A clinical study of hollow viscus injury due to blunt trauma abdomen

Background: Blunt trauma abdomen is one of the most common causes of morbidity and mortality among younger age group. Hollow viscus injury is one of the most common cause of mortality following blunt trauma abdomen. The Objective of this research was to study clinical presentation, diagnostic methods, treatment modalities and outcome of hollow viscus injury following blunt trauma abdomen.Methods: All patients with hollow viscus injury were included in this study, All the clinical, operative and postoperative parameters were recorded. It was a retrospective observational study.Results: Total number of patients with hollow viscus injury following blunt trauma abdomen were 15%. Amongst them 88.88% were males and remaining were females. The mean age of patients was 32 years. Road traffic accident was the most common cause of blunt trauma abdomen, seen in 72 % of patients. In 81.25% patients free gas under diaphragm was seen and remaining patients were diagnosed by ultrasonography. Ileum is most commonly site of perforation, and postoperative complications were seen in 66% of patients. Mortality was seen in 22.22% of patients.Conclusions: Hollow viscus injury following blunt trauma abdomen commonly seen in younger age group, and involves small bowel. Repeated clinical examination with appropriate imaging with multidisciplinary teamwork is the key for timely intervention for successful outcomes

Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania

<p>Abstract</p> <p>Background</p> <p>Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting.</p> <p>Methods</p> <p>A cross-sectional study involving all patients suspected to have acute appendicitis at Bugando Medical Centre over a six-month period between November 2008 and April 2009 was conducted. All patients who met the inclusion criteria were consecutively enrolled in the study. They were evaluated on admission using the MASS to determine whether they had acute appendicitis or not. All patients underwent appendicectomy according to the hospital protocol. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical judgment and not the MASS. The diagnosis was confirmed by histopathological examination. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software.</p> <p>Results</p> <p>A total number of 127 patients were studied. Their ages ranged from eight to 76 years (mean 29.64 ± 12.97). There were 37 (29.1%) males and 90 (70.9%) females (M: F = 1:2.4). All patients in this study underwent appendicectomy. The perforation rate was 9.4%. Histopathological examination confirmed appendicitis in 85 patients (66.9%) and the remaining 42 patients had normal appendix giving a negative appendicectomy rate of 33.1% (26.8% for males and 38.3% for females). The sensitivity and specificity of MASS in this study were 94.1% (males 95.8% and females 88.3%) and 90.4% (males 92.9% and females 89.7%) respectively. The Positive Predictive Value and Negative Predictive Value were 95.2% (males 95.5% and females 90.6%) and 88.4% (males 89.3% and females 80.1%) respectively. The accuracy of MASS was 92.9% (males 91.5% and females 87.6%).</p> <p>Conclusion</p> <p>The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy and can be employed at Bugando Medical Centre to improve the diagnostic accuracy of acute appendicitis and subsequently reduces negative appendicectomy and complication rates. However, additional investigations may be required to confirm the diagnosis in case of atypical presentation.</p

Ileal Perforation Peritonitis Caused By T. Saginata: A Case Report

Worms are rare but definitive cause of intestinal perforation. Ascaris Lumbricoides is the main cause of intestinal perforation, especially in children. Other worms reported to cause perforation include Enterobius vermicularis, Trichuris trichura, and Tania solium. Tapeworm infestation is one of the common problems in tropical countries; usually they are asymptomatic but sometimes associated with serious complication like intestinal obstruction, appendicitis, or perforation. Few cases have been reported of perforation caused by T.solium in the literature, we present here a case report of tapeworm (T. Saginata) causing small bowel perforation and peritonitis

A Prospective study of the Glasgow-Blatchford score performance in predicting clinical outcomes in patients with upper GI bleeding, in rural India

Introduction: Many patients present to the emergency department with varying grades of UGI bleed, so deciding whether a patient requires emergency endoscopy or managed on out patient basis is a challenging decision. The Glasgow-Blatchford Score (GBS) is an easy score to calculate and identifies patients who are a high risk. Methods: This was a prospective study. The data of adult patients presenting with upper GI bleeding were included in this study. A GBS was calculated for each patient based on clinical or laboratory variables at the time of presentation. The outcome of the patient was observed, and patients were divided in two groups i.e. high and low risk.Univariate analysis was performed to compare these two groups. Results: Total 86 patients with UGI bleeding were included in the study. Amongst them 88% were males and 12% females. Out of 86 patients, 38 patients were included in low risk group, and 48 patients were in high-risk group Mean Glasgow Blatchford Scoring scores were 5.94 for 38 low-risk subjects and 10.16 for 48 high-risk patients. The sensitivity and specificity were 100% and 36.82% respectively, for a cut-off value of GBS score &gt; 3, 95.83% and 63.15% for a cut-off value of GBS score &gt;5, and 91.66% and 73.68% for a cut-off value of GBS &gt;7. Conclusion: The Glasgow-Blatchford score is based on simple clinical and laboratory variables, which helps in risk stratification [High risk / low risk] of the patients presenting with upper GI bleed, in the emergency department

A clinical study of Fournier’s gangrene and use of honey dressing in treatment

Abstract- backgroundFournier’s gangrene is necrotizing fasciitis involving genitals and perineal regions.  Fournier’s gangrene is a surgical emergency. If not treated immediately it spreads rapidly causing septicemia leading to death. Mainstay of treatment is surgical and regular dressing. Various dressing materials are available like eusol,  in our study we use Honey as dressing material. This is a small work to attempt to study incidence, etiology and pathogenesis and use of dressing for the treatment of Fournier’s Gangrene.Materials and methods in our study we study 40 male patients of Fournier’s gangrene. We studied clinico- pathology of disease and use of honey dressing for the management of Fournier’s gangrene. Out of 40 patients 18 were treated with honey as dressing material and remaining 22 with eusol.Results- 40 patients were admitted and majority of patients were in age group &gt; 60 years mean age was 54.08 _ 15.47 years. Majority of patients belonged to lower socioeconomic class 82.5%. Most of patients presented in hospital within 7 days of initial symptoms. In this study etiological causes found in 85% of patients and among which most common were urogenital causes 32.5%. Majority of patients had chronic alcoholism and bad hygiene as predisposing factors. 25% were associated with diabetes mellitus. In this study 12% of patients were HIV positive. Most common organism found in pus culture was E.coli (42.5%) followed by Coagulase negative Staphylococci in 32.5%, Klebsiella in 12.5%, Pseudomonas in 7.5% and no organism were isolated in 5%.Mean days required for healthy granulation by honey dressing was 9.62+- 4.5 days and for eusol was 10.5 +- 3.79 days. In our study mortality was 22.5%

A clinical study of Fournier’s gangrene and use of honey dressing in treatment

Abstract- backgroundFournier’s gangrene is necrotizing fasciitis involving genitals and perineal regions.  Fournier’s gangrene is a surgical emergency. If not treated immediately it spreads rapidly causing septicemia leading to death. Mainstay of treatment is surgical and regular dressing. Various dressing materials are available like eusol,  in our study we use Honey as dressing material. This is a small work to attempt to study incidence, etiology and pathogenesis and use of dressing for the treatment of Fournier’s Gangrene.Materials and methods in our study we study 40 male patients of Fournier’s gangrene. We studied clinico- pathology of disease and use of honey dressing for the management of Fournier’s gangrene. Out of 40 patients 18 were treated with honey as dressing material and remaining 22 with eusol.Results- 40 patients were admitted and majority of patients were in age group &gt; 60 years mean age was 54.08 _ 15.47 years. Majority of patients belonged to lower socioeconomic class 82.5%. Most of patients presented in hospital within 7 days of initial symptoms. In this study etiological causes found in 85% of patients and among which most common were urogenital causes 32.5%. Majority of patients had chronic alcoholism and bad hygiene as predisposing factors. 25% were associated with diabetes mellitus. In this study 12% of patients were HIV positive. Most common organism found in pus culture was E.coli (42.5%) followed by Coagulase negative Staphylococci in 32.5%, Klebsiella in 12.5%, Pseudomonas in 7.5% and no organism were isolated in 5%.Mean days required for healthy granulation by honey dressing was 9.62+- 4.5 days and for eusol was 10.5 +- 3.79 days. In our study mortality was 22.5%

Difficult Airway Management Methods:A Survey in Medical Colleges in India

Presence of appropriate equipment and actual procedure employed, greatly affect the outcome in Difficult Airway situation. Medical Colleges being torchbearers in this, have been studied. Consultant presence during intubation in 54% Medical Colleges is commendable. Gum Elastic Bougie is rejected as first choice option by 71% Medical Colleges, though 88% Medical Colleges have mentioned Metal or PVC stylets as first choice options. Blind Nasal Intubation at 33% is the highest 2 nd choice option. The Fibreoptic Bronchoscope and Intubating Laryngeal Mask Airway at 29% and 17% respectively, obtain the third highest choice option. 67% Medical Colleges postpone the difficult airway case for investigations. It facilitates planning and preparation. Planned tracheostomy at combined 4 th and 3 rd choice option of 42% indicates handling of more complicated cases. Flexible fibreoptic stylets and Glidescope are not in the running. Development of low skill procedures for difficult airway is yet to catch up, as does that for invasive airway devices. We believe that this survey is the first such study carried out in Medical Colleges in India

Idiopathic Colonic Perforation in Adult—A Rare Case

Idiopathic perforation of normal colon in adults is rare. The cause for idiopathic perforation is not known. We report a case of idiopathic colonic perforation in adult who presented with sign and symptoms of perforative peritonitis. On laparotomy patient was diagnosed to have a colonic perforation. There was no causative factor for perforation in the patient. This case is reported because of rarity of this diseas