The Enterolith Causing Jejunal Obstruction, An Unusual Presentation: A Case Report

Enteroliths are a rare cause of intestinal obstruction. Patients can present with repeated episodes of intestinal obstruction as long as an enterolith is able to pass through the gut and then suddenly, they get stuck at the terminal ileum or present with the perforation peritonitis, as may happen in case of a diverticular disease. Here, we report the case of a young male presented to the emergency room with acute intestinal obstruction. During the explorative laparotomy, an enterolith was found stuck inside the proximal jejunum which was removed through an enterotomy. This was an interesting case, as the patient did not have any predisposing factors nor did we find any evidence of other pathologies intraoperatively. Moreover, the enterolith was stuck in jejunum, contrary to the belief that terminal part of the ileum is a most common site for the enteroliths to get stuck.

Post-ileal Appendicitis - A Resident’s Nightmare: A Case Report.

Vermiform appendix should not be considered a vestigial organ in human beings but a lymphoid organ which when inflamed causes serious trouble. Acute appendicitis usually presents with pain and tenderness in the right iliac fossa associated with nausea and anorexia. It may have an atypical presentation depending on the position of the appendix. In post-ileal appendicitis, the pain is localized around the umbilicus and the shifting of pain may be absent. The ultrasound of abdomen may not be very helpful in this case, but the computed tomography scan of the abdomen may help reach the diagnosis. The delay in diagnosis and subsequent treatment of acute appendicitis may have catastrophic results.

Peritonitis as a Result of Spontaneous Rupture of Uterus due to Pyometra: A Diagnostic Dilemma.

Peritonitis as a result of spontaneous rupture of the uterus due to pyometra is a very rare entity. Since 1980, only a few cases of spontaneous rupture of the uterus due to pyometra have been reported in the literature. It is a diagnostic dilemma for a surgeon and a possibility of this entity though very rare should be borne in mind in an elderly female patient with diffuse peritonitis as outcome improves greatly on timely diagnosis and proper management. We present a case of peritonitis due to spontaneous rupture of the uterus due to pyometra which was diagnosed at laparotomy and managed successfully.

A Rare Presentation of Primary Breast Tuberculosis in a Primigravida: A Case Report.

Tuberculosis is an endemic and very common disease in India. Breast tuberculosis is often confused with breast malignancy or pyogenic abscess. We report a rare case of breast tuberculosis which is successfully managed with Anti-tubercular drugs. After six months of compliant treatment patient delivered a healthy baby.

Internal hernia of the Broad Ligament leading to acute intestinal obstruction: a case report.

Acute intestinal obstruction is a frequently encountered surgical emergency but cases arising from internal herniation through the broad ligament are very rare. We report a case of a middle aged lady with intestinal obstruction due to internal herniation of small bowel through the right side of broad ligament and managing her successfully by timely and immediate surgical intervention.

Diagnostic value of Plain Abdominal Radiograph, Ultrasonography and Clinical impression of the surgeon in acute peritonitis.

Background: Exact pre-operative diagnosis of peritonitis remains challenging despite proper history taking and clinical examination, as well as advancement in new imaging techniques. The objective of this study was to highlight the diagnostic value of radiological investigations and clinical impression of the surgeon in acute peritonitis. Methods: We enrolled 50 patients with clinical features suggestive of acute peritonitis, which required surgery, were included. Evaluation of patients was done by detailed history, clinical examination, plain abdominal radiography, ultrasonography examination and final diagnosis on surgery after stabilizing the patient. Pre-operative diagnosis based on history, clinical examination and radiological investigations was compared with the operative diagnosis based on the operative findings. Results: The age of these patients varied from 5 years to 73 years with the mean age of 40.7 years. The commonest cause of acute peritonitis was perforated duodenal ulcer. Based upon history and examination accurate diagnosis of acute peritonitis with its underlying cause could be made in 94% of patients. Accurate diagnosis of perforated duodenal ulcer peritonitis could be made in 92.59% of cases based on history and clinical findings. Clinically acute appendicitis and perforated appendix was diagnosed with the clinical accuracy of 91.66%. On plain abdominal X-ray in standing position free gas under the right dome of the diaphragm was seen in 64% of the cases. The left lateral decubitus X-ray revealed free gas in peritoneal cavity in 70% cases. In our study with the help of ultrasonography of the abdomen we were able to diagnose 85.71% cases of acute appendicitis and 75% of perforated appendix. Free fluid in the peritoneal cavity on ultrasound of the abdomen was present in 70% of patients. Conclusion: In majority of cases of acute peritonitis, clinical impression of the surgeon plays a vital role in reaching the diagnosis if detailed history and meticulous clinical examination is carried out. However detailed history and meticulous clinical examination and radiological investigations may not be a foolproof diagnostic in all cases of peritonitis and the particular issue is settled on laparotomy.

A Prospective Study Comparing Single with Multiple Antibiotic Prophylaxis Dose in Elective Cholecystectomy.

Background: Cholecystectomy is one of the commonest, clean and contaminated surgery operations performed by the surgeons worldwide. Antibiotic prophylaxis in elective cholecystectomy is a controversial issue and our study was undertaken to evaluate the rate of infection and the usefulness and efficacy of antibiotic prophylaxis in elective cholecystectomies. Methods: The study comprised of 100 patients admitted for elective cholecystectomy. The first fifty patients undergoing elective cholecystectomy were given the prophylactic antibiotic outside the operation theater in the wards and the next fifty patients were given a single dose of injection cefuroxime (1.5 gm i.v). Results: In single dose antibiotic prophylaxis group 10.52% people developed surgical site infection in open cholecystectomy group while patients developed infection in laparoscopic cholecystectomy group but in multiple dose group 16.21% patients who underwent open cholecystectomy developed a surgical site infection while 10% developed an SSI in laparoscopic cholecystectomy group. In both the groups, results are statistically not significant. Conclusion: This study document that one single dose of prophylactic antibiotic, administered at induction of anaesthesia, is sufficient to prevent post-operative infective complications in patients undergoing elective cholecystectomy.