Early oral feeding, no nasogastric suction and no peritoneal drainage; compared to conventional post operative protocol in cases of gastric and small bowel anastamoses

To know the out come of a randomized controlled trial of early oral feeding, no nasogastric [NG] suction and no peritoneal cavity drainage after gastric and small bowel anastamoses. Patients admitted for anastomosis involving stomach and small bowel were randomized into two groups [50 patients each] by lottery methods of prewritten cards. In group A [control], patients were managed by conventional postoperative protocol [N/G decompression, peritoneal drain and nil per oral for 5 days]. In group "B" [under trial] patients were managed without NG decompression and peritoneal drain and were allowed oral feeds on third postoperative day. Surgery was done by various grades of surgeons from consultants to Senior Trainees. In group A, 39/50 patients were male and average age was 47.5 years. Morbidity recorded in this group was 14% including postoperative chest infection, wound dehiscence, vomiting and hypovolumia in one patient [2%] each. Three patients [6%] had anastamotic failure resulting into fistula. Three [6%] patients died of the procedure. In group B; 34/50 were males and average age was 42.5 years. Postoperative abdominal distension was recorded in 3 [6%] patients and vomiting in 2 [4%] patients. No anastamotic failure occurred in this group. Mortality was nil. Patients of gastric and small bowel anastamoses/ repair can be managed without N/G tube and peritoneal drain. These patients can be allowed home on fourth postoperative day

Bilateral simultaneous fractures neck of femur: a case report and review of literature

We report a case in an elderly lady who had an epileptic convulsion and sustained bilateral simultaneous fracture neck of femur. This lady was deaf and dumb and the diagnosis was therefore delayed. The patient was initially diagnosed as flaccid paralysis and was kept under observation. After 36 hours, x-rays of hip and dorsolumber spine was done that showed bilateral simultaneous fractures of hip. Both fractures were treated with bilateral modular hip hemiarthroplasties within 24 hours of diagnosis. She made uneventful recovery