scholarly journals Meconium peritonitis in a preterm infant: a surgical emergency

2021 ◽  
Vol 8 (4) ◽  
pp. 753
Author(s):  
Priyanka Yadav ◽  
Ankit Agarwal

Meconium peritonitis is sterile chemical peritonitis that occurs after intestinal perforation resulting in meconium leakage and subsequent inflammatory cascade within the peritoneal cavity. The clinical presentations after birth can range from completely sealed-off peritonitis without any symptoms, to severe peritonitis requiring emergency surgical intervention. We describe a case of meconium peritonitis in a premature infant following intestinal perforation. In the immediate postnatal period, the patient was intubated and a peritoneal drain was placed. Laparotomy with bowel resection was performed the following day. The postoperative course was uneventful and the patient was discharged home in good clinical condition.

2020 ◽  
Vol 132 (6) ◽  
pp. 1925-1929 ◽  
Author(s):  
Jennifer Kollmer ◽  
Paul Preisser ◽  
Martin Bendszus ◽  
Henrich Kele

Diagnosis of spontaneous fascicular nerve torsions is difficult and often delayed until surgical exploration is performed. This case series raises awareness of peripheral nerve torsions and will facilitate an earlier diagnosis by using nerve ultrasound (NUS) and magnetic resonance neurography (MRN). Four patients with previously ambiguous upper-extremity mononeuropathies underwent NUS and 3T MRN. Neuroimaging detected proximal torsions of the anterior and posterior interosseous nerve fascicles within median or radial nerve trunks in all patients. In NUS, most cases presented with a thickening of affected nerve fascicles, followed by an abrupt caliber decrease, leading to the pathognomonic sausage-like configuration. MRN showed T2-weighted hyperintense signal alterations of fascicles at and distal to the torsion site, and directly visualized the distorted nerves. Three patients had favorable outcomes after being transferred to emergency surgical intervention, while 1 patient with existing chronic muscle atrophy was no longer eligible for surgery. NUS and MRN are complementary diagnostic methods, and both can detect nerve torsions on a fascicular level. Neuroimaging is indispensable for diagnosing fascicular nerve torsions, and should be applied in all unclear cases of mononeuropathy to determine the diagnosis and if necessary, to guide surgical therapies, as only timely interventions enable favorable outcomes.


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Esworthy ◽  
N Johnson ◽  
J Dias ◽  
P Divall

Abstract Background Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is > 2mm; this value is often used as an indication for surgery if closed reduction is not possible. Method A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with >2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation. Conclusions Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.


2021 ◽  
pp. 6-9
Author(s):  
Sumathi Ravikumar ◽  
Yeganathan Rajappan ◽  
Durairajan Vaithiyanathan ◽  
Catherine Sindhuja

COVID 19 pandemic was declared by WHO as public health emergency on January 30,2020. Health system was reorganised with the aim to cope with the new disease and maintain essential health service. Many patients suffered from ARDS which lead to the modication of clinical and surgical activity. Current impact of COVID 19 outbreak on emergency surgical practice is still not developed. Varied presentation, diagnostic uncertainity, lack of guidelines present challenges to surgeons. AIM: The aim of our study was to evaluate the impact of the COVID-19 pandemic on emergency general surgery admissions and operations in our institution METHODS: We conducted a retrospective study in K.A.P.V.G.M.C. and M.G.M.G.H., Trichy from march 2020 to December 2020. All general surgical emergency admissions to KAPVGMC and MGMGH, district general hospital were included from march to December 2020.The details of diagnosis and subsequent management were retrieved from records. CONCLUSION: It was observed thatclinical decisions were made based on urgency of each case while simultaneously evaluating their COVID 19 status. The number of surgicalcases during COVID 19 period were signicantly reduced. Recognising asymptomatic carriers and need of emergency surgical intervention were the challenges faced by the surgeons. Effective communication between microbiologist, radiologist, anaesthetist and surgeon was necessary to attain a favourable outcome. .Inspite of challenges faced 80% had postoperative uneventful period other than prolonged duration of stay and were discharged and followed up. Covid 19 pneumonia and ARDS attributed to majority of death among the 20 % of deceased , other than septicemia


2017 ◽  
Vol 05 (01) ◽  
pp. e51-e54
Author(s):  
Zbyněk Straňák ◽  
Karel Pýcha ◽  
Simona Feyereislova ◽  
Jaroslav Feyereisl ◽  
Michal Rygl

Background Delayed surgery after stabilization of infants with congenital diaphragmatic hernia (CDH) is an accepted strategy. However, the evidence favoring delayed versus immediate surgical repair is limited. We present an extremely rare case of a very low-birth-weight infant with prenatally diagnosed left-sided CDH and unexpected transmural bowel perforations developing within the postnatal stabilization period. Case Report A neonate born at 31st week of gestation with a birth weight of 1,470 g with antenatally diagnosed left-sided CDH presented with bowel dilation leading to transmural bowel perforations on the 2nd day of life. Meconium pleuroperitonitis resulted in severe systemic inflammatory response syndrome, pulmonary hypertension, multiple organ failure, and death. Conclusion In neonates with CDH deteriorating under standard postnatal management, intestinal perforation, and early surgical intervention should be considered.


2014 ◽  
Vol 04 (02) ◽  
pp. 162-168
Author(s):  
R.-B. Trobs ◽  
A. Stein ◽  
U. Felderhoff ◽  
L. Hanssler

2021 ◽  
Vol 14 (3) ◽  
pp. 85-88
Author(s):  
Jok Thikuiy Gang ◽  
Sisay Kirba Kea ◽  
Samson Gebremedhin

Background: Ectopic pregnancy, a pregnancy in which the embryo implants outside the endometrial cavity, is an important cause of maternal mortality, especially in developing countries. It can be managed medically using methotrexate. In Ethiopia, limited evidence exists regarding the treatment outcome of this approach.Methods: This retrospective study was conducted based on medical records of ectopic pregnancies managed medically using methotrexate. The data of women who had unruptured ectopic pregnancy and who were managed medically in the study period at St. Paul’s Hospital Millennium Medical College were included. Data were extracted from patients’ medical records and analysed using SPSS software.Results: During the 5-year period 2015 to 2019, 81 women with unruptured ectopic pregnancy were managed medically using methotrexate with 93.8% (n=76) success. Methotrexate was administered intramuscularly to all patients in either single dose or multiple doses. Five out of the 81 patients underwent surgical intervention for either ectopic rupture or persistent ectopic mass. There were no fatal complications.Conclusion: Methotrexate is a successful and safe alternative to surgical management of unruptured ectopic pregnancy in our settings. It should be given a trial in patients who meet the selection criteria in a setting ready for emergency surgical intervention and blood transfusions.


Author(s):  
Dr. G. Someswara Rao ◽  
◽  
Dr. B. Visweswara Rao ◽  

Introduction: Perforation is defined as an abnormal opening in a hollow organ or viscus. All overthe world, perforation peritonitis is the most prevalent surgical emergency tackled and treated by asurgical team. The etiology leading to peritonitis in tropical countries shows a different spectrumfrom its western world. The present study was conducted to highlight the spectrum of hollow viscusperforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgicaltreatment, postoperative complications, and mortality encountered. Methods: The study was aprospective observational study conducted from March 2016 to March 2019 in the Department ofGeneral Surgery, Great Eastern Medical School and Hospital, Andhra Pradesh. A total of 320 patientswith perforation peritonitis were included in the study and underwent exploratory laparotomy.Results: Out of 320 patients, there were 276 males (86.25%) and 44 females (13.75%). Duodenalperforation was the most common type (34.38%), which was mainly due to Acid peptic diseasefollowed by Jejunal and Ileal perforations. Wound infection was the most common complication. Themortality rate was 8.44% (27 patients). Conclusion: Early diagnosis, resuscitation with fluids, andtimely surgical intervention are the most important factors deciding the fate of the patient withperforation peritonitis.


2017 ◽  
Vol 56 (205) ◽  
pp. 137-140
Author(s):  
Anil Kumar Adhikari ◽  
Mahuya Dutta ◽  
Chittra Ranjan Das

Introduction: The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. Methods: Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. Results: These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. Conclusions: Appropriate surgical intervention can avert morbidity and mortality. Keywords: accident; lower genital tract; Nepal; trauma.


2021 ◽  
Vol 103-B (9) ◽  
pp. 1457-1461
Author(s):  
George Philip Esworthy ◽  
Nick A. Johnson ◽  
Pip Divall ◽  
Joseph J. Dias

Aims The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement. Methods A systematic review of three databases was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. This search identified papers investigating functional outcome, including presence of arthritis, following injury. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter (1986) were the first to quantify a threshold, with all their patients developing arthritis with > 2 mm displacement. Some papers have discussed using 1 mm, although 2 mm is most widely reported. Current guidance from the British Society for Surgery of the Hand and a Delphi panel support 2 mm as an appropriate value. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, radiological arthritis does not correlate with the clinical presentation. Function following injury has been shown to be equivalent to an uninjured population, with arthritis progressing slowly or not at all. Joint space narrowing has also been shown to often be benign. Conclusion Knirk and Jupiter originated the threshold value of 2 mm. The lack of correlation between the radiological and clinical presentations warrants further modern investigation. Measurement often varies between observers, calling a threshold concept into question and showing the need for further development in this area. The principle of treatment remains restoration of normal anatomical position. Cite this article: Bone Joint J 2021;103-B(9):1457–1461.


2021 ◽  
Vol 14 (3) ◽  
pp. e239542
Author(s):  
Jothi Raamahlingam Rajaran ◽  
AJ Nazimi

The mylohyoid ridges or lines are pairs of anatomical bony structures located on the internal or lingual surface of mandible. They are the origin for the mylohyoid muscle. These bony structures are distinct in the mandibular molar region, well protected and gradually become undiscernible towards anterior mandible. Bilateral, isolated fracture of the mylohyoid ridges without concomitant mandibular fracture is rare and, to the best of the authors knowledge, was never previously described. This case report describes an isolated bilateral mylohyoid groove fracture, where one side of a necrotic bone fragment at the fracture site progress to became a nidus of infection, which later caused submandibular space abscess requiring emergency surgical intervention. Diagnosis, possible theory to explain the occurrence of isolated mylohyoid groove fracture and management of these condition are explained in this report.


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