A Clinical Review and Experience of Splenic Trauma in North India: A Retrospective Observational Study.

INTRODUCTION: The spleen is one of the frequently injured solid organs in abdominal blunt trauma. The standard of care is nonoperative nowadays depending on the hemodynamic stability (World Society of Emergency Surgery (WSES) grade I-III) of the patient due to advancements in treating modalities. Operative interventions are required in hemodynamically unstable patients or failure of nonoperative management. The study was planned to find the clinical spectrum of abdominal blunt trauma, specifically those having splenic trauma, and their subsequent management in an institution. METHODS: This is a retrospective observational study. All included patients with blunt abdominal injuries were treated in a level 1 trauma center between July 2021 and December 2022. Data regarding demographic profile, blood transfusion, pre- and postoperative findings, and management including the period of hospital stay, morbidity, and mortality were collected and analyzed. RESULTS: One hundred sixty-four patients were analyzed, of which 142 were males and 22 were females. The commonest mechanism of injury was motor vehicle collision, followed by falls. Grade III splenic injury was the most common injury, while the predominantly associated injury was rib fracture. The patients were managed preferably through nonoperative management, followed by angioembolization and operative management. The commonest postoperative complication was pneumonia. CONCLUSIONS: Nonoperative management of splenic trauma has evolved as the standard of care replacing operative management in order to sustain its immune function, thereby preventing overwhelming post-splenectomy infection.

Isolated Sigmoid Colon Perforation in the Setting of Blunt Abdominal Trauma: A Case Series.

Isolated colon injuries following blunt abdominal trauma have been reported with an incidence of 0.1-0.5 %, with sigmoid colon involvement being a rare entity. The sigmoid colon is reportedly involved only in 34.8% of isolated colonic injuries. The most common cause of colonic injuries is motor vehicle accidents. Contrast-enhanced computed tomography has a role in blunt trauma-induced bowel injury evaluation, with 82% accuracy and 64% sensitivity, but its role in the diagnostic evaluation of colonic injuries is controversial. Surgical treatment comprises primary closure, resection with or without anastomosis, and/or colostomy formation. Primary anastomosis is often favored, while colostomy creation is generally required if devascularized bowel segments present or infrequently in hemodynamic instability scenarios. Subsequent gross presentation, treatment delays due to diagnostic difficulties, and scarcity of management guidelines contribute to high morbidity and mortality. Additional research is required to accurately define patient presentation and explore the benefits of different surgical treatment options. Hereby is a case series comprising three adult male patients who presented with delayed diffuse severe abdominal pain and distension following blunt abdominal trauma. Computed tomography evaluation in the latter two had findings suggestive of pneumoperitoneum. Post resuscitation, exploratory laparotomy done in each patient denoted isolated sigmoid colon perforation with and without associated mesenteric hematoma. The decision of primary closure, resection with rectosigmoid anastomosis, and resection with end colostomy creation was taken in respective cases based on intraoperative findings of contamination, vascularity, and hemodynamics. Previously documented reports have mentioned findings of associated intra-abdominal solid organ injuries, which were absent in the present case series.

Fatal Cutaneous Mucormycosis Caused by Apophysomyces elegans: A Case Report and Review of Literature.

Primary cutaneous mucormycosis is a consequence of environmental Mucorales spores inoculation at the abraded skin. In a diabetic patient, these spores germinate quickly and disseminate hematogenously to the surroundings. Cutaneous mucormycosis is a rare but aggressive, invasive, and life-threatening fungal infection. Its presentation is nonspecific, but it rapidly results in necrosis of underneath tissues. Diagnosis can be readily made by KOH wet mount of excise tissue. However, a prompt diagnosis with multidisciplinary management is a prerequisite for a better outcome. We present a case of fatal cutaneous mucormycosis caused by Apophysomyces elegans, in a diabetic patient who succumbed to death despite extensive debridement and antifungal treatment.

Role of Serum Interleukin-6 and C-reactive Protein in Early Prediction of Severe Acute Pancreatitis.

Background: Early prediction of severity is an important goal in acute pancreatitis (AP), to identify 20% of patients who are likely to have a severe course. Such patients have an expected mortality of 15-20% and may benefit from early admission to high dependency or intensive care units, with parenteral or nasojejunal feeding and prophylactic antibiotics. In severe AP (SAP), multiorgan dysfunction accounts for most of early deaths. Aims: The aim of this article is to assess the role of serum interleukin (IL)-6 and serum C-reactive protein (CRP) in early prediction of severity of AP. Materials and Methods: This observational analytical study was conducted in the Department of General Surgery and Department of Biochemistry in our hospital in 62 patients as per inclusion and exclusion criteria. Results: IL-6 on day 1 and day 2 as well as CRP on day 2 was 100% sensitive but IL-6 on day 1 and day 2 had a maximum specificity of 88.37% among them when compared with a specificity of 81.4% of CRP on day 2. Though CRP on day 1 also had a specificity of 88.37%, its sensitivity was 89.47%. Conclusion: IL-6 and CRP together appear to be a promising marker for assessing the severity of AP within 48 h. We recommend to do IL-6 and CRP in patients with AP, which can help in predicting severity of the disease in patients.