Sigmoid Resection and Primary Anastomosis Without Any Diversion or Exteriorization for Impacted Foreign Body in Sigmoid Colon

Colorectal Resections are very often required as an essential surgical procedure for various diseases. These resections are usually accompanied with various forms of diversions with or without primary colo-colonic or colorectal anastomosis. Classically, these are usually preceded by a standard form of bowel preparation. Here, a different form of colorectal surgery without preceding bowel preparation, colorectal resection and primary anastomosis were done, without any covering or defunctioning ileostomy or any other form of diversion or exteriorization and envisaged no complication. A psychiatric adult patient presented with self-introduction of a large foreign body (bobbin) through his anus. On laparotomy, FB (bobbin) impacted at the apex of the loop of sigmoid colon. It was so intensely impacted that milking towards the rectum without serious injury was totally impossible. Sigmoid resection and primary colorectal anastomosis without any form of ileostomy or similar type of diversion or exteriorization was performed. Just before anastomosis, faecal matters were removed as far as possible all from remaining both proximal and distal segments. Then digital anal stretching was done and put a transanastomotic flatus tube through anus. The flatus tube was removed on the 7th post operative day. The outcome was smooth and uneventful. KYAMC Journal Vol. 10, No.-4, January 2020, Page 214-218

Spontaneous combustile pneumoperitoneum

Fire and explosions in the operation theatre during surgery in the era of cautery usage have been reported since many years. Significant complications or death can ensue as a result of such fires or explosions and surgeons should be aware of these hazards. A 38 year old female patient on the 6th day of admission, developed abdominal distension. Patient was managed conservatively with flatus tube insertion and serial x-ray monitoring. On the 8th day, repeat x-ray showed gas under diaphragm. Emergency laparotomy was undertaken. On opening the peritoneum using cautery, a hissing escape of gas was heard and this caught fire. On attempting to stem gas flow from the peritoneal hole, the operating surgeon sustained burn to his index finger and the glove melted. The peritoneal cavity was surprisingly free of any spilled contents. Small bowel was opened through a small enterotomy and decompressed. The colon steadfastly refused to collapse. This necessitated a transverse colotomy which, after decompression, was converted into a loop transverse colostomy. She underwent colonoscopy after three weeks wherein the colon was found to be free of any obstruction. The colostomy was closed. If there is free gas on entering a peritoneum, it will be wiser to avoid electro surgery. Instead, scissors or a scalpel should be used.

The nurse’s role in the effectiveness of dispensary management of young infants. A nurse and her assistance to an infant, family and doctor with correction of the functional intestinal colic during the first months of life

The article presents the main variants of functional gastrointestinal disorders in young infants - posseting, evacuation disorder, intestinal infantile colic, clinical features, modern view on the causes and methods for correction of these conditions (step-bystep methods to alleviate the pain syndrome). It also describes the manipulation methods that help with these conditions (inserting a flatus tube, cleansing enema in infants), as well as the basic principles for counselling and education of parents.

Metachronous volvulus of the splenic flexure: a rarer entity

Intestinal obstruction due to volvulus is a well-known entity in India, one of the ‘volvulus belt’ countries; but volvulus of the splenic flexure is a rare condition, even more so when metachronous. Only about half a century of citations has been mentioned in the surgical history since its first mention in literature. Our patient, a young man with a history of previous two abdominal operations presented with signs of intestinal obstruction which were confirmed by radiological findings to be volvulus of splenic flexure. Following failed attempted derotation by flatus tube, he underwent laparotomy, intraoperative derotation of the volvulus followed by resection of the involved segment and colo-colic anastomosis with diverting loop ileostomy. Apart from surgical site infection, his postoperative recovery was uneventful.