Background: Chronic abdominal pain is a major cause of surgical dilemma. Patients with chronic abdominal pain usually undergo a battery of investigations without yielding much in diagnosis. The pain in such patients therefore becomes chronic and perpetual source of discomfort. This study was under taken to assess the efficacy of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominal pain for longer than 3 weeks or more.Methods: This prospective study was performed at a tertiary care level hospital. All patients undergoing laparoscopy for chronic abdominal pain were included in the study from December 2013 to June 2015. The patient’s demographic data, duration of pain, diagnostic studies, intra-operative findings during laparoscopy, interventions performed and follow-up were recorded and evaluated.Results: A total of 50 patients, 22 females and 28 males, between age range of 10 years to 60 years underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average duration with pain was 10.38 weeks (range 4-32 weeks). Findings included abdomen chronic appendicitis in 15 patients, abdominal tuberculosis in 11 patients, ovarian cyst five patients, sub acute intestinal obstruction in five patients and liver abscess four patients. Meckel’s diverticulum, ectopic pregnancy, pelvic abscess, appendicular lump, Psoas abscess and typhilitis were noted in one patient each. Various procedures in accordance with pathology were performed. 92% of patients had pain relief at the time of follow up.Conclusions: Diagnostic laparoscopy is a better, cost-effective, and efficient method of establishing the diagnosis in patients with chronic abdominal pain.
Pilonidal disease is a common acquired surgical problem, which becomes the cause of marked discomfort and absentism amongst young men. It occurs in the cleavage of intergluteal cleft and is infamous for the recurrences following surgery and the associated prolonged wound care. Pilonidal sinus disease usually presents with an acute abscess, which later becomes a sinus with recurrent similar abscesses. Pilonidal sinus disease is of acquired origin and has multifactorial etiology. Many options are available in the management inclusive of conservative methods and operative procedures. Pilonidal sinus disease has remarkable recurrence rates after all the described surgical procedures. We studied cases of pilonidal sinus disease for their demographic pattern, clinical presentation and the applied surgical procedure. Recurrent pilonidal sinuses were evaluated for the possible cause of failure after previous surgical procedure. We present the article with thorough review of recent literature on pilonidal sinus disease.
Objective: Retrograde Intra Renal Surgery (RIRS) is a minimally invasive surgical modality for the treatment of renal stones. We evaluated the efficacy of RIRS in children below aged 12 years of age in the form of stone-free rate (SFR), complications and the feasibility of the procedure. Materials & methods: This retrospective study included all children ≤ 12 years of age, with upper urinary tract stones single or multiple ≤ 15 mm in size who underwent RIRS between February 2019 to November 2021. RIRS was performed with 7.5 Fr flexible ureterorenoscope over the guidewire, the stones were dusted with Laser and the ureteral stent was left after RIRS. All patients had the post-procedure stent removed within 3 weeks after checking for residual stones with X-ray and ultrasonography of Kidney-Ureter-Bladder (USG-KUB). Follow-up USG KUB was done at 4 months. Results: 15 patients included in our study met the inclusion criteria. The mean age was 8.7 ± 2.8 years, the mean stone size was 11.26 ± 2.14 mm and 26.6 % had multiple stones. Retrograde access failure was noted in 36.3 % in non stented patients. The mean operative time was 72.6 ± 20 minutes, fluoroscopy time was 4.4 ± 0.9 minutes and the mean LASER time was 26 ± 3.9 minutes. The mean hospital stay was 2.8 ± 0.9 days. Ureteral access sheath (UAS) was used in one patient. Conversion to mini PCNL was done in one pre stented patient due to access failure and one patient had a second look RIRS for residual stone. No major complications were noted except onr patient who had sepsis. The stone-free rates were 93.3% after primary RIRS and 100% after second look RIRS. Conclusions: RIRS is a feasible, safe procedure for pediatric upper urinary stones with excellent stone-free rates and a low rate of complications.
Case report of splenic abscess in a 35 year old male is presented with review of the literature. The patient was admitted with left sided lower chest pain and fever without any significant abnormality on physical examination and haematological investigations. On imaging studies a large splenic abscess was diagnosed which was initially treated by broad spectrum antibiotics. Aspiration under sonographic control was unsuccessful due to thick pus and debris in the abscess. Open splenectomy was done with a complete recovery of the patient. Splenic abscess is an infrequent clinical entity and carries a very high mortality in the untreated cases. Pathognomic clinical features of left hypochondrial pain, splenomegaly, fever and leucocytosis are present in only one-third of the cases. Diagnosis is mostly done by imaging, either Abdominal Sonography or CT Scan. So far no prospective study has been done to rationalize the management, probably due to paucity of cases. Antibiotics alone or with percutaneous drainage under imaging control are successful in many cases. Failed aspirations and splenic abscesses with concomitant pathologies need splenectomy. Splenectomy and complete removal of the source of the infection is still the mainstay of treatment. Detailed review of the available literature of the clinical problem and various methods of treatment of splenic abscesses are discussed in the article. KEYWORDS: Splenic Abscess, Percutaneous drainage of splenic abscess, Splenectomy. INTRODUCTION:Splenic abscess is an infrequent clinical entity. International literature has less than 600 reported cases so far. (1) Splenic abscesses have a very high mortality in untreated cases. Pathognomic clinical features of left hypochondrial pain, fever, splenomegaly and leucocytosis are present in only one-third of the cases. Diagnosis is mostly done by imaging i. e., Sonography or CT Scan. Various treatment modalities like aspiration under imaging control with appropriate antibiotics and splenectomy by open or laparoscopic approach have been described. So far no prospective study has been done to rationalize the management probably due to the paucity of cases.
This observational study was conducted on the victims of blunt abdominal trauma from 1 st January 2012 to 31 st October 2013 at Sri Aurobindo Medical College and Postgraduate Institute, Indore, which is a leading tertiary care centre in Central India. Fifty three patients of blunt abdominal trauma were included in the study and analysed on the basis of clinical profile, demographic pattern and overall outcome of the injuries. Road traffic accident was the commonest cause (74.47%). Sex distribution ratio showed male preponderance (81.13%). More than half (55%) were from the middle age group (20 to 40 years). These men must have been the sole breadwinners of their families and we can only imagine the socio-economical impact on their families. Most of them were involved in automobile accidents which could have been prevented. Increased use of fast moving vehicles and lack of knowledge about traffic regulations are responsible for these accidents. In the coming days the problem of polytrauma is going to increase in our hospitals. We should try to prevent the menace of automobile accidents. Rules and regulations of road safety and precautions while using the automobiles have to be imbibed at an earlier age. Schools, social media and licensing authorities of the government will have to play an important role in this matter. In spite of latest gadgets and state of art medical care facility, the outcome of abdominal trauma is marked by significant morbidity and mortality as it depends on concomitant injuries and unique problem of postoperative abdominal sepsis. We feel that proper understanding of etiology and pattern of blunt abdominal trauma may help in improving the final outcome. HOW TO CITE THIS ARTICLE:
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