The radiologic roadmap for treatment of an acute appendicitis patient who tested positive for coronavirus disease 19

Objective: In this study, we aimed to emphasize the role of radiological imaging in determining the treatment of a patient, who tested positive for COVID-19 and diagnosed with acute appendicitis during the pandemic. Methods: A 31-year-old patient presented to the emergency department due to abdominal pain. Ultrasound examination, thoracic and pelvic CT scan were performed. Results: Non-complicated appendicitis can be treated conservatively with antibiotics. Treatment can be maintained by starting with IV antibiotics and bridging therapy with oral antibiotics. Conclusion: This study aims to summarize how radiological follow-up can be used to decide on the suitability of the patient for appropriate medical treatment as an alternative to surgery in a patient, whose gold standard treatment is emergency surgical intervention, which is frequently encountered in the emergency department during the COVID-19 pandemic.

Ectopic pregnancy managed medically at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

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.

Day 14 Intervention for Penetrating Brain Injury with a Good Glasgow Coma Scale Score: A Case Report

Penetrating brain injury is a rare pathology generally requiring emergency surgical intervention. We discuss a case of penetrating brain injury by the umbrella in which surgical intervention was performed 14 days after the injury, and obtained good clinical results.

A Descriptive study on Conservative Management of Subacute Intestinal Obstruction and Its Outcome in Tirupati

BACKGROUND Intestinal obstruction can be defined as the partial or complete blockage of either the small intestine or large intestine or both, causing failure of intestinal contents to pass beyond the point of obstruction. Subacute intestinal obstruction implies incomplete obstruction. It is characterized by continuous passage of flatus and /or feces beyond 6 -12 hours of the onset of symptoms. We wanted to study the conservative management of subacute intestinal obstruction and its outcome. METHODS Data was collected from patients presenting to outpatient Department of General Surgery, SVRRGGH, Tirupati and emergency with the features of subacute intestinal obstruction during the period of March 2019 to April 2020 were included in the study. RESULTS The incidence is high in patients of age group 41-50 years with Male: Female ratio is 2.1:1. The most common presenting symptom is pain abdomen (92 %), followed by vomiting (84 %). In our study, exaggerated bowel sounds (60 %) are the most common physical finding. The most common cause of obstruction is Postoperative adhesions (36 %), followed by obstructed hernias (22 %). Out of 50 cases, 72 % of cases were managed successfully by conservative management. In the patients who were managed conservatively, most of them are due to postoperative adhesions. In the patients who underwent emergency surgical intervention, 50 % of cases operated on the 2nd day of admission. Most commonly done Surgery include Adhesiolysis (28.6 %), Herniorrhaphy (28.6 %) and Resection and anastomosis (21.5 %). CONCLUSIONS Our study showed that conservative management is successful in about 72 % of patients with subacute intestinal obstruction. Not all the patients attending the emergency ward with features of intestinal obstruction need emergency surgical intervention. Conservative management can be tried in selective cases in patients with SAIO, thereby reducing the rate of negative laparotomies and morbidity and mortality. KEYWORDS Sub-Acute, Intestinal, Obstruction Conservative, Outcome

An incidental concurrence causing gastric outlet obstruction

Phytobezoar which is described as an undigested or incompletely digested food. It is an odd cause of gastric outlet obstruction (GOO). The aim of this study is to present and discuss a case of GOO caused by cicatrised duodenal ulcer with a phytobezoar. 71-year-old male, presented with abdominal pain and vomiting (non-bilious) since 3days with peptic ulcer disease for 4 years. Examination and investigations revealed a bezoar requiring emergency surgical intervention. An exploratory laparotomy was conducted. A bezoar was palpated in the stomach and removed through posterior gastrotomy. Vagotomy with Posterior Gastrojejunostomy was done as drainage procedure for cicatrised Duodenal ulcer. GOO caused by phytobezoar can co-exist in patients with previous history of peptic ulcer disease and cicatrised duodenal ulcer. Urgent laparotomy may be indicated.

Bowel obstruction in obturator hernia: a challenging diagnosis

The obturator hernia is a rare pelvic hernia that presents as bowel obstruction caused by the presence of an intestinal segment, more often ileum passing through obturator foramen. This type of hernia accounts for 0.5-1.4% of all hernias. We reported the clinical case of a 74 year old woman with no previous surgical interventions, presented to ER with abdominal pain and distension, features of intestinal obstruction, which she had experienced for previous three days. A CT scan revealed a right jejunal, obstructed obturator hernia. The patient underwent an emergency surgical intervention with emergency exploratory laparotomy and repair. This case was presented as obturator hernia was a rare type of hernia due to its diagnosis, which is often unclear with non-specific pain radiating to legs mimicking neurological symptoms. A prompt suspect based for the non-specific symptoms is crucial for the diagnosis. Surgical management depends on early diagnosis and it is the only possible treatment for this pathology.

EMERGENCY SURGERY DURING COVID 19 AT K.A.P.V GOVERNMENT MEDICAL COLLEGE AND MGMGH , TRICHY

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

Meconium peritonitis in a preterm infant: a surgical emergency

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.

Bilateral isolated mylohyoid groove fracture progressing as submandibular abscess: an usual fracture pattern of mandible

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.

Abdominal tuberculosis requiring surgical intervention: A 10-year single-center experience

Background: Although uncommon in children, abdominal tuberculosis (ATB) can be a life-threatening condition with a subset requiring emergency surgical intervention. This study aims to determine the presentation, surgical procedures performed, and outcomes in children affected by abdominal tuberculosis. Methods: A retrospective chart review of all children undergoing surgical intervention for ATB from July 2007 to December 2018 was conducted. Data were analyzed using SPSS version 22. Results: Of 340 children with a diagnosis of ATB seen at the Indus Hospital’s TB clinic, 14 (4%) underwent laparotomy. Females were affected more commonly (57%), with a mean age at presentation of 11 years (range 8-14). Nine children required laparotomy for documented perforation, while 5 had an intestinal obstruction. Most children (n=10) had an established diagnosis of ATB before the surgical intervention; 2 children had completed 6–9 months anti-tuberculous treatment (ATT) courses, while 8 children had been on ATT for a mean period of 2.5 months at the time of developing acute surgical symptoms. Diversion ileostomy was made in 64%. Postoperative complications included sepsis (n=4), wound infection (n=3), abdominal collection (n=2), enterocutaneous fistula (n=2), and abdominal wound dehiscence requiring formal closure (n=2). There were 4 mortalities (29%); 10 patients were discharged after a median in-hospital stay of 12 days (range 6-35) of which 6 with ileostomies underwent reversal after completion of the ATT course. Conclusion: ATB has high morbidity and mortality. Perforation and obstruction can occur during or after the completion of ATT. Management requires early recognition and surgical intervention as indicated.