RESUMO
Background: Acute pancreatitis though a self limiting in 80-90% of cases, but in 10-20% cases there is pancreatic necrosis, multi-organ failure & recurring pancreatic injury . A simple accurate, clinical scoring system BISAP (Bed side index for severity in acute pancreatitis) collected data within 24hrs of admission to hospital in predicting patients at risk for developing organ failure, persistent organ failure and pancreatic necrosis. Methods: A prospective study done at SCB MCH, from Aug.2016 to Sept.2018. All patients admitted to the hospital as acute pancreatitis are included in this study which is characterized by acute abdominal pain, increased level of serum amylase and/or lipase, USG/CT/MRI of abdomen and pelvis done within 7days of admission which shows findings consistent with features of acute pancreatitis. Each component of the BISAP scoring system was studied for each patient in first 24hrs & each component was awarded one point .Organ failure is defined as a score of ≥ 2 in one or >3 organ as originally described in Marshall score. Oragn – failure was described as transient (<48hrs) or persistent (>48hrs) from the time of admission. All the datas were collected & analysed for patients developing organ failure, persistent organ failure, pancreatic necrosis and death. Results: In our study, out of 108nos. of patients, 67(62.1%) were males & 41(37.9%) were females. Alcohol being the leading cause in 57(52.8%) followed by gall stone in 32(29.6%) cases & others in19(17.6%) cases. Patients with BISAP score ≥3 had developed organ failure in 10 (34.4%)cases and with BISAP score ≤ 3 in 6(7.6%) cases. Out of 16nos. organ failure cases 12 cases were transient organ failure & 4cases were persistent organ failure all with BISAP score ≥3. Pancreatic necrosis developed in 18nos of cases of which 11nos with BISAP score ≥3 & 7nos with score ≤ 3. Conclusion: The BISAP score is simple & accurate method for early identification of patients at increased risk of developing organ failure, persistent organ failure, pancreatic necrosis within 24hrs of admission to hospital.
RESUMO
Background: Gastrointestinal and mesenteric injuries are the third most common type of injury from blunt trauma abdomen and are associated with high rates of morbidity and mortality.Objectives: To determine the clinico-demographic profile, localization of injury, diagnostic and management methods and the outcome in cases of hollow viscus injury (HVI) following blunt trauma abdomen which were admitted to our unit. Methods: Records of patients who were admitted emergently with gastrointestinal injuries and blunt abdominal trauma between July 2014 and July 2016 were reviewed retrospectively. Results: The study group comprised 65 patients with mean age of 33.3 ± 16.2 years and a male predominance (89.2%). The commonest cause of injury was road traffic accident in 44 (67.7%) cases. Ileum was the most common site of injury detected in 31 (41.3%) followed by jejunum in 26 (34.7%) cases. Treatment comprised primary closure of perforation in 48 (64%) cases, segmental resection and anastomosis in 22 (29.3%), and stoma in 5 (6.7%) cases. Three out of 5 cases of anastomotic leak occurred in patients who were operated at 8-24 hours or beyond. Associated injury to intra-abdominal solid viscera and other sites were present in 30.7%. The mean duration of hospitalization was longer in patients with associated injuries as compared to those with isolated HVI (12.2±4.6 days versus 9.3±0.8 days). Conclusion: Early diagnosis followed by prompt surgical intervention and careful monitoring for associated injuries is the key to favourable outcome in blunt HVI.