Background: Over decades the treatment of acute pancreatitis remains debatable with no common consensus on treatment guidelines, with some workers using octreotide infusion and some workers only relying on fluid therapy and symptomatic management. This is the first of its kind double blinded comparative trial between omega 3 fatty acid infusion versus octreotide infusion and its response in cases of acute pancreatitis.: Our aim is to study the efficacy of omega 3 fatty acid infusion and set a new treatment protocol in cases of acute pancreatitis with the use of omega 3 fatty acid infusion in all admitted cases of acute pancreatitis unless otherwise contraindicated.Methods: This is the first study where a doubled blinded randomised control trial was undertaken in proven cases of acute pancreatitis and patients were given omega 3 fatty acid infusion and octreotide infusion and the observations were documented and followed upon.100 cases of proven acute pancreatitis were randomised with double blinded closed envelop method. 50 cases were given omega 3 fatty acid infusion and other 50 were given octreotide infusion and the clinical response, symptomatic improvement was assessed and compared using BISAP and Marshal scoring systems and lipase levels. Chi Square test was used along with unpaired t test and p value was obtained in both groups.Results: Omega 3 fatty acid infusion was found to be highly significant as compared to octreotide in cases of acute pancreatitis in terms of clinical improvement, reduced hospital stay, reversal of organ dysfunction and SIRS.Conclusions: Omega 3 fatty acid infusion is the future in cases of acute pancreatitis which is cheap and easily available with no side effects and reduces the morbidity and mortality in acute pancreatits with reduced hospital stay in turn resulting in overall reduced medical expenditure.
IGG4 sclerosing mesenteritis is a very rare occurrence in the elderly which is often missed or undiagnosed. We present a very rare case of 70-year-old female who presented with vague abdominal discomfort associated with a huge intra-abdominal mass of size 18 cm*10 cm hard in consistency in the left hypochondrium slightly extending into the left lumbar region not associated with any bleeding per rectum, anemia, constipation, or features suggestive of obstruction. Diagnostic dilemma was established when contrastenhanced computed tomography abdomen revealed neoplasia of the transverse colon with luminal narrowing, fine-needle aspiration cytology of the mass revealed desmoid tumor, and colonoscopy revealed no luminal narrowing or mass lesion. Hence, the appropriate treatment plan the intraoperative challenges, and geriatric outcomes were taken into consideration.
INTRODUCTION: Acute Calculous cholecystitis(ACC) represents >90% of all cases of acute cholecystitis and accounts for 3–11% of hospital admissions. Obesity is dened as global epidemic by WHO. Obesity is an established risk factor for the cholesterol gallstone and subsequent cholecystectomy. Despite many reports on association of body-weight to gallstone disease, the effect of body-weight in severity of the cholecystitis has been rarely reported. Hence, this study was undertaken to assess the severity of association between the body mass index and severity of acute Calculous cholecystitis. OBJECTIVES: 1. To compare the association of obesity with severity of acute cholecystitis. 2. To study the associated pathological changes in the gall-bladder. METHODOLOGY: A cross-sectional study was carried out over a period of 18months from October2019-July2021 in the department of generalsurgery, Bapuji Hospital, Chigateri General Hospital, Davangere among 50 obese-patients with acute cholecystitis along with obesity(BMI >25kg/sq.mt) undergoing cholecystectomy. The data analysis was done using IBM statistical-package for social sciences(IBM SPSS). RESULTS: The mean age of the study population was 45.22±9.25yrs. The mean BMI of the patients was 29.85±2.76 Kg/sq.mt. 56% were overweight, 38% were obese classI and 6% were obese classII. Based on Tokyo guidelines2013 on acute cholecystitis in the present study 32% had GradeI (mild), 54% had GradeII (moderate) and 14% cases had GradeIII (severe) cholecystitis. There was a statistical signicant association between BMI and severity of cholecystitis with more severe cases with increased BMI. Among 50cases posted for laparoscopic-cholecystectomy 18%cases were converted to open-cholecystectomy. Obesity is a documented risk factor for the forma CONCLUSION: tion of gall-stone and BMI is used as a tool to measure obesity. In our study we found a positive association of body mass index and severity of acute CALCULOUS cholecystitis
Intestinal obstruction secondary to an internal hernia is rare and that occurring through a rent between the adhered inflamed vermiform appendix and appendices epiploicae of the proximal caecum is so rare that this case was the first of its kind ever to be reported. Such a cause for obstruction should be suspected in a patient with a virgin abdomen with no history/clinical features of an obstructing external hernia or abdominal tumor. A 28 year old man presented to the ER with features of intestinal obstruction, in whom CECT abdomen revealed multiple dilated small bowel loops with breaking-of seen in the region of the terminal ileum. Surgical exploration revealed internal herniation of the distal ileum through a rent between the adhered inflamed vermiform appendix and the appendices epiploicae of the proximal caecum; reduction of which was sufficient to relieve the obstruction and demonstrate healthy reperfusion. Adhesiolysis, epiploicae appendectomy and appendectomy was done with no other points of obstruction along the small bowel. Due to its rarity, non-specific presentation pattern and limited usefulness of imaging for diagnosis, a high index of suspicion with prompt early surgical exploration is a must for a successful outcome in such cases intestinal obstruction; especially in a virgin abdomen.
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