Effectiveness-of-post-operative-physiotherapy-after-emergency-laparotomy-to-prevent-post-pulmonary-complications-and-promote-early-mobilization—a-case-report

Laparotomy is the traditional surgical procedure where the large incision is made into an abdomen to explore and visible the abdominal internal organs so it is also called Exploratory Laparotomy. It's main purpose is to determine the source of pain, extent of injury and perform repair of damaged organs. It is a life saving technique for cancer and tumour cases. In critical conditions, the emergency laparotomy1 is performed to save patient's life. After surgery mainly due to midline incision the patient develops restricted pattern of breathing; thereby increasing risk of chest infections, atelectasis and other post pulmonary complications. Prolonged bed rest in same position may also develop oedema, pressure sores, muscle weakness to wasting. In this case 53 years old male with known HTN was admitted with abdominal pain, on – off fever, mild dyspnea after treating the symptoms further evaluation revealed carcinoma of stomach. After stabilizing, the patient under goes emergency laparotomy. But after the surgery the patient may highly prone to post pulmonary complications. The early post operative physiotherapy plays crucial role to avert post pulmonary complications and assist in recovery

Comparative analysis of P-POSSUM score at admission and pre-operatively in predicting postoperative mortality in patients undergoing emergency laparotomy

Introduction: Laprotomy remains one of the commonest emergency surgical procedure performed worldwide. But over the last few years, various perioperative quality improvement initiatives involving early interventions, intensive postoperative care, and indivisualised care approaches have ensured a decrease in the average mortality rate by 3.8%-8.3. An ideal scoring system should accurately predict outcomes, help determine who deserves more aggressive care, guide in deciding the extensiveness of surgery, and can be used broadly access emergency laprotomies for various disease pathologies. The scoring system should also be capable of analyzing risk adjusted morbidity and mortality amongst various healthcare providers. Aim: To access the accuracy of P-POSSUM score on predicting the mortality and morbidity in emergency laparotomy patients and to establish that the preoperative score is more accurate that admission score. Materials and Methods: 150 Cases of emergency laparotomy in General Surgery Department in IGIMS, Patna from September, 2020 to February, 2022 were taken up in this study. Patients below 18 years, routine surgery and 6 patients who could not be followed up for complete 30 days were excluded. Physiological P-POSSUM was calculated at the time of admission and just before operation, post resuscitation. Operative score was same for both Physiological P-POSSUM scores. Results: Mortality predicted at admission had statistically significant difference and p value was<0 xss=removed>.05. Most common complication was wound infection followed by septicaemia. Conclusion: P-POSSUM is a better predictor of mortality and morbidity in emergency laparotomies when scoring is done preoperatively.

A study on the incidence of abdominal malignancies presenting as acute abdomen in an emergency department

Background: Acute abdomen is one of the most common symptoms that bring a patient to an emergency department. An abdominal malignancy may be the cause of acute abdomen at least in a number of cases. The problem with this is the poorer outcome associated with it due to the lack of preoperative evaluation and preparation and also possible contamination that occurs in case of a perforation. This study aimed at studying the incidence of abdominal malignancies in the patients presenting as acute abdomen and the various presentations in which they present.Methods: Patients who presented with non-traumatic acute abdominal pain in the emergency department at our hospital who required surgery for acute abdomen were taken for the study and the incidence of malignancy in these cases were statistically assessed.Results: Out of the 375 patients who were operated for non-traumatic acute abdomen 62 patients i.e. 16.53% were found to have intraabdominal malignancy. Carcinoma colon was the commonest malignancy, 51.6%. Carcinoma stomach and rectum were the next most common malignancy. Commonest presentation was as a case of intestinal obstruction, 72.6% followed by perforation, 20.9%.Conclusions: In the era were the incidence and early detection of abdominal malignancies are on a rise, a significant portion of these cases present with acute abdominal symptoms and the morbidity associated with such a presentation is of importance. Early detection of the disease by screening is the solution for this.

Role of subcutaneous vacuum suction drain in prevention of abdominal wound complication in emergency laparotomy

Background: Some of the most common wound complications following laparotomy include hematoma formation, seroma formation, wound infection, burst abdomen and wound dehiscence. Closed-suction drains (CSDs) help to drain any wound collection and also reduce any dead space in the wound thereby promoting healing and preventing complication.Methods: We conducted a prospective study and included patients presenting with acute abdomen in emergency department. Patients were selected as per inclusion and exclusion criteria. Two groups (group A and B) with equal number of patients were created based on closed envelope technique. CSD was placed in the wound of patients in group A. Wound healing and complications were compared between the two groups.Results: 50 patients were included in the study with 25 in each group. Hematoma formation was found to be significantly more among group B (24.0%) compared to group A (4.0%). Seroma formation (p value =0.03917), SSI rate (p value =0.039) and wound dehiscence/burst abdomen (p value =0.0415) was more in group B than group A. The mean wound healing time (days) and mean hospital stay (days) was significantly more in group B.Conclusions: Placing a subcutaneous vacuum suction drain at the time of abdominal wall closure during emergency laparotomy results in better wound healing and reduces postoperative wound complication, hospital stay time, morbidity and also decreases overall healthcare cost.

Antimicrobial Susceptibility Pattern of Bacterial Isolates in Burn Patients in a Tertiary Care Center: A Prospective Study

Background: Burn injuries and deaths pose a major public health concern globally, especially in developing and underdevelopedcountries. As burn patients have lost their primary barrier and exposed to microorganism invasion continually and chronically,Staphylococcus aureus becomes one of the greatest causes of nosocomial infection in burn patients though it is a normalskin flora. The cases of antibiotic resistance have increased, and resistant species such as methicillin-resistant S. aureus(MRSA) provide additional challenges in the form of virulence factors. Multimodal infection control concept is required to limitthe spread of infection with multidrug-resistant organism including MRSA in a burn unit. The common pathogens isolated fromburn wounds are S. aureus, Pseudomonas aeruginosa, Streptococcus pyogenes, Acinetobacter baumannii, and various coliformbacilli. Hence, antimicrobial susceptibility pattern of bacterial isolates in burn patients plays a key role in the management ofthese patients.Materials and Methods: This prospective observational study involved the collection of wound swabs from burn patientsfrom June 2018 to May 2019. All patients with burn wounds irrespective of age and sex, admitted through surgery outpatientdepartment or casualty, during the period of study were included in the study.Results: Maximum prevalence was found for P. aeruginosa, i.e., 37.5% followed by S. aureus, for which the prevalencewas found to be 18.75%. The organism least commonly cultured was Acinetobacter; the prevalence of MRSA was found tobe 57.14% and the prevalence of methicillin resistance was found to be 42.8% in patients with Staphylococcus epidermidis.Overall, the prevalence of methicillin resistance was 51.72%. The drugs most effective against P. aeruginosa, the most commonisolate, were meropenem (97.62%) and piperacillin/tazobactam (90.48%) followed by gentamicin (64.29%). Meropenem andpiperacillin/tazobactam showed 100% efficacy against the other Gram-negative bacilli isolated as well. MRSA isolates showed100% sensitivity to vancomycin and linezolid closely followed by piperacillin-tazobactam combination. Klebsiella pneumoniaeshowed 100% sensitivity to meropenem and piperacillin/tazobactam.Conclusions: The overall isolation rate was 75%. Only solitary isolates were studied. Overall, Gram-negative organisms(66.66%) were more common than Gram-positive organisms (33.33%). P. aeruginosa (37.5%) was the most commonisolate followed by S. aureus (18.75%). The prevalence of MRSA was 57.14%, but all the MRSA isolates showed 100%sensitivity to vancomycin and linezolid. On antibiotic sensitivity testing, piperacillin/tazobactam (95.24%) was found to bethe most effective drug against all the organisms isolated. Meropenem (99.40%) was the most effective drug against theGram-negative organisms. Vancomycin (100%) and linezolid (100%) were the most effective drugs for the Gram-positiveorganisms.

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

Add on dexmedetomidine in the treatment of severe alcohol withdrawal in a patient of emergency laparotomy.

According to American statistics 90% of people drink alcohol at some time in life. The estimated prevalence of alcohol abuse among hospitalized in patients is 20 % and 10- 33 % in patients admitted to the ICU. Approximately 18% of these patients will develop alcohol withdrawal syndrome (AWS) whose symptoms can include physical and psychological manifestations that range from mild to life threatening. Although AWS has been reported in literature in post-operative periods and in intensive care unit, there is less information on treatment and preparing of a patient with AWS, coming for emergency surgical procedure. The surgical stress and deranged liver functions possess an additional challenge to the anesthesiologist. Here we are reporting the successful management of a case of delirium tremens by using Dexmedetomidine in pre, intra and post-operative period in a patient with hollow viscous perforation for emergency laparotomy.

Anesthetic management of the emergency laparotomy for a patient with multiple sclerosis: A case report / 대한마취과학회지

A 33-year-old male patient with multiple sclerosis (MS) received an emergency laparotomy because of perforated appendicitis. He had been suffering from MS for 2 years and the symptoms of MS were paraplegia and urinary incontinence. Anesthesia was induced with propofol and remifentanil and maintained with nitrous oxide, sevoflurane and remifentanil. Rocuronium was used for tracheal intubation. Train of four ratio and bispectral index scale were also monitored for adequate muscle relaxation and anesthetic depth. The patient emerged from general anesthesia smoothly and was extubated without any complication. Postoperative exacerbation of MS symptoms did not appear. However, he was rehospitalized because deep vein thrombosis (DVT) occurred after discharge and he received heparinization immediately. Eventually, he was discharged after a full recovery from DVT. We report a safe anesthetic management of the patient with MS, with the use of sevoflurane and with no the aggravation of MS during postoperative period.