Isolated pancreatic hyadatidosis

Pancreatic hydatidosis is a rare infection with a frequency of less than one percent. Most of the abdominal hydatid cysts occur in liver. The purpose of this study was to present our experience of few rare cases of isolated pancreatic hydatid cyst, its presentation and management. Five pancreatic hydatidosis patients admitted in Gandhi Medical College, Secunderabad between 2021 to 2023 were reviewed. Demographic characteristics, clinical findings, and laboratory data were collected. Commonest symptom was pain in left upper quadrant followed by jaundice. The preoperative diagnosis was established in 3 patients by combination of ultrasonography, computed tomography, endoscopic ultrasonography and serological tests. Surgical treatment was done in three cases and two were medically treated. None of them had recurrence during a follow-up of 1 year. Pancreatic hydatid cyst even if rare should be considered in any pancreatic cystic mass in endemic countries like India.

Bacteriological profile of patients with biliary obstruction in tertiary care center

Background: Bile ducts are usually kept sterile by bacteriostatic and flushing effects of bile. Patients presenting with biliary obstruction especially due to benign etiology have either single or multiple bacterial organisms. Acute cholangitis carries significant morbidity with variable mortality rate. The serious presentation of such toxic patients signifies the requirement of appropriate antibiotic treatment. Choledocholithiasis followed by neoplasm and benign biliary strictures are the common predisposing factors for obstruction. Widespread use of antibiotics over years lead to change in sensitivity pattern of organisms which necessitates change in empiric antibiotic usage. Methods: This retrospective study was conducted in department of medical gastroenterology. We studied 50 patients with biliary obstruction (clinical and demographic data were recorded). The diagnosis of cholangitis was made according to TG2018. While undergoing therapeutic ERCP, bile aspirate was collected by biliary cannulation and sent for microbiological analysis. The antibiotic susceptibility pattern and rest of the data were analyzed by appropriate statistical tests. Results: Mean age of the study group was 49 years. Majority were female in study (60%). Overall, 74% had benign etiology, 32% had cholangitis. Bile cultures were positive in 64% patients 75% of them had benign etiology (gallstone being most common; 56%) and 25% had malignant etiology. Bacterobilia in cholangitis patients was statistically significant in comparison to patients without cholangitis (p-0.01). Organisms grown are mainly aerobic gram negative, most common being E. coli, Klebsiella and Pseudomonas species. Patients having bacterobilia had mortality of 6.25% during hospital stay. Conclusions: In this study we found higher sensitivity to colistin (90.6%), tigecycline (81.25%), amikacin (75%) and least sensitivity was noted for ampicillin (6.25%) followed by cefixime (12.5%). Sensitivity to previously commonly used ciprofloxacin antibiotic was 31.25%. Study confirms the significance of obtaining routine bile sample during ERCP in obstructed biliary system to prevent dreaded complications of cholangitis.

Profile and outcomes of symptomatic pancreatic fluid collections at a tertiary care hospital

Background: Pancreatic fluid collections (PFCs) are seen in about 50% cases of pancreatitis. Most PFCs are usually asymptomatic and resolve spontaneously not requiring intervention. However, symptomatic and complicated PFCs require intervention. In this study we aimed at estimating clinical characteristics, demographics, modalities of treatment and their success rates. Methods: 40 patients with symptomatic PFCs were included in this study. Clinical characteristics, type and location of PFC, indication for treatment, type of intervention, their success and complication rates were recorded. Results: Among 40 patients, 29 were male and 11 females with mean age of 40.2±7.5 years. The most common PFC was pseudocyst (62.5%) followed by walled off necrosis (WON) (25%). The most common indication for intervention was abdominal pain (50%) followed by gastric outlet obstruction (25%), obstructive jaundice (15%) and sepsis (10%). The success rate of EUS guided transmural drainage was 95.6% for pseudocyst and 77.7% for WON. The rate of adverse events was 32% in pseudocysts and 40% in WON. DEN (direct endoscopic necrosectomy) was done in 3 cases of infected WON. Conclusions: The most common PFC seen in practice is pseudocyst followed by WON. Endoscopic (EUS guided) transmural drainage has emerged as the first line intervention for symptomatic PFCs. The rate of complications and associated morbidity is much lesser with endoscopic procedures compared to surgery. The success rate of endoscopic intervention is higher in cases of pseudocyst but complications are higher in necrotic collections.

Anorectal manometry profile among elderly patients with chronic constipation in a tertiary health center

Background: Constipation is a common condition in elderly in India. High resolution anorectal manometry (HRAM) is an essential tool in the evaluation. In this context, studies from south India are sparse regarding the motility data of elderly patients with functional constipation. We aimed at studying anorectal pressure patterns in this population of this part of the country. Methods: Manometric data of 50 elderly patients (?60 year), who underwent the procedure for chronic constipation (Rome IV), was retrospectively collected. Manometric parameters were compiled and observations tabulated. Results: Among 50 patients, 35 were (70%) males and 15 (30%) females with mean age of 66.5±3.2 years. In HRAM study, the mean resting pressure was 90.2±27.5 mmHg (range 43-153 mmHg) and mean squeeze pressure was 136.9±39.76 mmHg (range 88-223 mmHg). In present study 23 patients had abnormal HRAM suggestive of dyssynergic defecation (46%). Conclusions: The present study showed that 46% of the elderly constipation patients had defecation disorder. Defecation disorders are common in our population and there is a need to diagnose it as treatment perspectives differ from other causes of constipation.

Pedicled omental transfer for ischaemic limbs--a 5-year experience.

Chronic occlusive arterial diseases form a single largest entity amongst the peripheral vascular diseases. Current operative methods available for improving circulation often elicit poor results and the patient has to undergo an amputation. The technique of pedicled omental transfer has given hope of saving such unsalvageable limbs. Although symptomatic and clinical improvement has been reported by this method of "biological by-pass revascularisation", there are no simple, objective and easily reproducible tests to assess improvement in circulation. In this study pulse oximetry and stress testing have been used to assess revascularisation. This study comprised 56 patients (78 limbs) suffering from chronic occlusive arterial disease, spanning a period of 5 years. Patients were investigated and subjected to pedicled omental transplantation (omentopexy). Symptomatological assessment showed improvement in intermittent claudication in about 85% of patients, relief from rest pain in 86% and healing of chronic ulcers in 73% of patients. Objective tests of stress testing and pulse oximetry also showed improvement in circulation. Relief from ischaemia was more in cases of Buerger's disease (TAO) than in cases of atherosclerosis obliterans (ASO).

Prognosis in intra-abdominal sepsis.

Peritonitis is a common surgical problem with a high mortality rate. Recent advances have not brought down the mortality rate. Eighty six patients with intra-abdominal sepsis were studied for factors affecting prognosis. The factors which significantly affected prognosis were: duration of illness, source of infection and APACHE-II score. Further, among the factors contributing to APACHE II score, statistical analysis using logistic regression identified some factors which individually affect outcome. Our results indicate that mortality rate is high in patients with long duration of illness, postoperative peritonitis and organ system insufficiency.