It is often stated that the majority of large bowel neoplasms can be diagnosed by rigid sigmoidoscopy since they lie within range of the instrument (I). A prospective study was undertaken by one clinician to determine how often in practice it is possible to make a full sigmoidoscopic examination and to attempt to determine some factors that may be responsible for the failure to d o so.Rigid sigmoidoscopy was carried out in 238 consecutive new outpatients. The examination was performed without preparation of the bowel using Lloyd-Davies' pattern instrument (length 25cm, diameter 1.8cm) with the patient in the left lateral position. The furthest distance passed was recorded and, where the examination was considered to be limited, the reason was given to be the result of discomfort of the patient, the inability of the examiner, the presence of faeces obscuring vision or pathological narrowing of the bowel.The furthest distance the instrument could be passed was less than 14cm in 18 patients (7.5 per cent), from 14 to less than 16cm in 54 (22.7 per cent), from 16 to less than 22cm in 52 (21.9 per cent) and greater than 22cm in 114 (47.9 per cent). Examination beyond 16 cm was possible in 113 of 138 men (82 per cent) and 53 of 100 women (53 per cent), a significant difference (2' = 26.1; P
Bochdalek hernia (BH) is the commonest congenital diaphragmatic hernia, caused by the failure of the posterolateral diaphragmatic foramina to fuse properly. It is extremely rare in adults and accounts for 5-10%. Presenting a case of 48 years female with complaints of dry cough and left chest pain for 1 week. Diminished breath sounds and abnormal gurgling sounds heard on auscultation of left chest wall. X-ray chest showed elevated left hemi diaphragm and gastric bubble. Computed tomography (CT) chest revealed left diaphragmatic hernia with splenic flexure, transverse colon, mesocolon, spleen and upper pole of left kidney as content and atelectasis of left lung lower lobe. Patient underwent laparoscopic repair of hernia with mesh plasty. Intraoperatively, the contents were reduced into the abdominal cavity and left lung expansion noted. The defect of size 6×10 cm in the left diaphragm was sutured and composite mesh placed. Post-operative chest x-ray showed expanded left lung. On follow up of patient after 2 weeks and 1 month, patient was asymptomatic. BH in adults is an uncommon. The contents can be reduced via thoracic or abdominal approach, with abdominal approach having easier access. With the advent of minimal access techniques, delineating clear anatomy, more working space, early recovery, and early return to home and work is possible. Thus, laparoscopic repair of adult diaphragmatic hernia is a safe and effective modality of surgical treatment.
Background: Inguinal hernia surgery has continued to evolve historically from tissue repair to the present tension free repair by using mesh. Various tension free mesh repair have been demonstrated throughout the years after lichten stiens tension free meshplasty but inguinodynia continues to be a problem with all hernioplasties. All-in-one mesh hernioplasty showed zero incidence of inguinodynia in 50 patients who underwent this novel procedure. The primary aim of the study was to compare between all in one meshplasty vs conventional open meshplasty in inguinal hernia in tertiary care setup.Methods: Our study was done in SRM Medical college and research center attached to SRM University in Kattankullathur, Chennai for one and half year. It was comparative study between all in one meshplasty verses conventional meshplasty. A sample size of 100 patients was the part of this study, out of which 50 underwent mesh fixation by all in one meshplasty and 50 patients underwent mesh fixation by conventional meshplasty.Results: All-in-one meshplasty can be considered superior to conventional meshplasty in view of incidence of post-op neuralgia, operative time, duration of stay in hospital.Conclusions: All-in-one meshplasty can be considered as a good replacement for conventional hernioplasty in inguinal hernia repair expecting lesser post-operative morbidity and a better quality of life post-operatively.
Rectus sheath hematoma (RSH) is a rare but potentially life threatening complication of caesarean delivery. The nonspecific nature of entity, lower incidence of disorder and acute presentation may posses’ difficulty in timely recognizing this. Present patient presented as acute abdominal pain 38 hours post caesarean section. This is an attempt to increase the awareness of this rare but potentially grave condition, as timely diagnosis and fast intervention saved present patient.
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