Neonatal Surgical Emergencies in a Tertiary Care Center.

Background: Congenital anomalies those are incompatible with life unless they are corrected. They constitute the primary justification for pediatric surgery specialty because they demand experienced judgment in early diagnosis, expeditious management as well as highly refined operative technique and post-operative care. Materials and Methods: The clinical material in the present study consists of 124 neonates admitted to pediatric surgical ward of Medical College hospital, Jabalpur from 1st January 2011 to 31st July 2012. Results: Incidence of neonatal surgical emergency was 12.3% among all pediatric surgical admission, i.e. 124 cases in 1007 admissions. The most common neonatal emergency was constituted by gastrointestinal group observed in 49.1% cases. Next in order of frequency was skin defect, i.e., in 25.8% cases followed by respiratory emergency observed in 13.7% cases. Anorectal malformation was the most common cause of gastrointestinal emergency (63.5%). Out of total 35 cases gastrostomy alone was performed in 2 cases, gastrostomy along with ligation and division of trachea-esophageal fistula was performed in 1 case. Transverse colostomy alone in 26 (74.2%) cases and along with gastrostomy in 1 case. Ileostomy and nephrostomy were performed in 1 case each. Ligation and division of tracheoesophageal fistula and end to end anastomosis was done in 5 cases, in which general condition, of patient was good. Excision and repair of meningomyelocele and meningoencephalocele was possible only in 9 (45%) cases out of 20 cases. The mortality in surgical treated patients was (30%), i.e., 27 out of 90 patient treated surgically. Conclusion: There is a need to improve on neonatal surgical diagnosis and care at both primary and secondary health facilities to promote early referral of neonates to these centers. Skilled and dedicated staff with improved infrastructural facilities such as ventilators, a specialized neonatal surgeon, and operating theater and intensive care unit (NICU) will greatly minimize complex problems.

Effect of Candida infection on outcome in patients with perforation peritonitis.

Perforation peritonitis is treated with surgery and antibiotics. This study was conducted to identify bacterial and fungal microorganisms responsible for peritonitis in patients with hollow viscus perforation and to examine the influence of these microorganisms on the outcome. A prospective study was conducted from May 2005 to September 2006 involving 84 consecutive patients with spontaneous gastrointestinal perforation peritonitis, who were referred for surgery. Peritoneal fluid was analyzed by microbial culture and biochemical tests for bacteria and fungi. The Jabalpur Prognostic Score was calculated. Forty-two of the 84 patients had positive peritoneal fluid cultures. Escherichia coli was the most common bacterium (n=26) and Candida (n=13) the most common fungus isolated. Bacterial isolates were largely sensitive to amikacin while all the Candida isolates were sensitive to fluconazole. Mortality was significantly higher in patients with positive peritoneal cultures (15/42) compared with those with negative peritoneal cultures (0/42, p<0.001), and in patients with mixed bacterial and fungal-positive cultures (10/13) compared with those with isolated bacterial cultures (5/29, p<0.001). Using the Jabalpur Prognostic Score, positive fungal cultures were found to be associated with a significantly higher than expected mortality. Patients with gastrointestinal perforations and positive peritoneal cultures have a poor prognosis, which is significantly worsened by the association of positive fungal cultures. Early recognition and treatment of fungal infection is advisable.

A simplified prognostic scoring system for peptic ulcer perforation in developing countries.

BACKGROUND: Several complex prognostic scoring systems are available for abdominal sepsis. We constructed and assessed a simplified scoring system for peptic perforation, which can be easily used in developing countries. METHODS: One hundred and forty consecutive patients with perforated pre-pyloric or duodenal ulcer undergoing Graham's patch omentopexy closure were studied prospectively. Each factor was given a score based on its severity in accordance with the APACHE-II scoring system to construct the simplified prognostic (Jabalpur) scoring system, and multiple regression analysis was used to identify risk factors. This system was prospectively validated in the next 50 consecutive patients and compared to existing systems. RESULTS: The factors associated with mortality were age, presence of co-morbid illness, perforation-to-operation interval, preoperative shock, heart rate, and serum creatinine. The mean score in survivors (4.9) was less than that in those who died (12.5; p<0.0001). This scoring system compared favorably with other scoring systems. CONCLUSIONS: The Jabalpur scoring system is effective for prognostication in cases of peptic perforation. It is simple and user-friendly as it uses only six routinely documented clinical risk factors.