ABSTRACT
Introduction: Neglected cases of hemorrhoids presentingwith complications like strangulation are not uncommon,as observed in our tertiary care hospital. Under the abovebackground we conducted the present study to look into theprofile and management of the patients with complicated(especially strangulated) prolapsed hemorrhoids attending toour tertiary care hospital.Material and methods: This prospective hospital based studywas conducted in unit-II of department of general surgery inShri Maharaja Harisingh (SMHS) hospital Srinagar over aperiod of 5 years from January 2013 to December 2017. Allpatients with complicated prolapsed internal hemorrhoids(strangulation with infection, ulceration, gangrene, and/or necrosis) were enrolled in this study. Patients presentingwith features suggestive of complicated prolapsed internalhemorrhoids were subjected to clinical history, local inspectionand examination to confirm the diagnosis, and were managedappropriately.Results: During the study period of 5 years, 31 patients ofcomplicated (strangulated) prolapsed internal hemorrhoidswere enrolled. The age of our patients ranged from forty-fourto seventy-two years with mean age of 59.12±6.56 (SD=6.56)years. In our study 20 patients (64.5%) were from rural areaand 11 patients (35.5%) were from urban background. Mostcommon presentation in our study was strangulated prolapsedinternal hemorrhoid with pain, ulceration and infection.Conclusion: Patients with grade 3 and 4 internal hemorrhoids,patients having difficult access to health care facilities, andpatients having poor compliance to conservative treatment,should be offered surgical intervention at the earliest beforethe complications arise. Complicated prolapsed internalhemorrhoids can be managed initially conservatively (byprone position, bed rest, saline compresses, hot baths, icepacks, soothing topical applications, laxatives, antibiotics, sitzbath with antiseptic solutions)
ABSTRACT
Introduction: Management of infected wounds is notalways simple and easy. Vacuum-assisted closure (VAC) isa wound healing therapy that utilizes a dressing system thatcontinuously or intermittently applies a negative pressure tothe wound surface. Our aim was to assess the Feasibility andadvantages of simplified version of otherwise costly VAC, orsimple suction drainage in selected cases.Material and methods: This prospective study was conductedin the unit 2nd of department of surgery at SMHS hospital, anassociated hospital GMC Srinagar, over a period of 3 yearsfrom January 2014 to December 2016. During this period, 32patients were subjected to vacuum suction treatment and wereincluded in this study.Results: Wall suction (VAC) was used in 26 patients. MiniVac drain (USG guided) was used in 5 cases. In one patient ofscalp infection conventional large size suction drain was used.The time taken for the wounds to become healthy was 3 to7(average 3.5) days of VAC dressing or suction drainage. Noantibiotics were given during suction drainage in 21 patients.Need for grafting by split skin grafting method was felt in only2 patients. Mild discomfort (abnormal sensation) was reportedin 21 patients. Hospital stay for patients managed by suctiontherapy ranged from12 hours (breast abcess) to 16 days withan average of 7 days. The total cost incurred in the patientsundergoing VAC for a period of 15 days per patient was Rs.800 ($ 12).Conclusion: VAC seems to have revolutionary potential inthe management of the difficult to treat infected wounds asfar as its safety, speed and cost-effectiveness are considered.