A Study Of Intestinal Obstruction Conservtive Vs Surgical Management

INTRODUCTION: Intestinal obstruction can be defined as impairment to the abnormal passage of intestinal contents that may be due to either mechanical obstruction or failure of normal intestinal motility in the absence of an obstructing lesion.The causes of a small bowel obstruction can be divided into three categories: extra luminal, intrinsic, Intraluminal. METHODOLOGYThis is a retrospective observational study. All patients presenting to the Emergency and Out-Patient Department of surgery unit with features of intestinal obstruction were screened to identify the patients with AIO. RESULTS AND DISCUSSIONIn this study total 60 no. of pt. were evaluated during the period of January 2017 to June 2018. From these 60 pts. 22 pts. managed conservatively where as 38 pts. were managed surgically. Overall mean age group of these pt. was 54 and M:F ratio was 1.3:1. Male has higher incidence than female .Among these pts. abdominal pain and vomiting are more common symptom than obstipation .Among this 60 patients, 20 patients had previous abdominal surgery, 16 patient had exploratory laparotomy for abdominal trauma , perforation, gynaec procedure , appendicitectomy, etc. 4 patient developed features of obstruction following laproscopic T.L. among these 6 patients were managed conservatively and 14 patient undergo surgery.Mean duration for surgically managed was 2.8 days. Mean duration for conservatively managed patients was 2.9 days. Among the surgically managed pts. 14 had adhesions, 11 had stricture, 8 had obstructed hernia, 1 had intussusception, 4 had abdominal TB. Surgical procedures were done according to the cause of the obstruction.History of abdominal surgery was found to be more frequent in whom obstruction was relieved conservatively.

Non Operative Vs Operative Management Of Blunt Hepatic Injury A Retrospective Study

The liver is one of the most frequently damaged organs and remains the most common cause of death following blunt abdominal trauma.During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and non operative management.Currently, a non operative management constitutes the treatment of choice in patients with hemodynamic stability.The objective of this study is to examine the outcomes of blunt hepatic trauma, and compare surgical and nonsurgical treatment on patients admitted with hemodynamic stability and with no obvious indications of laparotomy.Methods: A retrospective study of the patients presented with blunt liver trauma was performed from 2016-2017.Variables analyzed included demographic data, cause of injury, grade of injury, associated injuries, vitals, haemoglobin values,number of blood transfusion, mode of treatment and complications.Clinical parameters, GCS were recorded in all the patients. ultrasonography and CT scan were also done. Patients with unstable hemodynamics who responded to fluid challenge and with stable hemodynamics were included in conservative management of liver trauma.Results: A total of 55 patients were analyzed. 5 patients had sustained severe injuries. Mean pulse rate in conservative group was 92 beats/min.Mean blood pressure inconservative group was 110/70 mmHg . Conservative treatment was followed in 50 patients with surgery undertaken in 6 of the patients from this group due to failure of conservative treatment. Mean duration of hospital stay in conservative and operative groups are respectively 17 and 19 days. P value is significant (0.04).Conclusions:A non-operative approach results in lower complications, a lesser need for blood transfusions and a lower mortality rate.Failure of conservative treatment did not show a higher incidence of complications or mortality.

Surgery for inguinal hernia in pediatric age.

Inguinal hernia repair is one of the most frequently performed surgical procedures in pediatric patients. An inguinal hernia does not resolve spontaneously and must be repaired because of high risk of complications. A retrospective analysis was performed on the hospital records including operative notes of admitted pediatric patients, aged up to 12 years, who underwent inguinal herniotomy. On observation, male affect more than female , right side inguinal hernia more common than left, due to let decent of testis on right side. Early detection and repair of inguinal hernia in pediatric is essential to decrease the potential morbidity and operative complications rate. This needs an increase in popular and pediatric awareness.