ABSTRACT
Background: The study was done with the aim to determine the clinical profile of patients with hollow viscous perforation and to compare MPI and APACHE II scoreMethods: This study was a prospective and retrospective observational study conducted in the department of General Surgery, Gandhi Medical College and associated Hamidia Hospital from the June 2017 to August 2019The possible score ranges from 0-47. All necessary preoperative data was recorded. Blood sample was taken and relevant blood investigations were done. Patients were resuscitated with iv fluids. Nasogastric tube and urinary cather insertion were done. The parameters of modified APACHE II score and Manheim’s peritonitis index were recorded at the time of admission. Patients underwent emergency laprotomy and correction of pathology was done.Results: Out of total 100 patients 79% were males, 21% were females, majority 45% belonged to the age group 26-35 years. To calculate the cut off point for mortality ROC curve was constructed. ROC curve analysis predicted that Manheim’s score of 22 or more would predict mortality. Out of total 16 deaths, 14 cases had Manheim’s score of 22 or more thus, giving the score a sensitivity of 87.5% and specificity of 77.38% and overall accuracy of 79% in our study. ROC also predicted that APACHE II score of 15 or more would predict mortality. Thus, giving APACHE II score a sensitivity of 93.75%, specificity of 100% and accuracy of 99%.Conclusions: We consider MPI to be a more simpler prognostic indicator than APACHE II score.
ABSTRACT
Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. Theoretically, echinococcosis can involve any organ. The liver is the most common organ involved, followed by the lungs. However, uterus and and adnexa have an incidence of 0.5-1%. Till date, three cases have been reported in which a parametrial hydatid cyst formed a bladder fistula. A 57 year old female was admitted with complaint of burning micturition along with white coloured urine for the last 15-20 days with no other significant history. On examination and evaluation, it was suspected to a neoplastic pelvic mass causing gross right sided hydronephrosis. All biochemical markers were within normal limits. The patient was explored surgically on which a thick-walled lesion was found in right parametrium. The cavity of the lesion was filled with daughter hydatid cyst, along with communication into the bladder via a fistula. Open cystectomy was done after evacuation of daughter cysts and irrigation with scolicidal agents. The fistula was repaired. The patient recovered uneventfully and was doing well on follow-up. The incidence of hydatid cysts in the female reproductive system is very low and constitutes less than 0.5% of all hydatid cysts. However, rare cases have been reported, thus the clinician must be aware of this rare disease and should take precautions while operating, as any spillage may lead to anaphylactic shock.