Diagnostic Significance Of Serum Ascites Cholesterol In Malignant And Non Malignant Ascites

INTRODUCTION: Ascites is a very common clinical problem. However, the ability to distinguish malignant from non-malignant and tubercular causes of ascites using various biochemical techniques would obviate the need of many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate usefulness of ascitic uid albumin, protein, SAAG and ascitic uid cholesterol level in diagnosis of malignant, non-malignant and tubercular ascites. MATERIALS AND METHODS: We conducted a prospective observational study in Department of medical gastroenterology, Madras Medical College from time period of January 2018 to December 2018. All cases of ascites of unknown etiology were evaluated and were grouped into malignant and benign ones. Patient having peritonitis were excluded from the study. In this groups, serum albumin,ascitic uid albumin, cholesterol were done. The data was processed in MS Excel and analysis was carried out using SPSS Ver. 23. RESULTS: Out of 80 patients, 30 were malignant (37.5%) and 50 were benign (62.5%).Cirrhosis was the most common cause of benign ascites and carcinoma stomach was the most common cause of malignant ascites. Ascitic uid cholesterol above the level of 100mg/dl has a specicity of 100% in detecting malignant ascites. CONCLUSION: SAAG, ascitic uid cholesterol having high specicity, can be used for differentiating between non-malignant and malignant ascites. It can also be used to differentiate tubercular ascites from malignant ascites.

Role of Therapeutic endoscopy vs surgery in the management of traumatic pancreatic injury – A tertiary referral center experience

Background: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Materials and methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining 9 presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed non-operatively. 9 patients had severe injury (>grade 3) – of which 4 underwent endotherapy, 3 had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed non-operatively, 3 underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

A study on periampullary diverticula 6 years ERCP experience from a referral centre

Introduction: Periampullary diverticula (PAD) are mucosal outpouchings commonly situated on the medial aspect of second part of duodenum; usually within 2-3 cm of the ampulla of vater. PAD are usually asymptomatic incidental findings during side viewing scopy. We aimed to analyze the influence of PAD in the management of patients who underwent ERCP during past 6 years in our centre. Materials and methods: Patients between the ages of 13 and 74 with the diagnosis of pancreaticobiliary diseases who underwent ERCP at Institute of medical gastroenterology, Madras Medical College from January 2012 to December 2017 were taken into account for retrospective analysis. We assessed and compared ERCP results in patients with and without PAD. Results: A total of 3412 patients underwent ERCP that of these 197(5.77%) patients had PAD. Among the 3412 cases , the incidences of PAD in patients age group less than 50 years was 2.6% and age group more than 50 years was 8.1%(P<0.001). Successful biliary cannulation was achieved in 79.18% (n=156) of patients with PAD and 93.1% of patients of patients without PAD (P<0.001). Of that in patients with PAD, for 28.93 %( n=57) cases underwent precut needle papillotomy. The papilla Rabindranath Eswaran, Premkumar Karunakaran, Allwin James, Venkateswaran Arcot Rajeswaran, Rajkumar Solomon. A study on periampullary diverticula – 6 years ERCP experience from a referral centre. IAIM, 2018; 5(6): 20-26. Page 21 was undetectable in 6 cases with PAD. Incidence of PAD was higher in choledocholithiasis group (9.2% vs 4.1%, p=0.003), but in incidence of CBD stricture had no difference. Complete clearance of CBD stones was achieved lesser in patients with PAD (72.4% vs 86.8% P=0.02). Conclusion: The frequency of PAD increases with age and occurs more in choledocholithiasis cases. Our experience showed decreased rate of cannulation success with PAD, increased difficulty in cannulation and decreased rate of successful stone retrieval.