Adhesive Small Bowel Obstruction: A Review.

Adhesion is a leading cause of small bowel obstruction. Adhesive small bowel obstruction has significant challenges in diagnosis, treatment and prevention with considerable impact on morbidity and socioeconomic burden. Small bowel obstruction caused by adhesion or any other aetiology is clinically indistinguishable due to similar clinical presentation. Computed Tomography scans and water-soluble contrast studies are more specific in diagnosis and possess value in predicting the need for surgery. Surgical management is indicated only in complicated cases or failed conservative treatments with the majority resolving with non-operative management. However, there is no clear-cut consensus about the timing of operative intervention. Meticulous surgical practice is the keystone in preventing adhesion formation despite the availability of numerous pharmacological and surgical strategies. This review aims to update the current knowledge of the pathophysiology of adhesion formation, treatment options and various prevention modalities of adhesive small bowel obstruction. Keywords: diagnosis; laparotomy; prevention; surgery.

Perforated Caecum in a Left-sided Amyand's Hernia: A Case Report.

Amyand's hernia is a rare type of inguinal hernia with an appendix inside an inguinal hernia sac. Most cases are diagnosed intraoperatively during hernia repair. A 66-year-old male was received at the Emergency Department with complaints of acute onset abdominal pain, vomiting, and groin swelling. The patient was diagnosed with obstructed left inguinoscrotal hernia with suspected bowel perforation. Following the emergency laparotomy, the intraoperative picture depicted a leftsided Amyand's hernia with a perforated caecum in the hernia sac. Mobile caecum, malrotation, situs inversus, and excessively long appendix denoted it to be the prime factors for the left-sided Amyand's hernia. A diverse range of pathological features and presentations might complicate the diagnosis and management of Amyand's hernia and all in all treatment has to be individualized according to the intraoperative finding. Keywords: appendix; case reports; hernia.

Postoperative Surgical Site Infections in the Department of General Surgery of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Surgical site infection is defined by the Centres for Disease Control and Prevention as a wound infection that occurs within 30 days of an operative procedure or within a year if an implant is left in place and the infection is thought to be secondary to surgery. It occupies 20% to 39% of all the infections acquired in hospitals. The aim of this study is to find out the prevalence of postoperative surgical site infections in the Department of General Surgery of a tertiary care centre. Methods: A descriptive cross-sectional study on a total of 384 post-operative patients of abdominal surgery was conducted in the Department of General Surgery of a tertiary care centre from August 1, 2020 to July 30, 2021 with ethical approval from the Institutional Review Committee (Reference number: 267). Convenience sampling was done. Post-operative patients fulfilling the inclusion and exclusion criteria were included in the study. Data were entered in Microsoft Excel and analyzed using the Statistical Package for the Social Sciences version 21.0. Point estimate was done at a 95% Confidence Interval along with frequency and percentages for binary data and mean with standard deviation for continuous data. Results: Among 384 patients, the prevalence of surgical site infection was found to be 65 (16.92%) (13.15-20.65 at a 95% Confidence Interval). The patients had a mean age of 42.06±21.92 years. Conclusions: The prevalence of surgical site infection was higher in our study in comparison to other similar studies conducted in similar settings. Keywords: cross-sectional studies; prevalence; surgical wound infection.

Management of Enterocutaneous Fistula: A Review.

Enterocutaneous fistula is any communication between bowel and skin or atmosphere outside the body. It can be classified by various means by etiology, organ of origin, etc. Enterocutaneous fistula can occur after any gastrointestinal surgery where there is some trauma during surgery or other associated causes such as malignancy, inflammatory bowel disease, foreign body, etc. Enterocutaneous fistula needs a multidisciplinary approach as its management is a very tedious and complex process. Sepsis, malnutrition, and dyselectrolytemia are three key factors during the management of enterocutaneous fistula, so these should be properly addressed for better and efficient outcomes. There is excess fistula effluent which should be replaced adequately in high output fistula. The nutrition of the patient plays a vital role in the success of enterocutaneous fistula management so if the patient can tolerate oral or enteral feeding should be commenced as soon as possible otherwise parenteral nutrition should be advised. Wound care should be done aggressively, proper skincare, timely drainage of any localised abscesses should be done. Patients should be properly resuscitated and stabilised before any definitive investigations and management. Surgical therapy can be staged and should not be rushed which results in failure of this complex disease process.

Prevalence of Complications after Limberg Rhomboid Flap in Patients with Cutaneous Defects at A Tertiary Care Hospital.

INTRODUCTION: Limberg rhomboid flap is an extremely useful and versatile technique to cover the cutaneous defects in various anatomical locations of different etiology and varied sizes. The main aim of the study is to find the prevalence of complications after limberg rhomboid flap in patients with cutaneous defects at a tertiary care hospital. METHODS: This descriptive cross-sectional study was conducted at a tertiary care hospital from October 2015 to November 2018 after obtaining approval from the institutional review committee. Study population is patient admitted to ward and outpatient department of surgery. Convenience sampling was done. Data was entered and analyzed in statistical package for social sciences and point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of total patients, the complications were seen in total 8 (15.7%) patients. Prevalence of complications is 8 (15.7%) at 95% confidence interval (7.85-23.56). Among which, complications were seen in 5 (9.8%) bed sore, 2 (3.92%) in pilonidal sinus, 1 (1.96%) in traumatic ulcer and none in neoplastic lesion and types of complications seen were wound gaping in 3 (5.88%) cases, surgical site infection in 2 (3.92%) cases, recurrent pilonidal sinus in 1 (1.96%) case, flap necrosis in 1 (1.96%) case and epidermolysis in 1 (1.96%) case. CONCLUSIONS: The Limberg rhomboid flap can be used safely in patients with cutaneous defect with minimal complications and good surgical outcome however prevalence of complications after limberg rhomboid flap in patients with cutaneous defects at tertiary care center is high compared to the previous studies done.

Mature brain tissue in the sacrococcygeal region.

Complete mature brain tissue in sacrococcygeal region is a rare congenital anomaly in a newborn, which usually is misdiagnosed for sacrococcygeal teratoma. Glial tumor-like ependymoma is also common in sacrococcygeal area but mostly appears later in life. We present a case of complete heterotopic brain tissue in the sacrococcygeal region. The patient underwent total excision of mass with coccygectomy. To our knowledge it is the second case being reported.

Repair of congenital nasal anomalies involving redundancy of structures.

OBJECTIVE: Rare congenital nasal anomalies include symmetric complete nasal duplication and asymmetric supernumerary nostrils. Complete nasal duplication may be either vertically stacked or horizontally oriented. It is a result of duplication of the nasal placode pair. Supernumerary structures include nostrils (with or without accessory cartilage) or fistulas that result from a fissure of the lateral nasal process. A case report is described whereby an adult accessory nostril, complete with an extra lower lateral cartilage, is repaired through direct excision and tip suturing. The importance of removing superfluous structures and reconstructing the normal anatomy by using an open rhinoplasty technique is stressed to achieve an aesthetic outcome.