Primary Transanal Swenson’s Pull-through in Hirschsprung’s Disease in SRHF, Mizoram, India

The purpose of this study was to analyze the patients of Hirschsprung’s disease (HD) who undergone primary Transanal Swenson’s Pullthrough operation, its short and intermediate term outcome in neonates, infants and children in the department of General/Pediatric Surgery in State Referral Hospital, Falkawn (SRHF)/MIMER, Mizoram, India. Methods: Twenty four patients with rectosigmoid HD underwent single-stage transanal Swenson’s procedure. The contrast enema finding with definite transition zone was relied upon for diagnosis. Full thickness rectal dissection was done starting from 0.5-1 cm above the dentate line. The mobilized colon was resected about 5 cm or more above the transition zone. Full thickness colo-anal anastomosis was then performed. Results: There were 21 male and 3 female patients and the ages of the patients ranged from 4 days to 3 years. The mean length of the resected colon was 19.54± 9.85 cm. The anatomical transition zone correlated with the pathological transition zone in all the cases. The mean follow up period was 8.28±3.9 months. Two patients had post-operative enterocolitis, and one patient had stricture of the anastomosis. Two patients expired during the follow up period, one due to sepsis and the other due to community acquired pneumonia. One patient continued to have occasional fecal soiling and one patient developed perianal fistula for which diverting colostomy was done. Two patients had ongoing occasional constipation. None of the patients had voiding disturbances or incontinence. Conclusion: Primary transanal Swenson’s pull through is a safe and viable alternative technique for patients with rectosigmoid HD. The procedure is feasible even in neonates and in upper sigmoid colon HD.

Marjolin’s Ulcer. A Retrospective Study on the Clinicopathological Features and Management

Background: Although reported rare by most literature the incidence of Marjolin’s ulcer appears to be on the rise and outcome of treatment remains poor. Methods: It is a retrospective study on cases of Marjolin’s ulcer treated at the Department of Surgery from 1st May 2016 to 31st April 2018. Data’s like aetiology, duration of latency, site, surgical managements, histopathological results were studied. Results: The mean age was 54.62 years. The etiologies were flame burn (57.14%), electrical burn (2.85%), cellulitis (17.14%), trauma (14.28%), decubitus ulcer (5.71%) and osteomyelitis (2.85%). The most prevalent site was lower extremities (48.57%) followed by upper extremities (37.14%), buttock (5.71%), trunk (2.86%) and axilla (2.86%). The histopathological findings were well differentiated (57.14%), moderately differentiated (20%) and poor differentiated (8.57%) squamous cell carcinomas. Most cases occurred more than 20 years after the initial injury. The most common surgical procedure was wide excision with STSG or flap coverage. Conclusion: Lower extremities remains the most common site usually occurring because of neglected old burn injuries. The most common aetiology flame burn still prevalent in rural low socioeconomic population explains its high incidence in developing countries.

Pattern of Acute Intestinal Obstruction and Outcome of Management in SRHF, Mizoram, India

Background: The purpose of this study was to evaluate the aetiological pattern of acute intestinal obstruction, symptomatology, physical findings and outcome of management in State Referral Hospital, Falkawn (SRHF)/Mizoram Institute of Medical Education and Research (MIMER), Mizoram, India. Methods: The study was carried out on fifty (50) consecutive cases of acute intestinal obstruction admitted in the Department of Surgery, SRHF/MIMER, Mizoram, India, during a period of 1st January 2015 to 31st December 2017. Results: In this series, seven aetiologies were identified namely, adhesions & bands (28%), cancer (26%), hernia (22%), intussusception (8%), volvulus (6%), tuberculosis (6%) and Meckel’s diverticulitis (4%) which are discussed in detail. All the patients complained of pain abdomen and 66% of them experienced nausea whereas 60% had vomiting. Distension of abdomen was complained by 80% while absolute constipation was complained by 82%. Per abdominal examination revealed distension in 92%, guarding in 38%, localized tenderness in 20% and palpable mass in 32%. Out of 50 cases, complications were encountered in 7 cases which constitute 14%. The mortality in this study was 4 (8%). Conclusion: The pattern of acute intestinal obstruction studied in order of frequency of occurrence is band/adhesion, cancer, hernia, intussusception, volvulus, tuberculosis and Meckel’s diverticulitis. The outcome of management was evaluated by analyzing the post-operative complications and mortality. The present study showed that, differentiation between simple and strangulation obstruction on clinical ground and investigative parameters was not possible with certainty.

Phospholipid and Cholesterol Concentration in the Bile of Cholelithiasis Patient in SRHF Mizoram, India

Background: The purpose of the study was to estimate quantitatively the phospholipids and cholesterol concentration of the gallbladder and hepatic bile and find out the possible role of their variation in the pathogenesis of cholelithiasis. Methods: The study comprised of 100 patients with cholelithiasis who were operated in the department of General Surgery in the State Referral Hospital, Falkawn (SRHF), Mizoram, India, during the period of June 2016 to May 2018. A group of 20 subjects undergoing surgery for conditions other than hepatobilliary diseases constituted the control group. Results: The value of total cholesterol and phospholipids obtained from the gallbladder bile of study was 226mg% and was 608mg% respectively and the ratio being 2.69. The value of total cholesterol and phospholipids obtained from hepatic bile of study was 121mg% and was 197mg% respectively and the ratio being 2.45, whereas the total cholesterol and phospholipids value obtained from the gallbladder bile of control group was 259mg% and 1077mg% respectively and the ratio being 4.16. Conclusion: The biochemical study shows that the phospholipids to cholesterol ratio are reduced in gallbladder andhepatic bile of patients with cholelithiasis as compared with normal subjects. This reduced ratio is found to be mainly due to decreased level of phospholipids rather than increased level of cholesterol in the bile of gallstone.