hemoglobin or hematocrit level and a high INR is supportive while CECT or MRI of the abdomen and pelvis is confirmatory. Management in a hemodynamically and neurologically stable patient include immediate withdrawl of the anticoagulant, bed rest, infusion of I.V. fluids, vitamin K, fresh frozen plasma and packed red cell transfusion, which ensures complete recovery in most of the cases. However angio-embolization to control ongoing arterial bleeding is lifesaving when feasible or emergent open decompression and bleeding control surgery can save the life or prevent permanent neurological damage to the limb. Decompression of the hematoma by ultrasound or computed tomography guided catheter drainage is helpful alternative in few selected cases. We report an elderly patient on warfarin, who suddenly developed difficulty in walking within hours of a strained defecation, diagnosed to suffer from left iliopsoas hematoma and responded to conservative management with complete resolution of symptoms by 3 weeks.
Retrospective observational study about patient friendly and cost effective wound care by newer concept of open dressing
(Medip Academy, 2020-01) Mane, Arun Y.; Naik, Narendra G.
Background: The choice of dressing material and to give wound cover varies according to the type of ulcer and the surgeon’s experience. It is practically not possible to do comparative evaluation among different types of dressing material and method to dress. The ideal dressing material and method to dress must be cost effective, comfortable to patient and early wound healing with minimal sequel of scar tissue. The article discusses about a newer method cost effective and patient friendly dressing to achieve effective end result in wound healing.Methods: Retrospective analysis of 50 patients treated from 01 April 2019 to 31 August 2019 by open dressing with written informed consent of patient and fulfilling ethical requirements at Rajiv Gandhi Medical College, Thane, Mumbai. The selection criteria of patients were cases with pressure dressing are excluded. The diabetic (40%), venous (20%) and traumatic (20%) ulcers are selected.Results: Out of 50 cases, in 76% sample cases ulcer healed by secondary intention without skin grafting. It was noticed better early improved status of the ulcer by excellent granulation tissue and without deterioration in status of large ulcers (24%), operated for skin grafting. The concept of covering wound by washed cotton cloth after regular wound wash, antiseptic ointment, and adjuvant conservative therapy, helped to improve patient’s comfort during outpatient department visit and inpatient department stay.Conclusions: It concludes that the newer concept of wound cover by washed cotton cloth is patient friendly and cost effective without compromising the status of wound healing.
A comparative study of closure versus non-closure of hernial defect in laparoscopic ventral hernia mesh repair
(Medip Academy, 2020-01) M., Nandeesh; V., Akash M.
Background: Laparoscopic ventral hernia repair has better out comes when compared to open mesh repair. But closure of the hernial defect is still a contentious issue. This study is designed to compare the outcome of closure versus non-closure of hernia defect in laparoscopic ventral hernia repair.Methods: A 2 years prospective randomized controlled study was conducted on 60 patients undergoing elective laparoscopic ventral hernia repair in the Department of General Surgery (November 2016 to October 2018).Results: The patients in the two groups were analyzed using Chi-square, ANOVA, Fisher exact test, and results were formulated. The mean age of ventral hernia was 41 years and overall incidence more in females. Paraumbilical hernia is the commonest variety of ventral hernia and 63.3% hernias were reducible. Average post-operative length of hospital stay was 2 days with no difference in both the groups. Post-operative pain was more in intraperitoneal onlay mesh (IPOM) plus group. Seroma formation and Incidence of mesh bulge was found be more in IPOM group, but there was no difference in the incidence of chronic pain or recurrence rate between the two groups. All the above proved statistical significance.Conclusions: Primary defect closure in ventral hernia along with mesh placement in laparoscopy seems to have better outcome, with respect to less chance of seroma formation and mesh bulge.

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