CESF are rare injuries. Early surgery in the form of debridement with broad-spectrum antibiotic coverage is recommended to prevent infectious complications and improve outcome. Outcome is dependent on three main factors-admission GCS score, intactness of duramater and post-operative CNS infections.
Laparoscopic cholecystectomy has rapidly become established as the popular alternative to open cholecystectomy, but it should have a safety profile similar to or better than that of open procedure. The aim of this study was to compare conventional cholecystectomy and laparoscopic cholecystectomy with respect to duration of procedure, complications, postoperative pain, analgesic requirement, antibiotic requirement, resumption of normal diet and period of hospital stay.50 patients with symptoms and signs of acute acalculous/calculous cholecystitis, selected randomly, were included in this study. Clinical profile, investigations, treatments, outcomes were analyzed. The highest age incidence was in the 5 th decade, more common in females. Pain in the RUQ of abdomen was the most common symptom. Ultrasonography showed gallbladder stones in almost all patients. The duration of LC (120min) was more than for OC (90min). The conversion rate of LC to OC was 8%. Post-operative morbidity was more in case of LC. The antibiotic and analgesic requirements were less in LC group. The resumption of normal diet was 2 days earlier in LC compared to OC group, and the hospital stay was 4 days less in LC group. The result showed the incidence of acute calculous/acalculous cholecystitis more in females, 5 th decade, presented more commonly with pain abdomen. Ultrasonography was the most common investigation. Laparoscopic cholecystectomy reduces the number of antibiotic and analgesic requirement, hospital days, pain disability, wound infection, and with better cosmesis, except for the prolonged operative time, which can be minimized in due course of time as the learning curve progresses.
From the standpoint of pathology, the term pyloric stenosis is usually inaccurate at least in adult patients, since the site of obstruction is rarely situated at the pylorus itself but is more often placed immediately proximal to the sphincter where the diagnosis of carcinoma is most probable or more distally in the duodenal bulb where the cause is almost invariably a duodenal ulcer. This study has been taken up to review the changes in presentation of gastric outlet obstruction in view of changing trends in the aetiology analysing the occurrence of benign and malignant causes, signs and symptoms, investigatory modalities, management and their results. The present study is an observational study a total of 50 cases were studied with Cicatrised duodenal ulcer and carcinoma pyloric antrum being the major causes. Clinical profile, investigations and treatment outcomes were analysed. The majority of patients had malignant gastric outlet obstruction with 32[64%] patients presenting with Gastric cancer and 18[36%] patients presenting with cicatrised duodenal ulcer. In this study most patients were in the fifth and seventh decades of life. Men outnumbered women by 3: 1. The clinical presentation is not different from those in other studies with non-bilious vomiting being common to all the patients with dehydration. Visible gastric peristalsis and succussion splash were more prominent in Cicatrised Duodenal Ulcer. All cases were subjected to serum electrolyte estimation. Out of them 20 cases [40%] showed electrolyte imbalance barium meal, ultrasound abdomen pelvis and CT scan abdomen being the other investigating tools. Blood group 'O' was common in cicatrized duodenal ulcer patients [77.7%] followed by blood group 'A' [11.1%]. Upper GI endoscopy was done in all cases [100%]. 32[64%] cases had pyloric antral Carcinoma in which 23 cases had fungating growth and the rest 9 had ulcerative growth and 18[36%] had cicatrized duodenal ulcer. 100% of cicatrized duodenal ulcer patients underwent truncal vagotomy with posterior gastrojejunostomy. In carcinoma of pyloric antrum, 56.25% underwent Billroth II Polya gastrectomy after subtotal resection and 25% underwent anterior gastrojejunostomy and 18.75% underwent feeding jejunostomy alone depending on the stage of the disease. The average hospital stay was 10 days. The overall mortality rate was 6% (9.3% for malignant cases). Mortality rate was zero in case of cicatrised duodenal ulcer. Surgical site infection was the most common post-operative complication accounting for 38.2% of cases. One patient with carcinoma pyloric region developed duodenal blow out on the 5th day and died due to biliary sepsis.
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