Small bowel obstruction due to subserosal endometriosis: an elusive condition

The bowel is involved in 3.8 to 37% of women with endometriosis, out of which nearly 1% present with signs of bowel obstruction to the surgeon. This report describes a case of acute small bowel obstruction in a 23 years old woman. The patient gave a history of intermittent episodes of pain abdomen and abdominal distension for the past 1 year with significant loss of weight. The menstrual cycles were normal. Although there was no history of Tuberculosis, a positive history of contact was present. The clinical and biochemical picture was suggestive of peritonitis. CECT of the abdomen revealed a long segment distal ileal stricture. With a provisional diagnosis of Tubercular Ileo-Caecal stricture perforation, a midline exploratory laparotomy was performed. The procedure consisted of right limited hemicolectomy and primary ileo-ascending anastomosis with a proximal loop ileostomy. Ileostomy was done to allow the healing of distal anastomosis and closure was done after 4 weeks. Histopathology of the resected segment of ileum revealed subserosal endometriosis. Postoperatively, the patient was not given any hormonal therapy and recovery has been uneventful over the past 1 year of follow up

Small bowel obstruction due to subserosal endometriosis: an elusive condition

The bowel is involved in 3.8 to 37% of women with endometriosis, out of which nearly 1% present with signs of bowel obstruction to the surgeon. This report describes a case of acute small bowel obstruction in a 23 years old woman. The patient gave a history of intermittent episodes of pain abdomen and abdominal distension for the past 1 year with significant loss of weight. The menstrual cycles were normal. Although there was no history of Tuberculosis, a positive history of contact was present. The clinical and biochemical picture was suggestive of peritonitis. CECT of the abdomen revealed a long segment distal ileal stricture. With a provisional diagnosis of Tubercular Ileo-Caecal stricture perforation, a midline exploratory laparotomy was performed. The procedure consisted of right limited hemicolectomy and primary ileo-ascending anastomosis with a proximal loop ileostomy. Ileostomy was done to allow the healing of distal anastomosis and closure was done after 4 weeks. Histopathology of the resected segment of ileum revealed subserosal endometriosis. Postoperatively, the patient was not given any hormonal therapy and recovery has been uneventful over the past 1 year of follow up

A randomised control trial study of early post-operative pain and intraoperative surgeon workload following laparoscopic mesh repair of midline ventral hernia by enhanced-view totally extraperitoneal and intraperitoneal onlay mesh plus approach

Introduction: The aim of this study was to compare the peri-operative outcomes, especially intraoperative surgeon workload and early post-operative pain, following midline ventral hernia repair by laparoscopic enhanced-view totally extraperitoneal (eTEP) approach and laparoscopic intraperitoneal onlay mesh plus (IPOM plus) approach. Patients and Methods: This single-centre randomised control trial study was conducted from January 2020 to June 2022. A total of 60 adult patients undergoing elective ventral hernia surgery with small- and medium-sized midline defects were included. Intraoperative surgeon workload and early post-operative pain were systematically recorded and analysed for each procedure. Results: Out of 30 patients assigned to each group, 29 patients underwent eTEP mesh repair and 27 patients underwent successful IPOM plus repair. The intraoperative surgeon's workload, especially mental demand, physical demand, task complexity and degree of difficulty as reported and felt by the operating surgeon, was significantly higher in the eTEP mesh repair group compared to IPOM plus group (P < 0.001) with comparable operating room distractions (P = 0.039). The mean overall post-operative pain score on post-operative day 1 was slightly less in eTEP mesh repair (4.28 ± 1.12) group compared to IPOM plus group (4.93 ± 1.17), which was statistically insignificant (P = 0.042). The eTEP group had significantly longer operative time and length of hospital stay compared to the IPOM plus group. Conclusion: Our study revealed significantly longer operative time, higher surgical workload and increased length of hospital stay in the eTEP group with comparable early post-operative pain in both groups, thus making eTEP mesh repair a more difficult and challenging procedure

Concurrent nonfunctional paraganglioma of the retroperitoneum and urinary bladder: A case report with literature review

Paragangliomas are the neuroendocrine tumors which arise from the chromaffin cell. Tumors arising from the adrenal medulla are known as pheochromocytomas, while others originating from the extra-adrenal site are known as extra-adrenal paragangliomas. Paraganglioma can be multifocal which can arise synchronously or metachronously. Paragangliomas are less functionally active than the pheochromocytomas; they secrete noradrenaline and rarely dopamine, while adrenal pheochromocytomas secrete adrenaline or nor-adrenaline. Nonfunctional multifocal paragangliomas are very rare. We report a case of a 45-year-old female with multifocal nonfunctional paragangliomas of the retroperitoneum and urinarybladder which were surgically removed, and the diagnosis was confirmed on histopathology

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population