ABSTRACT
Abstracts: Background: Acute intestinal obstruction is one of the commonest surgical emergencies accounting for nearly 30% of all acute abdominal emergencies. It is vital to distinguish strangulated from non-strangulated intestinal obstruction because former is associated with increase morbidity and mortality and is a surgical emergency. Success in the treatment of dynamic intestinal obstruction depends largely upon early diagnosis and skillful management of both the patho physiological effects of dynamic intestinal obstruction and the cause itself. Methodology: The present study includes fifty operated cases of dynamic intestinal obstruction of varied etiology admitted at our institution during the period of July 2008 to October 2010. Patients below the age of 10 years and Patients who were treated conservatively were not included in this study. The patients were followed up for a period varying from 3 months to 1 year postoperatively. Results: In present study post operative adhesions and bands were the commonest causes (40%) of dynamic intestinal obstruction. The most commonly performed surgery was adhesiolysis which consisted of division of band or adhesion causing obstruction. The majority of patients in the present study were in their third, fifth and sixth decades of life. The percentage of patients developing complications were much higher in strangulated obstruction. The overall mortality of 12% in the present series compares favourably with other series conducted in recent years. Conclusion: Both morbidity and mortality were higher in cases of strangulated obstruction when compared with simple luminal obstruction. Hence, an aggressive policy should be adopted to reach at an early diagnosis and treat accordingly, thereby preventing the potential complication of strangulation.
ABSTRACT
Background: Dermatofibrosarcoma protuberance is relatively uncommon low to intermediate grade malignant neoplasm with characteristic cytogenetic features. It constitutes less than 0.1% of all malignant neoplasms. Although metastasized rarely, it is locally aggressive tumour with high recurrence rate. It is a one of the rare type of law grade sarcomas that occur s anywhere in the body, usually arise from trunks and extremities. It rarely arises from abdominal wall. Objectives: The main objective of the present study was to study the outcome of surgical treatment of dermatofibrosarcoma protuberance. Methods: This study included 4 patients all retrospective and prospective from September 2008 to December 2013. They were subjected to detailed history taking and examination with relevant investigations and were subjected to surgery. They were followed up for at least 36-month period to assess for any recurrence. Results and Interpretation: Out of 4 patients, all were males. Mean age of presentation was 32 years. Site distribution was 25% trunk, 50% extremities and 25% neck. All patients underwent wide local excision. At the end of follow-up period of up to 3 years after surgery Overall recurrence rate was nil. Because of the potential of local recurrence, therapy for DFSP should be directed toward adequate local excision of the primary lesion. Minimal resection should include a surrounding margin, comprising 3-cm margin of normal skin and removal of underlying deep fascia. Compromising on margins invites higher chances of local recurrence. Conclusion: DFSP behaves like a locally infiltrating neoplasm. Despite their locally aggressive behaviour, distant metastasis occurs with extreme rarity. Because of this, it is reasonable that therapy should be directed towards adequate local excision of the primary lesion. Compromising on margins always invites higher chances of local recurrence.
ABSTRACT
Background:Acute peritonitis is an acute inflammation of the peritoneum, either localized or generalized. If there is delay in diagnosis and appropriate treatment, it may worsen the condition and produce a fata outcome. Acute peritonitis is an abdominal emergency containing 20-25% of total emergency. Laparoscopy has a significant role in diagnosis as well as management of acute peritonitis. Methods:The patients were selected from indoor registration cases from V.S. General Hospital from 2010-2012. In total, 30 patients underwent diagnostic and therapeutic laparoscopy for acute peritonitis. Results and Interpretation:Acute peritonitis is distributed in both sexes at almost same frequency. Acute peritonitis is distributed in all age groups. It is more common in 16-45 years age group which contains approximately 65-70%. Appendicitis is the major cause of peritonitis. Other causes were pericholecystic collection and perforation was the cause in 10% of patients. Conclusion:Diagnosis and management of the patient with acute peritonitis is a challenging part of a surgeon’s practice. Laparoscopy has a small but substantial role to play in relatively stable patients of acute peritonitis.