Severe abdominal pain in a post-menopausal obese female

A 56-year-old female came to emergency department with complaints of severe abdominal pain in the epigastric region with abdominal distention. She had also complained of fever. No significant past medical or surgical history was available. Her pulse rate and respiratory rate were 110/min and 26/min, respectively. On examination of abdomen, belly was distended with guarding and rigidity and periumbilical ecchymosis. She was post-menopausal. Per-vaginal and per-rectal examination were normal

unusual cause of left-sided severe chest pain

A 50-year-old lady presented to the emergency room with severe left-sided chest pain following an episode of forceful vomiting. A history of giddiness was present. Her past medical and surgical history were insignificant. On examination, she was having a respiratory rate of 24/ min and her blood pressure was 100/60 mmHg. She was diaphoretic and surgical emphysema was present. On plain radiography, hydropneumothorax was present. Gastrograffin study of the patient was performed

retrospective study of two-port appendectomy and its comparison with open appendectomy and three-port appendectomy

To establish the efficacy of two-port appendectomy as an alternative to standard laparoscopic and open appendectomy in the management of acute appendicitis. Of the 151 patients included in the study, 47 patients were in the open group, 61 in two-port and 43 patients were included in the three-port group. Only patients with uncomplicated acute appendicitis were included in the study. Patients with complicated appendicitis like perforated appendix, appendicular lump and appendicular abscess were excluded from the study. Patients converted to open procedure after initial diagnosis and patients with other pathology in addition to appendicitis were also excluded. Patients with recurrent appendicitis and chronic appendicitis were excluded. The total number of excluded cases was 50. Data were compared with cases of open and three-port appendectomy. The mean operative time was 43.94, 35.74, and 59.65 min [SD: 18.91, 11.06, 19.29] for open, two-port, and three-port appendectomy groups respectively. Mean length of stay in days was 3.02, 1.93, and 2.26 [SD: 1.27, 1.04, 1.09] for open, two-port, and three-port appendectomy groups respectively. Surgical site infection was significantly lower [P = 0.03] in laparoscopy group as compared to that in open appendectomy group. Seven patients [4.63%] developed surgical site infection, 5 [10.63%] in the open and 2 [1.92%] in the laparoscopy group. Surgical site infection was 1.63% and 2.32% in two-port and three-port appendectomy groups respectively. For uncomplicated appendicitis, the two-port appendectomy technique significantly reduces operative time as well as length of hospital stay. It also reduces surgical site infection as compared to open appendectomy group