A Case of Duodenal Perforation due to Ingested Neem Twigs Mimicking Acalculous Cholecystitis

Introduction: Most foreign bodies in the G.I tract areasymptomatic and probably pass spontaneously in stool. Fewmay cause complications and require interventions. Diagnosiscan be a challenge in certain cases. We present a case in whichthe ingestion of a Neem Twig caused duodenal perforationmimicking Acalculous Cholecystitis.Case report: A 63-year-old lady visited emergency withacute abdominal pain of 2 day history. Computed tomography(CT) showed mildly thickened Gall bladder with loculatedpericholecystic fluid collection which is extending intosubcapsular region of segment III of liver. A LaparoscopicCholecystectomy was planned in view of Acalculouscholecystitis. Intraoperative, an Omental phlegmon guardinga Neem (Azadirachta indica) twig which perforated out ofduodenum was found. Laparoscopy was converted to an openmidline Laparotomy and graham’s Omental patch repair ofduodenum perforation was done.Conclusion: The patient has been doing well since theoperation. She gave history of swallowing the Neem Twig6 Months prior to this surgery. Many a times open surgicalapproach would give a satisfactory search rather thanLaparoscopy

Evaluation of Clinical Outcome of Patients Undergoing Emergency Laparotomy with the Help of Portsmouth Predictor Equation for Mortality (P-Possum Score)

Introduction: Emergency laparotomy, though lifesaving, mayresult in significant morbidity and mortality. In an attempt toclinically evaluate patients undergoing emergency laparotomyand predict their mortality using the worldwide acceptedPortsmouth Predictor equation for mortality (P POSSUM), thepresent study was undertaken in the Surgery department of atertiary care hospital in eastern India.Material and methods: This observational cross-sectionalstudy included 60 patients aged between 15 to 75 years,undergoing emergency laparotomy during the specified studyperiod of one and half years.Results: It was observed that out of 60 patients, 63.3%were male, and mean age was 40.60 (16.67) years. Pepticperforation was the most common indication for laparotomy.Mean P POSSUM predicted mortality risk was 40.617%(Range-0.8 to 99.7). Twenty-four patients died during hospitalstay. ROC curve analysis of P POSSUM scores revealed thatif a cut off value of P POSSUM score of 42.45% was selected,mortality could be predicted with a sensitivity of 70.80% anda specificity of 83.30%.Conclusion: Thus, P POSSUM might be a useful tool inpredicting risk of short-term mortality following emergencylaparotomy