To highlight a very uncommon presentation of intestinal perforation in a child caused due to foreign body. 10-year-old kid presented to the emergency with chief complains of pain abdomen for 2 days. There was no evidence of any peritonitis. X-ray and Contrast enhanced computed tomography scan revealed no pathology other than gas under diaphragm. On exploration there was a concealed perforation caused due to chocolate stick ingested by the kid. There was no free fluid or contamination found in the peritoneal cavity. Foreign body ingestion by kids is very common. 80-90 % these objects pass with stool not causing any injury to the viscera. In 10 to 20 % cases they require endoscopic removal. 1 % of these cases can cause perforation and have to be removed surgically. Majority of the times these foreign bodies are not seen on X-rays or CT scans. There may be cases in which patients may not present with features of perforation peritonitis but still patients must be assessed properly to undertake intervention at appropriate time to reduce complication. In such children presenting to emergency with acute pain abdomen, a high degree of suspicion for foreign body ingestion should be kept in mind and evaluated accordingly. Keywords: Concealed perforation, Pediatric age group, No signs of peritonitis, X-ray, CECT Whole abdomen
Introduction: Like elsewhere Government in India took some drastic steps including nationwide lockdown, conversion of fully functional hospitals into coronavirus infectious disease (COVID) facilities to address the COVID 19 pandemic. As the impact of these measures on surgical patients is little studied in India, this study was undertaken to evaluate and assess the hardships of surgical patients at a teaching hospital in Northern India. Materials and Methods: This study included all patients who got discharged from surgery ward at the study site in March 2020. For data collection patients were contacted telephonically and a pretested semi-structured questionnaire was used to assess the logistic, financial and healthcare related concerns/barriers these patients experienced after their discharge in seeking medical care and anxiety levels related to their health and lockdown at the time of interview. Results: We could contact 63 patients out of maximum possible 85 patients (Response rate = 74.1%). A total of 26 patients (41.3%) visited health-care facilities other than the study hospital amounting to a total of 44 visits. Only 14 participants (53.8%) faced no difficulty whereas 12 (46.2%) experienced at least some difficulty in visiting these facilities/providers to receive health care. Almost all of them (23 participants, 88.5%) had to spend more time while over two fifth (11 participants, 42.3%) reported of spending more money than usual during these visits. Over a third (20 patients, 38.5%) experienced at least some anxiety while almost half of them (48.1%) were stressed more than usual with a significant 7.7% participants experiencing severe stress. Conclusion: There was hardship experienced by significant number of surgical patients during the initial lockdown phases in India. We recommend more research -both qualitative and quantitative -to better establish the impact of stringent measures on care of surgical patients.
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