Extra-adrenal pheochromocytomas (paragangliomas) are rare. We report the case of a 20-year-old female at 15 weeks gestation, who was detected to have a large paraganglioma (6.5 × 5 cm) in the organ of Zuckerkandl during an antenatal visit. After medical termination of the pregnancy, successful laparoscopic excision of the paraganglioma was performed.
Background:Choledocholithiasis is prevalent in 8 to 20 percent of patients with cholelithiasis. Of all the treatment options available, laparoscopic cholecystectomy post ERCP is one of the most commonly used modality. Surgeons have always experienced difficulties while performing a laparoscopic cholecystectomy post ERCP due to adhesions induced by ERCP. This study was to investigate this modality further to assess the difficulty during the procedure and the possible factors influencing this.Methods: Patients post ERCP who underwent interval laparoscopic cholecystectomy was studied in a tertiary care centre in the urban setting. Results:Out of the 40 patients studied over the 18 month period, 14 (35%) underwent conversion to open cholecystectomy. Calot’s triangle adhesions were the most common cause of conversion. Multiple ERCP sessions positively influenced the chance of conversion (P-value 0.014). Intraoperative bleeding was directly related to the Calot’s triangle adhesions which subsequently increased the chance of post-operative bile leak (P-value 0.022). No mortalities were encountered during the course of the study.Conclusions:Laparoscopic cholecystectomy in post ERCP patients is difficult but safe.
Chronic abdominal pain is a prevalent complaint that significantly impacts patients' quality of life, causing both physical and psychological distress. This study evaluates the role of diagnostic and therapeutic laparoscopy in addressing chronic and recurrent idiopathic abdominal pain, assessing its epidemiology, clinical features, and outcomes. A prospective study conducted on 63 patients revealed that diagnostic laparoscopy is a safe, effective modality that not only identifies underlying causes but also facilitates immediate therapeutic interventions. Positive outcomes were observed in over 90% of patients within two months of follow-up, highlighting its dual diagnostic and therapeutic efficacy.
ABSTRACT Background and Objectives: Most of the patients of Esophageal Malignancy present in advanced stage. These patients receive palliative treatment. We wanted to evaluate whether combination of SEMS and RT improves the grade of dysphagia. Methods: 165 patients diagnosed with Advanced Esophageal Malignancy in middle third of Esophagus with grade III dysphagia were enrolled for the study. Demographic data, grade of dysphagia, improvement in the grade of dysphagia, complications and survival were studied. Follow up was done for a period of 1 year. Results: All patients grade of dysphagia improved from grade III- IV to grade I-II. One patient had stent migration. Thirty patients died in one year Followup. Conclusion: SEMS along with RT may provide survival benefit in advanced Esophageal Malignancy.
Background: Perforative peritonitis is the most common surgical emergency in India that requires prompt and optimum surgical attention. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, management of peritonitis continues to be highly demanding, difficult and complex. This study was aimed to identify factors in patients with peritonitis which have a significant bearing on morbidity and mortality.Methods: The study was a single center, prospective observational study conducted in Lokmanya Tilak Municipal Hospital, Sion, Mumbai. 50 patients with perforative peritonitis presented to the emergency were included in our study. Detailed history & clinical examination performed, routine blood investigation were done followed by the use of appropriate diagnostic procedures such as X-ray erect abdomen, with additional help of abdominal ultrasound and abdominal CT scan. Different parameters were studied and analyzed.Results: 50 patients studied with age range 18-60 years with mean age of presentation 36.80 years and mortality rate was 16%. Majority of cases were male 88%. Tuberculosis was the most common co-morbidity (16%), most common site of perforation was gastroduodenal perforation (61%) [duodenum (48.9%) gastric (12.8%)] with peptic ulcer as the most common histopathology. We found most of the patients having no growth in peritoneal contamination followed by E. coli (34%) highly sensitive to amikacin. Most common complication was wound infection. We found delayed presentation >24 hrs, blood pressure <90 mmHg, respiratory rate >/=24/min, number of perforation, size of perforation >/=1 cm, site of perforation, amount of contamination >1000 ml and Mannheim's peritonitis index were the prognostic factors associated with morbidity. We could not find association between older age, sex, creatinine and hemoglobin but they were associated morbidity.Conclusions: The late admission to the hospital a very important cause of adverse outcome, leads to deterioration of patients. Tachycardia, tachypnea, hypotension, anemia, renal failure and septicemia, amount of contamination, size and number of perforations are the factors significantly predicting death (each significant at 5%). Thus, if patients having above mentioned symptoms could be detected early and prompt treatment could be provided accordingly; mortality can be reduced.
Background:Chronic abdominal pain is a common complaint of the patients seeking a primary care physician. It leads to evident suffering and disability, both physically and psychologically and it is associated with poor quality of life. Many diagnostic and therapeutic procedures have been described in literature, in that laparoscopy is one of the modalities that could be of benefit in such cases. Hence, the aim of the study was to evaluate the role of diagnostic and therapeutic laparoscopy in chronic and recurrent idiopathic abdominal and also to assess the epidemiology, clinical features, diagnostic modalities and management of chronic and recurrent abdominal pain.Methods: This is a single centre, prospective study done on 63 patients with chronic abdomen pain. The pain in all patients was of unknown etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findings and outcomes of the laparoscopy were recorded and analyzed.Results:In the present study Out of 63, 26 were male 37 were female showing female preponderance (58.7%) of patients presenting with chronic and recurrent abdominal pain with mean age of presentation 31.7 years. The majority of the patients in our study presented with pain in right lower quadrant pain (n=43) followed by pain in periumbilical region (n=7). Others had pain in other quadrants of abdomen. Only 6 patients had diffuse abdominal pain. In our study of 63 patients, the most common finding was chronic appendicular pathology, which was present in 56.1% patients, inflammatory or congenital band of adhesions noted in around 21.2 % patients, abdominal Koch’s was noted in 19.7%, mesenteric lymphadenopathy noted in around 18.2%, ovarian cyst findings were noted in around 7.6% patients, 2 patients had Meckel’s diverticulum and 4 had normal findings. 92.08% (n=58) patients had positive response (Reduction or complete relief of pain) at the end of one month in relation to effectiveness of diagnostic laparoscopy combined with a therapeutic procedure while 88.88% (n=56) had positive response at the end of two months.Conclusions:Laparoscopy is a safe, quick and effective modality of investigation for chronic abdominal pain. Not only does laparoscopy point to a diagnosis, it has the added advantage that therapeutic intervention can be done at the same sitting in most cases thus avoiding another hospitalization or another exploration of the abdomen. Diagnostic laparoscopy has a high diagnostic and therapeutic efficacy.
Introduction: Diabetic foot is a common clinical condition encountered by a general surgeon affecting the lower limbs more commonly causing neuropathy loss of sensation and delay in wound healing. The causes of ulcer can be venous, arterial, malignant but diabetic foot leads in morbidity and eventually mortality. Various factors affect healing of wound which will be assessed in the study Aim: An audit to look for the outcome of diabetic foot leading toneither healing or amputation or mortality. To study the factors affecting wound healing and observe the prognosis of diabetic foot like age of patient, atherosclerosis or peripheral arterial disease, haemoglobin of patient or the nutritional status Materials and Methods:Design: Prospective and observational Place of the study: Wards, intensive care units and operation theatres of the surgery department of a tertiary care hospital. Duration of the study: From March 2018 to June 2019, after obtaining Institutional Ethics Committee approval. Out of 200 patients of diabetic foot all were given primary surgery (debridement or primary amputation) along with adjuncts for those who required it on the basis of wound, only those patients requiring admission were taken into study including infected diabetic foot. Result: in the study it was found that diabetic foot ulcer is more common in 50-60 years of age group, adjunct help in making the process faster in such a way by building healthy granulation tissue and also increases the antibiotic response to infection. Among the adjunct vacuum or negative pressure wound therapy was found to be the best. PEDIS score when compared on day 30 were found to be reduced more in patients who received NPWT. So ulcer early filled with granulation tissue is prepared for early STSG thereby reducing the hospital stay.at times patient didn’t require STSG with NPWT. It also reduced the amputation rate hence helping limb salvage.
A 40-year-old man presented to the emergency department of our tertiary hospital with acute abdominal pain since 1 day, which responded to conservative measures initially. On further investigation and abdominal CT, he was diagnosed with closed loop small bowel obstruction with an encapsulated lesion with small bowel loops within, in the right iliac fossa, which was initially missed. On exploration, the patient had a sac in the right iliac fossa (paracaecal incarcerated internal hernia) with distended bowel loops within, the sac was excised after reduction of the contents. Postoperative recovery was uneventful.
This chapter was aimed to identify factors in patients with peritonitis which have a significant bearing on morbidity and mortality.In India, perforative peritonitis is the most frequent surgical emergency requiring immediate surgical care. Even with improvements in surgical methods, antibiotic treatments, and critical care assistance, managing peritonitis remains extremely challenging, complex, and demanding. The study was a single center, prospective observational study conducted in Lokmanya Tilak Municipal Hospital, Sion, Mumbai, India. Consecutive patients with perforative peritonitis admitted to the emergency and those who were fitting into the eligibility criteria included in the study. A detailed history and clinical examination and blood investigation performed followed by use of appropriate diagnostic procedures such as X-ray, CT-scan with additional help of USG and diagnostic paracentesis if required and according to the need of the hour. A total of 50 patients studied with age range 18-60 years with mean age of presentation 36.80 years and mortality rate was 16%. The result reveals that 33.33% of the mortality rate in age group 41-50 years which is highest followed by the deaths in age group 51-60 years is 28.6%. There is increasing trend in mortality with age except there is slight drop in age group 51-60 and 60% of >10 day hospital stay was found in that age group.. We found most of the patients having no growth in peritoneal contamination followed by E. coli (34%) highly sensitive to amikacin. Most common complication was wound infection. study indicated that most common surgical procedure used is primary closure as most common pathology was gastroduodenal perforation. Patients' condition deteriorates as a result of delayed hospital admission, which is a major contributing factor to unfavorable outcomes. The characteristics that significantly predict death are anemia, renal failure, septicemia, quantity of pollution, size, and number of perforations. These risks are all significant at 5%. Therefore, mortality can be decreased if patients exhibiting the aforementioned symptoms are identified early and receive the appropriate treatment.
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