A Rare Case of Bowel Gangrene in Pregnancy : A Surgical and Obstetric Catastrophe.

An unusual case of bowel gangrene involving jejunum upto the middescending colon leading to septicaemic shock, presented as a case of placental abruption with IUD with shock. Case Report : The 25 year old primigravida patient with 34 weeks of gestation was referred from peripheral obstetrician to SVNGMC, in a state of shock with clinical features suggestive of concealed type of placental abruption with IUD. In view of placental abruption with shock, emergency caesarean section was performed. Per Operative Findings: Foul smelling peritoneal fluid, IUD. Baby with placental separation with RP clot and gangrenous bowel from jejunum to middescending colon. As such long segment of bowel was involved; surgeon decided resection and end to end anastomosis was not possible. Propable diagnosis like superior mesenteric artery thrombosis/ Embolism was made. pt was put on low dose inj. Heparin and later managed in Surgical I.C.U. & succumbed on day 3 postop. Conclusion: Hypercoagulable state normally found in pregnant women which is believed to result in superior mesenteric vessel thrombosis and then intestinal ischaemia. It is extremely important not to miss any complaint like pain in abdomen and other G.I. complaints that may have any surgical or medical pathology associated with pregnancy.

Conservative surgical management of intestinal tuberculosis.

Forty-seven proved cases of intestinal tuberculosis admitted to the surgical ward of MKCG Medical College, Berhampur from 1985 to 1987 were subjected to laparotomy. The common pathology found were tubercles over the peritoneum, multiple strictures of intestine, ileocaecal mass, perforation of the intestines, bands and adhesions and mesenteric node involvement. The patients with acute abdomen were operated in emergency and rest as an elective procedure. Conservative surgeries like stricturoplasty, local intestinal resection, perforation closure, by-pass procedures and local ileocaecal resection were done in most of the cases and only in 2 cases right hemicolectomy was done. Biopsy was taken from the viscera, peritoneum and mesenteric nodes. Postoperative mortality was 6.4%, mostly due to toxaemia and fluid and electrolyte imbalance. Postoperative complications in most of the cases were wound infection. All were given a short course of antituberculosis regimen containing INH, rifampicin and ethambutol. Patients were followed up to one year and definite improvement was noted.

Prognostic factors in intestinal gangrene.

103 patients with intestinal gangrene were treated over a ten-year period in Ile-Ife, Nigeria. The various causes of the intestinal gangrene were herniae (63%), intussusception (20%), adhesions (12%), volvulus (3%) and mesenteric vascular occlusion (2%). The presence of pre-operative shock, purulent and faeculent peritonitis, intra-peritoneal perforation of bowel and involvement of long bowel segments in the gangrene process; constitutes the important prognostic factors. The presence of a pre-operative febrile response also influences the course of the disease while the age and sex of the patient, the duration of symptoms and the portion of bowel involved showed no relationship with the ultimate outcome. It is recommended that the patients with the ominous prognostic factors constitute a high risk group and should be given intensive care to ensure survival.

Ganhos potenciais em anos de vida com a exclusäo dos óbitos por doenças infecciosas intestinais em Fortaleza, no período 1978-80 / Potencial gains in years of life with the exclusion of causes of death by intestinal infections diseases in Fortaleza, 1978-80

Analisa-se o impacto da mortalidade das Doenças Infecciosas Intestinais (D.I.I.) em Fortaleza, no período 1978-80, através das Tábuas de Vida de Múltiplo Decremento, observando-se os comportamentos das probabilidades de morte, de sobrevivência e nas esperanças de vida. Os resultados mostraram substancias ganhos potenciais de anos de vida, sobretudo em menores de cinco anos, e que a exclusäo das D.I.I. como causa de morte representaria uma progressäo de uma década em Saúde Pública. Tecem-se consideraçöes sobre o envolvimento dos possíveis fatores condicionantes das D.I.I. e destaca-se a importância desse método para o diagnóstico e planejamento em Saúde