The Role of Indomethacin in Isolated Polyhydramnios

Objective: To study the role of Indomethacin in patients with Idiopathic Polyhydramnios who were symptomatic. Methods: A prospective study was conducted in Prathima Institute of Medical Sciences, Karimnagar from September 2017 to May 2019. Eighteen patients with Idiopathic Polyhydramnios who presented with respiratory embarrassment, premature opening of os or presence of uterine activity were given Indomethacin orally at a dose of 25mg 6th hourly. The significance of changes in AFI was tested by paired t test. Results : There was significant improvement in the symptoms in all the eighteen patients. The mean age of the patients in our study was 26.4±5.5 years. The majority 14(77.7%) of women were multigravida. Mean gestational age at presentation was 30.78±1.56 weeks. Mean AFI at presentation was 31.56±3.68 cm. Indomethacin was given orally at a dose of 25mg, every 6th hourly for a mean duration of 22.5±6.38 days. Mean AFI at the end of treatment was 20.28±5.64 cm. Pregnancy was prolonged by an average of 5.5±1.89 weeks. The difference in AFI at the end of treatment was statistically significant (p<0.05). Oligohydramnios was seen in one patient. Mean gestational age at delivery was 36.28±1.41 weeks. 17(94.4%) of them had good neonatal outcome. There was one neonatal death at< 7 days of birth. Conclusion: Indomethacin significantly decreases amniotic fluid volume in patients with Idiopathic Polyhydramnios and relieves symptoms but close surveillance is necessary.

Huge abdominal swelling due to haemorrhagic splenic cyst

Splenic cyst is an uncommon problem in surgical practice. It is usually diagnosed in scanning procedure. In some cases it produces symptoms like abdominal mass, abdominal pain, distention, constipation either due to haemorrhage, rupture or big size. In our case, patient presents with abdominal pain, distention, vomiting, constipation and respiratory embarrassment. Routine investigation was done and diagnosis was confirmed after laparotomy, Splenectomy was done. Post operative recovery was good.Bang Med J (Khulna) 2016; 49 : 34-36

Omphalocele: A Case Report

A neonate with giant omphalocele was posted for repair on 3rd day of life. Anesthesia management was challenging as liver and intestines herniated through the anterior abdominal wall defect. Anticipating post-operative respiratory embarrassment, the child was kept on ventilatory support for two days, recovered fully.

Esophagojejunal anastomotic leak managed with self expandable metallic stent

ABSTRACTEsophagealjejunal anastomotic leak after gastrectomy is a serious surgical emergency with high mortality. This report describes a 57-year-old male with esophagojejunal anastomotic leak following total gastrectomy for gastric cancer and was managed successfully with self-expandable metallic stent. To our knowledge this is the first such report from India. This case report highlights the need of interdisciplinary coordination in managing this difficult clinical situation. Endotherapy with self-expandable metallic stent (SEM) provided twin benefits of improving respiratory embarrassment and the joy of eating. Therapy of such difficult cases must be individualized; however, and SEM stent usage is a viable option (J Dig Endcsc 2013;4(1):13–15)

Acute presentation of a plunging ranula causing respiratory distress: case report

Objective:A plunging ranula is an uncommon cause of neck swelling which typically presents in a gradually progressive fashion. This report describes a rare case of acute presentation of a plunging ranula. The condition progressed rapidly to respiratory distress, requiring urgent surgery.Case report:A 14-year-old male student presented with a rapidly enlarging neck swelling associated with a sublingual swelling. Computed tomography suggested the diagnosis of plunging ranula. Several hours after admission, the neck swelling became very tense and the sublingual swelling enlarged dramatically. The tongue was pushed upwards and backwards by the sublingual swelling, causing respiratory embarrassment and requiring urgent surgery. Four months after surgery, there was no evidence of recurrence.Conclusion:To the best of the author's knowledge, this is the first case report of a plunging ranula progressing acutely and rapidly to cause respiratory compromise. The literature is reviewed and pertinent features concerning the diagnosis and management of plunging ranula are presented.

Cervical pneumatocoele following total thyroidectomy

Cervical pneumatocoele following thyroidectomy is rare. Urgent surgical intervention is necessary in the setting of widespread tissue emphysema and respiratory embarrassment. We describe a patient with a large pneumatocoele presenting six weeks after a total thyroidectomy who was managed successfully without surgical re-exploration. We also discuss the aetiology of cervical pneumatocoele as well as the potential indications for operative versus conservative management.