Abdominal tuberculosis: a surgical emergency

Background: To study and assess the clinico-pathologic profile, intra-operative findings, surgical intervention performed and outcome in terms of morbidity and mortality of the patients included in the study group.Methods: This study was carried out at Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, a tertiary care hospital between November 2011 to March 2015. It was a retrospective study in which the records of the patients operated upon in the emergency department as peritonitis or acute intestinal obstruction and whose diagnosis was later confirmed as tuberculosis on histopathology were analysed with regards clinic-pathologic profile, intra-operative findings, surgical intervention performed and outcome in terms of morbidity and mortality.Results: The mean age of our study group was 28.7 years. 70% of our patients were found to be in the underweight category and 30% were in the normal category. Fourty three (56.6%) presented to the hospital with features suggestive of peritonitis and thirty-three (43.4) were suffering from acute intestinal obstruction. The commonest intra-operative finding encountered was ileal perforation followed by multiple small bowel perforations, solitary stricture of the small bowel with perforation, ileo-cecal mass, adhesions or bands, single or multiple strictures, stricture with impending small bowel perforation and jejunal perforation. The frequently performed surgical procedures were ilesotomy, resection and anastamosis of the involved bowel, primary repair of thr perforation, right hemicolectomy, adhesiolysis, stricturoplasty (done in case of single stricture, mostly), jejunostomy and peritoneal and omental biopsy.Conclusions: Tuberculosis is a very grave disease, studies with larger number of patients need to be conducted to standardise its surgical management as at present there is no standardised surgical management protocol

Evaluating serum bilirubin levels in acute appendicitis and appendiceal perforation

Background: Acute appendicitis is one of the commonest surgical emergencies. Authors undertook this study to evaluate serum bilirubin levels in acute appendicitis and appendiceal perforation.Methods: A retrospective study evaluating the serum bilirubin levels in acute appendicitis and appendiceal perforation was carried out for 6 years at three tertiary care hospitals at India from 2014 to 2019. Patients having acute appendicitis and appendiceal perforation, confirmed on histopathology, with no other medical or surgical comorbidity were included in the study.Results: The total number of our study subjects was 927. 306 patients had appendiceal perforation, amongst these, 226 (74%) had hyperbilirubinemia. Out of the 621 patients having acute appendicitis only 186 (30%) had hyperbilirubinemia. The lowest and the highest serum bilirubin levels of this study group were 0.6 and 3.1 mg/dl, respectively, with an average of 1.6 mg/dl. In patients diagnosed to be having acute appendicitis, the lowest and highest serum bilirubin levels were 0.6 and 2.4 mg/dl, respectively, with an average of 1.3 mg/dl. As for the patients having appendiceal perforation the lowest and highest serum bilirubin levels were 0.8 and 3.1 mg/dl, respectively, with an average of 1.8 mg/dl.Conclusions: Hyperbilirubinemia is seen in acute appendicitis but predominantly in appendiceal perforation, so serum bilirubin estimation may help us in diagnosing appendiceal perforation pre-operatively if and when used in conjunction with other available diagnostic modalities

Prognostic implications of double J ureteral stenting in patients with renal stones undergoing extracorporeal shockwave lithotripsy

Background: Most patients with uncomplicated kidney stones can be successfully treated with extracorporeal shockwave lithotripsy (ESWL). Double-J ureteral stent is used to facilitate stone clearance, however double-J ureteral stents themselves may cause complications. Study conducted the study to know the exact role of double J stent in ESWL.Methods: 80 patients undergoing ESWL were divided into two groups, group A (n=40) double J stenting and group B (n=40) without double J stenting. Both groups were compared for stone fragmentation, stone clearance, number of shockwaves required for fragmentation, time required for passing through ureter, steinstrasse, Urinary Tract Infection.Results: Both the groups were comparable for age, sex, stone size and stone location distribution. There was no significant difference in clearance of stone and no. of shockwaves received for clearance in both the groups. The overall incidence of steinstrasse between the two groups was insignificant with a p value of 0.644. The incidence of UTI was significantly higher in stented group (p value 0.032).Conclusions: Study recommend ESWL without double J stent in patients having solitary renal calculus of size < 2 cm. Double J stent predisposes the patient to multiple complications including urinary tract infection which increases the morbidity of the patient. Based on our study we conclude that double J stenting in patients of renal calculus of size < 2cm, prior to ESWL is not beneficial

Carcinoid Klatskin tumour: A Rare Cause of Obstructive Jaundice

Carcinoid tumours of the extrahepatic biliary ducts represent an extremely rare cause of bile duct obstruction. We report a case of obstructive jaundice secondary to carcinoid tumour arising at the hilar confluence. Resection of the primary tumour was done and the patient is doing well on follow-up. This case demonstrated that surgery offers the only potential cure for biliary carcinoid and aggressive surgical therapy should be the preferred treatment in cases of potentially resectable biliary tumours

Penile Fracture: Experience from a Third World Country

Aim. To ascertain the clinical presentation, commonest age group affected, and treatment of patients diagnosed to have penis fracture. Materials and Methods. We performed a retrospective study carried at a tertiary care hospital from January 2005 to January 2011. All the 36 patients diagnosed to have penile fracture were enrolled in the study group. The diagnosis was made based on the clinical findings in the patients. All, except two patients, were managed by a standard surgical procedure, same for all the patients, on the day of presentation to the hospital. All the data pertaining to the presentation, management, and followup of these patients were studied and scrutinized thoroughly. Results. Thirty-four patients were operated while 2 refused surgery. Most of our patients were between 16 and 30 years (55.6%) of age. The commonest presenting complaints were penile swelling and detumescence during sexual intercourse or an erection. All except two of our patients were managed with immediate surgical repair which had excellent results even in the presence of associated urethral injury. Conclusion. Fracture of the penis is a surgical emergency which can be best managed by immediate surgical repair with excellent results even in the presence of urethral injury

Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy

Aim. To assess the occurrence of SSIs in patients with spillage of gallbladder contents and bacteriobilia during laparoscopic cholecystectomy. Methods. We evaluated 113 patients who underwent laparoscopic cholecystectomy between September 2013 and April 2015. The SSIs and their relationship with gallbladder rupture and bacteriobilia were assessed. Results. The mean age of patients developing SSIs was 45.57 ± 8.89 years. 18 patients (16%) had spillage of bile from the gallbladder. Percentage of SSIs overall was 6%, while percentage of SSIs in gallbladder content spillage was 5.5%. Organism profile of the culture from surgical site showed monomicrobial infection: 58% Staphylococcus aureus, 14% Pseudomonas, and 14% E. coli. The occurrence of SSIs in patients with bacteriobilia was 16% as compared to 2% in patients without bacteriobilia. Conclusions. Gallbladder content spillage is not a significant risk factor leading to increase in SSIs. The occurrence of SSIs is significantly higher in patients with bacteriobilia

Taenia saginata: A Rare Cause of Gall Bladder Perforation

We report a case of biliary peritonitis caused by gall bladder perforation due to Taenia saginata induced gangrenous cholecystitis. Although parasites are not unusual causes of biliary tract disorders, especially in disease endemic areas, but this is for the first time that Taenia saginata has been reported to cause gall bladder perforation

Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy

Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot’s triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries