A comparative study of primary cellulitis and its local complications in lower limbs in diabetics and non-diabetics through the new Amit Jain’s staging system from India

Background: The objective of the study was to validate Amit Jain’s staging system for cellulitis in diabetic and non-diabetic lower limbs and to predict the outcomes associated with cellulitis and surgical procedures done in them.Methods: We conducted a prospective study in department of surgery at Raja Rajeswari Medical College and Hospital Bengaluru, India. The study period was from December 2018 to November 2019. Statistical analysis was done using SPSS 22 and R environment ver.3.2.2.Results: A total of 36 patients were included in this study of which 21 were diabetics and were in placed in group A and 15 were non diabetics and placed in group B. 83.3% of the patients were males. 73.3% of non-diabetics had stage 1 cellulitis and 33.3% of diabetics had stage 1 and 2 each. 47.2% of patients underwent debridement and it was significantly common in diabetics (p=0.037) and also it was common in higher stages of cellulitis (p=0.001). 8.3% had amputation in this series. All the major amputations were done in stage 4 cellulitis (p=0.002).Conclusions: In this validation study, it can be seen that cellulitis is common in both diabetics and non-diabetics but it is severe in diabetic patients. Stage 3 was more common in diabetics compared to non-diabetics. Amit Jain’s staging system of cellulitis is a simple, easy, practical, focal classification that guides therapy and predicts amputation.

Primary ileal volvulus: a rare cause of small intestinal obstruction

A 50-year-old lady presented to us in the emergency department with history of acute abdominal pain and vomiting since the past 24 hours. Abdominal examination showed tenderness and guarding in the hypogastrium, lumbar and right iliac fossa region. Initial diagnosis of ruptured appendicitis was considered but exploratory laparotomy gave us an intra-operative surprise. Small bowel volvulus is extremely rare in clinical practice and their symptoms are usually nonspecific. The diagnosis is typically confirmed at surgery most of the time just like in this case. No etiology of this volvulus was found in this patient. Ileal volvulus carries a significant risk of mortality. Awareness of this condition among surgeons will help to reduce the morbidity and mortality associated with this unusual form of intestinal obstruction.

Multiple jejunal perforations in dengue.

Gastrointestinal perforation is one of the common complications that are associated with high mortality. Stomach, duodenum, ileum and colon are common site of perforation whereas jejunum is an uncommon site for perforation. We report an interesting case of jejunal perforation that occurred in a female patient. To our knowledge, this is the first such isolated case of multiple jejunal perforation in dengue that is being reported in the literature.