ABSTRACT
Introduction: Hollow viscus perforation is a significant cause of surgical mortality. Various attempts have been made to identify high-risk patients preoperatively and optimize and manage such patients more aggressively. This study aimed to evaluate the predictors of outcome in patients undergoing emergency laparotomy for perforation peritonitis. Methods: This retrospective cross-sectional study was conducted on perforation peritonitis cases admitted to the Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, India. The association between preoperative patient variables with postoperative complications, anastomotic leaks, need for intensive care unit (ICU) admission, and 30-day mortality were evaluated. Results: Tachycardia at the time of admission (t = 2.443, p = 0.020), hypotension (χ2 = 18.214, p = <0.001), lower haemoglobin (t = -4.134, p = <0.001), higher blood urea nitrogen levels (W = 1967.000, p = 0.012), International Normalised Ratio (INR) ≥ 1.5 (χ2 = 17.340, p = <0.001), the mean albumin level 2.89 ± 0.77 g/dL (t = -2.348, p = 0.027), and delay in surgery (χ2 = 28.423, p = 0.008) were significant associate factors of mortality. The association between need for ICU admission and higher pulse rate on admission (W = 2782.500, p = 0.011), lower systolic blood pressure (W = 1627.500, p = 0.029), higher blood urea nitrogen (W = 2299.000, p = 0.030) and serum creatinine levels (W = 2192.500, p = 0.045), preoperative coagulopathy (χ2 = 6.773, p = 0.017), hypoalbuminemia (t = -2.515, p = 0.016), and delay in surgery (χ2 = 17.780, p = 0.016) was significant. Conclusion: Based on the results of this study, hypotension, azotaemia, coagulopathy, and delay in surgery, increase the risk of postoperative mortality of patients undergoing emergency laparotomy for perforation peritonitis. Tachycardia, hypotension, azotaemia, hypoalbuminemia, and pre-operative coagulopathy were good predictors of need for ICU admission. Shock at presentation, deranged renal function and coagulopathy were associated with an increased risk of postoperative complications.
ABSTRACT
Cystic lymphangioma is a benign tumour that occurs secondary to obstruction of lymphatic channels. Its appearance in the paediatric age group is quite common, but adulthood presentation is infrequent. Common locations are head and neck areas, whereas intra-abdominal occurrence is rare. To date, a few retroperitoneal cystic lymphangioma cases have been reported. A pre-operative clinical detection is always confusing, and most often, the diagnosis rests over the intraoperative findings and histopathological examination. The cyst's complete surgical resection remains the treatment of choice in patients with bulky, rapidly growing lesions or symptoms. Herein, we report a large retroperitoneal cystic lymphangioma that mimicked the mesenteric cyst clinically.
Subject(s)
Lymphangioma, Cystic , Mesenteric Cyst , Retroperitoneal Neoplasms , Adult , Child , Humans , MesenteryABSTRACT
Tailgut cysts are congenital anomalies that are rare and arise from incompletely regressed primitive hindgut. These are more commonly found in women and are usually asymptomatic. When symptoms develop, these can present with pain, infection, hemorrhage, difficulty in defecation, and rarely malignant change. We report a middle-aged married woman who presented with deep-seated perineal pain for a couple of months, which increased during defecation and sexual intercourse. Although abdominal examination was unremarkable barring deep tenderness in the hypogastrium, rectal and vaginal examinations suggested a tender pelvic swelling. An abdominal ultrasonographic examination diagnosed a cystic swelling in the pelvis extending until the Levator ani muscles. Considering her symptoms, a pelvic abscess was diagnosed and transvaginal drainage was done. Due to persistence of symptoms and recurrence after a month, she was further investigated and was diagnosed to have a presacral benign cystic tumor based on CT and MRI scans of the pelvis. The lesion was completely excised through a combined abdomino-perineal approach and histopathological report suggested a benign tailgut cyst. That a cystic presacral swelling with features of inflammation can be confused with a deep pelvic abscess is hereby highlighted in this report. An MRI scan is diagnostic of these lesions. Failure to differentiate it from a pelvic abscess may result in drainage, which may be of concern if the lesion is malignant.
ABSTRACT
Artificial intelligence (AI) is the future of surgery. Technological advancements are taking place at an incredible pace, largely due to AI or AI-backed systems. It is likely that there will be a massive explosion or "Cambrian explosion" of AI in our everyday life, largely aided by increased funding and resources spent on research and development. AI has also significantly revolutionized the medical field. The concept of machine learning and deep learning in AI is the crux of its success. In surgical practice, AI has numerous applications in the diagnosis of disease, preoperative planning, intraoperative assistance, surgical training and assessment, and robotics. The potential automation of surgery is also a possibility in the next few decades. However, at present, augmentation rather than automation should be the priority. In spite of the allure of AI, it comes with its own price. A robot lacks the "sixth sense" or intuition that is crucial in the practice of surgery and medicine. Empathy and human touch are also inimitable characteristics that cannot be replaced by an AI system. Other limitations include the financial burden and the feasibility of using such technology on a wide scale. Ethical and legal dilemmas such as those involving privacy laws are other issues that should be taken under consideration. Despite all these limitations, with the way technology is progressing, it is inevitable that AI and automation will completely change the way we practice surgery in the near future. Thus, this narrative review article aims to highlight the various applications and pitfalls of AI in the field of surgery.
ABSTRACT
Intussusception, although quite common in children with the classic triad of cramping abdominal pain, bloody diarrhea, and palpable masses, is a rare cause of acute abdomen with myriad presentations in adults. It is defined as the telescoping of a proximal segment of the gastrointestinal (GI) tract, called the intussusceptum, into the lumen of the adjacent distal segment of the GI tract, called intussuscipiens. Due to its different manifestations and time course, adult colonic intussusception often poses a diagnostic challenge for emergency doctors. The treatment of colonic intussusception in adults typically involves surgery, often with bowel resection and anastomosis followed by a defunctioning loop ileostomy. We report a case of left-sided colocolic intussusception secondary to a tubular adenoma as the lead point, which was successfully treated by resection and primary anastomosis. The pathological diagnosis of the lesion was reported as adenocarcinoma and resected bowel margins were found free of the tumor.
