Spontaneous mesenteric hemorrhage

Spontaneous intra-abdominal hemorrhage or abdominal apoplexy is an acute abdominal emergency which can exhibit a wide spectrum of clinical presentation. With the expanding avenues for anticoagulation therapy, this condition is becoming commoner. The association of this condition with antiplatelet therapy is less well established. We present a case of spontaneous mesenteric hematomas causing intestinal obstruction in a patient on antiplatelet therapy for ischemic heart disease. A review of etiology, clinical presentation and protocol of management is also presented. A high index of suspicion on the part of the clinician is essential to ensure a favorable outcome in this condition

A study comparing preoperative intra-incisional antibiotic infiltration and prophylactic intravenous antibiotic administration for reducing surgical site infection

Introduction: Surgical site infection (SSI) continues to be a distressing problem since time immemorial, as it happens to be one of the major causes of post-operative morbidity and mortality. Many methods have been evolved to combat wound infection, but the rate of wound infection has been more or less static over the past few decades. The search for alternative modes of management is going on and one of the methods is intra-incisional infiltration of antibiotics. Aims and Objectives: To study the comparative efficacy of pre-operative intra-incisional antibiotic infiltration and prophylactic parenteral antibiotic therapy in reducing surgical site infection. Materials and Methods: This is a prospective randomized controlled study comprising of 120 patients divided in to three groups i.e. 40 in each group. Group A comprising 40 patients were subjected to local infiltration of 1 gram of Cefotaxime around the site of incision, 20 min before the induction of anesthesia. Group B comprising of 40 patients were administered a single dose of 1 gram of Cefotaxime intravenously 20 minutes before the surgical incision and Group C comprising of 40 patients were administered local infiltration of 1 gram of Cefotaxime as well as intravenous administration of 1 gram of Cefotaxime, 20 minutes before surgical incision. Inclusion criteria were patients in age group of 20-60 yrs, procedures that lasted for less than 2 hours, clean and clean contaminated surgical procedures. The exclusion criteria were patients with diabetes mellitus and those on steroid therapy. Incidence of SSI, type of organisms cultured in case of infection were studied. Results: Overall incidence of SSI in Group A was 10%, in Group B 18%, and Group C 2.5%. Frequency of infection due to gram positive bacteria was more as compared to gram negative in the cases that developed SSI. The commonest organism isolated was Methicillin Sensitive Staphylococcus aureus (MSSA). Conclusion: The incidence of SSI was lower in the group of patients who were subjected to intra-incisional antibiotic infiltration as compared to the group who received prophylactic intravenous (IV) antibiotic. There was significant reduction in incidence of SSI in the group, which received both Intra-incisional as well as IV antibiotics. There was no definite correlation between the duration of surgery to the development of SSI in this study

Role of perinephric drain in the era of internal drainage (DJ stent) in open renal surgery

Objective: The purpose of the study was to evaluate the effect of internal drainage on the perinephric drain after open renal surgeries. Materials and Methods: 68 patients who had undergone open renal surgeries were prospectively studied. Patients were divided in two groups randomly: Group A (n = 33) without double J stent and group B (n = 35) with Double J stent. In both groups, perinephric drain was placed. Results: The average drain output and duration of perinephric drain kept in group A and B were 36 ml and 29 ml and 4.63 days and 3.35 days, respectively. The commonest surgical complication was wound infection (9.72%). Complaints like frequency, dysuria, and hematuria during follow-up were less in group A than in group B. Conclusion: With the use of double J stent, there is considerable decrease in drain volume and early removal of perinephric drain. Late irritative urinary complaints were seen more in the group with double J stent

A comparative study of onlay and retrorectus mesh placement in incisional hernia repair

Introduction: Incisional hernia after abdominal surgery is a well-known complication and the incidence of incisional hernias continues to be 2-11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. The retro-rectus mesh placement or the sub-lay technique, popularized by Rives and Stoppa in Europe, has been reported to be quite effective, with low recurrence rates (0-23%) and minimal complications. Aims and Objective: The purpose of this study was to compare the traditional on-lay mesh and retro-rectus mesh placement in incisional hernia repairs in terms of time taken for surgery, early complications (wound infections, Mesh extrusion), and Delayed complications (Recurrence). Materials and Methods: This is a prospective study which was conducted in the surgical department of our hospital. A total of 50 cases were included in this study. Of these cases, 25 cases were operated by the on-lay mesh method and 25 by retro-rectus mesh placement. Only the patients with midline hernias up to 10 cm in diameter were included in the study. Result: The operative time for retro-rectus mesh placement was insignificantly higher than that of on-lay mesh repair, whereas, complications like superficial Surgical site infection SSI were identical in both the study groups, but deep SSI leading to infection of mesh was higher in on-lay mesh repair. The recurrence rate was found to be 4% in on-lay mesh repair and 0% in retro-rectus mesh repair. Conclusion: The follow-up period in this study was 6months; hence, late recurrences were not taken into account. However, the low rate of local complications and the low recurrence rate indicate that retro-rectus mesh repair has an advantage over traditional on-lay repair