scholarly journals A study of surgical management and its outcome in adult patients with intestinal obstruction

2019 ◽  
Vol 6 (12) ◽  
pp. 4370
Author(s):  
Sandesh R. Deolekar ◽  
Bibekananda Mahapatra ◽  
Subash Subudhi ◽  
Pragati Singhal
Keyword(s):  
Intestinal Obstruction ◽  
Surgical Management ◽  
Late Presentation ◽  
Adult Patients ◽  
Postoperative Adhesions ◽  
Surgical Emergencies ◽  
Urine Examination ◽  
High Incidence ◽  
The Mean ◽  
Tomography Scan

Background: Intestinal obstruction (IO) is one of the most common surgical emergencies, for which the therapeutic strategy has evolved progressively. The aim of this study was to assess the etiology, clinical spectrum and the outcome after surgical management of IO in adult patients.Methods: A prospective, observational study was conducted in adult patients admitted for IO and undergoing surgical management. All patients underwent routine haematological investigations, urine examination (routine and microscopic) and ultrasonography abdomen and pelvis. Specific investigations like serum amylase levels, X-ray abdomen and pelvis (supine and erect) and computed tomography scan were done, if indicated. Treatment modality was confirmed once definitive diagnosis of IO was made. All treated patients were observed for postoperative complications. They were followed up after 7 days and one month postoperatively.Results: In this study, the mean age of patients was 45.8 years and 60% were males. The most common cause of IO was found to be postoperative adhesions followed by paralytic ileus. Out of 80 patients of IO, 50 required surgical intervention, majority of which were treated with release of adhesions (38%) and resection anastomosis (44%). Poorer outcomes were observed in cases of malignancy and mesenteric ischaemia. Mortality (14%) was mainly due to complications like septicemia and respiratory tract infection.Conclusions: The commonest cause of IO in our study was postoperative adhesions. Poor outcome of the disease was associated with late presentation to the hospital, which had high incidence of bowel damage with associated faecal contamination of the peritoneum.

scholarly journals STUDY OF SURGICAL MANAGEMENT OF INTESTINAL OBSTRUCTION FROM CENTRAL INDIA: A CROSS SECTIONAL STUDY

2021 ◽  
Vol 10 (3) ◽  
pp. 3070-3073
Author(s):  
Samadhan Patil
Keyword(s):  
Abdominal Pain ◽  
Intestinal Obstruction ◽  
Surgical Management ◽  
Central India ◽  
Signs And Symptoms ◽  
Tertiary Hospital ◽  
Acute Intestinal Obstruction ◽  
Postoperative Adhesions ◽  
Cross Sectional ◽  
Mortality And Morbidity

Intestinal obstruction is a common surgical emergency with high mortality and morbidity rates. About 15% of all emergency room visits for acute abdominal pain are due to intestinal obstruction. Acute intestinal obstruction may manifest in a variety of ways, from a relatively normal appearance with only minor abdominal pain and distension to a condition of hypovolemic or septic shock (or both) that necessitates an emergency procedure. In present study we aimed to evaluate surgical management of intestinal obstruction at our tertiary hospital. The current research included patients aged 21 to 80 who had an acute intestinal obstruction that was surgically treated. After initial resuscitation, patients with strong signs and symptoms of acute obstruction were treated with an appropriate surgical procedure. All of the information was recorded in a preformat and analysed using descriptive statistics. 144 patients had surgery for acute intestinal obstruction during the study period. 51 to 60 years old was the most common age group (26 %), followed by 41 to 50 years old (21 %). In a ratio of 2.8:1, male patients were more frequently affected than female patients. Previous abdominal surgery (56 %), diabetes (31 %), smoking (25 %), hypertension (24 %), and bronchial asthma/ COPD (15 %) were all found to be common comorbidities in this research. Postoperative adhesions (47 %), malignancy (15 %), obstructed hernia (11 %), and Koch's abdomen were the most common causes of intestinal obstruction in this report (8 %). Adhesiolysis (47 %), resection and anastomosis (22 %), diversion colostomy (13 %), and hernioplasty were the most common surgical procedures in this study (11 %). The most common post-operative complications were fever (15%) and wound infection (11%) respectively. The post-operative mortality rate was 13%. (9 patients). Complications such as septicaemia, peritonitis, and respiratory infection account for the majority of deaths. Intestinal obstruction is often caused by postoperative adhesions. Early operative procedures, in combination with clinical diagnosis and radiological findings, may enhance the outcome of acute intestinal obstruction.

scholarly journals Acute intestinal obstruction due to appendicular tie syndrome: a rare case report

2019 ◽  
Vol 6 (9) ◽  
pp. 3446
Author(s):  
Akash Agrawal ◽  
Palak Vora
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Rare Case ◽  
Acute Intestinal Obstruction ◽  
Postoperative Adhesions ◽  
Surgical Emergencies ◽  
Common Causes ◽  
Rare Case Report

Acute intestinal obstruction is one of the most common surgical emergencies encountered by surgeons on daily bases. Most common causes for small bowel obstruction includes postoperative adhesions and hernia. One of the rarest cause of intestinal obstruction is appendicular band syndrome. Here we report a case of small bowel obstruction due to appendicular tie syndrome in a 70 years old male patient at GMERS hospital, Dharpur, Patan, Gujarat, India.

scholarly journals Surgical Management for Late Presentation of Supracondylar Humeral Fracture in Children

2007 ◽  
Vol 15 (2) ◽  
pp. 177-182 ◽  
Author(s):  
A Tiwari ◽  
RK Kanojia ◽  
SK Kapoor
Keyword(s):  
Surgical Management ◽  
Corrective Osteotomy ◽  
Kirschner Wire ◽  
Late Presentation ◽  
Humeral Fractures ◽  
Supracondylar Humeral Fracture ◽  
Fractures In Children ◽  
Kirschner Wire Fixation ◽  
Supracondylar Humeral Fractures ◽  
The Mean

Purpose. To report the results of surgical management for late-presenting displaced supracondylar fractures of the humerus in children. Methods. Between February 2002 and June 2003, 40 children (mean age, 7 years) with late presentation (range, 2–12 days) of displaced supracondylar humeral fractures were prospectively recruited. Gentle closed manipulation under image intensification was attempted in all patients, except one with a compound open fracture. Manipulation was successful in 25 patients and percutaneous skeletal stabilisation with Kirschner wires was performed. The remaining 15 patients were treated with open reduction and Kirschner wire fixation, using a mediolateral approach. Results. The mean delay in presentation was approximately 4 days. No patients presenting more than 7 days after injury had the fracture reduced by closed manipulation. The mean hospital stay was 41 hours. At the final follow-up (mean, 18 months), 88% of the patients had a satisfactory result, according to Flynn's criteria. Conclusion. Operative treatment for late presentation of supracondylar humeral fractures in children is effective. It minimises the risk of complications and the need for continuous traction or corrective osteotomy.

High Incidence of Symptomatic Meckel's Diverticulum in Patients Less than Fifty Years of Age: An Indication for Resection

2007 ◽  
Vol 73 (3) ◽  
pp. 271-275 ◽  
Author(s):  
Robert Mckay Frcsc
Keyword(s):  
Small Intestine ◽  
Surgical Management ◽  
Complication Rate ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Adult Patients ◽  
Asymptomatic Patients ◽  
High Incidence ◽  
Heterotopic Tissue ◽  
Congenital Diverticulum

Meckel's diverticulum is a congenital diverticulum of the small intestine. Complications include perforation, inflammation, bleeding, obstruction, and volvulus. Resection of asymptomatic Meckel's diverticuli has been recommended; however, indications are not well defined. To delineate indications to resect asymptomatic Meckel's diverticulum, the charts of 16 men and 13 women, mean age 55.1 ± 23 years, confirmed at surgery with Meckel's diverticuli, were retrospectively reviewed. Two groups were identified: symptomatic resected (9); asymptomatic (20), which included resected (10) or not resected (10). The age ranges, male:female (M:F) ratios, the height:diameter ratios, heterotopic tissue, surgical management, and complications were recorded and compared. The average age for symptomatic resection was 34.9 ± 23.2 years compared with 64.2 ± 16.5 years for asymptomatic patients ( P = 0.0006). Of patients under 50 years of age, 70 per cent (7/10) were symptomatic compared with 10 per cent (2/19) of those over 50 years of age. Overall, the M:F ratios between the groups were similar, and the average M:F ratio was 1.23:1. Surgical management of resected Meckel's diverticuli included 10 segmental resections and 10 diverticulectomies; one of each was laparoscopic. There were no differences in the complication rate, nor in outcomes between the groups. Heterotopic tissue was only identified in symptomatic patients, 33 per cent (3/9) versus 0 per cent (0/10) in resected asymptomatic patients. The height:diameter ratios were similar between the groups. Adult patients with symptomatic Meckel's diverticuli were more likely to be under the age of 50 and to have heterotrophic tissue. Resection of asymptomatic Meckel's diverticulum should be considered in patients under 50 years of age; patients over age 50 years of age will be less likely to benefit from prophylactic resection.

Surgical management of congenital heart defects in adolescent and adult patients, between years 2001–2008

2009 ◽  
Vol 150 (37) ◽  
pp. 1739-1743 ◽  
Author(s):  
István Hartyánszky ◽  
Andrea Székely ◽  
László Király ◽  
Zsolt Prodán ◽  
Sándor Mihályi ◽  
...  
Keyword(s):  
Surgical Management ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Adult Patients

A felnőttkorban operált veleszületett szívhibák között vezetnek az I. rekonstrukciós beavatkozások: a) frissen felismert betegségek, b) megelőzően inoperábilisnak ítélt kórképek, c) pulmonalis hypertonia, jobbkamra-elégtelenség miatt „elkésett” műtétek. Növekszik a II. REDO műtétek száma: a) residuumok korrigálása, b) kinőtt, diszfunkciós homograftok cseréje, c) műtéti/intervenciós korrigálás utáni recoarctatio (aneurysma, dissectio) sebészete, d) aorta valvulotomia/valvuloplastica, illetve társvitiumok (TGA) korrigálásának következményeként Ross-műtét, műbillentyű-beültetés . Betegek, eredmények: A 2001–2008 között végzett 4496 műtét közül 166 volt fiatal-felnőtt korú (16–52, átlagéletkor: 28 év) (Ia: 77, Ib: 15, Ic: 4, IIa: 11, IIb: 22, IIc: 9, IId: 28). Műtéti mortalitás nem volt, 1 beteg pulmonalis hypertoniás krízisben, 1 jobbkamra-elégtelenség miatti malignus ritmuszavarban, 2 többszerv-elégtelenségben halt meg. Konklúzió: A rizikófaktorokat a pulmonalis hypertonia és a jobbkamra-elégtelenség jelenti. A bonyolult sebészi megoldások a „congenitalis szívsebész” számára nem jelentenek problémát, de koraibb diagnózisok, terápiában az extracorporalis membránoxigenátor használata az eredményeket javíthatja.

scholarly journals Comparison of Propofol and Thiopentone Anaesthesia (with Special Reference to Recovery Characteristics)

1987 ◽  
Vol 15 (4) ◽  
pp. 389-393 ◽  
Author(s):  
W. M. Weightman ◽  
M. Zacharias
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Day Case ◽  
Early Recovery ◽  
Day Case Surgery ◽  
Pain On Injection ◽  
High Incidence ◽  
Case Surgery ◽  
Repeated Doses ◽  
The Mean

Thiopentone and propofol were used for the induction and maintenance of anaesthesia in unpremedicated patients undergoing minor gynaecological procedures. There were no significant differences in the induction and maintenance characteristics except for a high incidence of pain on injection and a greater fall in the mean systolic blood pressure associated with propofol in comparison with thiopentone. Propofol was associated with a quicker early recovery as well as a faster psychomotor recovery, as tested by a peg-board. However, complete psychomotor recovery was not achieved for up to three hours in some patients receiving propofol and so caution is advised regarding the early street fitness of patients receiving repeated doses of the drug for day case surgery.

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

scholarly journals An unusual cause of recurrent pediatric vomiting (an extraluminal pyloric duplication cystic): A case report

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Leen Jamel Doya ◽  
Naya Talal Hassan ◽  
Fareeda Wasfy Bijow ◽  
Hanin Ahmed Mansour ◽  
Sawsan Ahmad ◽  
...  
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Early Recognition ◽  
Outlet Obstruction ◽  
Abdominal Ultrasound ◽  
Duplication Cyst ◽  
Common Symptom ◽  
Surgical Emergencies ◽  
Recurrent Vomiting ◽  
Life Threatening ◽  
Tomography Scan

ABSTRACT Vomiting is a common symptom of a multitude of diseases in children. It is usually part of benign illness and can occur at any age. Recurrent vomiting can be a symptom of life-threatening medical or surgical emergencies. It can be rarely caused by an extraluminal pyloric duplication cyst. Early recognition is essential for preventing delays in management and potential complications. Here we report a case of an extraluminal pyloric duplication presenting as progressive gastric outlet obstruction cyst in a 14-month-old Syrian boy. The diagnosis was made through abdominal ultrasound, gastrointestinal endoscopy and abdominal computed tomography scan.

P3656Fontan operation performed in adult patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Santos Monteiro ◽  
C Cruz Lamas ◽  
M C Terra Cola ◽  
A J Oliveira Monteiro ◽  
M Machado Melo ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Fontan Operation ◽  
Cardiopulmonary Exercise Testing ◽  
Adult Patients ◽  
Venous Blood Flow ◽  
Inhospital Mortality ◽  
Vo2 Max ◽  
Venae Cavae ◽  
The Mean

Abstract Introduction Treatment of patients with univentricular physiology is based on a sequence of palliative surgeries which end with the Fontan operation, when all venous blood flow is diverted to the lungs, bypassing the heart. Most centers advise to complete this process around 4 years of age, and there are few data about the performance of the Fontan operation in adults. Purpose To describe the results of the Fontan surgery when performed in adult patients. Methods A retrospective review of patients submitted to the Fontan operation between 2014 and 2018, with data collection from charts, regarding their pre-operative state and follow up, including improvement in exercise capacity and hemoglobin levels. Results There were 12 patients submitted to the Fontan operation in the study period, with mean age 24±5 years, 8 female and 4 male. Two patients had no previous surgery, 2 only had bandage of the pulmonary artery, 7 had the Glenn surgery and 1 had the Damus and the Glenn surgery. Five patients had tricuspid atresia (TA) with valvular pulmonary stenosis (PS) or atresia, 1 patient had TA alone, 2 had TA with transposition of the great arteries, 1 patient had double inlet left ventricle (LV) with PS, 2 had double inlet LV with coarctation of the aorta, and 1 patient had hypoplastic right heart. One patient had suspected Noonan Syndrome. The patients who did not have Glenn surgery were submitted to connection of superior and inferior venae cavae with the pulmonary artery in the same procedure (4 patients). Seven patients had the fenestrated Fontan procedure. Six patients had a combined operation. Inhospital mortality was 0%. One patient died 4 months after the surgery due to bilateral subdural hematoma. The immediate post operative complications were tachyarrhythmia (2); important bleeding (2); pericardial effusion (4); pleural effusion (7); provisional pacemaker (1); junctional rhythmn (1); temporary hemodialysis (1); infection of the operative wound (1); fungal endocarditis (1); and mild stroke (1). The mean duration of hospitalization was 41.5±18.7 days. The length of hospital stay after surgery was 31.1±16.2 days. The exercise functional capacity improved in all patients. Before surgery there was 1 patient NYHA II that became NYHA I, 10 were NYHA III and became II or I, and 1 patient who was NYHA IV became II. The average oxygen saturation before surgery was 82% ± 8.2% and after was 91.7% ± 4.7%. The mean hemoglobin went from 17.8 g/dL to 13.9 g/dL. Eight patients performed cardiopulmonary exercise testing (CPX) before surgery, 1 patient was Weber B, 4 patients Weber C, 1 D and 1 E. Mean VO2 max was 11.7 ml/kg.min (± 3.69), and the mean slope was 71.8±35.0. Four patients performed CPX after surgery, mean VO2 max was 16.5±7.3, and mean slope was 39±16.6. Mean follow up was 20.3±17.7 months. Conclusions The Fontan operation is safe in adult patients and may still confer them significant benefits.

scholarly journals 24-Hour Measurement of Gastric pH in Rural South Africa

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Alastair M. Sammon ◽  
Eugene J. Ndebia ◽  
Ekambaram Umapathy ◽  
Jehu E. Iputo
Keyword(s):  
South Africa ◽  
Ambulatory Monitoring ◽  
Duodenogastric Reflux ◽  
Lower Oesophageal Sphincter ◽  
Gastric Ph ◽  
Night Time ◽  
High Incidence ◽  
The Mean ◽  
H Pylori ◽  
High Level

Background. Previous studies have established norms of 24-hour gastric pH profiles for western countries. This study was designed to establish the pattern for a rural African population with a high incidence of oesophageal cancer.Methods. After lower oesophageal manometry a probe was placed 10 cm distal to the lower oesophageal sphincter. We carried out 24-hour ambulatory monitoring of gastric pH on 59 healthy subjects. This was satisfactorily completed on 26 female and 18 male (age 21–64, median 35) subjects in the Transkei region of South Africa.Results. The mean 24 hour gastric pH was 2.84 and the mean night-time pH was 3.7. 40 volunteers recorded a night-time pH reaching over 4. 33 volunteers recorded a night-time pH over 7. Night-time alkalinisation was present for 136.4 minutes (25th centile 22.8, 75th centile 208.1) at pH4 or over, and 79.3 (2.5, 122.7) minutes at pH7 or over. Episodes of rapid alkaline rise were 17 (10, 47). 21.1% of these occurred while supine. 35 of 36 tested subjects were positive forH. pyloriIgG.Conclusion. Gastric alkalinisation is common in Transkei, at a higher pH than that reported in other studies, and is sustained longer. Nighttime alkalinisation is frequent. This suggests a high level of duodenogastric reflux.

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