Role of acute physiology and chronic health evaluation II scoring system in risk stratification and management of small bowel perforations

Background: Despite the surgical treatment, sophisticated intensive care units, latest generation antibiotics and a better understanding of pathophysiology, the morbidity and mortality rate of perforation peritonitis are still high. Patients are usually managed by subjective decision of surgeon based on which mortality is very high.Methods: This was a double-blind observational study conducted over a period of 18 months on 50 patients with small bowel perforations. Based on the acute physiology and chronic health evaluation (APACHE) II score at presentation, patients were triaged into 3 groups: group 1 (score ≤10), group 2 (score 11 to 20) and group 3 (score >20). Study population was managed by the subjective decision of the operating surgeon who was blinded off the APACHE II score of patients. Hence removing the possibility of bias and observing a correlation between surgical outcome and APACHE II score of the patient.Results: Patients with higher APACHE II score (>10) were more likely to undergo exteriorization of bowel. Length of hospital stay was also found to be increased with an increase in score. APACHE II score of 10 was found to predict mortality with significant difference between 2 groups. Below this score the mortality was 0% and above this score the mortality rate rose to 31.25%.Conclusions: APACHE II can be used as a reliable and uniform scoring system as its assessment at presentation in patients of small bowel perforations provides an insight to their surgical management as well as predicting overall outcome.

Neuroendocrine tumour of colon mimicking psoas abscess: an unusual presentation of an uncommon malignancy

Psoas abscess is a rare disease usually arising due to a benign underlying pathology such as tuberculous disease of spine, Crohn’s disease and diverticulitis. But it can be an uncommon presentation of intra abdominal malignancy. Spontaneous rupture of colon cancer, combined with psoas abscess formation is very rare. Most of these cases have been reported in relation to carcinoma colon. Colon is an uncommon site for neuroendocrine tumors. 70-80% of these tumors are asymptomatic and are found incidentally at the time of surgery or on colonoscopy. Through this article we report a rare case of neuroendocrine tumor (NET) of colon in an elderly man presenting as psoas abscess associated with intestinal obstruction.

A rare case of testicular dislocation with inguinal hernia as a delayed presentation after scrotal trauma

Testis can be damaged either by blunt or penetrating trauma. Traumatic dislocation of testis is rare sequelae of scrotal trauma. Patients usually present at the time of injury and diagnosis is usually made on emergent basis. However, delayed or missed diagnosis may occur as scrotal injury may be overlooked in the presence of other associated injuries or due to lack of awareness of its possible occurrence. In this article, we report a case of 60 years old gentleman who presented with inguinal hernia with empty left hemiscrotum with history of blunt injury to scrotum 15 years back. The peculiarity of case lies in the fact that the dislocation of testis was diagnosed 15 years after trauma and the displaced testis was found to be atrophic.