INTRODUCTIONBurst abdomen (abdominal wound dehiscence) is a severe post-operative complication. Incidence as described in literature ranges from 0.4% to 3.5%.1 Burst abdomen is defined as post-operative separation of abdominal musculo-aponeurotic layers, which is recognised within days after surgery and requires some form of intervention.Various risk factors are responsible for wound dehiscence such as emergency surgery, intra-abdominal infection, malnutrition (hypoalbuminemia, anaemia), advanced age, systemic diseases (uraemia, diabetes mellitus) etc.2 Good knowledge of these risk factors is mandatory for prophylaxis. 3Patient identified as being high risk may benefit from close observation and early intervention.The study aims to find etiological factors of burst abdomen in hospitalised patients, evaluate current management methods and to compare conservative and operative approach with respect to complication and outcomes. ABSTRACTBackground: Burst abdomen (abdominal wound dehiscence) is a severe post-operative complication. Burst abdomen is defined as post-operative separation of abdominal musculo-aponeurotic layers. The study aims to find etiological factors of burst abdomen in hospitalised patients, evaluate current management methods and to compare conservative and operative approach with respect to complication and outcomes. Methods: All cases presenting with abdominal wound dehiscence after surgery were included. An elaborate clinical history was taken in view of the significant risk factors, the types of surgery performed, type of disease involved and management methods and their outcome. A total of 82 cases were included in this prospective study. Data was analyzed using appropriate software. Results: The results concluded that male patients have a higher incidence of laparotomy wound dehiscence and in 5
A 20-year-old male patient presented with complaint of epigastric pain and vomiting, 1 day after an episode of bike handle injury. Ultrasound showed only mild free fluid in the abdomen. The patient gradually developed tachycardia, hypotension and guarding in the abdomen. CT scan revealed complete pancreatic transection between the neck and the body with segmental separation about an inch. Serum lipase was raised. Exploratory laparotomy revealed acute pseudocyst formation and necrotic slough on the transected ends. Distal pancreatectomy without splenectomy was performed. The patient recovered uneventfully.
Background: We profiled the patients of acquired oesophageal strictures coming to our hospital in terms of causes, clinical presentation, efficacy of investigations and treatment modalities.Methods: In this two-year observational study, all patients presenting with complaint of difficulty in swallowing were enrolled and subjected to detailed history taking, examination, barium swallow study and other investigations. The patients were managed with surgical and/or non-surgical approaches, as indicated.Results: Out of total 46 eligible patients, 34 presented with malignant strictures while 12 presented with benign ones. Dysphagia was the commonest symptom in patients with malignant (31, 91.17%) as well as benign strictures (12, 100%). Shouldering with hold up of barium (19, 55.88%) was the most common finding noted in malignant strictures, while those with benign stricture had smooth tapering (7, 58.33%) as the commonest finding. On flexible endoscopy, the level of growth corroborated with the barium swallow findings in all 34 patients with malignant strictures and the lower one third (16, 47.05%) was observed to be the most common site of affection. Majority (21, 58.8%) of patients were having squamous cell carcinoma, with adenocarcinoma dominating in lower one third lesions (13 out of 16, 81.25%). No cases of adenocarcinoma were noted in middle and upper one third lesions.Conclusions: Majority of patients with malignant strictures were having squamous cell carcinoma, with adenocarcinoma dominating in lower one third lesions. Surgical resection led to relief from dysphagia in all the 6 cases of oesophagectomy with oesophagogastric anastomosis in malignant stricture cases with excellent long term survival and symptomatic relief
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