Ileostomy in the Treatment of Typhoid Enteric Perforation Among Patients Presenting Late in The Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3360-3361
Author(s):  
Shandana Gul ◽  
Mahwash Anjum Shafiq ◽  
Fazal-e- Nauman
Keyword(s):  
Late Onset ◽  
Loop Ileostomy ◽  
Abdominal Distension ◽  
Late Presentation ◽  
Fecal Fistula ◽  
Surgical Department ◽  
Medical College ◽  
Enteric Perforation ◽  
Group A ◽  
One Year

Introduction: Typhoid enteric perforation is a communal acute emergency of abdomen in our hospital settings. Maximum patients in Pakistan come from rural zones and have a serious illness when presented in the laten final stages. Objective: To govern the importance of an ileostomy in cases of late presentation with enteric perforation. Study Design: A retrospective study. Place and Duration: In the surgical Department of Islam Medical College and Teaching Hospital Sialkot for one year duration from July 2020 to July 2021. Methods: 52 total patients of typhoid enteric perforation were included in our department. 5 to 32 years was the age range of patients with an average age of 16 years. Most of these patients have complaints of fever, abdominal pain, abdominal distension and vomiting Results: 52 patients with late presentation of typhoid perforation were alienated into 2 groups. All cases of group A underwent laparotomy and perforation exteriorization was done as loop ileostomy. In group A, when exteriorization was performed as the first procedure, fecal fistula was later developed in 12 cases. Ten of these cases had to be re-examined and the second perforation was found to be close to the original one. The mortality was observed in three cases. Conclusion: In a relatively normal-looking intestine, restoration of the margin, closure of the two layers of perforation, and ileostomy near the perforation are safer in the case of late onset of typhoid fever enteric perforation. Keywords: typhoid perforation, double-layer closure and ileostomy

scholarly journals Study of intestinal stoma: our experience at Rajarajeswari Medical College and Hospital

2019 ◽  
Vol 6 (10) ◽  
pp. 3622
Author(s):  
Veena A. ◽  
Hariprasad T. R. ◽  
Gopal S.
Keyword(s):  
Loop Ileostomy ◽  
Medical College ◽  
Stoma Formation ◽  
Artificial Opening ◽  
End Colostomy ◽  
Enteric Perforation ◽  
Intestinal Stoma ◽  
Perianal Sepsis ◽  
Carcinoma Colon ◽  
Operative Findings

Background: Stoma is an artificial opening of intestinal or urinary tract to the abdominal wall. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it.Methods: This is a retrospective descriptive observational study carried out in a surgical unit of Rajarajeswari Medical College and Hospital, Bangalore from August 2015 to August 2016. Data was collected by previous record files including age, gender, history of presenting illness, indication, type of stoma, type of surgery, appropriate operative findings and follow up of the cases. The results were collected, analysed and compared with other studies.Results: A total of 25 patients were evaluated age ranged between 20-70 years. Out of 25 patients 17 were admitted in emergency while 8 in out-patient department. The most common type of stoma made was loop ileostomy (44%) followed by end ileostomy (28%), end colostomy (16%) and loop colostomy (12%). Main indication for a stoma formation was enteric perforation (56%) followed by carcinoma colon and rectum (32%), perianal sepsis (21%), Koch’s abdomen (11%), penetrating injuries (11%). Of the various complications encountered with intestinal stoma, peristomal skin Excoriation (16%) was the most common complication observed followed by other complications as mentioned in study.Conclusions: In spite of enormous exposure of general surgeons towards stoma formation the complications are inevitable. Early detection of complication and its timely management is the keystone.

scholarly journals A STUDY OF SURGICALAPPROACH TO TYPHOID ILEAL PERFORATION

2020 ◽  
pp. 1-3
Author(s):  
Sitesh Kumar Karn ◽  
Ramesh Kumar Ajai ◽  
Debarshi Jana
Keyword(s):  
Primary Closure ◽  
Loop Ileostomy ◽  
Exploratory Laparotomy ◽  
High Rate ◽  
Ileal Perforation ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Clinical Presentations ◽  
Enteric Perforation ◽  
Full Proof

Introduction: Even with variety of procedures, typhoid (enteric) perforation still has a high rate of morbidity and mortality. The aim ofthe present study is to study clinical presentations, to evaluate management pattern of typhoid ileal perforation, to determine mortality and morbidity of perforation and to study the re-exploration rate and causes of re-exploration and its effect on mortality and morbidity. Methods: This prospective observational study was conducted in the Department of Surgery at Nalanda Medical College and Hospital, Patna, Bihar during May 2019toApril 2020. A total 45 patients with typhoid ileal perforation were included in the study. Among them, 32 cases (71%) undergone the simple primary closure of the perforation and peritoneal lavage after refreshing the edge, 7 cases (16%) undergone exploratory laparotomy with proximal loop ileostomy with primary closure and 6 (13%) were operated by exploratory laparotomy with resection anastomosis. Results: Mean duration of the stay for patient undergone PC+PL was 10.20 days and for ileostomy it was 18.4 days and for RA + PL it was18.6 days. Total 37 incidences of complications were found in 45 cases. Among them wound infection was presented in 16 (43%) and burst abdomen presented in 2 (5%) cases. Fecal fistulae, post-operative collection and pneumonitis were present in 4 (11%) cases each. Conclusion: The overall mortality was found nearly 4 percent in our study. The typhoid ileal perforation should be always treatedsurgically. There are many operative techniques to deal with but no one is full proof.

Primary Anastamosis Versus Colostomy in Patients with Penetrating Colonic Injuries

2021 ◽  
Vol 15 (5) ◽  
pp. 1159-1161
Keyword(s):  
Hospital Stay ◽  
Stab Wound ◽  
Primary Anastomosis ◽  
Primary Group ◽  
Emergency Ward ◽  
Colonic Injury ◽  
Surgical Department ◽  
Group A ◽  
One Year ◽  
Group B

Objective: The aim of this study is to determine the outcomes among primary anastomosis versus colostomy in patients with penetrating colonic injuries. Study Design: Comparative Study Place and Duration: Study was conducted at surgical department of Mardan Medical complex, Mardan and Bakhtawar Amin Medical & Dental College, Multan for duration of one year from January, 2020 to January 2021 Methods: 70 patients were presented in this study. Patients were aged between 18-75 years. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients penetrating colonic injuries were admitted in emergency ward. Patients were equally (n=35) divided into 2-groups, A and B. For abdominal surgery, group A received primary anastomosis and group B received colostomy. Post-operatively outcomes and complications among both groups were identified. SPSS 22.0 version was used to analyze the data. Results: Mean age of the patients was 29.48 ± 16.4 years with mean BMI 23.16 ± 08.13 kg/m2. Total 50 (71.43%) were males and 20 (28.57%) were females. Fire arm injured 55 (78.6%) was the most common cause of colonic injury followed by stab wound 10 (14.3%) among both groups. Small gut 28 (40%) was the most common organ injured followed by liver 13 (18.6%). Mean hospital stay in primary group was 7.45 ± 7.6 days while in colostomy group hospital stay was 9.54 ± 5.9 days. Postoperatively complications were lower in group A, wound infection found in 9 (25.71%) patients while in group B it was 11 (31.43%). Rate of mortality in primary group was 2 (5.71%) while in colostomy group was 4 (11.43%). Conclusion: We concluded in this study that primary anastomosis was effective because of less hospital stay and less post-operatively complications as compared to colostomy. Mortality rate was higher observed in colostomy group as compared to primary. Keywords: Colostomy, Primary anastomy, Colonic Injuries

scholarly journals AN OBSERVATIONAL STUDY TO EVALUATE THE INCIDENCE OF MENINGITIS IN NEONATES WITH LATE-ONSET SEPSIS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Vivek Kumar ◽  
Manoj Kumar ◽  
Gopal Shankar Sahni
Keyword(s):  
Observational Study ◽  
Premature Infants ◽  
Late Onset ◽  
Age Group ◽  
Inclusion Criteria ◽  
Bacterial Sepsis ◽  
Detailed History ◽  
Medical College ◽  
Late Onset Sepsis ◽  
One Year

Introduction: Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in newborns, particularly in premature infants. The present study was undertaken to know the incidence of meningitis in neonates with late onset sepsis. Material and Methods: Hospital based observational study, conducted in department of Pediatrics, Shri krishna Medical College and Hospital Muzaffarpur Bihar India, conducted for a period of one year. 324 patients fulfilling the inclusion criteria were included and subjected to detailed history, clinical examination followed by investigations. Results: The annual incidence of meningitis in LOS was 15. The majority of patients (44.44%) presented in the age group of 3-7 days. In meningitis cases 100% cases were lethargic; seizures in 89%, fever in 53%. Blood culture was positive in 33.92% cases of meningitis. Meningitis was seen in 66.66% of proven gram negative sepsis as against 33.34 cases of proven gram positive sepsis and 14.28% expired with meningitis and 4.10% expired with no meningitis.  Conclusions: Meningitis is common in late onset sepsis, associated with high mortality. Keywords: Meningitis, Preterm, LBW, Lumber puncture

scholarly journals TO FIND RELATIONSHIP BETWEEN COLONIC MUCOSAL CHANGES IN PATIENTS OF LIVER CIRRHOSIS WITH PORTAL HYPERTENSION.

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Dr. Prashanth P. N. ◽  
Ankit Meshram
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Portal Hypertension ◽  
Serum Albumin ◽  
Serum Bilirubin ◽  
Abdominal Distension ◽  
Medical College ◽  
Intestinal Infections ◽  
Mucosal Changes ◽  
One Year

Background: The aim of the study is to find relationship between Colonic Mucosal changes in patients of Liver Cirrhosis with Portal Hypertension conducted at MGM Medical College & M. Y. Hospital, Indore for one year. Result: The commonest symptom in patients was abdominal distension 30 (100%), next common was jaundice 20 (66.7%), malena 17 (56.7%), hemetemesis 10(33.3%), hematochezia 10(33.3%), and pruritis 2(6.6%) was noted. It is evident from table no .13 that out of 30 patients , serum prothrombin time  was prolonged in 30 (100%) patients ,serum albumin was decreased in 20 (66.7%) patients , platelet count was decreased in 16 (53.3%) , serum bilirubin was raised in 14 (46.7%) patients , SGOT/SGPT  was raised in 17 (56.7%) patients. Conclusion: Our study states that most of the changes which we found on colonoscopic studies were similar to other studies. The only finding which we got in excess in comparison to other studies was colitis like abnormality which was 73.3% which may be probably due to chronic intestinal infections which occur in our country. Keywords: Colonic Mucosal, Liver Cirrhosis, Portal, Hypertension.

scholarly journals Two eras of laparoscopic cholecystectomy: an experience of 3000 cases

2017 ◽  
Vol 4 (9) ◽  
pp. 2920
Author(s):  
Jahangir Sarwar Khan ◽  
Raheel Ahmad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
Invasive Procedure ◽  
Minimal Invasive ◽  
Surgical Department ◽  
Medical College ◽  
Symptomatic Gallstones ◽  
Group A ◽  
Group B ◽  
Cbd Injury

Background: Laparoscopic cholecystectomy (LC) a minimal invasive procedure is regarded as gold standard for gallstone disease for many years. With increase learning curve of surgeons, the incidence of complications of this procedure decreases significantly. The purpose of study was to compare the experiences of Laparoscopic cholecystectomy performed.Methods: It was a retrospective cohort study conducted in Surgical Department, Rawalpindi Medical College and author's surgical clinic. From 1st January 1998 to 31st December 2014. Total 3000 patients of Laparoscopic cholecystectomy were divided into 2 groups. First 1500 cases (operated between January 1998 to December 2007) in Group A and next 1500 cases (operated between January 2008 to December 2014) in Group B. Preoperative diagnosis, intraoperative findings and injuries especially incidence of CBD injuries with post-operative complications and their management were evaluated.Results: Out of 3000 cases 2585 (86.1%) were females and 415 (13.8%) were males. Total 18 (0.6%) cases had CBD injury during LC. 17 cases were in group A which decreased significantly to 1 case in Group B. Mean operative time was 30 minutes. Wound infection remained the most common postoperative complication.Conclusions: In our setup, the burden of laparoscopic cholecystectomy for symptomatic gallstones have increased with very low incidence of complications.

scholarly journals Comparison of Efficacy of Nebulisation with Salbutamol versus Adrenaline in Acute Bronchiolitis in Children aged Two Months to Two Years

2019 ◽  
Vol 8 (1) ◽  
pp. 27-32
Author(s):  
Vijay Kumar Sah ◽  
Arun Giri ◽  
Sanjay Sah ◽  
Niraj Niraula
Keyword(s):  
Age Groups ◽  
College Teaching ◽  
Assessment Instrument ◽  
P Value ◽  
Age Group ◽  
Acute Bronchiolitis ◽  
Medical College ◽  
Group A ◽  
One Year ◽  
Group B

Background: Bronchiolitis is an acute, highly communicable lower respiratory tract infection. A variety of agents ranging from nebulised racemic epinephrine, salbutamol and routinely available levoepinephrine have been tried. The Present study was aimed at comparing the effectiveness of adrenaline and salbutamol in acute bronchiolitis in children aged 2 months to 2 years. Materials and Methods: The Present study was conducted at Nobel medical College Teaching Hospital over the period of one year from Feb 2018 to Jan 2019. Two different cohorts were identified in which clinically diagnosed cases and were grouped into Group A and Group B to receive the different drugs as per the study protocol. Respiratory Distress Assessment Instrument (RDAI) Scores was used for clinical assessment. Results: The age of the patients ranged from 2 months to 24 months with a median of 8 months. The males constituting about 57.42% of the study population of 155 patients. On comparing the prenebulisation variables with 10 and 30 minutes post nebulisation values, it was found that Both adrenaline and salbutamol caused overall significant improvement in RR (p-value <0.00001 in both groups) except in the age group of 19-24 months. Adrenaline was seen to be superior to salbutamol in decreasing the RR (p<0.0001) except for children in the age group of 19-24months. Adrenaline also caused greater rise in heart rate in comparison to salbutamol in all age groups. Conclusion: This study concludes that Adrenaline was seen to be superior to salbutamol in decreasing the RR and RDAI, although it showed variance with age.

scholarly journals CLINICAL SIGNIFICANCE OF UTERINE SCAR TENDERNESS AND THIRD TRIMESTER SONOGRAPHIC SCAR THINNING IN PREDICTING SCAR COMPLICATIONS

2021 ◽  
pp. 1-3
Author(s):  
Supriya Kumari ◽  
Surya Narayan ◽  
Kumudini Jha ◽  
Debarshi Jana
Keyword(s):  
Clinical Significance ◽  
Third Trimester ◽  
Medical College ◽  
Lower Segment Cesarean Section ◽  
History Of ◽  
Group A ◽  
Uterine Scar ◽  
One Year ◽  
Group B ◽  
A Prospective Study

Objective: To determine the clinical significance of uterine scar tenderness and sonographic scar thinning in predicting strength of scar in patients with lower segment cesarean section (LSCS). Method: A prospective study was conducted over a period of one year in the department of Obstetrics and gynecology, Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Women undergoing LSCS with history of previous one LSCS were assessed for scar tenderness and; their third trimester's sonographic LUS scar thickness detail was noted. They were divided in two groups (A & B) on the basis of whether scar tenderness and/or sonographic scar thinning (< 3.5 mm) were present or not. Findings were correlated with intra-operative scar conditions. Result: Study showed that out of 50 patients of group A, 23 patients had scar complications while 27 patients had no such complications. Out of 47 patients of group B, only 5 had scar complications, while in remaining 42 patients no scar complication was found intra-operatively. Conclusion: Timely done caesarean section in pregnant woman with scar tenderness and/or thin third trimester sonographic scar can definitely bring down the neonatal and maternal morbidity and mortality.

Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0220-0228 ◽  
Author(s):  
Marion Vircoulon ◽  
Carine Boulon ◽  
Ileana Desormais ◽  
Philippe Lacroix ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Medical Group ◽  
Consensus Definition ◽  
Transcutaneous Oxygen ◽  
European Consensus ◽  
Group A ◽  
One Year ◽  
Group B

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

Comparative Study Between Clean Intermittent Self-Catheterization (Cisc) and Continuous Indwelling Catheterization (Cidc) in Relieving Acute Refractory Retention of Urine Due to Benign Enlargement of Prostate (Bep)

2020 ◽  
Vol 21 (2) ◽  
pp. 105-110
Author(s):  
Md Shawkat Alam ◽  
Sudip Das Gupta ◽  
Hadi Zia Uddin Ahmed ◽  
Md Saruar Alam ◽  
Sharif Muhammod Wasimuddin
Keyword(s):  
Comparative Study ◽  
Acute Urinary Retention ◽  
Bladder Capacity ◽  
Inclusion Criteria ◽  
College Hospital ◽  
Medical College ◽  
High Incidence ◽  
Group A ◽  
Group B ◽  
Better Than

Objective: To compare the clean intermittent self-catheterization (CISC) with continuous indwelling catheterization (CIDC) in relieving acute urinary retention (AUR) due to benign enlargement of prostate (BEP). Materials and Methods :A total 60 patients attending in urology department of Dhaka Medical college hospital were included according to inclusion criteria ,Patients were randomized by lottery into two groups namely group –A and group –B for CISC and IDC drainage respectively . Thus total 60 patients 30 in each group completed study. Results : Most men can safely be managed as out-patients after AUR due to BPH. The degree of mucosal congestion and inflammation within the bladder was found to be lower in those using CISC and the bladder capacity in these patients was also found higher.Patients with an IDC had a high incidence of UTIs then that of patients with CISC. During the period of catheterization the incidence of UTI was 43.3% in group B in comparison to 40% in group A; before TURP 36% in group B in comparison to 10% incidence in group A.According to patient’s opinion CISC is better than IDC in the management of AUR. Experiencing bladder spasm, reporting blood in urine, management difficulties, incidence and severity of pain were less in CISC group, and the method of CISC was well accepted by patients as well as their family members. Conclusion: From the current study it may be suggested that CISC is better technique for management of AUR patient due to BPH than IDC. It can also be very helpful when surgery must be delayed or avoided due to any reasons in this group of patients. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.105-110

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