Introduction: Internal hernia presenting with intestinal obstruction is a rare entity with reported incidence of 0.6% to 5.8% only. The present case is of internal herniation through a peritoneal rent in the Pouch of Douglas, occurring six years after abdominal hysterectomy. Till date only 4 cases of hernia through a rent in pouch of Douglas are reported.
Objective: Presenting here a case of internal hernia which was treated successfully
Conclusion: Internal hernia occurring through peritoneal rent in Pouch of Douglas and presenting with intestinal obstruction six years after abdominal hysterectomy is rarest of its kind.
Background: Fournier’s gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors.Methods: It is a descriptive prospective study in 71 patients with FG treated at Pravara Rural Medical College and Hospital, Loni, who presented between September 2013 and September 2015.Results: In the present series of 71 patients, 57% were between 50-70 yrs. UTI and alcohol consumption being most common co-morbid conditions and scrotal abscess (53.52%) being the most common presentation. Serum creatinine (p value 0.0008), total leucocyte count at presentation (p value 0.004) had a significant association with duration of recovery. The mean duration of stay was 16.08±3.28 days with a median of 15 days. The Fournier gangrene severity index score calculated was <9 in 59.15% of patients, and >9 in the remaining ≈40% with a mean of 8.309±3.49. A single mortality was recorded during our study.Conclusions: Serum creatinine and total leucocyte count at presentation could play a pivotal role in not only initial emergency management but also as factors for monitoring the progress of treatment.
Background: Wound care management has long been a primary point of care for surgeons and clinicians alike. The burden of care and time required in the management of wounds has led to development of innovative and expensive materials which alleviate the burden of healing on our physiology and reinforce the healing mechanisms. Methods: A case series analysis of 240 patients included on accrual was carried out. These patients were randomly assigned to 3 groups. Group A ulcers were dressed with 2% acetic acid soaked sterile pads. Group B received the acetic acid-iodine combination and group C dressed with traditional Povidone-Iodine ointment and solution. These ulcers were evaluated on admission and on intervals of 5 days with a customized scoring system, Dr. Kamal’s adaptive wound healing score (KAWHS). A sterile culture swab with coverage of healthy granulation tissue was considered the primary end point of the study. Results: Resolution of slough was significantly earlier in group A and B as compared to group C. odor subsided earliest in group A, followed by group B and C. Resolution of purulent discharge was achieved earliest in Group B which was significant in comparison to group A and C. Wound healing was observed to be better in acetic acid usage groups. Conclusions: Acetic acid dressings are effective in treating chronic non-healing wounds with mono and poly-microbial culture.
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