scholarly journals Study to determine etiological factors and surgical outcome of non traumatic abdominal hollow viscus perforation

2020 ◽  
Vol 7 (12) ◽  
pp. 4132
Author(s):  
Akshay S. Marathe ◽  
Varsha N. Bijwe
Keyword(s):  
Late Presentation ◽  
Sudden Onset ◽  
Morbidity And Mortality ◽  
General Surgeon ◽  
Peptic Ulcer Perforation ◽  
Hollow Viscus ◽  
Early Presentation ◽  
Etiological Factors ◽  
Chief Complaints ◽  
Hollow Viscus Perforation

Background: Hollow viscus perforation leading to peritonitis is a common emergency faced by a general surgeon. Late presentation, missed diagnosis and late interventions are frequent causes of morbidity and mortality. Thus in an interest to find out etiological factors, to assess the common type of perforations with their clinical presentation, surgical out come and finally prognosis and complications; forms the basis of present study.Methods: We carried out prospective study on total of 60 patients presenting with sudden onset pain in abdomen with guarding and rigidity per abdominally for etiology, surgical management and post- operative complications. Study was conducted between 1 January 2018 to 31 December 2018 (12 months), with follow up period up to 30 June 2019 (6 months).Results: Most common age group involved is 20-39 years (51.6%). Peptic ulcer perforation is the most common cause of hollow viscus perforation (46.4%). Abdominal pain and vomiting were the most common chief complaints and tenderness with guarding rigidity being the most commonly observed sign. Gas under diaphragm on X-ray standing abdomen is suggestive of hollow viscus perforation (41 out of 60 cases) but, it is not obligatory. Surgery is the main modality of treatment. Wound infection is the most commonly observed post-operative complication.Conclusions: Hollow viscus perforation leading to peritonitis is one of the most common emergencies faced by a general surgeon. Early presentation, Proper diagnosis and timely interventions decrease morbidity and mortality.

scholarly journals Comparative study between POMPP score versus Boey score to predict morbidity and mortality in peptic perforation peritonitis

2021 ◽  
Vol 8 (2) ◽  
pp. 543
Author(s):  
Bhanu Prakash K. R. ◽  
Subhas Patil ◽  
Manasa Mohan
Keyword(s):  
Peptic Ulcer ◽  
Morbidity And Mortality ◽  
High Rate ◽  
P Value ◽  
Peptic Ulcer Perforation ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Ulcer Disease ◽  
Ulcer Perforation ◽  
Perforation Peritonitis

Background: Peptic ulcer disease (PUD) results from an imbalance between stomach acid-pepsin and mucosal defense barriers. It affects 4 million people worldwide annually. Peptic ulcer perforation is one of the most common surgical emergencies and is associated with a high rate of morbidity and mortality. This is due to presence of various risk factors among the population like H. pylori infection, long term NSAID use, alcohol ingestion, smoking and steroid use. Peptic ulcer perforation peritonitis usually requires an emergency surgical intervention and hence the need for this study, to compare POMPP and Boey scores as predictors of morbidity and mortality in patients with peptic perforation peritonitis.Methods: This prospective observational study was conducted in the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020. All patients above 18 years with features of hollow viscus perforation with per-operative finding of perforated peptic ulcer were included in the study. Patients with histopathology suggestive of malignancy were excluded.Results: A total of 65 patients were included in the study. On analysis of the data by Chi-square test, P value of both POMPP and Boey scores was found to be <0.05 which is statistically significant. The most important predictive factors of mortality and morbidity were duration of perforation >24 hours, age >65 years and pre-operative shock.Conclusions: Both scoring systems are easy to use and can assist in accurate and early identification of high-risk patients and are important in predicting mortality and morbidity in patients with peptic ulcer perforation.

scholarly journals EFFECTIVENESS OF MANNHEIM PERITONITIS INDEX IN PREDICTING THE MORBIDITY AND MORTALITY OF PATIENTS WITH PERITONITIS FOLLOWING HOLLOW VISCUS PERFORATION

2020 ◽  
pp. 48-50
Author(s):  
Pradipta Pandit ◽  
Tanmoy Bhuyan ◽  
Rahul Kushwaha
Keyword(s):  
Surgical Treatment ◽  
Antimicrobial Agents ◽  
Risk Groups ◽  
Morbidity And Mortality ◽  
Related Factors ◽  
Hollow Viscus ◽  
Mannheim Peritonitis Index ◽  
Medical College ◽  
Specific Factors ◽  
Hollow Viscus Perforation

Background: One of the common cause of emergency surgery in India is peritonitis due to hollow viscous perforation. The morbidity and mortality of secondary peritonitis remains high despite advances in surgical skills, antimicrobial agents and supportive care. Many factors determine the prognosis and outcome which includes patient related factors, disease specific factors and management of the case. Management of these case are done by categorizing patients into different risk groups. Based on measuring simple clinical parameters in case of hollow viscous perforation Mannheim peritonitis index (MPI) is calculated. To know efficacy of MPI for predicting morbidity and mortality in hollow viscous perforation this study was conducted. Methods: 50 patients who were undergoing surgical treatment for peritonitis following hollow viscous perforation at Silchar Medical College and Hospital, Silchar were included in study. Clinical data, surgical treatment, outcome were documented and analysed. Results: In patients with MPI more than 29 the morbidity and mortality rate were higher. The most common complication in patients with MPI less than 21 was surgical site infection while of those with MPI more than 21 the respiratory complications were common. The ICU stay of the patients were increased if the MPI Score was higher. Conclusions: MPI is simple and effective in predicting morbidity and mortality in patients with hollow viscous perforation and is very easy to calculate.

Anesthetic management of a patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock

2021 ◽  
Vol 25 (2) ◽  
Author(s):  
Reza Widianto Sudjud ◽  
Djoni Kusumah Pohan ◽  
Muhammad Budi Kurniawan ◽  
Hana Nur Ramila
Keyword(s):  
Hemorrhagic Shock ◽  
Blunt Abdominal Trauma ◽  
Massive Transfusion ◽  
Damage Control ◽  
Anesthetic Management ◽  
Hollow Viscus ◽  
Permissive Hypotension ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol ◽  
Hollow Viscus Perforation

Hemorrhagic shock is a form of hypovolemic shock in which severe blood loss leads to inadequate oxygen delivery at the cellular level. Death from hemorrhage represents a substantial global problem, with more than 60,000 deaths per year in the United States and an estimated 1.9 million deaths per year worldwide, 1.5 million of which result from physical trauma. This case report aims to stress the need of handling cases of hemorrhagic shock in accordance with damage control protocol. Hemorrhagic shock management using permissive hypotension management, bleeding control, massive transfusion protocol (MTP), minimal crystalloid therapy, and adjuvant therapy is the best approach to get optimal outcome to prevent triad of death. In this case, the application of damage control resuscitation has not been fully implemented because of several constraints. Key words: Hemorrhage; Hemorrhagic shock; Permissive hypotension; Massive Transfusion Protocol; MTP; Resuscitation; Damage control Citation: Pohan DK, Sudjud RW, Kurniawan MB, Ramila HN. Anesthetic management on patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock. Anaesth. pain intensive care 2021;25(2):217-221. DOI: 10.35975/apic.v25i2.1474 Received: 11 January 2021, Reviewed: 15 January 2021, Accepted: 16 February 2021

scholarly journals Clinical Presentation of Preterm Neonates with Intraventricular Hemorrhage: Experience in a Tertiary Care Hospital in Dhaka

2017 ◽  
Vol 7 (3) ◽  
pp. 194-197
Author(s):  
Tasnima Ahmed ◽  
Abdul Baki ◽  
Tahmina Begum ◽  
Nazmun Nahar
Keyword(s):  
Clinical Features ◽  
Intraventricular Hemorrhage ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Morbidity And Mortality ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Care Hospital ◽  
One Year

Background: Intraventricular hemorrhage (IVH) is common among preterm infants as many of them survive with the advancements in neonatal care. Severe IVH may lead to significant morbidity and mortality. The objective of our study is to find out the significant clinical signs of IVH in preterm neonate for early detection by ultrasonography.Methods: This prospective observational study was done in special care baby unit (SCABU), Bangladesh Institute of Research & rehabilitation of Diabetic, Endocrine & metabolic Disorder (BIRDEM) for a period of one year. Eighty five preterm neonates were included in this study. Clinical features of IVH like- convulsion, lethargy, irritability, bulged fontanelle, recurrent apnea, sudden onset of respiratory distress, sudden pallor and bradycardia were observed. Cranial ultrasound studies were done within 7 days of life in all cases to identify IVH.Result: Mean gestational age of these neonates was 31.31(±2.2) weeks & mean birth weight was 1413.42 (±330.55) gm. Among 85 preterm neonates 21(24.7%) developed IVH, confirmed by ultrasonography of brain. Clinical features like convulsion, bulged fontanel, repeated apnea & sudden pallor were significantly present in IVH group.Conclusion: Intraventricular Hemorrhage constitutes an important cause of morbidity and mortality in neonate. This study showed that clinical features like convulsion, bulged fontanel and sudden pallor had a significant relationship with intraventricular hemorrhage which will help for its early detection.Birdem Med J 2017; 7(3): 194-197

Examining the effectiveness of examination at 6–8 weeks for developmental dysplasia: testing the safety net

2018 ◽  
Vol 104 (10) ◽  
pp. 953-955 ◽  
Author(s):  
Mike Reidy ◽  
Caitlin Collins ◽  
Jamie G B MacLean ◽  
Donald Campbell
Keyword(s):  
Safety Net ◽  
Late Presentation ◽  
Developmental Dysplasia ◽  
Positive Finding ◽  
Invasive Treatment ◽  
Early Presentation ◽  
Current Form ◽  
Non Invasive ◽  
The Uk ◽  
Dysplasia Of The Hip

ObjectiveThe ‘GP check’ at 6–8 weeks forms part of the selective surveillance system for developmental dysplasia of the hip (DDH) in the UK. It is imperative to pick up DDH within the first months of life to allow for non-invasive treatment and the avoidance of surgery. We aim to investigate the effectiveness of hip examination at 6–8 weeks.MethodsThis is a longitudinal observational study including all infants born in our region in the 5 years following 2006. Early presentation was defined as diagnosis within 14 weeks of birth and late presentation after 14 weeks. Treatment records for early and late DDH as well as referrals for ultrasound (US) following examination at 6–8 weeks were analysed. Attendance of the examination at 6–8 weeks in those patients who went on to present with a late DDH was also analysed.Results23 112 live births occurred during the study period. There were 141 confirmed cases of DDH. 400 referrals for US were received following examination at 6–8 weeks; 6 of these had a positive finding of DDH. 27 patients presented after 14 weeks and were classified as late presentations. 25 of these patients had attended examination at 6–8 weeks and no abnormality had been identified.ConclusionsThe sensitivity of examination at 6–8 weeks was only 19.4%, its specificity was 98% and it had a positive predictive value of 1.5%. For many years the check at 6–8 weeks has been thought of as a means to identify those children not identified as neonates; however, we found that four out of five children with DDH were not identified by the check at 6–8 weeks. Unfortunately, we conclude that the presumed safety net of the examination in its current form is not reliable.

scholarly journals Cas/Medevac in field area: An experience and lessons drawn

2019 ◽  
Vol 63 ◽  
pp. 33-38
Author(s):  
Murtaza ◽  
P Biswal
Keyword(s):  
United Nations ◽  
Medical Care ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Medical Establishment ◽  
Level Ii ◽  
Incremental Information ◽  
Standard Operating ◽  
Field Area ◽  
Hollow Viscus Perforation

Introduction: Success of Cas/Medevac missions depends on effective coordination between all agencies involved. The focus by medical authorities on the treatment and medical care at time leads to avoidable procedural complexity. Certain lessons are drawn from the United Nations (UNs) field areas for Cas/Medevac missions/laid down procedures and recommendations made for streamlining our own procedures. Materials and Methods: The data pertaining to Cas/Medevac details from IFH Level-II Malakal (UN Mission in South Sudan [UNMISS]) for January 2017 - February 2018 were collected and analyzed. Standard operating procedures (SOPs) followed in the UN field areas for Cas/Medevac missions were also studied and analyzed. Results and Discussion: A total of 19 cases were air evacuated from IFH Level-II UNMISS to higher medical establishments and 11 cases from periphery to IFH Level-II in 1 year plus period. Aeromedical issues involved are discussed here with emphasis on Medevac of patient with suspicion of hollow viscus perforation/pancreatitis. Procedures and documentation followed in the UN Medevac missions are discussed and suggestions made for improving Cas/ Medevac procedures in field areas. A sample of Cas/Medevac incremental information form is also suggested. Conclusion: Timely evacuation of a casualty to an appropriate medical establishment can reduce mortality and morbidity significantly. Experience of Cas/Medevac missions in the UN field area is presented in this paper along with analysis and discussion on SOPs followed in the UN mission areas. Suggestions are made to refine and streamline our own Cas/Medevac procedures in field areas and theaters of conflict.

scholarly journals Surgical management and perioperative complications of peritonitis secondary to hollow viscus perforation in a tertiary care centre

2021 ◽  
Vol 8 (11) ◽  
pp. 3359
Author(s):  
Lokesh M. G. ◽  
S. Chandrashekar ◽  
Arundathi Raikar ◽  
Abhishek S. S.
Keyword(s):  
Perioperative Complications ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Hollow Viscus ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Threatening Condition ◽  
Hollow Viscus Perforation

Background: High mortality and morbidity is associated with peritonitis secondary to hollow viscus perforation, proving it a most common life threatening condition which needs emergency surgical care. Hence a proper evaluation was needed regarding appropriate management to have a better outcome, which was a challenge to operating surgeon.Methods: A serial study of 96 cases of peritonitis secondary to hollow viscus perforation was conducted at tertiary care centre, department of general surgery, Mysore medical college and research institute, Mysore, Karnataka from the period of August 2020 to July 2021. Data related to aetiology, surgical intervention and its peri-operative complications were noted. Appropriate statistical analyses were done to draw the inference.Results: Out of 96 cases studied, 74 were male, 22 were female with mean age of 45.53 years. Most common cause of peritonitis was GU perforation, followed by idiopathic, infective, malignancy, appendicular perforation and Trauma.Conclusions: Hollow viscus perforation being most common surgical emergencies, surgical outcomes and its related complications depends on age, general condition, site, co-morbidities and aetiologies.

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