Correlation of Clinical Findings with Radiological and Intraoperative Findings in Cases of Intestinal Obstruction

Intestinal obstruction accounts for 15% of all patients presenting to emergency department with complaints of acute abdominal pain. Recognising obstruction early, aggressive preoperative treatment, skilled surgical techniques and intensive postoperative management improves outcome. We wanted to correlate the clinical findings with radiological and intra-operative findings in cases of intestinal obstruction.METHODS50 cases of intestinal obstruction chosen by simple random technique, were studied in the department of general surgery at MMIMSR, Mullana, Ambala. Intraoperative findings were compared with x-ray, USG abdomen and CT abdomen findings.RESULTSAdhesions and bands (26%) were found to be the most common cause of intestinal obstruction. Most common finding on plain x-ray abdomen was the presence of dilated gut loops (82%). USG abdomen has limited diagnostic value in cases of intestinal obstruction with most common finding reported in USG abdomen being that of small bowel obstruction (62%). Out of 49 patients who underwent CT scan abdomen and surgery, CT findings matched with intraoperative in 45 patients (91.84%) and the most common finding was adhesions and bands (22.4%).CONCLUSIONSX-ray abdomen and USG abdomen have limitations and are diagnostic only in a handful of cases. CT abdomen provides much more elaborate information and helps the surgeon to understand the pathology. Preoperative CT also helps prevent laparotomies in scenarios where surgeon with preoperative knowledge can opt for laparoscopic approach, thereby reducing postoperative stay in the hospital and complication. So, understanding of the imaging modalities and knowing when to use them and what to look for can save precious time of the patient and also that of the surgeon allowing for early diagnosis and better plan of treatment.

Comparative Study of Conventional Three Ports with Single Port Laparoscopic Inguinal Hernia Repair in a Tertiary Care Hospital

Introduction: Inguinal hernia repair is the most frequentlyperformed surgical procedure worldwide. Advances inlaparoscopic techniques have ushered an opportunity toimprove and improvise many surgical procedures. Singleincision laparoscopic surgery (SILS) was developed withthe aim of reducing the invasiveness of conventionallaparoscopy, and has been successfully performed by manysurgeons. Aim of the study was to asses the safety andfeasibility of single por laparoscopic approach for inguinalhernia repair.Material and methods: This study was conducted on 50patients presenting to Acharya sri chander college of MedicalSciences and Hospital, Sidhra, Jammu ASCOMS over aperiod of one year from November 2011 to October 2012 withuncomplicated inguinal hernia in whom 25 patients underwentsingle port laparoscopic TAPP(SPL-TAPP) hernia repairand 25 underwent conventional three port transabdominalpreperitoneal hernia repair.Results: No significant differences were noted among patientdemographics. The age group ranged from 20-60 years. Themean Age, weight and height in SPL-TAPP were 44.4, 59.46and 157.2 cm respectively. Mean operative time, hospital stayin single port TAPP was significantly lower as compared toconventional surgery. Moreover postoperative complicationswere also lesser in SPL-TAPP with almost no reoccurances.Conclusion: Single port TAPP offers to be safe andefficacious with minimum reoccurances and shorter hospitalstay