Background: Oncological surgical emergencies of abdomen pose a typical problem for surgeons with respect to the choice of curative and palliative treatments and procedures in absence of opportunity for proper evaluation and support of multidisciplinary approach. For appropriate management, it is important to understand the epidemiological and clinical profile of this disease complex.Methods: A prospective analysis of abdominal emergencies encountered in emergency surgery department was done over a period of two years at a single institution and the malignancies were studied with respect to the pattern of clinical presentation and epidemiological characteristics.Results: At our centre, the incidence of intraabdominal oncological emergencies requiring surgery was found to be 6.56% of total emergent presentations excluding abdominal trauma cases. The overall mortality for study duration was 29% and the perioperative mortality within 30 days was 24%. Colonic malignancies (62%) and gastric malignancies (28%) were the most common to present as emergency. It was noted that small bowel (5%) and ovarian malignancy (5%) were not common. Perforation peritonitis was the only presentation as acute emergency in carcinoma stomach. In colonic malignancies, obstruction was the most common emergency presentation (92.5%) and perforation was an uncommon mode of presentation (7.5%).Conclusions: Surgical intervention appears to be unavoidable in the situation of a malignancy presenting as an emergency case, despite the awareness that most of these patients are going to have a limited life expectancy. A high rate of perioperative mortality is observed in emergent presentations of oncological abdominal emergencies.
Background: General surgeons perform surgeries for Fistula in ano day in and day out as elective procedures. Fistula in ano is more common nowadays because of improper hygiene. 3 major basic aims of Fistula in ano surgeries are control of sepsis closure of fistula and maintenance of continence. Post operatively some patients developed anal incontinence due to sphincter injury which affects patients’ day to day activity. The present study compared the utility and effectiveness of two standard procedures LIFT (Ligation of Intersphincteric Fistula Tract) and Fistulectomy in terms of anal incontinence.Methods: This study included 100 patients with fistula in ano during the 6 months period from January 2017 to June 2017. Randomized controlled trial was done to divide the patients into two groups. Group A underwent fistulectomy and Group B underwent LIFT (Ligaton of intersphincteric fistulous tract). Post-operative anal incontinence between the two groups were observed for 6 months.Results: In our study it was observed that four patients of group A (fistulectomy) had anal incontinence whereas no patients in group B (LIFT) developed anal incontinence.Conclusions: LIFT (Ligation of intersphincteric fistulous tract) is a better procedure when compared to fistulectomy in preserving sphincter function and preventing anal incontinence offering better quality of life.
Background: The aim of present study is to evaluate the perioperative monitoring of intra-abdominal pressure and abdominal compartment syndrome and its association with the postoperative morbidity in terms of kidney function and pulmonary atelectasis and mortality of the patients undergoing emergency laparotomy.Methods: A prospective study was done in 100 patients undergoing laparotomy. The study was conducted in the department of general surgery, Government Kilpauk medical college and hospital for the period of six months from January 2015 to June 2015. The study group of 100 patients was divided into 2 groups, each group containing 50 patients. The first group containing 50 patients having increased intra-abdominal pressure undergoing emergency laparotomy and second group containing 50 patients undergoing elective laparotomy. The post-operative morbidity in terms of kidney function by means of urea, creatinine and urine output and pulmonary atelectasis with the help of chest x-ray and mortality analyzed compared in between the two groups.Results: By comparing the two groups, the group undergoing emergency laparotomy with increased intra-abdominal pressure had increase in the incidence of postoperative morbidity and mortality than the elective laparotomy group without elevated intra-abdominal pressure.Conclusions: Thus, the perioperative monitoring of intra-abdominal pressure is highly useful in diagnosing intra-abdominal hypertension and abdominal compartment syndrome and thereby helps in minimizing the post-operative morbidity and mortality in emergency laparotomy patients.
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