Early Complications of Suture Closure of Perforated Duodenal Ulcer: A Study of 100 Cases

Perforated Duodenal Ulcer is one of the commonest surgical emergencies, most prevalent in middle aged male persons. Most perforations of doudenum are spontaneous but there is an increasing incidence of perforation following the use of NSAIDs. Repair of duodenal ulcer perforation is an urgent and contaminated operation. So, patients may develop post operative complications, like wound sepsis, pneumonia, paralytic ileus, septicemia, shock, electrolyte imbalance, repair failure, duodenal fistula, intra abdominal abscess, burst abdomen etc. Here 100 cases of Perforated Duodenal Ulcer was admitted in surgical wards of R.M.C.H from 01.01.2004-31.12.2005 and all of them underwent laparotomy suture closure of perforation and peritoneal toilet. Meticulous postoperative follow up was done for an average period of 7-10 days to see the complications. 21 post operative complications were found among 100 patients. Most complications occurred in elderly patients with delayed admission, I e, 48 hours after symptoms. The commonest complications were pulmonary (4%), pelvic collection (4%), wound infection (3%), septicemia (2%), burst abdomen (2%), paralytic ileus (2%). 2 out of the 100 cases died from post-operative septicemia. Better prognosis can be expected in young patients who come early with a stable haemodynamic state. doi: 10.3329/taj.v18i2.3192 TAJ 2005; 18(2): 122-126

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267 Ascertain Impact of Using Low-Fidelity Simulation Scenarios in Preparation for Practical Surgical Finals

British Journal of Surgery ◽

10.1093/bjs/znab134.129 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Awan

Keyword(s):

Surgical Simulation ◽

Positive Impact ◽

Real Life ◽

Surgical Emergencies ◽

Operative Complications ◽

Medical Emergencies ◽

Structured Approach ◽

Acute Patients ◽

Kinaesthetic Learning ◽

Post Operative Complications

Abstract Introduction Simulation has become the new way of preparing doctors to deal with medical emergencies, we investigate it using in managing ward-based surgical emergencies. Method Final year medical students completed pre- and post-session questionnaires related to themes of preparedness, anxiousness, and confidence in management of acute surgical presentations versus post-operative complications. The intervention was divided into classroom based teaching and common surgical scenarios enacted using Sim-Man. Results Preparedness increased by a third following participation in surgical simulation scenarios among participants. Anxiousness related to surgical finals decreased by 9%. Confidence in managing acute patients increased by 25% compared to pre-session results. Moreover, 35% of participants felt more confident in managing post-operative complications after the session. On average, participants scored 8/10 for usefulness of the sessions in highlighting areas to concentrate focus upon during revision. Conclusions Simulation is slowly becoming a staple in undergraduate training and our results emphasise positive impact of using this as a revision tool. Kinaesthetic learning is more memorable during simulation which serves as a confidence boost in self-perception of managing both acute and post-operative surgical patients. Anxiety associated with exams and managing real-life emergencies can be dampened by rehearsing scenarios and following a structured approach as championed by medical simulation.

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Perforated duodenal ulcer: incision or suture closure?

Russian Medical Inquiry ◽

10.32364/2587-6821-2020-4-2-78-82 ◽

2020 ◽

Vol 4 (2) ◽

pp. 78-82

Author(s):

V.N. Nikitin ◽

◽

V.M. Sitnikova ◽

A.S. Vyal’tsin ◽

M.V. Ganenkov ◽

...

Keyword(s):

Duodenal Ulcer ◽

Perforated Duodenal Ulcer ◽

Suture Closure

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POST OPERATIVE COMPLICATIONS IN PATIENTS OPERATED FOR APPENDICITIS, AN EXPERIENCE IN PIMS PESHAWER.

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2016.6.2.809-815 ◽

1969 ◽

Vol 6 (2) ◽

pp. 809-815

Author(s):

MUHAMMAD KHAN ◽

MUHAMMAD UZAIR ◽

MUHAMMAD IFTIKHAR ◽

MUNIR AHMAD

Keyword(s):

Postoperative Complications ◽

Intestinal Obstruction ◽

Wound Infection ◽

Paralytic Ileus ◽

Iliac Fossa ◽

High Rate ◽

Abdominal Abscess ◽

Mortality And Morbidity ◽

Operative Complications ◽

Post Operative Complications

BACKGROUND: Appendicitis is one of the most common acute abdominal states of illnesses. Mostof the patients presented to our surgical emergency department are suffering from acute appendicitis.Early diagnosis and treatment reduce the mortality and morbidity of acute appendicitis significantly.The aim of the study was to determine the post operative complications of acute appendicitis.OBJECTIVE: The objective of this study is to know postoperative complications of openappendicectomy and its related morbidity and mortality in patients presenting to PIMS HospitalPeshawar, KPK.MATERIAL AND METHODS: This study was conducted in General Surgical Unit, PeshawarInstitute of Medical Sciences (PIMS) from June 2015 to July 2016. The design of the study wasdescriptive type. Patients coming to emergency or surgical OPD were examined after detail history,investigation and then operated. Postoperative complications of appendicectomy along with otherfindings were noted.RESULTS: 100 patients were admitted and operated, 86% were male and 14% female, 54% were inthe age range of 21-30 years. Most (80%) presented with pain right iliac fossa of 1 day duration,majority (76%) presented in typical way. mass formation was found in 9% cases. Inflamed appendixwas commonest in (82%) cases, perforated appendix (12%) and normal appendix found in (6%) cases.Among the complications, wound infection was recorded in (20%), intra-abdominal abscess (8%),paralytic ileus (5%), intestinal obstruction (4%) and (1%) case of each DVT, bleeding and death werenoted.CONCLUSIONS: variations in signs and symptoms lead to delay in diagnosis and high rate of posop complications like wound infection , intra-abdominal abscess , paralytic ileus , intestinal obstruction , DVT, bleeding and death.KEY WORDS: appendicitis, post-operative complications.

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Factors Associated with Intestinal Obstructions among AdultsinKeysaney Hospital, Mogadishu- Somalia

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v1i2.13 ◽

2018 ◽

Vol 1 (2) ◽

pp. 70

Author(s):

Abdijabar Mohamud Moalim ◽

Abdurrahman Osman Fiqi ◽

Abdirizak Ahmed Dalmar ◽

TuncEren ◽

Handan Ankarali ◽

...

Keyword(s):

Bowel Obstruction ◽

Clinical Judgment ◽

Paralytic Ileus ◽

Disease Process ◽

Wound Dehiscence ◽

Large Bowel Obstruction ◽

Cross Sectional ◽

Common Cause ◽

Operative Complications ◽

Post Operative Complications

Background: Intestinal obstruction (IO) is the failure of propagation of intestinal contents, and may be due to a mechanical or functional pathology.Objective: The aim of this study was to find out the factors, causes, management, and complications associated with IO among adults at KeysaneyHospital.Materials and Methods: A three-year hospital based cross-sectional study was carried out between January 1st, 2014 and December 31st, 2016 with use of the data collected from 180 patients’ medical files including demographics, duration of the disease process, year of admission, hospital stay, causes of IO, operative findings, management, outcomes and complications.Results: In the study group, 148 (82.2%) patients were men, whereas 32 (17.8%) were women, and among all admitted patients, 88 (48.8%) patients lived in Mogadishu. The peak age was between 21-40 years, with a second peak age among elderly patients between 51-70 years. A majority of the patients of 73% presented within more than a week of illness, while 67 (37.2%) patients were discharged within the first week, 47 (26.1%) were discharged within the second week, and 66 (36.6%) stayed in the hospital for more than two weeks. Mechanical obstruction accounted for 142 (78.9%) of all cases. Mechanical small bowel obstruction (SBO) was the most common type with a rate of 61.1%, followed by mechanical large bowel obstruction (LBO) with a rate of 15.6%, while mechanical SBO/LBO was found in 2.2% as compounds of volvulus. Paralytic ileus was found in 9.4% of the cases. The type of obstruction could not be determined in 11.6% of the cases. Overall, adhesions and bands (36.7%) were the most common cause of obstruction followed by strangulated hernias (16.7%) and volvulus (12.7%). Tuberculosis peritonitis (7.8%) was the most common cause of paralytic ileus. Nonoperative management was carried out in 94 (60%) patients while the remaining 64 (40%) cases underwent surgery. Common post-operative complications were wound infection (3.3%) and peritonitis (2.8%). Other rare post-operative complications included wound dehiscence and organ failure.Conclusions: Several factors contribute to either the cause, or the management of IOs. Some of these determinants may include the time since the onset of illness because of late presentation due to lack of health facilities, lack of health awareness, ignorance and poverty. Poor clinical judgment and lack of management guidelines are also the negative factors leading to poor prognosis in these patients.International Journal of Human and Health Sciences Vol. 01 No. 02 July’17. Page : 70-78

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Role of Mechanical Bowel Preparation in Preventing Anastomotic Leakage in Elective Colo-rectal Surgery

Faridpur Medical College Journal ◽

10.3329/fmcj.v13i1.38010 ◽

2018 ◽

Vol 13 (1) ◽

pp. 8-11

Author(s):

Molla Sharfuddin Ahmad ◽

Swapan Kumar Biswas

Keyword(s):

Anastomotic Leakage ◽

Bowel Preparation ◽

Rectal Surgery ◽

Mechanical Bowel Preparation ◽

Electrolyte Imbalance ◽

Operative Complications ◽

Group A ◽

Group B ◽

Post Operative Complications

Mechanical bowel preparation is routinely done before colorectal surgeries to reduce morbidity and mortality all over the world. The role of mechanical bowel preparation in preventing complications is recently disputed. The aim of the study was to assess whether elective colorectal surgery can be performed without mechanical bowel preparation. This cross sectional comparative study was carried out to assess the role of mechanical bowel preparation in post-operative complications in elective colon and rectal surgery in the department of surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and SSMC-Mitford Hospital during the period of 1st January 2007 to 31st December 2007. Fifty patients undergoing surgery for carcinoma of colon and rectum were included in the study. Patients were allocated in two groups by non-probability convenient consecutive technique-one group with mechanical bowel preparation with polyethylene glycol and one group with no preparation before surgery. All patients in the study group were followed up for at least one month after surgery for wound infection, anastomotic leakage and intra-abdominal infection. Total 50 patients were randomly divided into two groups (group A, 25 patients & Group B, 25 patients). Group A was the preparatory group and Group B was the non-preparatory group. The type of surgical procedure and the type of anastomosis did not differ significantly between two groups. Sixty percent patients of group A developed post-operative complications; on the other hand 40% patients of group B developed post-operative complications. My study proved that no advantage is gained by pre-operative mechanical bowel preparation and can be easily avoided in order to save the patient from unwanted events like nausea, vomiting, electrolyte imbalance and also increased chance of post-operative complication.Faridpur Med. Coll. J. Jan 2018;13(1): 8-11

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Pelvic Canal Narrowing Caused by Triple Pelvic Osteotomy in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633130 ◽

1994 ◽

Vol 07 (03) ◽

pp. 110-113 ◽

Cited By ~ 6

Author(s):

D. L. Holmberg ◽

M. B. Hurtig ◽

H. R. Sukhiani

Keyword(s):

Postoperative Complications ◽

Pelvic Osteotomy ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Canal Width ◽

Operative Complications ◽

Post Operative Complications

SummaryDuring a triple pelvic osteotomy, rotation of the free acetabular segment causes the pubic remnant on the acetabulum to rotate into the pelvic canal. The resulting narrowing may cause complications by impingement on the organs within the pelvic canal. Triple pelvic osteotomies were performed on ten cadaver pelves with pubic remnants equal to 0, 25, and 50% of the hemi-pubic length and angles of acetabular rotation of 20, 30, and 40 degrees. All combinations of pubic remnant lengths and angles of acetabular rotation caused a significant reduction in pelvic canal-width and cross-sectional area, when compared to the inact pelvis. Zero, 25, and 50% pubic remnants result in 15, 35, and 50% reductions in pelvic canal width respectively. Overrotation of the acetabulum should be avoided and the pubic remnant on the acetabular segment should be minimized to reduce postoperative complications due to pelvic canal narrowing.When performing triple pelvic osteotomies, the length of the pubic remnant on the acetabular segment and the angle of acetabular rotation both significantly narrow the pelvic canal. To reduce post-operative complications, due to narrowing of the pelvic canal, overrotation of the acetabulum should be avoided and the length of the pubic remnant should be minimized.

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LAPAROSCOPIC REPAIR OF PERFORATED DUODENAL ULCER PATCH VERSUS CONVENTIONAL SURGERY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i1.600 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Dr. Anil Kumar Saxena ◽

Dr. Devi Das Verma

Keyword(s):

Duodenal Ulcer ◽

Laparoscopic Repair ◽

Open Repair ◽

Wound Dehiscence ◽

Duodenal Perforation ◽

Perforated Duodenal Ulcer ◽

Conventional Surgery ◽

Duodenal Ulcers ◽

Duration Of Operation ◽

Repair Group

Introduction: For many surgeries for duodenal ulcer Laparoscopic repair has become gold standard for many elective procedures such as ant reflux procedures, laparoscopic cholecystectomy and in colorectal surgery. Although in the emergency setting such as in the management of perforated duodenal ulcer Laparoscopic repair has been slow and limited. Since 1990, for the treatment of perforated peptic ulcer Laparoscopic repair has been used which has been widely accepted as an effective method. Duodenal ulcer is defined as a peptic ulcer which develops in the first part of the small intestine called duodenum and usually present as a perforation of acute abdomen. In perforated duodenal symptoms as severe and sudden onset abdominal pain that is worse in right upper quadrant and epigastrium and usually followed by nausea and vomiting. In this situation there is rapid generalization of pain and in examination shows peritonitis with lack of bowel sounds. Aim: The main objective of this study is to evaluate outcome of laparoscopic surgery in comparison with conventional surgery. Material and methods: All the patients with clinically diagnosed with perforated duodenal ulcers presenting within 24 hours of symptoms and undergoing surgery were included during the study period. Total 50 patients were included with age group 15-65 years. All the patients with perforated duodenal ulcers were included which go through either conventional open or laparoscopic without omental patch repair. Result: Total 50 patients were included in these studies which were divided into two group with 25 patients in each group as laparoscopic duodenal perforation repair group and conventional open repair group. Mean duration of operation (in minutes) was 105.4±10.4 in laparoscopic duodenal perforation repair group whereas mean duration of operation (in minutes) was 67.3±8.6 in conventional open repair group. Mean duration of number of doses of analgesics required in laparoscopic group and conventional open group as 9.5±1.7 and 17.2± 3.1 respectively. Out of 25 patients in each group of laparoscopic duodenal perforation repair group and the conventional open repair group the outcome were noted with their post operative complication as shown in table no 5 below. In Post-operative complications 21(84%) patients in laparoscopic duodenal perforation repair group and 14(56%) patients in conventional open repair group had no complications. 4 (16%) patients in the laparoscopic duodenal perforation repair group and 2(8%) patients in conventional open repair group showed Post-operative complications as chest infection. In the conventional open repair group patients present with wound dehiscence and wound infection and Wound dehiscence and chest infection were 4(16%) and 5(20%) respectively whereas nil in Laparoscopic duodenal perforation repair group. Conclusion: Duodenal ulcer perforation is a life-threatening emergency which required urgent management for the patients. Due to the advance in duodenal ulcer perforation closure by laparoscopy it becomes popular and favorite choice. With certain criteria, laparoscopic closure of perforated duodenal ulcer is safe and effective though it was associated with longer operating time and had no impact on the outcome. Hence laparoscopic closure was better in comparison to open repair for the earlier returns to normal daily activities. Keywords: Duodenal ulcer, Laparoscopic repair, Post-operative analgesia, conventional surgery

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