scholarly journals Gastrointestinal Perforation by Ingested Foreign Bodies: Experience at A Surgical Department in Tunisia

2021 ◽  
Author(s):  
Atef MEJRI ◽  
Emna Trigui ◽  
sarra saad ◽  
jasser yaacoubi ◽  
skander mrad ◽  
...  
Keyword(s):  
Foreign Body ◽  
Hospital Stay ◽  
Foreign Bodies ◽  
Length Of Hospital Stay ◽  
Gastrointestinal Perforation ◽  
Duration Of Symptoms ◽  
Female Ratio ◽  
Surgical Department ◽  
Low Middle Income Countries ◽  
The Mean

Abstract Background Management of gastrointestinal perforation by ingested foreign bodies remains a topical subject following technological progress. This work aims to analyze, the epidemiological features, the management in a Tunisian surgical department and to access the most realistic and beneficial management of gastrointestinal perforation by ingested foreign bodies in a low-income country, where there is a paucity of information regarding this subject Methods This is a retrospective review of 24 patients with gastrointestinal perforation by ingested foreign bodies treated in the General Surgery department of Jendouba Hospital in Tunisia from January 2010 to December 2019. Results 24 patients with gastrointestinal tract perforation by an ingested foreign body were managed at our surgical ward. The mean age of patients was 56.58 years with extreme ranging 25-72 years with a male to female ratio 2/1. Three patients (12.5%) had psychiatric disorder, one had myasthenia (4.1%), two patients were alcoholics (8.33%), three patients were toothless (12.5%) and two (8.33%) patients were veiled. According to ASA classification, 6 (25%) patients were ASA I, 15 (62.5%) patients ASA II, 3 (12.5%) ASA III. The mean duration of symptoms was 2.16 days and ranges from 1 to 7 days. All patients (100%) presented to the emergency department with acute abdominal pain. Sixteen patients (66.66%) had a fever, twelve (50%) had vomiting and four (16.66%) had a sub-occlusive syndrome. All patients had performed abdominal x-ray. The foreign bodies were objectified in only six cases (25%). CT scan was performed in 16 (66.66%) patients and the location of ingested foreign bodies was obtained in 9 patients preoperatively (37.5%) and in 4 patients (16.66%) after proofreading. All the 24 patients underwent surgery and they were operated during their initial hospital stay. The most common site of perforation was the terminal ileum (62,5%) followed by the duodenum (12, 5%). Enterectomy was the procedure of choice in 20 patients (16 underwent an enterostomy and 4 patients underwent an enteroanastomosis) and four patients had a simple suture. The foreign body was found in all patients. Two patients developed postoperative complications: one case of intraabdominal abscess and one patient had a wound dehiscence . The median length of hospital stay following surgery was 4.08 days (range 2-7 days). The mortality rate was 4.16 %. All patients managed with enterostomy, had their stoma closed after 3-5 months. Conclusion Open Surgery still remains a management with satisfactory morbidity, mortality and length of hospital stay. However, we estimate that for low/middle-income countries, investing in laparoscopy, for these cases, would be more realistic and more beneficial allowing improving more the outcomes. For this fact, promoting radiologic diagnosis is highly recommended in order to increase prospective identification of the foreign body location and perforation site, allowing a safe laparoscopic approach.

scholarly journals Triple tubostomy and its outcome for blunt duodenal injury

2019 ◽  
Vol 22 (1) ◽  
pp. 12-17
Author(s):  
Narendra Pandit ◽  
Tek Narayan Yadav ◽  
Laligen Awale ◽  
Shailesh Adhikary
Keyword(s):  
Hospital Stay ◽  
Primary Closure ◽  
Early Stage ◽  
Primary Repair ◽  
Length Of Hospital Stay ◽  
Damage Control Surgery ◽  
Duodenal Fistula ◽  
Duodenal Injury ◽  
Female Ratio ◽  
The Mean

Introduction: Blunt duodenal injury in an uncommon form of abdominal injuries, which comprises less than 5% of all injuries. The diagnosis and management are challenging, because of delays in diagnosis due to subtle signs and symptoms in its early stage of presentation. Primary repair along with triple tubostomy (gastrostomy, retrograde duodenostomy and feeding jejunostomy) is a simple and safe method of damage control surgery in this group of patients. This study aims to report our experience in the management of this uncommon procedure. Methods: This is a retrospective analysis of the patients undergoing triple tubostomy (TT) for blunt duodenal injury at the Department of Surgery, B.P.Koirala Institute of Health Sciences (BPKIHS), Dharan, over a three and half years. The study included demographics, clinical profile, length of hospital stay, postoperative morbidity (duodenal fistula), rate and timing of spontaneous closure of fistula and mortality. Results: Eleven (6.7%) patients out of 164 blunt trauma abdomen had sustained a duodenal injury. Eight patients who underwent TT were included in the study. The mean age of the patient was 31.8 years (range: 18-67), with a male: female ratio of 3:1. The mean time to trauma and presentation was 4.25 days. The most common site of injury was the second part of the duodenum (87.5%), AAST grade III was seen in 62.5%, two (25%) patients were in shock at presentation. Eight patients required primary closure with triple tubostomy. Postoperatively, all patients had a duodenal fistula, which closed spontaneously in 6 (75%) patients at a mean duration of 17 days, with a mean postoperative length of hospital stay of 33.5 days. The remaining two (25%) patients died of an active fistula. Conclusion: Blunt duodenal trauma, when presented late can be managed with primary closure and triple tubostomy with acceptable postoperative outcomes.  

scholarly journals LAP STAPLER GASTROJEJUNOSTOMY WITH TOTAL TRUNCAL VAGOTOMY FOR BENIGN GASTRIC OUTLET OBSTRUCTION.

2020 ◽  
Vol 4 (9) ◽  
Author(s):  
Sahun .
Keyword(s):  
Hospital Stay ◽  
Postoperative Complication ◽  
Operative Time ◽  
Outlet Obstruction ◽  
Length Of Hospital Stay ◽  
Truncal Vagotomy ◽  
Term Outcome ◽  
Female Ratio ◽  
Advantages And Disadvantages ◽  
The Mean

Aims: To study the advantages and disadvantages of laparoscopic truncal vagotomy and gastrojejunostomy, the outcome of surgery in terms of – mean operative time, Conversion rate, Postoperative pain measurement, intraoperative and postoperative complication and duration of hospital stay. Methods: A prospective analysis of operative, postoperative and short term outcome of 21 patients were carried out during time period of 2016 to 2019. Results: Out of 21 patient,.64% patients were males and 36 % patients were females. Male to female ratio was 1.7: 1. The mean operative time required was 130 minutes and the mean pain scale measured was 3 ± 0.81 on second day .The incidence of intraoperative and early postoperative complication was 5.26 % and 10.52 % respectively. The mean length of hospital stay was 8 days. Average follow up duration was 12 months. Conclusion: It is viable and safe option with shorter operative time and length of stay. It can be performed successfully with minimal morbidity and no mortality. However extreme care and skill is required to identify anatomy and handling of stapler. Keywords: Laparoscopy; Stapler Gastrojejunostomy; Vagotomy; Endoscopy.

scholarly journals A Five-Year Review on Pediatric Foreign Body Aspiration

2020 ◽  
Author(s):  
Zuraini Mohammad Nasir ◽  
Sethu Thakachy Subha
Keyword(s):  
Foreign Body ◽  
Hospital Stay ◽  
Foreign Bodies ◽  
Clinical Presentation ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Foreign Body Aspiration ◽  
Flexible Bronchoscope ◽  
Delayed Treatment ◽  
Younger Age

Abstract Introduction Foreign body aspiration is a leading cause of accidental death in children. Clinical presentation varies from non-specific respiratory symptoms to respiratory failure making diagnosis challenging. Objective To review pediatric patients who underwent bronchoscopy due to suspicion of foreign body aspiration at a tertiary center in Malaysia. Methods We retrospectively studied patients < 11 years old who underwent bronchoscopy from 2008 to 2018. Results Over the 10-year period, 20 patients underwent bronchoscopy, and 16 were found to have foreign body aspiration with equal gender distribution. The most common age group was < 3 years old (75%). The most common clinical presentations were choking (82%) and stridor (31%). Foreign bodies were removed using flexible bronchoscope in 8 cases (50%), and difficulties were encountered in 6 cases (75%). Rigid ventilating bronchoscope was used in 8 cases (50%) with no difficulty. The most common object found was peanut (19%). The majority of foreign bodies were lodged in the right bronchus (43%). Eight patients (80%) received delayed treatment due to delayed diagnosis. The length of hospital stay was longer in the younger age groups. Conclusion Clinical presentation and chest radiograph findings were comparable across all age groups. The most difficulties encountered during foreign body removal were via flexible bronchoscope, in children < 3 years old. There was no significant correlation between age and type of foreign body aspiration. The majority of patients who received delayed treatment were < 3 years old. The length of hospital stay was longer in the younger age groups.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures

2020 ◽  
pp. neurintsurg-2020-016728
Author(s):  
Joshua S Catapano ◽  
Andrew F Ducruet ◽  
Stefan W Koester ◽  
Tyler S Cole ◽  
Jacob F Baranoski ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Diagnostic Procedures ◽  
Femoral Access ◽  
Catheter Size ◽  
The Mean ◽  
The Difference ◽  
Procedure Type ◽  
Angiographic Findings

BackgroundTransradial artery (TRA) access for neuroendovascular procedures is associated with fewer complications than transfemoral artery (TFA) access. This study compares hospital costs associated with TRA access to those associated with TFA access for neurointerventions.MethodsElective neuroendovascular procedures at a single center were retrospectively analyzed from October 1, 2018 to May 31, 2019. Hospital costs for each procedure were obtained from the hospital financial department. The primary outcome was the difference in the mean hospital costs after propensity adjustment between patients who underwent TRA compared with TFA access.ResultsOf the 338 elective procedures included, 63 (19%) were performed through TRA versus 275 (81%) through TFA access. Diagnostic procedures were more common in the TRA cohort (51 of 63, 81%) compared with the TFA cohort (197 of 275, 72%), but the difference was not significant (p=0.48). The TRA cohort had a shorter length of hospital stay (mean (SD) 0.3 (0.5) days) compared with the TFA cohort (mean 0.7 (1.3) days; p=0.02) and lower hospital costs (mean $12 968 ($6518) compared with the TFA cohort (mean $17 150 ($10 946); p=0.004). After propensity adjustment for age, sex, symptoms, angiographic findings, procedure type, sheath size, and catheter size, TRA access was associated with a mean hospital cost of $2514 less than that for TFA access (95% CI −$4931 to −$97; p=0.04).ConclusionNeuroendovascular procedures performed through TRA access are associated with lower hospital costs than TFA procedures. The lower cost is likely due to a decreased length of hospital stay for TRA.

scholarly journals Oesophagal foreign Bodies Ingestion: Experience of 109 Cases

2020 ◽  
Vol 11 (4) ◽  
pp. 7410-7416
Author(s):  
Firas Shaker Mahmoud Al-Faham ◽  
Samer Makki Mohamed Al-Hakkak ◽  
Laith Fathi F. Sharba
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Middle Part ◽  
Food Refusal ◽  
Surgical Department ◽  
Magill Forceps ◽  
Pediatric Age Group ◽  
Body Sensation ◽  
Medical City ◽  
Foreign Body Impaction

Esophageal foreign bodies ingestion is a worldwide surgical issue in pediatric age group while less likely in adults. We estimate endoscopic, clinical and therapeutic sides of this situation in the surgical department in Al-Hussein Teaching Hospital, Karbala city, Iraq and in Al-Sader Medical City, Najaf city, Iraq. The study made to revise our experience for all patients admitted to our hospitals with a diagnosis of oesophagal foreign bodies and their treatments and outcome. The medical registrations resolved concerning demographic information, symptoms presented, investigation and treatments. We revised 109 (61 males and 48 females) patients ranged from 4 months to 65 years with (median age of 2 years). Coins most repeatedly ingested objects (27.5%), miscellaneous metal objects (17.4%), batteries (13.8%) and food (9.2%). The clinical features we encountered vomiting (27.5%), dysphagia (22.9%), asymptomatic (15.6%), drooling and food refusal (12.8 %) and foreign body sensation (8.3%). Usually X-ray screen finding the foreign body in 89(81%) patients. Magill forceps and rigid oesophagoscope performed within six hours from admission under general anaesthesia and from 12-48 from time of ingestion. Foreign body Impaction in the hypopharynx and the upper part of the oesophagus (68.8%) middle part (23%) and the lower part (8.2 %).100(91.7%) patients recovered completely without any complications,9 (18.3%) patient get bleeding, mucosal ulceration and infection which treated successfully.

scholarly journals Beneficial effects of a mouthwash containing an antiviral phthalocyanine derivative on the length of hospital stay for COVID-19

2021 ◽  
Author(s):  
Paulo Sérgio da Silva Santos ◽  
Bernardo da Fonseca Orcina ◽  
Rafael Rahal Guaragna Machado ◽  
Fabiano Vieira Vilhena ◽  
Lucas Marques da Costa Alves ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intensive Care ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
World Health ◽  
Care Hospital ◽  
Duration Of Symptoms ◽  
Intervention Protocol ◽  
Phthalocyanine Derivative

Abstract Background: The risk of contamination and dissemination by SARS-CoV-2 has a strong link with nasal, oral and pharyngeal cavities. Recently, our research group observed the promising performance of an anionic phthalocyanine derivative (APD) used in a mouthwash protocol without photoexcitation; this protocol improved the general clinical condition of patients infected with SARS-CoV-2. Methods: The present two-arm study evaluated in vitro the antiviral activity and cytotoxicity of APD. Additionally, a triple-blind randomized controlled trial was conducted with 41 hospitalized patients who tested positive for COVID-19. All the included patients received World Health Organization standard care hospital treatment (non-intensive care) plus active mouthwash (experimental group AM/n=20) or nonactive mouthwash (control group NAM/n=21). The adjunct mouthwash intervention protocol used in both groups consisted one-minute gargling/rinsing / 5 times/day until hospital discharge. Groups were compared considering age, number of comorbidities, duration of symptoms prior admission and length of hospital stay (LOS). The associations between group and sex, age range, presence of comorbidities, admission to Intensive care unit (ICU) and death were also evaluated. Results: The in vitro evaluation demonstrated that APD compound was highly effective for reduction of SARS-CoV-2 viral load in the 1.0 mg/mL (99.96%) to 0.125 mg/mL (92.65%) range without causing cytotoxicity. Regarding the clinical trial, the median LOS of the AM group was significantly shortened (4 days) compared with that of the NAM group (7 days) (p=0.0314). Additionally, gargling/rinsing with APD was very helpful in reducing the severity of symptoms (no ICU care was needed) compared to not gargling/rinsing with APD (28.6% of the patients in the NAM group needed ICU care, and 50% of this ICU subgroup passed way, p=0.0207). Conclusions: This study indicated that the mechanical action of the protocol involving mouthwash containing a compound with antiviral effects against SARS-CoV-2 may reduce the symptoms of the patients and the spread of infection. The use of APD in a mouthwash as an adjuvant the hospital COVID-19 treatment presented no contraindication and reduced the hospital stay period. Trial Registration: The clinical study was registered at REBEC - Brazilian Clinical Trial Register (RBR-58ftdj).

scholarly journals Effects of the COVID-19 Pandemic on the Epidemiology of Knee and Shoulder Arthroscopy

2021 ◽  
Vol 58 ◽  
pp. 004695802110560
Author(s):  
Krystian Kazubski ◽  
Łukasz Tomczyk ◽  
Piotr Morasiewicz
Keyword(s):  
Hospital Stay ◽  
Shoulder Arthroscopy ◽  
Demographic Data ◽  
Epidemiological Data ◽  
University Hospital ◽  
Female Ratio ◽  
Duration Of Hospital Stay ◽  
The Mean ◽  
Orthopedic Patients ◽  
Male To Female

The purpose of our study was to comprehensively assess the effect of the COVID-19 pandemic on knee and shoulder arthroscopy performed in an orthopedic department of a university hospital in Poland. This study compared the data on all shoulder and knee arthroscopy procedures performed in two different periods: The period of the COVID-19 pandemic in Poland (from March 4, 2020, to October 15, 2020) and the corresponding period prior to the pandemic (March 4, 2019, to October 15, 2019). The study evaluated epidemiological data, demographic data, and hospital stay duration. The total number of arthroscopy procedures conducted in the evaluated period in 2020 was approximately 8.6% higher than that in the corresponding 2019 period. The mean duration of hospital stay for orthopedic patients after their knee or shoulder arthroscopy was 3.1 days in 2020 and 2.8 days in 2019. Our study revealed the mean age of arthroscopy patients during the pandemic to be lower at 48.4 years than the 51.2 years recorded in 2019. The male-to-female ratio was shown to be lower at .85 during the pandemic, having decreased from 1.5 in 2019. The COVID-19 pandemic did not reduce the number of arthroscopy performed at our center, and the mean age of the patients did not change. However, the pandemic had a marked effect on the mean duration of hospital stay and male-to-female ratio.

Neurogenic claudication associated with posterior vertebral rim fractures in children

2012 ◽  
Vol 10 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Jonathan G. Thomas ◽  
Jerome Boatey ◽  
Alison Brayton ◽  
Andrew Jea
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Signs And Symptoms ◽  
Leg Pain ◽  
Neurogenic Claudication ◽  
Pediatric Age Group ◽  
Fractures In Children ◽  
The Mean

Object Outside of the patient population with achondroplasia, neurogenic claudication is rare in the pediatric age group. Neurogenic claudication associated with posterior vertebral rim fracture is even more uncommon but nonetheless causes pain and disability in affected children and adolescents. The purpose of this study was to describe the surgical results of 3 adolescents presenting with neurogenic claudication and posterior vertebral rim fracture when treated with laminectomy alone. Methods The medical and operative records of the 3 pediatric patients were retrospectively reviewed. Presenting signs and symptoms and CT findings, such as the interpedicular distances between T-12 and L-5, were obtained. Perioperative results were assessed, including operative time, blood loss, length of hospital stay, and complications. Findings at latest follow-up were also recorded, including a patient satisfaction survey. Results The 3 patients (1 girl and 2 boys) had a mean age of 14.7 years (range 14–15 years) and underwent follow-up for a mean of 11.3 months (range 5–18 months). Notable preoperative signs and symptoms included back pain (all patients), leg pain (all patients), leg numbness (1 patient), and leg weakness (1 patient). No patient presented with bowel and/or bladder dysfunction. The mean blood loss during laminectomy was 123 ml (range 20–300 ml), and the mean length of hospital stay was 4.3 days (range 3–6 days). On average, decompression was performed at 2.2 levels (range 2–2.5 levels). All 3 patients reported at most recent follow-up that they were “satisfied” with the surgery. There was 1 complication of instability from an iatrogenic pars fracture, which required reoperation and posterior instrumented fusion. Conclusions To the best of the authors' knowledge, this report represents the first surgical series of pediatric neurogenic claudication associated with posterior vertebral rim fractures. Pediatric neurosurgeons may infrequently encounter neurogenic claudication associated with a posterior vertebral rim fracture in children. To treat children with neurogenic claudication associated with posterior vertebral rim fractures, a simple laminectomy may be a safe and efficacious alternative to discectomy and removal of fracture fragments.

Stroke in a Subsaharan Nigerian Hospital—A Retrospective Study

1989 ◽  
Vol 19 (1) ◽  
pp. 11-14 ◽  
Author(s):  
S A Bwala
Keyword(s):  
Duration Of Symptoms ◽  
Female Ratio ◽  
Transient Ischaemic Attacks ◽  
History Of ◽  
Hospital Deaths ◽  
Insulin Dependent ◽  
The Mean ◽  
The University ◽  
First Time ◽  
Male To Female

The case records of 53 consecutive Nigerian inpatients with stroke in the University of Maiduguri Teaching Hospital, Maiduguri were retrospectively reviewed. The mean age at presentation was 55 years and the male to female ratio was 2.5: 1. The mean duration of symptoms before presentation was 11.1 weeks and the average duration of stay in hospital was 3 weeks. Thirty-three (63%) of the lesions were infarctive and 19 (37%) were haemorrhagic. Only 3 (6%) patients gave a history of prior transient ischaemic attacks (TIAs). Forty-two (79%) patients were hypertensive at presentation out of which 27 (64%) had the hypertension diagnosed for the first time. Four (8%) patients were non-insulin dependent diabetics. There were 11 hospital deaths (21%). Thus hypertension, more than half undiagnosed at admission, was the most common risk factor for stroke in the hospital population studied.

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