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Right hepatic artery (RHA) is a branch of the common hepatic artery; however, there are cases documented in the literature showing anatomical variations. Accessory RHA is an incidental finding during hepatobiliary and pancreatic surgery. This artery should be identified, carefully separated, and preserved during these surgeries. We encounter the variation while doing Whipple’s procedure in a 61-year-old patient diagnosed with carcinoma of the head of the pancreas. Intra-operatively, accessory RHA was present which was arising from the superior mesenteric artery. It was identified, carefully separated, and preserved. Variations in the origin of the artery may make it vulnerable to injuries during surgical procedures if due care is not taken
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Background: Acute appendicitis is the most common surgical emergency worldwide. The treatment of choice is emergency appendectomy. A delayed diagnosis and hence a delayed treatment increases the complication rate. Despite the best efforts negative appendectomy rate is still high since there is no single best test available to reach the diagnosis.Methods: This was an institutional study conducted at DRPGMC Tanda, comprising of 28 patients and 7 healthy controls. The patients with clinical diagnosis of acute appendicitis were subjected to appendectomy after taking a blood sample for serum procalcitonin and performing an ultrasonogram of abdomen.Results: We observed that mean levels of procalcitonin (PCT) were significantly higher in patients of acute appendicitis in comparison to healthy controls. The range of PCT levels in group 2 i.e., patients with uncomplicated acute appendicitis were from 0.54 to 0.74 ng/ml with mean value of 0.61 ng/ml, whereas in group 3 i.e. patients with complicated acute appendicitis, the range were from 1.14 to 2.56 ng/ml with mean value of 1.62 ng/ml. PCT levels were significantly higher in group 3 as compared to group 1 and group 2 (p<0.0001). In group 2, mean PCT levels were significantly higher in comparison to group 1 (p<0.0001). Statistical analysis of our data shows a cut-off value of procalcitonin to be 0.203 ng/ml. We observed sensitivity and specificity of PCT to be 96% and 100% respectively.Conclusions: This study concludes that levels of serum PCT can be used as a laboratory marker for making a diagnosis of acute appendicitis and also for predicting its severity.
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Introduction: The diagnosis of acute appendicitis has essentially been clinical, but USG abdomen has been said to be highly accurate in diagnosing AA. The surgeon’s perspective may not always be the same. Materialsand methods: Appendectomy data of 106 patients from two hospitals of Kangra region was retrospectively analysed. The data was collected for age, sex, initial pre-operative diagnosis, USG findings, intra-operative findings, Histo-pathological examination (HPE) report, post operative hospital stay. Observations:It revealed a sensitivity of about 54% and specificity of 100% for diagnosing AA with the help of USG abdomen. AA was seen most commonly in males as compared to females. Mean age of presentation was 29.34 +/-14.4 years. Mean hospital stay was 3.68 +/-2.25 days. Most common initial preoperative diagnosis was AA (84%). Most common position of the appendix during surgery was retrocecal (53.7%). HPE report revealed AA in 105 patients. Conclusion:USG abdomen is often falsely assuring, leading to unnecessary delay in effectively managing a patient of AA further leading to increased complications. Only the clinically equivocal cases require further radiological investigations where CECT abdomen is the preferred investigation, but it should be used judiciously.
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Background:Poisoning in childhood is major health concern. But the profile of substances used & their relative outcome change according to age, availability of substances, pattern of life and medical awareness in different geographical areas.In this hospital-based study, we sought to investigate the epidemiology and outcome of acute poisoning among children admitted to a pediatric emergency department. Methods: This is a retrospective descriptive study conducted in Pediatric department of Rajendra Institute of Medical Sciences, a tertiary care hospital in Ranchi, Jharkhand .Children and adolescents less than 18 years of age with diagnosis of acute poisoningduring January 2018 –June2018 were included in the study. Results:In our study,97children presented with diagnosis of acute poisoning (3.32% of admissions). 59patients (60.8%)were boys. The greatest proportion of patients (45%) were aged between 1 and 5 yrs. Regarding the intention of poisoning, 91.8% were accidental .Bites accounted for 32.9%, drug ingestion- 19.5%, hydrocarbon ingestion & pesticide,rodenticide for 13.4% , corrosives-1%, household items- 2%, unknown substance -17% of the total cases.14 patients (14.4%)required admission to intensive care unit.Mean duration of hospital stay was 40 hrs. 2 children succumbed to complications during the study period, others were discharged successfully. Conclusion:Most of pediatric poisoning cases are preventable calamities. Death due to poisoning in children can largely be avoided if sufficient awareness can be created among parents and guardians.
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Enteroliths are a rare cause of intestinal obstruction. Patients can present with repeated episodes of intestinal obstruction as long as an enterolith is able to pass through the gut and then suddenly, they get stuck at the terminal ileum or present with the perforation peritonitis, as may happen in case of a diverticular disease. Here, we report the case of a young male presented to the emergency room with acute intestinal obstruction. During the explorative laparotomy, an enterolith was found stuck inside the proximal jejunum which was removed through an enterotomy. This was an interesting case, as the patient did not have any predisposing factors nor did we find any evidence of other pathologies intraoperatively. Moreover, the enterolith was stuck in jejunum, contrary to the belief that terminal part of the ileum is a most common site for the enteroliths to get stuck.