ABSTRACT
Abstracts: Background: To study the different modes of clinical presentation and study clinical outcome in various causes of large bowel obstruction in adults and to accomplish the operative management and to anticipate the postoperative complications and their management. Methodology: This is a prospective observational study of large bowel obstruction in adults and was carried out in 2012-2014. Results: A total 50 cases of large bowel obstruction were studied. Maximum patients11(44%) cases belonged to age group 51-60yrs. Obstipation is seen in50(100%), pain in 44(88%), distension in 50(100%), tenderness in 44(88%), constipation in 50(100%),rigidity in 14(28%). In present study, malignancy was the commonest (24 cases – 48%) cause of large bowel obstruction. There were 10 cases (20%) of stricture, 8 cases (16%) of volvulus, two case (4%) of endometriosis and two case (4%) of intussusception causing large bowel obstruction. Pseudo-obstruction comprised 4 cases.20 cases (43.5%)were operated for resection anastomosis of pathological part to relieve obstruction, while 18 cases (39.1%) were operated for temporary colostomy due to lack of definitive procedure either due to unresectable mass or gross contamination of bowel loop. Rest of the cases 8(17.3%) were operated for end colostomy or ilestomy. Wound infection was the commonest complication observed in 10 cases.6 patients died due to septicaemia.Pleural effusion was present in 4 patients.Skin excoriation around colostomy occurred in 6 cases. Mortality of the study was 6 (12%) cases. Conclusion : Old age (51-60) was the most common age group affected by large bowel obstruction.Colorectal carcinoma was the leading cause of large bowel obstruction . In our study. Distention and constipation were predominent symptoms.. Plain X-ray erect abdomen is the single most important diagnostic tool for diagnosing obstruction and its level of obstruction.CT SCAN abdomen confirmed the type and site of obstruction and spread of tumor in cases of large bowel malignancy.Early recognition and timely intervention is important to prevent the bowel from going for gangrenous changes.
ABSTRACT
A case of acute thrombotic occlusion is presented in a chronically stenosed subclavian artery with subclavian steal phenomenon noted on colour Doppler study and angiography. Because of economic constraints, thrombolysis with angioplasty was done instead of stenting. The patient is on follow-up for the past one year showing considerable improvement. The present case report confirms the efficacy of angioplasty as a suitable option in patients, who cannot afford to have a stent.