Background: Despite extraordinary advances in modern radiology and laboratory investigations an accurate diagnosis of acute appendicitis cannot be made in atypical cases. No single diagnostic aid can dramatically reduce the rate of negative appendicectomy.Methods: To reduce the rate of negative appendicectomies, application of RIPASA and Alvarado scoring done in every clinically diagnosed cases of appendicitis in a prospective study from January 2015 to January 2016 was done. 100 patients with right lower quadrant abdominal pain fulfilling the inclusion and exclusion criterion underwent appendicectomy in Mahatma Gandhi Hospital, Dr. S.N. Medical college, Jodhpur, Rajasthan, India.Results: The results of both scoring system were reported and were correlated with intraoperative and histopathological findings. Chi-square test was applied to calculate the p-value for the association between the variables of studied. The mean age was 24.86 years (10-80 years) and there were 61 males and 39 females in the study. Histopathological examination confirmed appendicitis in 95 patients with 5 negative appendicectomies. Negative appendicectomy rate for RIPASA and Alvarado score was 2.17% and 1.54% respectively. Accuracy for RIPASA and Alvarado score was 93% and 68% respectively.Conclusions: RIPASA score is a more valuable tool for diagnosing acute appendicitis with 93% accuracy, sensitivity 94.74% and specificity 60%; inspite of sophisticated investigations like CT, thus reducing the cost of treatment and minimize negative appendicectomy rate.
Background: Infection is a common cause of morbidity and mortality in burn patients. Clinical diagnosis of bacteremia and/or sepsis in burn patients is difficult for a number of reasons. It could be symptomatic and/or asymptomatic as a result of immune deficiency secondary to thermal injury.Methods: A retrospective study was conducted at Mahatma Gandhi Hospital Burn Unit Associated with Dr. S. N. Medical College, Jodhpur, Rajasthan. Fifty burn patients were investigated for bacterial profile of burn wound infections. Specimens were collected on 3rd and 7th day of burns in the form of wound swabs. The organisms were isolated and identified by standard microbiological methods. Antimicrobial susceptibility test was done by Kirby -Bauer disc diffusion method.Results: Gram negative organisms were found to be more prevalent. The most common isolate was Pseudomonas aeruginosa (P. aeruginosa) -38%, followed by Staphylococcus aureus (S. aureus) -35%, Klebsiella spp.-8%, Acinetobacter spp -5%, Staphylococcus epidermidis - 5%, Proteus spp. -3% and Escherichia coli -1%.Conclusions: Pseudomonas was the commonest cause of infection in fire burn patients in our setting followed by S. aureus. About 82% of the isolates showed multiple resistances. In light of our findings, regular antibiotic resistance test has to be done for each patient in order to select an appropriate antimicrobial agent.
Left-sided acute appendicitis (LSAA) is a rare cause of acute pain in the abdomen and is associated with developmental anomalies such as situs inversus (viscus) totalis (SIT) and midgut malrotation (MM). Due to the rarity along with the atypical presentation, diagnosis of LSAA is difficult, and if it is not managed timely, complications of appendicitis such as perforation can result. Imaging including contrast-enhanced CT scans and ultrasound aids in establishing the diagnosis. In case of a diagnostic dilemma, a diagnostic laparoscopy is an optimal option that offers diagnostic as well as therapeutic benefits. Operative intervention, preferably laparoscopic, is the standard treatment of LSAA. We report a case of appendicitis in a 36-year-old man with SIT detected radiologically who presented with pain in the left side of the lower abdomen for two days. Minimal tenderness was noted on the left iliac fossa during per abdominal examination. Abdominal ultrasonography was showing probe tenderness in the left iliac fossa, and contrast CT of the abdomen was suggestive of appendicitis with SIT. The patient was managed by laparoscopic appendicectomy. Therefore, we conclude that LSAA should be listed in the differentials of the various causes of left-sided pain in patients with SIT or MM. Clinical diagnosis is often difficult, and CT scan is crucial to establish the diagnosis as well as confirm rotational anomalies. Surgery, preferably laparoscopic, represents the appropriate treatment of LSAA.
Background: Bowel obstruction is one of the most common causes of acute abdomen and also a common surgical emergency.The causes of IO vary significantly depending on geographical location. The aim of this study was to identify the etiology, clinical presentation, management and outcomes of patients with acute mechanical IO presenting in Jodhpur, Rajasthan.Methods: A prospective study was conducted at Mahatma Gandhi Hospital and Mathura Das Mathur Hospital (associated with Dr. SN Medical College), Jodhpur, Rajasthan. 100 patients with acute intestinal obstruction were admitted and evaluated. Blood routine, X-Ray abdomen, USG abdomen and CECT (if required) were done. A pre-operative diagnosis was made. Intra-operative findings and Post-operative complications were noted and follow up was done till the patient was discharged from the hospital.Results: A total of 69 male and 31 female patients, presented with acute mechanical IO during the period of the study. Mean patient age was 48.5 years with peak incidence in those aged 31-45 years. The foremost signs and symptoms were abdominal distension (88%), obstipation (87%), abdominal pain (81%) and nausea/ vomiting (47%). Adhesions and bands (29%), hernia (13%), neoplasm (9%) and pseudo-obstruction (8%) were the leading causes of intestinal obstruction. The sensitivity of X-ray and USG in present study was 67% and 75% respectively. Most common complication associated was wound infection (17%) followed by paralytic ileus (7%) and respiratory tract infections (6%). Late presentation was associated with poor prognosis. 4 patients expired before surgery. Post-operative mortality was associated with 6 patients and was more common in cases which presented with gangrenous bowel.Conclusions: The most common causes of IO in this study were adhesions and bands, hernia, neoplasm and pseudo-obstruction. Presence of bowel gangrene was associated with higher morbidity and mortality.
Trichobezoar, a rare disorder commonly seen in psychiatric patients having a habit of plucking and eating their own hair, is a ball of hair admixed with gastro-intestinal secretions that leads to the blocking of the passage of food particles. Presentation of the disease is variable, ranging from asymptomatic to severe complications including obstruction and perforation. We report a case of a 27-year-old female patient who presented with an acute abdomen and on laparotomy, gastric perforation secondary to large gastric trichobezoar was found. The patient was treated with en bloc removal of the trichobezoar.
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