BACKGROUNDWith an exponential rise in the prevalence of HIV infection among the population the incidence of surgical emergencies in these patients is also high. Keeping in view of the immunocompromised state, a Retrospective Observational Study was done to look at the causes and also the outcomes with regards to CD4 cell count. METHODSCase Records of 127 patients who were admitted to the Emergency Surgical Ward, diagnosed/screened positive for HIV positive status over a period of three years were studied. The various types of surgical emergencies and outcomes following interventions among these patients were analysed with regards to the CD4 cell counts. RESULTSAcute abdomen was the commonest surgical emergency reported among these patients where 93 patients out of 127 presented with acute abdomen whereas remaining 34 patients had nonabdominal surgical causes. Morbidity reported among these patients has no relation to the CD4 cell count whereas mortality was seen mostly among patients with low CD4 cell count. CONCLUSIONAcute surgical emergencies are no longer uncommon among patients with HIV positive status and the outcomes are also reasonably good. A thorough and a careful clinical evaluation is mandatory before a surgical intervention is planned as a significant number of patients can be managed conservatively.
Enterocutaneous fistula is a common complication encountered in the post-operative period. It is the most catastrophic problem resulting in significant morbidity and mortality. Various factors have been detected which play a role in the development of enterocutaneous fistulae like age of the patient, time of presentation, Organ of Origin, pathology of the disease, general condition of the patient, metabolic abnormalities, etc. Identification of these risk factors, early diagnosis and early intervention and decision making will give good outcomes. AIM To study the aetiology, risk factors, morbidity and ideal management of enterocutaneous fistulae. MATERIALS AND METHODS Study includes thirty two (32) patients treated for enterocutaneous fistulae in our hospital between January 2012 and December 2014.At the time of diagnosis of the fistula, the patients were classified according to the site of the fistula and the volume of output. They were subsequently investigated and managed according to the standard protocol. RESULTS Mortality is 50% in 5 th decade of life. In the present series, 0% mortality was noted in patients who had duodenum and jejunum as the organ of origin. Ileum and stomach comprised of 25% each in the contribution to mortality while 50% of all the patients with colocutaneous fistulae died subsequently. High output fistula has mortality of 27.77%. Mortality of 20% and 27.41% was noted in patients were managed conservatively and by surgery respectively. CONCLUSION Index surgery early admission, an adequate antibiotic cover, vigorous resuscitation replacing fluids and electrolytes, blood transfusions, monitoring of all basic parameters and rightful decompression of the proximal bowel are all important measures to prevent the development of an enterocutaneous fistula. Prevention plays a definitely important role in patients with enterocutaneous fistulae.
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