ABSTRACT
Background: Tuberculosis is a major health problem in developing countries. Inspite of considerable advances, abdominal tuberculosis still continues to be of paramount health issue in India, owing to its vague and non-specific presentation challenging the therapeutic skills of present day surgeon. Surgical intervention was frequently used in the past for diagnosis is not necessary and is reserved for complications like obstruction, perforation, fistula, or a mass which does not resolve with medical therapy.Methods: 30 patients admitted in Department of Surgery satisfying the inclusion criteria from November 2015 to October 2017. Patients were selected on a prospective basis.Results: In this study out of 30 patients, 16 patients were treated conservatively with anti- tubercular therapy (ATT) alone and 14 patients underwent surgical treatment. Out of 14 patients, 5 patients were operated on emergency basis and 9 were operated electively. Of the 5 emergency cases, 2 patients underwent resection anastomosis of small bowel, 1 patient underwent adhesiolysis, and 3 patients with hollow viscus perforation underwent perforation closure with peritoneal drainage.Conclusions: Tuberculosis has become a resurgent global problem with increasing numbers of extrapulmonary manifestations, non-specific features of abdominal tuberculosis result in difficulty in establishing a diagnosis, hence prompt initiation of treatment that can be either medical management or a surgical procedure is important to prevent morbidity and mortality associated with it.
ABSTRACT
Background: The aim of the study to study the modalities in the management of splenic trauma. Factors affecting non operative management in order to improve the outcome of conservative management, and the factors responsible for conversion to operative management.Methods: 30 patients were admitted in the Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, satisfying the inclusion criteria between 01 June 2016 to 31 August 2018.Results: A cross-sectional type of study was performed. Among the 30 patients, 21 were male and 9 were female. It was seen that in 80% of patients the mode of injury was road traffic accident. Human assault, animal attack and fall from height contributed to 6.66% each. The most common reason for conversion to operative management was fragile hemodynamic status of the patient. 20% of the cases were grade I, 40% grade II, 26.66% grade III, 6.66% each of grade IV and grade V, all cases of grade IV and grade V were managed operatively. In this study 60% of the cases could be managed conservatively, 1 case (3.33%) splenorraphy was done. 33.3% (1/3rd) patients required splenectomy, and 1 (3.33%) patient expired who presented late and with hemodynamic instability, belonged to grade V splenic injury.Conclusions: Conservative management has replaced splenectomy as the most common method of splenic trauma management in patients with stable hemodynamic status. Higher grades of splenic injuries have been managed conservatively. As a result, 60% of all blunt splenic injuries can be managed non-operatively with a success rate of 98%. Operative management associated with stringent intensive care unit (ICU), transfusions are restricted to higher grades of splenic injuries.