Wandering ascaris coming out through the abdominal wall

A rare case of ascaris coming out through the anterior abdominal wall is reported here. A 40-year-old female had undergone dilatation and curettage by a quack. On the second day she presented with presented with features of peritonitis. She was explored. Resection anastomosis of the ileum was done for multiple perforations of the ileum. Patient developed a fistula in the anterior abdominal wall which was draining bile-colored fluid. On the 12[th] postoperative day a 10-cm-long worm was seen coming out through the fistulous tract which was found to be Ascaris lumbricoids. Ascaris lumbricoids can lead to many complications ranging from worm colic to intestinal obstruction, volvulus, peritonitis, pancreatitis, cholangiohepatitis, liver abscess and many more. Worm has been reported to come out through mouth, nostrils, abdominal drains, T-tubes etc. But ascaris coming out through the anterior abdominal wall is very rare hence reported here

Penetrating cardiac injury: a review

Cardiac injury presents a great challenge to the emergency resident because these injuries require urgent intervention to prevent death. Sometimes serious cardiac injury may manifest only subtle or occult symptoms or signs. As there is an epidemic of cardiac injuries in Kashmir valley due to problems of law and order, we herein present a review on management of such injuries

Ulcerative colitis: a challenge to surgeons

Ulcerative colitis is a chronic disease that specifically affects the mucosa of the rectum and colon. Although the etiology of this recurring inflammatory disorder remains essentially unknown, there have been significant advances in identifying the likely genetic and environmental factors that contribute to its pathogenesis. The clinical course of the disease typically manifests with remissions and exacerbations characterized by rectal bleeding and diarrhea. Since ulcerative colitis most commonly affects patients in their youth or early middle age, the disease can have serious long term local and systemic consequences. There is no specific medical therapy that is curative. Although medical therapy can ameliorate the inflammatory process and control most symptomatic flares, it provides no definitive treatment for the disease. Proctocolectomy or total removal of the colon and rectum provides the only complete cure; however, innovative surgical alternatives have eliminated the need for a permanent ileostomy. The aim of this review is to provide a detailed account of the surgical management of ulcerative colitis

Crohn's disease: a surgeon's perspective

Crohn's disease [CD] is known for wide anatomic distribution, different presentations, life-threatening complications, and multiple modalities of management. Its multiple implications are still unaddressed. Since all the patients do not show a good response to medical modalities of treatment, a significant percentage of these patients are referred to the surgeon for the palliation of complications or for the ultimate curative treatment. Since most surgeons come across such patients only rarely, it is sometimes difficult for them to choose the appropriate procedure at the time of need. Moreover, the various surgical modalities available for the different presentations and complications of the disease have not been adequately discussed. The aim of this review is to offer insight and a detailed account of the management of CD from a surgical perspective. This review offers an overview of the various surgical options available, their utility in context, and an approach to various scenarios of complicated CD

Vascular injuries caused by tear gas shells: surgical challenge and outcome

Tear gas shells are used to disperse the mob during any type of street protests. Vascular injuries due to tear gas shells have not been reported. The present study was undertaken to analyse the pattern, presentation, management and outcome of vascular injury due to tear gas shells. Eighteen patients with vascular injury caused by tear gas shells from 1[st] Jan. 2008 to 31[st] Dec 2009 were studied. Patients with vascular injuries caused by causes other than tear gas shells were excluded from the study. All patients were treated with reverse saphenous vein graft as segmental loss was less than 2.5 cm. wound infection was the most common complication, followed by graft occlusion. Amputation rate was 16.66%. Associated nerve injury occurred in 44.44% of the patients. Tear gas shell injuries should not be taken lightly. They can cause injuries as serious as vascular injuries. Vascular injuries cased by tear gas shells require prompt revascularization to improve limb salvage. Despite proper revascularization, patients have significant morbidity and need proper rehabilitation in the follow ups

Missile diaphragmatic injuries: Kashmir experience

Importance of repairing a diaphragmatic tear due to a missile injury cannot be overemphasized.Even a small diaphragmatic rent should be repaired because of morbidity and mortality caused by subsequent herniation and strangulation. Fifty-three cases with diaphragmatic injuries caused by penetrating missiles were studied from January 1997 to January 2007. All the patients were primarily explored either for thoracic or abdominal penetrating trauma; the diaphragmatic injury was an associated incidental intraoperative finding. Thoracotomy was performed in 18 patients, Laprotomy in 33 patients and in two patients combined thorocoabdominal approach was utilised for managing associated visceral injuries. Overall mortality was 37.7%. Mortality was dependent on associated injuries of thoracic and abdominal viscera. Most patients died due to associated injuries and septicaemia. None of the patients had any sequelae of diaphragmatic repair. Immediate repair of diaphragmatic injury is of paramount importance to prevent subsequent complications of herniation and strangulation