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Marginal ulcers are rare complications of pancreatoduodenectomy. Patient can present with varying symptoms such as epigastric discomfort, pain, dysphagia, or can present in emergency department with complications like bleeding and perforation.
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Introduction and importance: The purpose of T-tubes is to induce inflammation around it in the common bile duct, forming a fibrous tract for drainage of bile. The leakage of bile into the peritoneum is a drastic complication following T-tube removal. A provisional diagnosis of choleperitoneum is established in the presence of persistent pain with guarding and rigidity. Imaging techniques can be used for the identification of biliary leakage. With most cases, patients recover with either conservative or surgical management. Case presentation: We present you a 65 years old malnourished female with features of choleperitoneum immediately following T-tube removal and was planned for conservative management with constant monitoring in surgical intensive care unit. The patient deteriorated despite adequate treatment and went into septic shock which resulted into her demise. Clinical discussion: Biliary peritonitis is not very uncommon but a life-threatening complication of T-tube removal. Poor nutritional status may also lead to delay in fistulous tract formation and there is a relative risk of biliary leakage during removal of T-tube. The use of a latex T-tube is more effective in mature tract formation and has less incidence of bile leakage. Seldinger's method, which involves using a wire to guide the removal of the T-tube, shows a significant reduction of biliary leakage. Conclusion: The mortality in biliary peritonitis significantly rises in cases of infected bile. The adverse reaction following the removal of T-tube was 4.3% and about 3% were severe enough to be admitted to the hospital.
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Introduction and importance: Retroperitoneal extension is a rare and fatal complication of Fournier's gangrene (FG) which mandates immediate surgical intervention for better outcome. Case presentation: A 70-year-old male presented to the emergency department with a history of bilateral painful scrotal swelling for 7 days with fever and abdominal pain for 3 days. On his general examination, he was septic with necrotic patches in the perineum and bilateral scrotum. Imaging revealed soft tissue gas and collections in scrotum extending to the right retroperitoneum with massive collection suggestive of retroperitoneal abscess. Following resuscitation and intravenous antibiotics, immediate exploratory laparotomy was done to drain the retroperitoneal abscess followed by debridement of Fournier's gangrene. The patient remained well on follow up. Clinical discussion: Fournier gangrene is a fulminant polymicrobial infection of the perineum, scrotum and penis which when complicated by retroperitoneal extension, has a very high mortality. Majority of patients have an immunocompromised condition. Early diagnosis with prompt surgical drainage and debridement (within 6 hours) significantly reduces the mortality. Conclusion: High index of suspicion, careful clinical examination and timely use of imaging is crucial for early diagnosis of this rare but fatal complication of FG. Furthermore, adequate resuscitation with prompt surgical intervention is the key for a favorable outcome.
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Introduction: Laparoscopic cholecystectomy (LC) has been established as the gold standard treatment for symptomatic gallstones, however surgeons face the risk of injuring bile ducts and vessels due to the inherent limitations of laparoscopy. Methods: This is a cross-sectional study done in the Department of Surgery, Shree Birendra Hospital (SBH) on patients who were posted for LC. The study period was through April 2021 to September 2021. During LC, the anatomy of RS was noted and classified into Group A (RS present) or Group B (RS absent). Data analyses were performed considering a p-value of <0.05 as statistically significant. Results: RS was present in 169 (93.9%) out of 180 cases. The open sulcus type was found in 114 cases (67.5%), followed by closed type in 26 (15.4%), slit sulcus type in 22 (13.0%), and scar type in 7 (4.1%) cases. Injury to cystic artery occurred in one case (0.15%) of Group A while in two cases (18.18%) of Group B (p-value = 0.001). The adjusted operative time in Group A and Group B were 50.61 ± 10.33 min and 69.86 ± 15.28 min respectively (p-value = 0.005). There was significant difference between Group A and Group B in conversion to open surgery - 01 (0.59%) and 04 (36%) respectively (p-value < 0.001). Surgical Site Infection (SSI) was detected in nine (5.33%) cases among Group A and in three (27.2%) cases among Group B (p-value = 0.028). Conclusion: RS can be considered as an important anatomical landmark for safer LC with fewer injuries to cystic artery, SSI, conversion to open surgery and shorter operative time.
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Novel coronavirus disease 2019 (COVID-19) pandemic was originated in Wuhan, China, in December 2019. So far, more than 4 million people worldwide have been infected with the virus. Various manifestations of coronavirus have been reported since the pandemic began. Among them, acute abdomen is one of the manifestations of COVID-19. Some studies have reported acute pancreatitis in several patient due to COVID-19 infection. In this study, we report a rare case in whom SARS-CoV-2 caused acute severe hemorrhagic necrotizing pancreatitis.
