Can preoperative serum lactate dehydrogenase levels predict postoperative pulmonary complication following an emergency abdominal surgery? An observational study

Background: Postoperative pulmonary complications (PPC) are one of the commonest complications following gastrointestinal surgery. They lead to increase in morbidity and mortality. Lactate dehydrogenase (LDH) is an enzyme present in essentially all major organ systems. Studies have shown measurement of its activity levels and its isoenzyme pattern may provide additional information about lung and pulmonary endothelial cell injury. The objectives of the present study were to study the levels of serum LDH in patients with and without post-operative pulmonary complications following emergency abdominal surgery.Methods: The study was designed as an observational study. All patients ≥18 years of age undergoing gastrointestinal surgery, excluding those with prior lung pathology were included in the study. The demographic parameters, clinical parameters and laboratory parameters along with details of pulmonary complications were recorded. Serum LDH level were assessed on admission. Levels of serum LDH were compared between patients with and without post-operative pulmonary infections and were assessed for significance.Results: Incidence of PPC was 28% in our study. There was significant difference in the mean age in the group with and without PPC (p=<0.001). Smoking habit, serum albumin total protein and upper abdomen incision surgery were associated with increased incidence of PPC. Pleural effusion was the commonest PPC seen in patients. Serum LDH was not significantly associated with the incidence of PPC.Conclusions: Pre-operative serum LDH level is not a predictive factor for occurrence of postoperative pulmonary complication. Age, smoking, total protein, serum albumin, upper abdomen incision were found to associated with increased risk of PPCs.

Are NSAIDS Really Responsible For Increasing Incidence Of Duodenal Perforation – Our Experience

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs for pain and inflammation all over the world by medical practitioners. Long-term overuse of these drugs leads to severe gastrointestinal complications such as peptic ulcers and erosions. Aim of study is to evaluate the incidence of NSAIDS related peptic ulcer perforation in our region and to know the role of NSAIDS in the causation of duodenal perforation. Methods: This was retrospective study conducted in the Department of General Surgery Rohilkhand Medical College and Hospital on 51 patients of duodenal perforations to know its causation with NSAIDS. The results obtained were compiled in a tabulated form. Mean ± Standard Deviation (SD) were analyzed using with Statistical Package for Social Sciences (SPSS 23.0). The level P < 0.05 was considered as the cutoff value for significance. Results: The Mean age of all patients was 43.86±11.05 years. In majority of 28 (54.90%) patients NSAIDS was responsible either alone or concomitantly associated with excessive smoking and alcohol in 20(71.42%) patients and NSAIDS alone in 8(28.57%) patients. Conclusion: Excessive high dose intake of these drugs and intake of the combination of two NSAIDS instead of single NSAIDS therapy has resulted in increased chances of peptic ulcer perforation. So indiscriminate use of NSAIDS should be avoided.

Heterotopic Triplet Pregnancy: Bilateral Tubal Pregnancy and an Intrauterine Pregnancy.

Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. We report a rare case of heterotopic pregnancy, resulting from spontaneous conception, in a 30-year old woman with no known risk factors for heterotopic pregnancy. Emergency laparotomy followed by right salpingectomy, left salpingostomy and evacuation of non-viable intrauterine pregnancy contributed towards saving the patient's life.

Heterotopic Triplet Pregnancy: Bilateral Tubal Pregnancy and an Intrauterine Pregnancy.

Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. We report a rare case of heterotopic pregnancy, resulting from spontaneous conception, in a 30-year old woman with no known risk factors for heterotopic pregnancy. Emergency laparotomy followed by right salpingectomy, left salpingostomy and evacuation of non-viable intrauterine pregnancy contributed towards saving the patient's life.

Reparación de vena iliaca primitiva con segmento de ligamento falciforme / Repair of the common iliac vein with a segment of falciform ligament

Reportar cómo, en el manejo de un paciente con lesión de vena iliaca primitiva, brindó buenos resultados el realizar autoplastia con ligamento falciforme. Presentamos el caso de un varón de 26 años sin antecedentes personales de importancia. Ingresó al servicio de urgencias del Hospital San Vicente de Paúl, Medellín, Colombia, con múltiples heridas por arma de fuego, hemodinámicamente estable. En laparotomía demostró perforaciones en intestino delgado y meso, desgarro en unión ileocecal y vena iliaca primitiva en un 50 de su circunferencia. Se realiza anastomosis término-lateral en unión ileocecal y reparación de vena iliaca con autoplastia del ligamento falciforme. El paciente evolucionó satisfactoriamente, no presentó complicaciones inmediatas post-quirúrgicas como tromboembolismos, estenosis u obstrucción en el sitio de sutura. Las lesiones vasculares abdominales presentan una alta mortalidad y morbilidad. El conocimiento anatómico del retroperitóneo, las vías de abordaje de los vasos, así como la exploración clínica adecuada, ayudará a disminuir las complicaciones y la mortalidad de estos pacientes. La reparación de heridas de grandes vasos venosos abdominales con parche de peritóneo es una buena alternativa para este tipo de traumas vasculares.

Objective: To report on how, handling a patinet with an injury in the common iliac vein, autoplasty with falciform ligament provided good results. This is the case of a male, 26 years old with no significant medical history. He was admitted in the ER of the San Vicente de Paul Hospital in Medellín, Colombia with multiple firearm wounds, in a stable condition regarding his hemodynamics. In laparotomy showed perforations in the small intestine and the mesocolon and tears in ileocecal joint and common iliac vein in 50 of its circumference. End-to-side anastomosis in ileosecal joint and repair of iliac vein with autoplasty from falciform ligament were made. Patient evolution was satisfactory, there were no post-operative complications such as thromboembolism, stenosis, or obstruction in the suture level. Abdominal vascular injuries have a high mortality and morbidity rate. Anatomic knowledge of retroperitoneum, ways of approach of vessels as well as na appropriate clinical exploration will be helpful in reducing complications and mortality in these patients. Repair of wounds of big abdominal venous vessels with peritoneum patch is a good choice for this type of vascular trauma.