Enterocutaneous fistula is a common complication encountered in the post-operative period. It is the most catastrophic problem resulting in significant morbidity and mortality. Various factors have been detected which play a role in the development of enterocutaneous fistulae like age of the patient, time of presentation, Organ of Origin, pathology of the disease, general condition of the patient, metabolic abnormalities, etc. Identification of these risk factors, early diagnosis and early intervention and decision making will give good outcomes. AIM To study the aetiology, risk factors, morbidity and ideal management of enterocutaneous fistulae. MATERIALS AND METHODS Study includes thirty two (32) patients treated for enterocutaneous fistulae in our hospital between January 2012 and December 2014.At the time of diagnosis of the fistula, the patients were classified according to the site of the fistula and the volume of output. They were subsequently investigated and managed according to the standard protocol. RESULTS Mortality is 50% in 5 th decade of life. In the present series, 0% mortality was noted in patients who had duodenum and jejunum as the organ of origin. Ileum and stomach comprised of 25% each in the contribution to mortality while 50% of all the patients with colocutaneous fistulae died subsequently. High output fistula has mortality of 27.77%. Mortality of 20% and 27.41% was noted in patients were managed conservatively and by surgery respectively. CONCLUSION Index surgery early admission, an adequate antibiotic cover, vigorous resuscitation replacing fluids and electrolytes, blood transfusions, monitoring of all basic parameters and rightful decompression of the proximal bowel are all important measures to prevent the development of an enterocutaneous fistula. Prevention plays a definitely important role in patients with enterocutaneous fistulae.
Diabetic foot is the most common complication of diabetes. Amputation which is the end result of diabetic foot disease is associated with significant morbidity and mortality. Since it is crucial to identify those at an increased risk of diabetic foot complications, a detailed study of the natural history of diabetic foot, various clinical characteristics, according to Wagner grading of lesions, their outcome and management protocol followed in our hospital was undertaken in our hospital. AIM AND OBJECTIVE: Evaluation of diabetic foot lesions based on Wagner grading system, outcome and management protocol followed in our hospital. MATERIALS AND METHODS: A prospective study done on hundred diabetic foot patients in our own hospital over a period of one and half year. Data was obtained from a questionnaire developed to record the medical history, examination details, investigations reports, treatment details and final outcome at the end of stay. Infection was classified based on Meggitt-Wagner, classification/grading. RESULTS: Diabetic foot was very common in elderly age group (>55yrs) 54% and male dominant (87%). Majority of them had diabetes for more than five years (47%) and complications of diabetes were present on admission in 15% of them. Grade I(29%), Grade III (27%) & Grade IV (24%) lesions based on Wagner's grading accounted for majority of diabetic foot lesions. Multiple toe disarticulation/ above knee / below knee amputation accounted for a quarter (23%) of surgical interventions in our hospital. The glycemic control in most of patients was very poor with RBS>200 mg/dl (70%) and glycosylated hemoglobin>7g% (74%) of them. A quarter of the patients stayed for at least a month in the hospital (25%). CONCLUSION: It can be concluded that diabetic foot in various forms accounts for significant morbidity in the surgical wards. Wagner's grade I (29%) Grade III (27%), Grade IV (24%) constituted majority of lesions. Factors contributing mainly are poor glycemic control at the time of admission, presence of gangrene, complications of diabetes nephropathy, neuropathy and associated co morbidities (peripheral vascular disease, hypertension, ischemic disease). A lot of scope for improvement is their in the approach to treatment of diabetic foot as most of the cases belong to Grade I (29%) where proper patient education can avoid dreadful complications and Grade III (27%), Grade IV (24%) if properly managed morbidity can be reduced considerably.
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Abdominal tuberculosis is the 6 th most common form of extrapulmonary tuberculosis, among which ileocaecal tuberculosis is most common. Tuberculosis has been declared a global emergency by the World Health Organization (WHO) and is the most important communicable disease worldwide. Approximately one third of the world population is infected and about three millions die each year from this disease. It presents with a wide variety of symptoms and signs. Gastrointestinal tuberculosis presents to emergency department as subacute intestinal obstruction, acute intestinal obstruction and peritonitis. Although Antitubercular chemotherapy is the mainstay in treatment of abdominal tuberculosis, surgical intervention becomes necessary for two reasons-diagnostic and therapeutic. Diagnostic laparotomy becomes necessary for histopathological/microbiological diagnosis, more often in patients with peritoneal or lymph node TB. Therapeutic surgery is the treatment of choice in emergency for treating intestinal obstruction & peritonitis. Morbidity and mortality will be high in patients with late presentation and associated comorbidities. AIMS AND OBJECTIVES: (1) To study various modes of presentation and management of Gastrointestinal Tuberculosis at emergency surgical care, in our hospital, its management and outcomes. (2) To evaluate the morbidity and mortality in acute presentations of Gastrointestinal tuberculosis. MATERIALS AND METHODS An Observational study of 40 patients admitted in the acute surgical care unit of Our Hospital, Hyderabad, presenting with acute abdomen who have been confirmed to have Gastrointestinal tuberculosis at laparotomy and on histopathology from Aug 2013 to Aug 2015. The patient was managed by laparotomy and procedure according to the mode of presentation. All the patients were given ATT post operatively. RESULTS Gastrointestinal tuberculosis is more common in 2 nd and 3 rd decade of life. Acute presentations were found to be more common in male. Intestinal obstruction is one of the commonest presentation of gastrointestinal tuberculosis presenting as surgical emergency and contributes significantly to high morbidity and mortality. Morbidity and mortality is less in the study due to early intervention and effective chemotherapy. CONCLUSION A high index of suspicion, proper evaluation and therapeutic trial in suspected patients is essential for an early diagnosis and timely definitive treatment, in order to decrease the morbidity and mortality associated with this disease.
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