Intestinal Stoma Experience Of 100 Cases At Tertiary Care Hospital

Introduction :An intestinal stoma is an opening of the intestine on anterior abdominal wall made surgically. Stomas are used to divert the fecal stream away from distal bowel in order to allow a distal anastomosis to heal as well as to relieve obstruction in emergency situation. Aims & Objectives : 1) to identify indications for commonly performed stomas 2) to study complications associated with stomas. Methods: This is a retrospective study was carried out in a surgical unit of A tertiary teaching Hospital, Ahmedabad from January 2016 to December 2018. Data was collected retrospectively from medical records and meticulous history taking including age, gender, indication, type of stoma, type of surgery, careful clinical examination, appropriate operative findings and follow up of the cases were noted. The results were analyzed and compared with other studies. Results: A total of 100 patients were evaluated age ranged between 12- 85 years (50.5 ± 29.01 years) Male to female ratio was 7:3. Of the 100 patients 88 were admitted in emergency while 12 in out-patient department. The most common type of stoma made was loop ileostomy (62%) followed by sigmoid colostomy (13%) and transverse loop colostomy (9%). Main indication for a stoma formation was enteric perforation (35%) followed by Koch’s abdomen (16%). Of the various complications encountered with intestinal stoma, peristomal skin irritation (45%) was the most consistent complication followed by laparotomy wound infection (22%). Conclusions: In Spite of vast exposure of general surgeons towards stoma formation the complications are inevitable. Early detection of complication and its timely management is the keystone

A Comparative Study Of Open Haemorrhoidectomy And Stapled Haemorrhoidopexy

ntroduction:Haemorrhoidsor‘Piles’isafrequentlyobserveddiseaseinsurgicalpractice.Variousnon‐surgicalandsurgicaltreatmentsareavailable.Openhaemorrhoidectomy(Milligan‐Morgan)isawidelyusedprocedure.Arecentnoveltechniquecalled‘Stapledhaemorrhoidectomy’,firstdescribedandperformedbyItaliansurgeonAntonioLongoisgainingworldwiderecognitionforitsbenefits.Aim:TocompareStapledhaemorrhoidectomywithopen(MiliganMorgan)haemorrhoidectomyintermsofpost‐operativepain,resumptionofdailyactivity,hospitalstay,post‐operativebleeding,urinaryretentionandanalincontinence.StudyDesign:Prospective,comparativestudyfromAugust2017toAugust2018.MaterialsandMethods:Atotalof80patientsbetweentheagegroupof20and70years,diagnosedtohavegradeIIIorIVhaemorrhoidswereincludedinthestudy,dividedinto2groups,Group1undergoingOpenhaemorrhoidectomy(40patients)andGroup2undergoingStapledhaemorrhoidectomy(40patients).Postoperativelypatientsofbothgroupswerereviewedatthetimeofdischarge.Allpatientsweregivenaquestionnaireanddatacollectedverballyandanalysedstatistically.ComparativeanalysisbetweenthetwogroupsweredonebasedonIndependentstudents‘t’test.Results:ThemeanageofpatientsinOpenhaemorrhoidectomy(OH)groupwas42.2andStaplerhaemorrhoidectomy(SH)groupwas38.5.86.6%weremalesand13.4%werefemalesinOHgroup,90%weremalesand10%werefemalesinSHgroup.Post‐operativebleedinginbothOHandSHgrouphadanincidenceof2%.Post‐operativeurinaryretentionwasseenin4%and8%inOHandSHgrouprespectively.Inbothgroups,post‐operativeanalincontinencewasnotseen.BasedonIndependentsample‘t’testthepost‐operativepain,Post‐operativehospitalstayanddurationofresumptionofdailyactivitywaslessinSHgroupcomparedtoOHgroupandstatisticallysignificantwithp<0.001.However,complicationslikepost‐operativebleeding,urinaryretentionandanalincontinencearealmostsameinboththegroupsConclusion:StapledHaemorrhoidectomyislesspainfulwithshorterdurationofhospitalstayandresumptionofdailyactivityisfasterthantheopenhaemorrhoidectomy.However,longtermfollow‐upisrequiredtoknowtherecurrencerateinstapledhaemorrhoidectomy.

A Study Management Ofacute Pancreatitis; Role Ofrecent Criteria In Prognosis And Management Of Acute Pancreatitis

AbstractAim :To compare APACHE-II scoring, C-Reactive Protein (CRP), Interleukin-6 (IL-6) estimation and Contrast Enhanced Computed Tomography in assessing the severity of acute pancreatitis and prognosis of the condition. .To determine the role of these investigations and the most accurate investigation for the detection of severity of acute pancreatitis and prognosis at 72 hours. Method:The present study was conducted at the Department of General Surgery, V.S. General Hospital, Ahmedabad. The Study population consisted of first50 cases of acute pancreatitis fulfilling the inclusion criteria. It was a prospective study. Results: Apache II scoring done at admission predicted severe pancreatitis in 8 cases out of 10 cases which turned out to be severe on Atlantic classification. So, there was 2 false negative cases in severe group. Apache II score at admission predicted 38patients as mild pancreatitis thus giving false positive result in 2 cases. Pearson Chi-square test of significance was applied for the analysis of the data. This clinical scoring done at admission had a sensitivity of 80%,specificity of 95%, positive predictive value of 80%, negative predictive value of 95% and accuracy of 92%. Serum CRP level of the patients at admission predicted 7 as severe pancreatitis out of 10 actual cases of severe pancreatitis thus giving false negative result in 3 cases. This biochemical assay labeled 26 cases as mild at admission thus giving false positive rate in 14 cases. Statistical analysis of the data yielded a p value of 0.07 (Pearson Chi-square test) indicating that the data was statistically insignificant. Estimation of serum CRP level at admission had sensitivity of 70%, specificity of 65%, PPV of 33.33%, NPV of 89.65% and accuracy of 66%. Serum IL-6 level of the patients at admission predicted 8 as severe pancreatitis out of 10 actual cases of severe pancreatic thus giving false negativeresult in 2 cases. This biochemical assay labelled 36 cases as mild at admission thus giving false positive rate in 4 cases. Estimation of serum IL-6 level at admission had sensitivity of 80%, specificity of 90%, PPV of 66.67%, NPV of 94.74% and accuracy of 88%. Conclusion: .Evaluation of the different prognostic indications for the detection of severity at admission showed that Apache II score as well as serum IL-6 were the best indicators of severity. However, due to the complex nature of the calculation, the Apache II score might prove to be cumbersome. Whereas serum IL-6 being costly and not being easily available in the setup is its main drawback.

Study of recent trends in acute pancreatitis.

Background: Acute pancreatitis is an acute condition presenting with abdominal pain and usually associated with raise pancreatic enzyme level in the blood or urine as a result of inflammatory disease of pancreas. Pancreatitis is a disease of wide clinical variation ranging from mild discomfort alone to a severe illness with hypotension, metabolic derangement, sepsis, multiple organ failure and death. Mortality from acute pancreatitis has decreased from around 12 to 2 percent, according to a large epidemiologic study of acute pancreatitis. However, mortality rates remain much higher in subgroups of patients with severe disease. Aims & Objective: To study recent trends in acute pancreatitis, to study the various etiological factors for development of acute pancreatitis, assessment of various clinical features, complication, investigations and diagnosis of acute pancreatitis and its complications, to evaluate various modalities of the treatment for acute pancreatitis and its complications. Material and Methods: Material of this study consists of 50 patients of acute pancreatitis who were admitted in our Hospital. The clinical presentation clinical examination was carried out, and physical findings, associated medical conditions, laboratory and radiological investigations, severity, management and outcome were studied and the etiology was determined by reviewing the medical records of all cases documented to have acute pancreatitis during the period of study. Results: Average hospital stay for 50 patients in our study is approximately 7 days. The diagnosis of acute pancreatitis was considered when abdominal pain is associated with elevation of serum amylase level. Abdominal pain (100%), fever (82%), vomiting (86%), abdominal distension (40%) and dyspnoea (50%) are its common clinical symptoms. Conclusion: Gallstones and alcohol abuse are the main causes of acute pancreatitis. There is no mortality in our study. Among all the patients, only 4 patients in the follow-up developed complications approximately after 2 months of duration of attack; and they undergone for operation. Clinical examination, serum amylase and ultrasonography are still the diagnostic tool for pancreatitis. Most cases of pancreatitis can be managed conservatively with early diagnosis, aggressive medical management and by treatment of cause.

Filariasis presenting as generalized lymphadenopathy - A rare case report.

Filariasis is endemic worldwide in the tropical areas. It is not uncommon in India. It is commonly presents as lymphadenopathy limited to groin and femoral triangle or as filarial lymphoedema of lower limbs but presenting features as generalized lymphadenopathy is very rare. Conventional diagnostic procedures include the demonstration of microfilaria in the blood smears but in our case it was diagnosed even in FNAC and confirmed with excision biopsy of lymph node. Microfilaria may be missed if you are not aware of the possibility, particularly in cases where tissue eosinophilia is absent. The purpose of this paper is to aware surgeons to keep in mind the rare differential diagnosis of this uncommon entity while treating a case of generalised lymphadenopathy.

A study of accuracy of triple assessment as a clinical tool for the diagnosis of a palpable breast lump.

Background: Diseases related to breast are the highest in this country as well as in the world. Various types of lesion from inflammation to carcinoma can affect breast. Some lesions are common in young females while others in elderly age group. Early presentation and prompt diagnosis is essential to relieve anxiety of non-neoplastic conditions, and in case of carcinoma, it can save the patient from metastases. In this study many cases related to breast lesions from the region are reported in the surgery clinics of this institute and various breast diseases are being managed in the clinical departments. For disease confirmation, many diagnostic procedures are recommended with aims to help in decision for surgical treatment. To study prevalence of various breast disease condition coming to our hospital and their management. Analysis of pattern and prevalence will be a valuable guideline for clinicians of this location to compare with that of others. This study was to evaluate the accuracy of Triple assessment (physical examination, mammography and fine needle aspiration cytology) as a clinical tool for the diagnosis of a palpable breast lump. Aims & Objective: (1) To study incidence for breast disease; (2) To study etiopathogenesis of it; (3) To study patient presentation and manifestation; (4) To study management of various breast diseases; and (5) To study various modalities of treatment. Material and Methods: This prospective study was carried out in the department of surgery during period from 1st march 2011 to 28th February 2012 in indoor and outdoor patients. Each patient was study in detail with relevant clinical history, examination, mammography and histological findings and management. The study comprised of total 100 patients of breast disease treated with various modalities. Results: In the study of total 100 cases, inflammatory conditions were present in 15%, fibrocystic lesion 35%, fibroadenoma 20%, gynaecomastia 2% and carcinoma 10%. This comparative study reported data by clinical analyses, mammography and histological findings in 100 women with ages from 18 to 60. Malignant carcinoma found in 10% of cases while benign breast disease and other condition found in 90% of cases. Conclusion: Fibrocystic disease was the commonest lesion in this study with 30 years as the average age of presentation. Malignancy was detected above 47 years of age. Ninety patients with breast lumps interpreted by Triple Assessment as benign correlated with the histopathological findings whereas of 10 malignant lumps. This gives Triple Assessment an overall accuracy of 100% in our study.

Clinical profile of cases of alcoholic liver disease.

Background: Alcohol is most common substance abused. Alcoholic liver disease is a major health care problem in India. Alcohol consumption is directly associated with liver disease mortality and accounts for increased social and economic costs. Alcoholic liver disease may take the forms of acute involvement (alcoholic hepatitis) or chronic liver disease (steatosis, steatohepatitis, fibrosis and cirrhosis. The severity and prognosis of alcohol- induced liver disease depends on the amount, pattern and duration of alcohol consumption, as well as on the presence of liver inflammation, diet, nutritional status and genetic predisposition of an individual. While steatosis is complete benign disease, liver cirrhosis is associated with marked morbidity, mortality and life expectancy shortening. Aims & Objective: To study alcoholic liver disease, clinical presentation, to access the severity of alcoholic liver disease and its complications and their treatment response and overall outcome among patients using laboratory and radiological parameters. Material and Methods: A total of 50 patients were studied and their clinical profile, laboratory parameters and radiological investigations were taken. Results: Among 50 patients 58 % belonged to age group 40-49 years. All were male. 78 % of patients from urban areas, with 60 % belonging to middle class.60 % of patients have chief complaint of abdominal distension and melena each. Jaundice (60%) and ascites (60%) were commonest finding. All patients had raised SGPT, SGOT, S.AlPO4 and S. bilirubin suggesting liver damage. Prolonged PT and reduced S. albumin suggested reduced protein synthesis because of liver disease. Alcoholic hepatitis was in24% cases, while 40% had fatty liver and 36 % had alcoholic cirrhosis. Overall mortality rate was 20 %. , most common cause is encephalopathy (40%), coagulopathy leading to DIC (40%) and hepatorenal syndrome (20%). Conclusion: Alcoholic liver disease was seen among the productive age group with high morbidity and mortality. Mortality and morbidity associated with this disease is matter of serious economic loss to the nation and grief for the society

Comparison of percutaneous ultrasound guided needed aspiration and open surgical drainage in management of puerperal breast abscess.

, less morbidity and will allow the patient to carry on breast feeding. Aims & Objective: The aim of this study is to compare the management of puerperal breast abscess by percutaneous ultrasound guided needle aspiration versus open surgical drainage with special attention to resolution and complications. Material and Methods: In this interventional study, 70 puerperal breast abscess cases were randomly divided and undergone either percutaneous ultrasound guided niddle aspiration (Group A) or open surgical drainage (Group B) and results were compared. Results: Failure rate for aspiration therapy was17.14% with 06 patients requiring conversion to open surgical drainage after aspiration and were excluded from study. The resolution time was less in aspiration group. Painful and cumbersome daily changes of dressing, mammry fistula in 3 patients with ugly scar were the main drawback of open surgical drainage as compared to aspiration. However, there was high failure rate of aspiration therapy in abscesses presenting later than 5 days (45.83%) and those with >5 cm size (55.55%) on ultrasonography. Conclusion: Percutaneous ultrasound guided needle aspiration has acceptable failure rate and is an effective alternative to open surgical drainage of puerperal breast abscess especially for those present early and of small size.

Splenogonadal fusion - A review of rare anomaly.

Splenogonadal fusion is a rare congenital malformation that involves an abnormal connection between the spleen and the gonad or mesonephric derivatives. It manifests itself as a mass consisting of splenic and testicular or ovarian tissue. Splenogonadal fusion has been classified into two types; continuous, where there is a direct connection between spleen and gonad; and discontinuous, where ectopic splenic tissue is attached to the gonad, but there is no connection to the spleen. Many cases had an associated other anomalies either genital or systemic. Knowledge about the existence of such an uncommon entity is essential even to be suspected preoperatively as the appearance at exploration can be misleading as a malignant mass and often results in unnecessary gonadal removal.

Crossed testicular ectopia- A review.

Crossed testicular ectopia, an extremely rare anomaly, is a deviation of testicular descent resulting in unilateral location of both testis, the etiology of which is not exactly known till yet. In most cases, the patient comes to the hospital because of cryptorchism on one side, and inguinal hernia on the other side, so the patients are usually very young. It is often not diagnosed until surgical exploration. This manuscript illustrates this condition with possible etiology, clinical features, diagnosis and management reported in the literature.

Comparison between total and subtotal thyroidectomy in Graves’ disease.

Objective: To compare the results of total thyroidectomy and subtotal thyroidectomy amongst the surgically treated patients with Graves’ Disease. Material and Method: This study includes 50 patients of Graves’ disease out of which 27 patients underwent for total thyroidectomy and 23 underwent for subtotal thyroidectomy. Comparison done in regards to postoperative complication between total and subtotal thyroidectomy in terms of advantages and disadvantages. Results: Incidence of transient or permanent recurrent laryngeal nerve palsy and hypocalcemia were high amongst the patients operated for total than subtotal thyroidectomy. Thyroid function tests were normal in all patients after total thyroidectomy with hormone replacement therapy and 17.39% of patients had hypothyroidism after subtotal thyroidectomy. Recurrence rate was nil and 21.73% respectively in total and subtotal thyroidectomy. One patient of subtotal thyroidectomy had occult carcinoma in histopatholical examination which required revision of surgery. Conclusion: Total thyroidectomy is superior to subtotal thyroidectomy based on the considerable surgical risk and lack of recurrence in total thyroidectomy as well as the risk of occult carcinoma and questionable ability of the subtotal thyroidectomy to maintain the euthyoid state.