ABSTRACT
Background: Acute appendicitis is one of the commonest surgical conditions requiring emergency appendectomy. The diagnosis is usually suspected clinically and confirmed on either ultrasound or Computed tomography. The aim of our study is to improve the diagnostic accuracy of acute appendicitis and reduce the rate of negative appendectomy. We have modified the Alvarado’s score by incorporating C- reactive protein and deleting two of its components (leukocyte shift to left and migration of pain from umbilical region to right iliac fossa). Methods: We successfully used this scoring system on a sample size of 100 patients. Out of 100 patients, diagnosis was confirmed on histopathological examination in 76 patients. Neutrophilic infiltration of the muscularis layer was considered as the diagnostic criteria for acute appendicitis. Ten patients were diagnosed only on CECT abdomen as Appendicular lump. These patients were not operated. Alternate diagnoses were made in twelve patients with MAS score of 5 or less and in two patients with MAS score of more than 6. Results: On statistical analysis, the result showed that the MAS is a very specific (85.7%) and highly sensitive (95.3%) in detecting Acute Appendicitis, taking Histopathology or CT as gold standard test. While, the positive predictive value is 97.6%, negative predictive value is only 75%. Conclusions: This means that it is difficult to rule out acute appendicitis in patients with lower scores. However, for such patients further investigations can be done to reach to a final diagnosis.
ABSTRACT
Background: Adhesive small bowel obstruction is one of the commonly encountered clinical problems associated with repeated hospitalization. Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need of operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. Aim: To evaluate the role of Gastrografin in predicting the need of surgery in post-operative intestinal obstruction and its therapeutic effect in management of adhesive intestinal obstruction. Methods: This prospective nonrandomized controlled trial study was conducted on 72 patients with a diagnosis of adhesive small bowel obstruction. All patients were divided into Groups A and B. In 36patients of Group A, Gastrografin dye was administered and serial abdominal X-rays were taken up to 24 hours. The patients, in whom contrast reached caecum within 24 hours, the result was positive for partial obstruction and they were treated conservatively. False positive included high-grade partial obstructions that ultimately required surgery. If the contrast failed to reach the large bowel within 24 hours, the patient was considered to have complete obstruction and was operated. In 36 patients of Group B, all these patients were treated conservatively and were operated when required. Qualitative data was analysed by Fisher exact test. Results: In our study, in gastrograffin group 83.3% of cases were managed conservatively and 16.6% were operated, whereas in control group 66.6% were managed conservatively and 33.3% were operated (P value=0.02). Further in case of patients who received dye 88.9% patients resolved within 24 to 48 hours were as in case of controls only 33.3 % patients resolved within 24 to 48 hours. Therefore, in our study gastrograffin had 100% sensitivity and 86.6 % specificity, 86.6% positive predictive value and 100% negative predictive value. Overall accuracy was calculated to be 88.88%. The mean hospital stay of group A patients was 4.4 days and in case of group B was 6.3 days (p value 0.009). Conclusions: Gastrografin was effective and safe for prediction of need for surgery in adhesive small bowel obstruction. Furthermore, it speeds the resolution of obstruction and reduces the need for operation.
ABSTRACT
Background: Hydrocele is among the commonest benign conditions of scrotum. Its incidence is around 1% in adult male population with a predilection for males above 40 years of age. Conventional surgical procedures like Jaboulays Eversion of Sac (EOS) and Lords plication of redundant tunica vaginalis remain the most commonly used procedures used in the treatment of idiopathic adult hydrocele. Both procedures are invasive and are associated with durable success and low incidence of recurrence. These procedures are however associated with many post-operative complications like pain, hematoma, infection, persistent swelling and induration of scrotal skin, wound related complications, chronic pain and reduced fertility. All these translate into high morbidity, loss of work hours and increased surgical expenses. To avoid / minimize these complications associated with plication or excision of the redundant hydrocele sac fenestration has been proposed as a minimal access procedure. Fenestration exposes the secretory surface of the tunica vaginalis sac to the lymphatic-rich subcutaneous tissues, from where the hydrocele fluid is cleared off the scrotal cavity. Methods: The present study was carried out in the Department of General Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard during the time period of June 2014 - December 2015. 120 patients of primary vaginal type hydrocele with ASA grade 1 were randomly allocated into two groups of 60 patients each – one group for the Mini-Hydroceletomy MiH-(Group A) and the other group for routine Jaboulays EOS (Group B). All the patients were followed up for a period ranging from 6-18 months. Results: Mean age of patients was 42 years for jabouleys and 45 for mini hydrocelectomy group. Mean hydrocele volume for Group A was 240 ml and for group B was 252 ml. Average time for the procedure in group A was 10-12 min (mean 11min) and for group B was 25 -30min (mean 27min). In Group A, Average incision length was 2.1 cm whereas in Group B it was 5.4 cm. Conclusions: We hereby present our experience that mini-hydrocelectomy (MiH) technique to be the procedure of choice for medium sized uncomplicated hydroceles.