ABSTRACT
Background: Gastroduodenal artery (GDA) is usually the first branch of the common hepatic artery from celiac trunk. In patients with chronic pancreatitis visceral artery aneurysms, incidence of up to 10% has been reported. The aneurysms occur most frequently in the splenic artery (10.4%); the common hepatic, gastroduodenal (1.5%), and pancreaticoduodenal arteries are affected. Material and Methods: It was a cross-sectional study conducted in the Department of General Surgery and Forensic Medicine, N.S.C.B. Medical College, Jabalpur during the period from August 2012 to August 2013. Abdomen of the cadaver will be accessed by the standard postmortem midline incision (sternum to pubes). Vascular anatomy of the GDA and vein will be dissected out in-situ using standard surgical instruments. The distance from the pylorus to the GDA will be measured by measuring tape. Results: In our study, out of total 31 cadavers, 19 (61.2%) were of male and 12 (38.8%) were of females. In all the cases, the site of origin of GDA is from the celiac axis of the common hepatic artery. Out of total 19 male cadavers, 17 (89%) showed a distance of 2.5-3 cm between pylorus and GDA and remaining 2 (11%) showed a distance of 3-3.5 cm. Conclusion: In our study, GDA has been seen arising from common hepatic artery from the celiac axis in 100% of cases. Previous studies have also given very less percentage of rare sites of origin but with the advent of newer modalities of investigations such as Doppler studies and computed tomography angiograms this very less percentage of rare variations can be diagnosed if there are knowledge and suspicion. This will help a lot to prevent major catastrophe during surgeries and radiological interventions.
ABSTRACT
Background: There are various modalities of treatment available for management of hemorrhoids ranging from conservative measures including dietary measures, sclerotherapy to surgical techniques including band ligation, excision. Appropriate modality should be tailored on individual basis. Objective: To compare the results with those after open hemorrhoidectomy performed under spinal anesthesia (SA) and local anesthesia (LA). Methods: Present randomized controlled trail was carried out in the Department of Surgery, N.S.C.B. Medical College, Jabalpur, 24 cases with hemorrhoids. Cases were randomized with a help of randomization sequence generated with a help of statistician into either local or under SA group. Results: Mean visual analog scale (VAS) score signifi cantly low at 90 min and 6 h in LA group. Post-operative complications such as hypotension, urinary retention, and bleeding are not found in both groups except headache which is signifi cant in SA group. Post-operative hospital stays signifi cantly low in LA group. Conclusion: Open Milligan–Morgan hemorrhoidectomy is feasible under LA. Post-operative outcomes are better under LA in terms of pain, bladder evacuation, hospital stay and cost effectiveness with comparable complications.
ABSTRACT
Background: Surgeons must be conscious of unexpected sources of hemorrhage, such as an aberrant obturator artery or vein, and unexpected iliopubic vessels and take appropriate precautions to avoid injury to these structures. Objective: Evaluating the incidence of normal and aberrant origin of the obturator artery and vein. Materials and Methods: A total of 72 human hemi-pelvises were taken including both the fresh cadavers arrived in mortuary with preserved pelvises in Department of Anatomy at Netaji Subhash Chandra Bose Medical College, Jabalpur. Laparotomy done with midline anterior incision up to the pubic symphysis and dissection carried out in the pelvic and retropubic region to expose the branches of the common iliac artery. Results: Obturator artery common originates from the anterior trunk of the internal iliac artery and less frequently from other branches of internal or external iliac artery. Abnormal communication found in 45.8% of hemi-pelvises which are mostly venous. Conclusion: Obturator artery the most common originates from anterior trunk of internal iliac artery. Abnormal venous communications (venous corona mortis) are a very common and knowledge of abnormal communications of obturator vessels is crucial for the different surgeries at pelvic region.