Background: Fissure-in-ano is a very common anal disorder which predominantly presents with severe pain. Lateral internal sphincterotomy remains the main treatment modality. This may be performed using open or closed method, each with their attendant complications. Objective: This prospective study compared the results and complications of open versus closed technique of lateral sphincterotomy in patients with chronic anal ssure. Materials and Methods:Atotal of 64 patients with chronic anal ssure were enrolled in this study. Of these, 34 patients underwent open lateral sphincterotomy, and 30 underwent closed sphincterotomy. They were followed up for 6 months postsurgery. The results and complications of the two groups were compared and statistically analyzed. Results: Post-operative complications such as pain, bleeding, infection, incontinence, and recurrence were compared between the two groups. Pain, bleeding, and incontinence to atus were signicantly lesser in the closed group (P < 0.05), while there was no difference in the incidence of infection and recurrence between the two groups. Conclusion: Closed lateral internal sphincterotomy is a better alternative compared to open sphincterotomy in the treatment of chronic anal ssures.
Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies. Methods: A total 140 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of WBC count, C-Reactive protein (CRP), USG and Alvarado scoring system and were subsequently operated, were included in the present study in our institute. Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients.Most of the patients of acute appendicitis presented with more than one of above symptoms. The most common presenting symptom was right iliac fossa pain affecting 96.19% of cases (migratory 62.86% and non-migratory 33.33%), followed by anorexia (78.10%) and nausea (66.67%). The other symptoms were fever (65.71%), vomiting (46.67%), constipation (28.57%), right sided flank pain (22.86%), dysurea (19.05%), suprapubic pain (15.24%), diarrhoea (14.29%) and generalized abdominal pain (13.33%) in decreasing order of frequency. Right iliac fossa pain was the most common presentation in non-appendicitis group, followed by anorexia. There was no significant difference in symptoms among these two groups.In this study 54.29% of patients with acute appendicitis had Alvarado score between 7 – 8 and 34.29% of patients with acute appendicitis had Alvarado score between 9 – 10. On the other hand majority of the patients of non-appendicitis group had a score below 7. Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.
Background: Following injury to the extremities and head, abdomen is the third most commonly injured part of the body. Blunt abdominal trauma (BAT) is particularly deceptive because of the delay in clinical manifestations for hours or even days, even though the damage to the internal organs might be serious and lethal. Road traffic accident (RTA) is the most common mode of injury to cause BAT. Diagnostic modalities like FAST and CT scans have caused a significant change in the trends regarding management from surgical to a more conservative approach. Current research aimed to study the blunt trauma abdomen with respect to management and outcome in GMC, Bettiah, W. Champaran, Bihar. Material and methods: This observational study is based on 50 cases of BAT who presented in Department of Surgery, Govt. Medical College & Hospital, Bettiah, Bihar with respect to clinical presentation, investigations, management and outcome. Results and outcomes will be depicted in various tables. Results: In the present study, demographic data like age and sex, the mode of injury, presenting Hb (in gm%), commonly injured organs, the management done and the associated mortality was observed and compared. It was found that BAT commonly involves young males in the age group of 30-40 years. RTA is found to be the most common mode of injury. Spleen was the most commonly injured solid organ followed by liver. Hollow viscus injury was seen in 10 out of 50 patients in our study. Conservative management was done in 37 out of 50 patients. Mortality was observed in 3 out of 50 cases. Conclusion: The study was conclusive of the fact that young males who sustained BAT due to RTA were the most commonly affected group. It also was conclusive that spleen and liver are the most commonly injured organs in BAT and conservative management should be followed wherever possible. Mortality was significantly higher in patient presenting with decreased hemoglobin.
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