Ectopic pregnancy as general surgical emergency

A prospective evaluation of 17 patients of ectopic pregnancy presenting in the general surgical emergency over a period of four years is presented. Mean age of the patients was 22.6 years. Presenting complaints included sudden, severe abdominal pain and features of syncope. History of ammenorrhoea was present in 13 patients. 15 patients were married and two unmarried who denied history of contact. 13 patients had tachycardia. All had tenderness, rebound tenderness and muscle guard. 13 out of 15 patients examined had adnexal tenderness. 5 out of 9 patients had positive results on culdocentesis. Routine investigations were within normal limits. 15 patients had involvement of right tube and 2 patients left tube. Salpingectomy was the mode of management in all patients. In 7 patients it was combined with appendicectomy. A very low incidence of post operative complications was found. There was 1 death in the series. Mean hospital stay was 6 days. A number of risk factors were elucidated which predispose to tubal pregnancy. Emergency surgeon dealing with the general surgical cases should keep this possibility in mind if sudden abdominal pain and the features of shock are seen in a female during reproductive age

Acute abdomen a complication of uterine intervention

A prospective evaluation of 19 patients of complicated abortion presenting in the general surgical emergency over a period of four and a half years is presented. The mean age of the patients was 25.4 years. Presenting complaints included acute abdominal pain, vomiting, abdominal distension and absolute constipation in all cases. 16 patients were married and 3 unmarried. Tachycardia, pyrexia, generalised abdominal tenderness, guarding and absent bowel sound were present in all cases. Free gas under the diaphragm was present in 11 patients and multiple air fluid level in 8 patients. 13 out of 19 patients had intestinal injury [10 small gut and 3 colon]. 7 patients had external evidence of intestinal injury. Fundus of the uterus and posterior fornix were the common sites of perforations. Fundal perforations were repaired. Hysterectomy was carried out when the perforation involved the fornixes and major vessels and in those patients who pre-operatively asked for it. In six patients resection and anastomosis for small gut injury was carried out where as in four patients perforations were repaired. In 3 patients with colonic injury, resections and anastomosis of the injured colon along with transverse colostomy were carried out. There were two deaths in this series. The incidence of post operative complications was low. Mean hospital stay remained 8 days. Emergency surgeon dealing with general surgical emergencies should keep this possibility in mind if patient gives history of D and C and features of acute abdomen

Gynaecological emergencies in general surgery and their management

A series comprising of 97 cases admitted as acute abdomen in general surgical ward which later turned out to be gynaecological emergencies, is presented. These were managed over a period of three years and eight months. Total admissions were 2644. All the patients underwent surgery successfully. Cases are discussed and routine laparoscopy is suggested to establish a correct diagnosis