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Background/Aim:Enteric perforation is a grave complication of typhoid fever. Laparotomy with primary closure is the treatment of choice depending upon the bowel condition. Fecal fistula formation is the main concern in primary closure and the incidence of this complication dramatically decreases when omentum is used as a patch over primary closure.Materials and Methods:A total of 176 patients underwent laparotomy for enteric perforation and they were divided into two groups randomly; Group I–Primary closure with omental patch and GroupII– –Only primary closure. The outcomes were measured in relation to hospital stay, wound infection, septicemia, fecal fistula, and mortality.Results:The incidence of complications including fecal fistula and mortality is significantly lower in the group I patients. Fecal fistula occurs in 7.7% in group II, while in only 1.1% in group I. The mortality is also lower 3.3% in group II, while 1.1% in group I.Conclusion:Primary closure with omental patch is a better option as compared with only primary closure in enteric perforation patients. It can be recommended as an alternative method to primary closure only in enteric perforation patients.

Background: A laparotomy for peritonitis due to perforated peptic ulcer is one of the commonest emergency operations done by a general surgeon and is still associated with a marked mortality and morbidity. The aim was to assess the current mortality and morbidity in patients operated for perforated peptic ulcer and to identify the factors associated with increased mortality in these patients.Methods: All adult patients operated for perforated peptic ulcer over a period of one year were included in this prospective observational study. The demographics, clinical presentation, pre-operative laboratory parameters, operative findings, operation done, and the outcomes were noted in pre-designed proforma. Mortality and morbidity was assessed and factors relating to increased mortality were determined using standard statistical tests of significance such as Chi square test and the student’s t test.Results: 55 patients underwent laparotomy for perforated peptic ulcer (23 gastric and 32 duodenal perforations). There were 53 males and only 2 females in the group. Their mean age was 44 years. The mortality was 16% (9/55) and morbidity was 25% (14/55). Complications were encountered in 14 patients, most commonly surgical site infection in 13% cases, entero-cutaneous fistula occurred in 3 patients and one of them expired despite re-exploration due to persistent sepsis. The other two patients survived, and fistula healed spontaneously. The operative procedure done was Graham’s patch or it’s modification. Only 2 patients had antrectomy with Billroth II reconstruction.Conclusions: Despite the advances in management of critically ill patients, the mortality (16%) and morbidity (25%) for this common surgical emergency remains high and is unchanged over the last half century. Presence of comorbidities and low serum albumin are associated with an increased risk of adverse outcome.

Background: Although the role of Helicobacter pylori infection in noncomplicated peptic ulcer disease has been definitively established, the precise relationship between the organism and ulcer complications is doubtful. Recurrent ulcer disease after peptic ulcer perforation mainly occurs in patients with H. pylori infection, which suggests that the microorganism plays an important role in this complication.Methods: This observational study was conducted in the Department of General Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over a period of January 2013 to December 2013 and included 75 subjects who underwent exploratory laparotomy for peptic ulcer perforation. The tests used for the diagnosis of H. pylori are mucosal biopsy at the time of surgery, Rapid urease test (RUT), Stool antigen test.Results: In this study, H. pylori infection was found to be present in 61% of these patients as detected by biopsy. There were 66 males and 9 females. Infection with H. pylori is almost universal in patients aged more than 70 years.Conclusions: In the Indian context patients presenting with perforation should be tested for infection with H. pylori utilizing a gastric antral mucosal biopsy taken at the time of operation for histological analysis and eradication therapy should be advised to all those who are found positive.

Background: This study attempted to document the indications for lower limb amputation (LLA) and its outcomes especially the wound healing problems, reamputations and subsequent use of prosthesis for mobilization in Indian population.Methods: This observational study included 92 patients over a period of 18 months. Indications, level of LLA, morbidity and reamputation rates after LLA were recorded. Stump status, wound healing and other morbidity was followed over period of one month. The use of prosthesis and level of mobility were assessing in follow-up over a period of six months.Results: There were total 109 LLA in 92 patients as some of these patients had to undergo revision of amputation stump at a higher level. Atherosclerosis (29.3%) was the main cause for LLA. Age group 35-55 years and male patients were most commonly needed LLA. Total 64.13% patients developed post-operative wound infection and 18.4% patients underwent reamputation. E. coli and Staphylococcus were the most common organism cultured from the infected surgical site. Conversion of below knee amputation (BKA) to above knee amputation (AKA) was the most frequent reamputation and atherosclerosis was the leading cause. According to final level LLA, 54 had major amputations (above ankle joint), only 37% were using a prosthesis whereas majority of patients were dependent on crutches/walker.Conclusions: Patients of atherosclerosis and trauma had a higher frequency of reamputations. Only 37% of major LLA opted for prosthesis whereas majority of patients mobilize by other means like crutches or walker.

Therapeutic platelet reduction is an effective modality for the reduction of platelet count in patients with treatment of extreme thrombocytosis resulting from a variety of primary and secondary causes of thrombocytosis, which may be associated with thrombotic or hemorrhagic complications of varying degrees. These cases when symptomatic fall into the ASFA Category II indication for therapeutic platelet apheresis procedure. Here, we report a case of postsplenectomy secondary thrombocytosis presenting with extremely high platelet counts and subsequent thrombosis in the shunt and successful treatment after therapeutic platelet reduction. The case is being presented to bring forth the fact that therapeutic platelet reduction is an easy procedure that gives quick and good results and also to bring to the attention of transfusion specialists an associated but as yet unreported procedural finding.

Background: Spleen is the meeting ground of medicine and surgery and most patients for elective splenectomy are primarily evaluated by physicians and then referred to the surgeons. Both physicians and surgeons need to be aware of the utility of splenectomy as a therapeutic option in various medical conditions. This study looks at the indications for elective splenectomy and the outcomes over a decade at a tertiary care centre in North India. It also evaluates the adherence to protocols recommended for prevention of OPSI in adults.Methods: A hospital based prospective observational study was conducted at a tertiary care hospital situated in Uttarakhand, North India, over a duration of 10 years from October 2006 to October 2016. The inclusion criteria for the study were all the patients undergoing splenectomy for the non-traumatic indications.Results: Sixty-one patients underwent splenectomy in the 10 years’ duration. The age range of patients was from 17-79 years with twenty-six males and rest females. Hypersplenism was the commonest indication for splenectomy. There were eleven cases of primary hypersplenism and there were twenty-five cases of secondary hypersplenism. Portal hypertension was the main cause of secondary hypersplenism requiring splenectomy.Conclusions: The major indications of elective splenectomy were hypersplenism secondary to portal hypertension due to EHPVO and haematological disorders mainly ITP. Mortality is 2.4% and morbidity is 21.4%. Vaccination rates of 75% were seen in planned splenectomy however, no case of OPSI recorded in this series.

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