Tropical Gastroenterology

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5th Asia/Oceania Regional Congress of gerontology. November 19-23rd 1995.
(1995-10-01) Sharma, M P
6th World Congress on Medical Ultrasound.
(1991-07-01) Sharma, M P
Abdominal aortic aneurysm and peptic ulcer disease: experience of a single unit in Sri Lanka.
(2002-04-14) Samarasekera, D N; Gunawardhane, P A H A; Sheriffdeen, A H
The abdominal cocoon and an effective technique of surgical management.
(2005-01-25) Samarasam, Inian; Mathew, George; Sitaram, V; Perakath, Benjamin; Rao, Anakamma; Nair, Aravindan
The Abdominal Cocoon is a very rare cause of small bowel obstruction. It is caused by encapsulation of the small bowel by a fibrous membrane. This tropical disease, seen in young females, has also been reported in males. This is one of the largest series of the Abdominal Cocoon, with five new patients (3 males and 2 females) being reported. The traditional surgical treatment of choice is by lysis of adhesions. All patients in this case series had small bowel intubation done in addition to adhesiolysis. Although small bowel intubation is an established procedure for various causes of recurrent small bowel obstruction, to our knowledge this is the first report of its use in the management of the Abdominal Cocoon. We report our surgical technique in the management of this rare disease.
Abdominal cocoon due to primary peritonitis: barium meal is valuable in diagnosis.
(2004-04-09) Raju, G Suryanarayana
Abdominal cocoon, a rare condition in which the small bowel is encased in a membrane, resembles peritoneal fibrsis. There are only 16 case reports of this condition in the world literature. A 15-year-old girl presented with recurrent abdominal pain due to distal small bowel obstruction. Abdominal X-ray showed multiple air fluid levels like small intestinal obstruction. Contrast study revealed segregation of the small bowel loops with a dilatedproximal small intestine and gradual narrowing of the distal ileum with the obstruction; the mucosal pattern was preserved till the distal ileum. Contrast was not flowing into the colon. At laparotomy, the small intestine was seen to be encased and coiled up in a membrane. The membrane was excised, resulting in release of the obstruction.
Abdominal cocoon in a male: rare cause of intestinal obstruction.
(1995-10-01) Wig, J D; Goenka, M K; Nagi, B; Vaiphei, K
Abdominal cocoon, which is characterised by encasement of bowel by a fibrous membrane, is a rare cause of intestinal obstruction. It occurs primarily in females with only three cases reported earlier in males. We report a male patient presenting with small bowel obstruction and detected to have abdominal cocoon at surgery. Incision of thick membrane and lysis of adhesions led to relief of obstruction without any recurrence.
Abdominal compartment syndrome--an old syndrome, a new perspective.
(2007-10-18) Puneet,; Chauhan, V; Singh, S; Gupta, S K; Shukla, V K
The abdominal compartment syndrome is a life threatening condition resulting from pathologic elevation of the intraabdominal pressure. Prompt diagnosis is required to avoid significant sequelae. Diagnosis of this syndrome is based on clinical findings and intra abdominal pressure monitoring. Treatment consists of decompressive laparotomy, which corrects the pathology. Various surgical techniques are described to manage the open abdomen. Despite considerable attention accorded to this disorder, it is still associated with high morbidity and mortality. This review article deals with the identification of risk factors, pathophysiology, diagnostic criteria and treatment of critically ill patients with the abdominal compartment syndrome.
Abdominal fine-needle aspiration biopsy.
(1985-10-01) Salazar, Y; Thomas, E
Abdominal imaging in the diagnosis of portal hypertension.
(1997-01-01) Das, K; Chawla, Y
Abdominal packing for surgically uncontrollable haemorrhage.
(2010-01) Gupta, Manoj; Nimbalkar, Sangeeta; Singla, Punit; Kumaran, Vinay; Mohanka, Ravi; Mehta, Naimish; Saluja, Satish; Soin, A S; Nundy, S
Background: Using abdominal packs is often a life-saving technique for uncontrollable bleeding during operations. It prevents worsening of the hypothermia, coagulopathy and acidosis which usually accompanies massive bleeding till they may be corrected and the packs removed later. However, packing may be associated with a mortality of 56 to 82 % due to continued bleeding, intra-abdominal abscesses and the compartment syndrome. We follow a policy of early abdominal packing (considering it after a 6 unit intraoperative blood loss) before the situation becomes irreversible. Patients and methods: Between January 1997 and September 2008, abdominal packing for uncontrollable bleed was done in 49 patients (M:F 34:15, mean age 43 years) . The risk factors for mortality were analyzed. The reasons for uncontrollable bleed were : liver trauma (8), liver tumours (3), following liver transplantation (4), pancreatic necrosectomy (17) and miscellaneous causes (17). Results: There were 16 postoperative deaths (32.7%). On univariate analysis, hypovolaemic shock, a low urine output, raised INR, blood requirement of more than 6 units, hypothermia <340C, metabolic acidosis and sepsis were associated with an increased mortality. However, on multivariate logistic regression only hypothermia was significantly associated with mortality. Conclusion: A fair survival rate can be achieved by early and judicious use of abdominal packing especially before hypothermia supervenes.
Abdominal tuberculosis in children.
(1990-07-01) Sharma, A K; Agarwal, L D; Sharma, C S
Problems in the management of abdominal tuberculosis in children are discussed with reference to 80 surgically proven cases. The protean clinical manifestation depends on the site and the extent of the disease and its complications. The clinical diagnosis is difficult because of the vague symptoms, non-specific signs, and non-availablity of specific diagnostic tests. The most common type of pathology seen in abdominal tuberculosis in the paediatrics age were adhesive variety followed by nodal type. Strictures of the small bowel are uncommon and hyperplastic variety is rarely seen in this age group. Response to the antitubercular drugs is excellent however, the post operative complications and mortality remain high.
Abdominal tuberculosis presenting as an inguinal hernia.
(2005-04-18) Bhatia, S; George, R K; Sharma, R
Abdominal tuberculosis: diagnosis by laparoscopy and colonoscopy.
(2002-07-16) Ibrarullah, Md; Mohan, A; Sarkari, A; Srinivas, M; Mishra, A; Sundar, T S
BACKGROUND: Histopathological confirmation in abdominal tuberculosis is difficult due to suboptimal noninvasive access to the involved area. Peritoneoscopy and colonoscopy provide semi-invasive access to the peritoneum, large intestine and ileocecal area. Information on the diagnostic yield of these two investigation in abdominal tuberculosis is scarce. OBJECTIVE: To evaluate the role of laparoscopy and colonoscopy in the diagnosis of abdominal tuberculosis. PATIENTS AND METHODS: Between January 1998 and July 2001, 34 patients were diagnosed to have abdominal tuberculosis on the basis of laparoscopy or colonoscopy. The case records of these patients were retrospectively reviewed to assess the usefulness of laparoscopy and colonoscopy in the diagnosis of abdominal tuberculosis. RESULTS: Laparoscopy was performed in 23 patients. Peritoneal tuberculosis was diagnosed in 19 of them, characterized by presence of ascites, multiple whitish tubercles, fibrous bands and adhesions, hyperaemic edematous bowel loops or dense adhesions without ascites. Multiple jejunoileal hyperemic short segments with serosal neovascularization was noticed in three patients. One patient had cecal mass with pericecal inflammatory adhesions. In three patients, laparoscopy was converted to open laparotomy due to bowel injury, extensive adhesions, and difficulty in assessing lymph nodal mass in one patient each. Peritoneal biopsy confirmed the diagnosis in 10 of the 15 (67%) patients. In one patient pericecal tissue biopsy confirmed the diagnosis. The remaining patients received therapeutic trial with anti tuberculosis treatment. All patients showed good response. Thus laparoscopy provided positive diagnosis of tuberculosis in 20/23 (87%) and positive histology in 10 of the 15 (67%) patients with peritoneal lesions. Thirteen patients underwent colonoscopy. Mucosal lesions involving terminal ileum, cecum and colon was noted in 11 patients. Colonoscopic biopsy confirmed the diagnosis in six of the 11 patients (54%). Non of these patients had any complication related to colonoscopy. CONCLUSION: Laparoscopy was safe and helped in the diagnosis of peritoneal as well as intestinal tuberculosis in 87% of patients. Colonoscopy is useful for colonic and terminal ileal lesion with a positive diagnostic yield of 54%.
Abnormal prothrombin (PIVKA-II) and hepatocellular carcinoma.
(1991-04-01) Okuda, H; Nakanish, T; Furukawa, M; Yamagata, H; Obata, H
Abrikosoff's tumor of the esophagus: case report and review of literature.
(2006-01-17) Harikumar, R; Simikumar,; Aravindan, Sunilkumar K K P; Thomas, Varghese
Abrikosoff's tumor or granular cell tumor is a neoplasm of neural origin, usually located in the head and neck region. A majority of these neoplasms are benign. Only 4-6% of granular cell tumors are located in the gastrointestinal tract. It is extremely unusual for these tumors to be located in the esophagus. This case is being reported in view of the rarity of this lesion. A brief review of literature with stress on diagnostic evaluation and management issues is also included.
Academic gastroenterology in the U.S.A.
(1987-10-01) Pitchumoni, C S; Hertan, H I
Achalasia cardia: A study of 113 patients managed with indigenous dilator.
(2006-01-17) Nijhawan, S; Mathur, A; Kumar, D; Tandon, M; Rastogi, M; Joshi, A; Shende, A; Agarwal, N; Rai, R R
BACKGROUND: Endoscopic dilatation of achalasia cardia is an effective nonsurgical management option. It requires costly pneumatic dilators which are used under fluoroscopic guidance. This study assesses the efficacy and safety of an indigenous pneumatic dilator used without fluoroscopic guidance. METHODS: Over a period of eleven years, 113 patients (69M, 44F) ofachalasia cardia underwent dilatation with indigenous pneumatic dilators without fluoroscopic guidance. The dilatation was performed under endoscopic vision. RESULTS: The procedure was successful in all patients. After six weeks following dilatation, there was significant improvement in the mean dysphagia score 3.63 + 0.61 to 0.53 + 0.93 (P<0.01). The response was still significant (0.78 + 1.03, P <0.05) at the end of one year. Excellent response with single dilatation was seen in 70.7% patients. After two dilatation sessions 92% of patients showed an excellent response. One patient had perforation. There was no mortality. CONCLUSION: Pneumatic dilatation under endoscopic vision without fluoroscopic assistance with the indigenous dilator is very effective and safe for short term treatment of achalasia carida.
Acquired volvulus following Nissen fundoplication.
(2003-01-17) Ashok, L; Anand, L; Surendran, R; Jayanthi, V
Nissen fundoplication is the procedure of choice for the management of gastroesophageal reflux disease. We report a case of acquired gastric volvulus following open fundoplication. The mechanism of formation and correction of the volvulus is discussed.
Acute appendicitis: a quality assurance study.
(2003-04-08) Paudel, Rajesh Kumar; Jain, Bhupendra Kumar; Rani, Sudha; Gupta, Satyendra Kumar; Niraula, Surya Raj
The parameters that indicate the quality of patient care in acute appendicits (AA) were evaluated. One hundred sixty-four patients, who underwent emergency appendectomy (EA) at the B.P. Koirala Institute of Health Sciences, Dharan, Nepal were studied prospectively. The mean duration of the symptoms was 42.2 +/- 69.5 hours (range 2-720 hours, median 24 hours). The mean waiting period in the hospital was as 12.7 +/- 21.8 hours (range 1-188 hours, median 7 hours). Special investigations' such ultrasonography, computed tomography or laparoscopy, were not used for diagnosis. The perforation rate was 39%. The histopathology report of 79% of the patients was available. Diagnostic accuracy in histologically evaluated patients was 91.5%. One patient (0.6%) died. The mean hospital stay was 3.2 +/- 2.0 days (range 1-17 days). Patients who had to wait in hospital for < 24 hours before surgery had a longer duration of symptoms, underwent exploratory laparotomy through a mid-line incision more frequently, had a higher incidence of perforated/gangrenous appendix and longer hospital stay. The mean medical expenditure for patients treated in the general ward was Nepali Rupees (NR) 2485 +/- 504 (range NR 1372-4500). The majority of patients/guardians (88%-97%) were satisfied with the medical expenditure incurred, promptness of service, behaviour of the hospital staff and the facilities available in the hospital. The diagnostic accuracy and cost of treatment were favourable. The longer duration of symptoms, non-utilization of special investigations for diagnosis, high perforation rate and less than cent-per cent biopsy rate are the aspects that require attention to improve the quality of surgical care.
Acute fatty liver of pregnancy: a case report a review of the literature.
(2003-07-26) Krishna, Rajesh; Valavan, R Thiruma; Sathyanarayanan, V; Rajendiran, C
Acute fatty liver of pregnancy (AFLP), a rare and potentially fatal disease, usually affects a primi gravida during the third trimester of pregnancy. We report a case of AFLP with a favourable maternal outcome.

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