HighlightsSurgical diagnosis of conditions causing acute abdominal pain in situs inversus is complicated by the mirror image anatomy.Chest X-ray and Ultrasonography abdomen can be helpful in diagnosing this condition.Laparoscopic cholecystectomy in situs inversus is problematic for right handed surgeons.We describe a modified 4 port configuration where right handed surgeons can use the left mid-clavicular port for dissection.
Background: Laparoscopic cholecystectomy (LC) can be the easiest or the most difficult laparoscopic operation. Conversion to open surgery has been a traditional marker of difficult LC. Recent studies have shown that C-reactive protein (CRP) may be helpful to surgeon in knowing the pathological condition of gall bladder before removal. Aim of this study was to evaluate the role of CRP as a predictor of difficult LC or its conversion.Methods: This study was done from 1 march 2016 to may 2017 in department of general surgery, SMS hospital Jaipur, under single unit. All patients with cholelithiasis admitted in single unit of SMS hospital undergoing LC were included in this study. Exclusion criteria were high BMI (>35), proven congenital anomaly of gall bladder, previous abdominal surgery, any conditions increasing CRP and immunocompromised patients. CRP was done for each patient.Results: Mean age of our 148 patients was 50.41 years. Female to male ratio was 4.28:1. Mean CRP was 22.2±18.2 mg/dl for simple cholecystectomy, 46.5±32.0 mg/dl for difficult cholecystectomy and 83.6±22.4 mg/dl for laparoscopic converted to open cholecystectomy, which was statistically significant (p value 0.0002).Conclusions: CRP is a potent predictor of difficult laparoscopic cholecystectomy and its conversion preoperatively. Patients with preoperatively high CRP have higher chance of complication intraoperative and high chances of conversion to open.
Background: Appendicitis is inflammation of appendix. Appendicitis remains the most common abdominal surgical emergency. There is no reliable specific marker for acute appendicitis and its complications. C- reactive protein is an acute phase reactant produced by the liver during the acute inflammation, which rises rapidly in presence of inflammation. CRP is a more sensitive and reliable indicator of inflammatory processes than ESR and leucocyte count. The aim of this study was to evaluate whether CRP predict the severity of appendicitis.Methods: This study was hospital based, observational study. After history and clinical examination, patient underwent USG whole abdomen. Diagnosis of appendicitis was established. After that patient underwent routine blood investigations including, CRP. After confirming diagnosis of appendicitis, patients underwent appendectomy and biopsy of appendix was sent for histopathological examination.Results: In our study, CRP value > 6.15mg/L has a sensitivity of 100.0% and a specificity of 54% in predicting complicated perforated or gangrenous appendicitis. The positive predictive value and negative predictive value of CRP were 100% and 61.54% respectively. The cut off level at around 6mg/dL needs to be handled carefully and a person with high CRP should undergo surgery immediately.Conclusions: This study clearly suggested that CRP leads to precise prediction of the severity of acute appendicitis for treatment. A person with high CRP should undergo surgery immediately ures.
Background: Intestinal perforation is a common surgical problem, which need proper attention. Typhoid is the most common cause of bowel perforation. With the concept of a correct diagnosis of perforation in reference to its etiology and further study of etiological factor (typhoid) in relation to epidemiology, surgical treatment and outcome, the present study has been undertaken.Methods: It is a prospective, observational study in which 50 cases of enteric perforation admitting in SMS Hospital at JAIPUR were observed. All patients of enteric perforation peritonitis were evaluated by detailed history, clinical examination and radiological as well as laboratory investigations. After initial resuscitation patient were treated by operative procedures. Postoperatively progress report, morbidity and mortality data were observed.Results: Mean age of patients was 26.38 years. Male to female ratio was 4:1. Enteric perforation is more common in patients with poor nutritional status and rural area. Primary repair of perforation was done in patient with small perforation with relatively healthy bowel, while ileostomy was done in patients with large perforation of longer duration, multiple perforations and edematous bowel with necrotic patches. Mortality was highest in patients who underwent primary repair and proximal loop ileostomy (33.3%) and lowest in patients in which exteriorization of the perforation as loop ileostomy was done (10.3%).Conclusions: The time interval between occurrence of perforation and starting of specific therapy is the most important factor in deciding the ultimate outcome of the typhoid perforation patient and operative procedure is another important factor in deciding the outcome.
Background: Gall stone disease is the most common biliary pathology and frequently encountered in our daily practice. Patients with gall stone that experienced at least one attack of acute cholecystitis is defined as complicated gall stone disease (CGSD). Aim of this study was to find out the association between complicated gall stone disease and the metabolic syndrome.Methods: This prospective, observational study was done from 1st March 2017 to 30th November 2018 in department of general surgery, SMS hospital Jaipur. All patients with cholelithiasis admitted in general surgery department were included. Metabolic syndrome was defined by adult treatment panel III (ATP III) criteria. All patients were divided in two groups: complicated gall stone disease (CGSD) and uncomplicated gall stone disease (UGSD).Results: Mean age was 47.2 years in CGSD group and 46.7 year in UGSD group. Female to male ratio was 8.2:1 in CGSD group and 4:1 in UGSD. Metabolic syndrome was presented in 64 patients (58.2%) of CGSD group and 24 patients (21.8%) of UGSD patients, which was statistically significant (OR 4.986, CI 2.763-8.995, p value <0.001). Five components of metabolic syndrome were compared in both CGSD group and UGSD group. Lower serum HDL-C level and hyperglycemias was statistically significant in CGSD group as compared to UGSD group.Conclusions: Metabolic syndrome can be use to predict complicated gall stone disease. Hyperglycaemia and lower HDL-C associated with CGSD. One should be aware about possible metabolic syndrome background when dealing with gall stone disease patients.
Background: Tetanus is an acute neurological fatal disorder caused by anaerobic spore forming bacillus Clostridium tetani, which produced an exotoxin (Tetanospasmin) in a wound. Purpose of this study was to find out the clinico-epidemiological factors of tetanus and how we can modify or minimize the outcome of this disease.Methods: This prospective, observational study was conducted in isolation ward in department of general surgery, SMS hospital Jaipur (Rajasthan) from 1 March 2016 to October 2017. Two hundred patients with clinical diagnosis of tetanus, who were admitted in single unit of SMS hospital, recruited in this study. Patients with age less than 1 yr were excluded. After admission, patient’s detailed history and thorough clinical examination done. The day to day progress of the cases was followed till the time of their discharge from the hospital. Outcome variables were age, gender, geographical area, causes of tetanus and site of injury, precipitating factors, role of baclofen, morbidity, cured and mortality.Results: In this study, mean age of patients were 17 years and male to female ratio was 2.44:1. Most of patients were from rural backgrounds with rural to urban ratio of 6.14:1. Overall mortality in present study was 16.5%. The severity of disease directly related with mortality. The mortality for mild, moderate and severe tetanus was 0%, 1.9% and 68.1% respectively.Conclusions: Though tetanus is a vaccine preventable illness, its prevalence is high in our country. The incidence of tetanus can be reduced by: strengthening of primary immunization programme; proper wound management and giving prophylactic tetanus immune globulins along with tetanus vaccine.
Background: Acute severe pancreatitis is life threatening condition with organ failure, pancreatic necrosis, infections, and death. Multiple factor scoring systems are used for triage decision to manage of acute pancreatitis according to severity. Our purpose of this study was to assess the efficiency of the bedside index of severity in acute pancreatitis (BISAP) score and computed tomography severity index (CTSI) scoring system to predict severity of acute pancreatitis.Methods: This hospital based observational, prospective study was conducted from 01 March 2019 to May 2020. An inclusion criterion was patients admitted with diagnosis of acute pancreatitis. Comparative analysis was done for BISAP and CTSI in terms of severity and mortality.Results: The mean age was 44.7±16.2 years and male to female ratio was 1.9:1. BISAP score had 91.7% sensitivity and 51.4% specificity in predicting severity of acute pancreatitis with 38.6% positive predictive value (PPV) and 94.9% negative predictive value (NPV). CTSI score had 95.8% sensitivity and 44.4% specificity in predicting severity of acute pancreatitis with 36.5% PPV and 96.9% NPV. The area under curve (AUC) for BISAP and CTSI was 0.853 (95% CI: 0.769–0.937) and 0.901 (95% CI: 0.831– 0.97) respectively.Conclusions: We conclude that BISAP score is better predictor of severity and mortality in acute pancreatitis and can safely be utilized to predict severity of acute pancreatitis in situations where use of CT is limited due to cost factor or availability, especially in rural areas. BISAP score is a scoring system that can be easily calculated with available clinical data even in small hospital setups.
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