scholarly journals Different outcomes of spontaneous gall bladder perforation owing to timing of surgical intervention: report of 2 cases

2020 ◽  
Vol 7 (11) ◽  
pp. 3835
Author(s):  
Nawaz M. Dakhani ◽  
Yamanur P. Lamani
Keyword(s):  
Case Report ◽  
Gall Bladder ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Bladder Perforation ◽  
Type I ◽  
Delay In Diagnosis ◽  
Type Iii ◽  
Pain Abdomen ◽  
Atypical Clinical Presentation

Gall bladder perforation (GBP) is a rare life-threatening complication with a high mortality due to atypical clinical presentation and delay in diagnosis due to atypical clinical presentation. Case report 1, 70-year-old female presented with complaints of pain abdomen, vomiting and blackish pigmentation over abdomen since a week. She was in shock on presentation, with necrotic patch over abdomen and abscess collection at umbilicus. Ultrasound revealed GBP at fundus with thick collection in gastrohepatic recess with overlying abdominal wall cellulitis. CECT was not possible and the patient could not be taken for surgery due to unstable vitals and expired the next day. Case report 2, a 68-year-old male presented with complaints of pain abdomen over right side with vomiting. Abdomen was tender diffusely with guarding in right hypochondrium. Ultrasound showed distended gall bladder (GB) with multiple calculi. Magnetic resonance cholangiopancreatography (MRCP) showed a GBP at fundus with pericholecystic collection extending into hepatogastric recess. He underwent total cholecystectomy and post-operative period was uneventful. Acute cholecystitis has a perforation rate of 2-11% due to cystic duct obstruction, ischemia and necrosis. Our first patient had type-III GBP and was in shock and did not survive due to bad condition on arrival whereas the second patient had type-I GBP and underwent cholecystectomy without any complications. Type-I and type-II GBP as proposed by Niemeier have better outcomes compared to type-III. Rapid diagnosis and surgical intervention are very much necessary for reducing mortality as they rarely present with typical signs and symptoms of perforation. 

Viral Characteristics and Clinical Presentation in Dengue Co-infection—Findings from a Facility Based Observational Study in Odisha, India

2020 ◽  
Author(s):  
Jyotirmayee Turuk ◽  
Subrata Kumar Palo ◽  
Sonalika Rath ◽  
Jyotsnamayee Sabat ◽  
Subhra Subhadra ◽  
...  
Keyword(s):  
Case Report ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
Recent Past ◽  
Standard Case ◽  
Pain Abdomen ◽  
Atypical Clinical Presentation ◽  
The World ◽  
Important Health ◽  
One Year

Abstract Background: Dengue is a widespread disease affecting many countries and about two fifth of the world is at risk for this disease. In India, the dengue incidence has increased in recent past and emerged as an important health problem in many states including Odisha. Cases with dengue co-infection with other diseases usually have atypical clinical presentation.Methods: A facility based longitudinal study was carried out over a period of one year to determine the dengue co-infection and its outcome. The suspected cases were clinically assessed following a standard case report format and serological investigations including serotyping were carried out.Results: 33.6% samples were dengue positive of which 78.5% were positive for NS1 Ag, 26.6% positive for dengue IgM and 5.1% to both. Among the dengue positive cases, 60.9% were male and mean age was 31.52 (+/- 17.03) years. High occurrence of cases was during May to November with maximum in August. Among the 975 dengue positives, 57 (5.8%) were found to have co-infection. Chikungunya was the most common co-infection in 71.9%, followed by herpes simplex (HSV) (7%) and other diseases. Fever was the most common presenting symptom (98.2%), followed by myalgia (91.2%), pain abdomen (12.3%), Rash/lesion (8.8%), burning micturition (5.3%), Petechiae (1.7%) and Pruritus (1.7%) among the co-infected cases.While DEN-2 serotype was observed in majority (74.1%) more than two serotypes was found in 5.85% of dengue positives .Conclusions: All the four dengue serotypes were found to be circulating with DEN-2 as the most predominant one. About 5.8% of dengue cases have co-infection (mainly with chikungunya) and clinically present with atypical signs and symptoms.

scholarly journals Acute gall bladder perforation: case series over three years

2017 ◽  
Vol 4 (2) ◽  
pp. 538 ◽  
Author(s):  
Desh Pal Singh ◽  
Sharadendu Bali ◽  
Maneshwar Singh Utaal
Keyword(s):  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Clinical Presentation ◽  
Case Series ◽  
Bladder Perforation ◽  
High Morbidity ◽  
Delay In Diagnosis ◽  
Generalized Peritonitis ◽  
Abdominal Symptoms ◽  
Acute Perforation

Background: Acute perforation of gall bladder is a life threatening condition. It is a complication of acute cholecystitis. This is not an uncommon condition and resembles acute cholecystitis in its presentation. If there is delay in diagnosis and management there is high morbidity and mortality. It should be diagnosed as early as possible for better prognosis.Methods: This is a retrospective study wherein data of cholelithiasis, acute and chronic cholecystitis and perforated gall bladder from our hospital for the last three years 2014-2016 was collected. The clinical presentation, investigations routine and radiological, surgical and medical management was analysed.Results: Total numbers of patients with chronic cholelithiasis were 3534, patients with acute cholecystitis were 133, and numbers of patients with gall bladder perforations were 22, making it 0.6% of gall bladder disease patients and 16.5% among patients with acute cholecystitis. TLC was invariably raised in all the cases. 12 out of 22 cases were managed conservatively while others underwent surgery. There was no mortality in the series.Conclusions: Gall bladder perforation occurs in about two weeks or several weeks after episode of acute cholecystitis, the incidence of occurrence of perforation increases to four folds if there is delay in proper management of acute cholecystitis more than two days after the onset of symptoms. Clinical presentation varies from an acute generalized peritonitis to nonspecific abdominal symptoms and thus requires prompt diagnosis for better prognosis.

Non-malignant gall bladder perforation: Our experience from an institution-based retrospective analysis of 25 cases

2021 ◽  
pp. 004947552110365
Author(s):  
Abhijeet Kumar ◽  
Nirmal Prasad Shah ◽  
Narendra Pandit ◽  
Suresh Prasad Sah ◽  
Rakesh Kumar Gupta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gall Bladder ◽  
Clinical Presentation ◽  
Gallbladder Perforation ◽  
Type I ◽  
Computed Tomography Scan ◽  
Duration Of Hospital Stay ◽  
Symptoms And Signs ◽  
Tomography Scan ◽  
Better Than

Gallbladder perforation still continues to perplex surgeons; 25 such patients diagnosed either pre- or intra-operatively and managed at our institute over the last 10 years period were analysed. Only eight were diagnosed pre-operatively, while a large majority (17) had a wrong initial working diagnosis. Symptoms and signs were variable. No blood investigation was specific. A computed tomography scan was generally better than ultrasound in detecting the perforation. All our cases were managed operatively with no mortality and a mean duration of hospital stay of 6.8 days. Most perforations were extra-hepatic (84%) and those of Niemeier’s type I (52.2%). Because of its varied clinical presentation, gallbladder perforation is often an intra-operative diagnosis, but early intervention carries a good outcome.

RA05.04: MANAGEMENT & OUTCOMES OF ANASTOMOTIC LEAKS FOLLOWING ESOPHAGECTOMY: A PROSPECTIVE 10-YEAR SINGLE-SITE EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 28-28
Author(s):  
Joel Lambert ◽  
Sanya Caratella ◽  
Eloise Lawrence ◽  
Bilal Alkhaffaf
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Surgical Intervention ◽  
Type I ◽  
Oral Contrast ◽  
Open Approach ◽  
Type Ii ◽  
Anastomotic Leaks ◽  
Type Iii ◽  
Significant Difference

Abstract Background Anastomotic leak after esophagectomy is associated with high levels of morbidity and may impact negatively on oncological outcomes. The aim of this single centre study was to describe our experience in managing these complications Methods From 2007–2017 data was reviewed retrospectively from our prospectively maintained electronic database. All patients underwent either 2 or 3 phase esophagectomy for cancer of the oesophagus or esophago-gastric junction. All histological sub-types and stage of cancer were included in the analysis. Anastomotic leaks were classified according to the Esophagectomy Complications Consensus Group (ECCG) guidelines; type I—conservative management, type II—non-surgical intervention, type III—surgical intervention. Results 224 esophagectomies were included in our analysis (104 (46%) minimally invasive, 120 (54%) open approach). The incidence of all anastomotic leaks was 10% (23/224). Surgical approach did not influence the incidence of anastomotic leak (minimally invasive 10 (43%), open approach 13(57%), P = 0.76). Five patients (22%) had a type I leak, 9 patients (39%) type II and 9 (39%) had a type III leak. There was an increase in the number of leaks managed non-surgically over the last 5 years compared to those in the first five years of our dataset (2012–2017: 11/23 (48%) vs 2007–2012: 4/23 (17%) P = 0.08). The median time for leak diagnosis was 8 days. Most leaks were diagnosed with oral contrast CT 19 (83%). Median hospital stay after anastomotic leak was 58.5 days. Type III leaks were associated with an increased length of stay (median 84 days) compared to type I&II leaks (median (38.5 days) (P = 0.002 95% CI 18.19- 74.41). There was no significant difference in 30-day mortality between type I&II (0 patients) and type III leaks (1 patient) P = 0.260. Conclusion Low mortality rates with anastomotic leak can be achieved. In centres with experienced radiological and endoscopic skills, most anastomotic leaks can be managed non-surgically. Disclosure All authors have declared no conflicts of interest.

scholarly journals Rectosigmoid prolapse - a case report

2015 ◽  
Vol 72 (12) ◽  
pp. 1118-1121
Author(s):  
Vasilije Jeremic ◽  
Srdjan Mijatovic ◽  
Slobodan Krstic ◽  
Sanja Dragasevic ◽  
Tamara Alempijevic
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Sigmoid Colon ◽  
Severe Pain ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Preoperative Management ◽  
Perianal Region ◽  
Rectosigmoid Colon ◽  
Possible Cause

Introduction. Many factors have been indentified as a possible cause of rectal prolaps. Despite the fact that it is not a lifethreating condition, its clinical presentation varies, and sometimes it can present as an emergency. We presented a patient with prolapse of an unusually large segment of the rectosigmoid colon caused by chronic constipation, as an incarcerated segment repaired surgically. Case report. A 62-year-old female patient was referred to the Emergency Department in bad condition with severe pain in the perianal region. On examination a complete rectal prolaps as well as a part of sigmoid colon were found. Macroscopically, the prolapsed segment appeared edematous, livid, with ulcerations. An attempt to manually reduce prolapse failed, therefore resection of 50 cm of sigmoid colon with rectopexy had to be performed. No complications occurred and the patient was without symptoms six months later. Colonoscopy did not reveal any abnormality. Conclusion. Although the preoperative management and preparation of the patient was limited, emergancy surgical intervention for such a case was the strategy of choice due to magnitude of the prolapsing segment. It provided a successful and permenant solution.

scholarly journals Use of Metaphyseal Sleeves in Revision Knee Arthroplasty

2017 ◽  
Vol 24 (2) ◽  
pp. 5-10
Author(s):  
M. V Girkalo ◽  
I. A Norkin
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Type I ◽  
Type Ii ◽  
Short Term ◽  
Type Iii ◽  
Revision Knee Arthroplasty ◽  
Total Knee

Purpose. To study the short-term results of revision knee arthroplasty performed using metaphyseal sleeves. Patients and methods. During the period from 2013 to 2015 the total number of 40 patients was operated on. Type I femoral defects (by AORI classification) were diagnosed in 11 (27.5%), type II - in 26 (65.0%), type III - in 3 (7.5%) cases. Type I tibial defects were diagnosed in 2 (5.0%), type IIa - in 24 (65.0%), type IIb - in 11 (27.0%) and type III - in 3 (7.54%) cases. Metaphyseal femoral sleeves were used in 8 and metaphyseal tibial sleeve - in 40 patients. Results. Follow up period made up from 12 to 43 (mean 32.8) months. Excellent and good results by KSS scale were achieved in 30 (75.0%) of patients, by functional KSS scale - in 24 (60.0%) patients. Mean point by Knee Society Total Knee Arthroplasty Roentgenographic Evaluation scale in patients with femoral and tibial metaphyseal sleeves made up 2.35 versus 0.375 that confirmed the absence of progressive bone resorption. No one case of aseptic instability of the revision implant was observed. Repeated surgical intervention due to reinfection and knee joint contracture with pain syndrome was performed in 2 (5.0%) patients. Conclusion. The obtained data enable to recommend the use of metaphyseal sleeves for revision knee arthroplasty in patients with tibial and femoral defects of types II and III by AORI classification.

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