ABSTRACT
Background: Perforation of terminal ileum is a cause for obscure peritonitis with severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention. The objective of this study was to evaluate the clinicopathological characteristics in Ileal perforations because of confusion and controversy over the diagnosis and optimal surgical treatment of terminal Ileal perforation -a cause of obscure peritonitis. Materials and methods: Patients underwent emergency explorative laparotomy for hollow viscus perforation surgery in general surgery department was included in present study. Edge biopsy specimen was sent to histopathological examination. All patients were tested for widal positivity and were started on anti- salmonella treatment if it was positive. Based on intra- operative finding and histopathological reports, ATT was started for those who are positive for tuberculosis. All patients were monitored in the post-operative period for complications. All patients were followed up for a period of six months. Results: A total of 60 patients with Ileal perforation were included in the study of which 50 were males and 10 were females accounting for 83.33% and 16.67 % respectively. The most common symptom was pain abdomen which was present in all the patients (100%). The next common symptom was vomiting seen in 44 out of 60 patients (73.33%) followed by fever seen in 38 out of 60 patients (63.33%). Absent bowel sounds was found in 36 out of 60 patients (60%). Air under diaphragm on erect X-ray abdomen was found in 56 patients (93.33%). Conclusion: Bacterial culture and tissue histopathology though confirmatory are time consuming, and immunological tests are expensive. And administration of ATT helped to treat the patients successfully. A high index of suspicion for intestinal tuberculosis is needed in patients who are on immunosuppression.
ABSTRACT
Background: Abdominal pain is one among the common reason to visit the casualty. Appendicitis remains the commonest cause in it. An accurate diagnosis is needed for the essential treatment. Materials and methods: All patients admitted in emergency surgical ward as acute abdomen and underwent emergency surgeries during a period of November 2015 to January 2016 (3 months) in our Stanley Hospital were studied. Patients with history of trauma were excluded from the study. Patients managed conservatively were also excluded from the study. A total of 268 cases underwent emergency abdominal surgery were studied. The age, sex, type of surgery done, etc. details were collected from the emergency registers and other records available. The results were tabulated for age and sex incidence according to different surgeries done. Results: A total of 178 cases of acute appendicitis were operated. The majority of cases were in the age group of 10-30 years. 2 patients having appendicular mass were operated and 6 appendicular abscess patients were operated and drained. Most of the patients were operated by open appendectomy and few numbers of patients operated via laparoscopy technique. A total of 32 cases of intestinal perforation were studied. Out of 32 during the study 2 case of gastric perforation and 2 cases of ileal perforation were reported. Total number of cases operated was 20 with inguinal hernia accounting for 15 cases and umbilical hernia 2 and epigastric hernia 2 cases, 1 case of incisional hernia. 3 cases (10%) of large bowel obstruction observed and were due to gangrenous bowel, sigmoid.