Intraoperative localization and monitoring of migrating foreign body using transesophageal echocardiography.

Radiological imaging is often used for the preoperative localization of foreign body following blast injury, but their utility in case of migration during intra‑operative period is limited. Transesophageal echocardiography (TEE) has been used for intra‑operative localization and removal of intra‑cardiac foreign body; however, reports for localization of extracardiac migrating foreign body are few. Preoperative radiological imaging, in a victim of factory blast‑injury, suggested foreign body in the posterior mediastinum. However, the intra‑operative TEE showed it in the left atrium, which later migrated into the left ventricle necessitating a change in surgical approach for its removal.

Current management of pancreatic trauma.

Background: Although pancreatic trauma is uncommon, it poses a diagnostic and therapeutic challenge. Any delay in diagnosis raises morbidity and mortality. This study highlights the current management and outcome in patients of pancreatic trauma at a single tertiary care center. Methods: This is a retrospective analysis of prospectively collected data of 24 patients diagnosed to have pancreatic trauma. Collected data was analyzed for age, gender, mechanism of injury, hemodynamic status at presentation, initial serum amylase levels, CECT abdomen findings, AAST-OIS grade of pancreatic injury, injury to other organs, management, complications and outcome. Results: The mean age of these 24 patients was 25 years; 19 were male and 5 females. The mechanisms of pancreatic trauma included blunt abdominal trauma in 21 (87.5%) cases and penetrating injury in 3 (12.5%). Seven (29.16%) patients were managed by non-operative management and 17 (70.83%) underwent surgery. Complications were more frequent in the operative group as compared to the non-operative group. Neither endocrine deficiency nor any mortality was noted in the non-operative management group; while there were 2 cases of endocrine deficiency and 3 mortalities in the operative group. Conclusions: Pancreatic trauma is more common in young male patients and more commonly inflicted by motor vehicles accidents. Low grade blunt pancreatic injury in hemodynamically stable patients and selected patients with high grade blunt pancreatic injury can be managed successfully by non-operative management with no increase in morbidity or mortality and most patients with high grade blunt pancreatic injury and those having penetrating injuries need surgical intervention.

Relevance of day care laparoscopic cholecystectomy in a developing nation.

Feasibility, safety and success of day care laparoscopic cholecystectomy (DCLC) has been well established in advanced countries. The information on (DCLC) is not available from developing nations. All patients of gallstone disease undergoing laparoscopic cholecystectomy under the care of the two participating surgeons at the post graduate Institute of Medical Education & Research were considered for day care laparoscopic cholecystectomy. The selection criteria were: elective cases only, patients less than 70 years, American Society of Anesthesiologists (ASA) grade I and Grade II, living within 20 Kilometers of the hospital, availability of a responsible adult carer at home, access to a telephone and a means of transportation to hospital if needed. Clinical and operative data were recorded prospectively. All patients were discharged 6 to 8 hours after surgery with the advice to contact the surgical team over phone whenever necessary or on the day after discharge. Out of the total 236 laparoscopic cholecystectomy performed over a period of 26 months, 106 patients (44.9%) underwent laparoscopic cholecystectomy as day care procedure. Five patients (4.8%) were admitted after surgery. Four patients were admitted because of conversion and one patient was admitted because of suspected myocardial infarction. Hundred and one patients (95.2%) were discharged on the same day. There was no major morbidity and patient's acceptance was high. Day care laparoscopic cholecystectomy is feasible, safe, and acceptable to patients.