Schwannoma is a benign tumour of peripheral nerve sheath. It usually arises from head, neck, and trunk. Retroperitoneal schwannoma is a rare entity, accounting for only 0.3–3% of total schwannomas. Majority of retroperitoneal schwannomas reported in literature have a diameter of 5 to 15 cm. Preoperative diagnosis is difficult due to low frequency, nonspecific clinical course, and nonspecific imaging features. Histology usually provides definitive diagnosis. Schwannomas are solitary, well-circumscribed, and noninvasive, so complete surgical excision provides good result. We report a case of a 23-year-old male, who presented with progressive abdominal distension and intermittent episodes of intestinal obstruction. CECT was suggestive of huge solid-cystic mass in abdominopelvic region. Image guided percutaneous aspiration revealed around 1 litre of frank pus and FNAC was suggestive of abscess. Exploratory laparotomy revealed a large 32 × 28 × 26 cm mass with solid and cystic components containing 1 litre of pus. Histological features of tumour were suggestive of benign schwannoma and immunohistochemistry for S-100 was positive. Postoperative recovery was uneventful. We report this case of a retroperitoneal schwannoma because of giant size, rare location, unusual presentation, and diagnostic dilemma.
Biliary obstructions are rarely caused by a foreign body and have received sparse attention. We present an unusual case with pruritis and abdominal pain caused by impacted full length surgical gauze within the common bile duct. The patient had previously undergone an open cholecystectomy. Radiological investigations were inconclusive and suggestive of either a calculus or a cholangiocarcinoma. Surgical exploration revealed full length surgical gauze within the common bile duct. Because imaging modalities are often non-determinant, the possibility of biliary tract obstruction from a foreign body should be borne in mind for patients with unusual presentations, especially those who have previously undergone surgery.
Background: Trauma is one of the major cause of mortality and morbidity in both developed and developing countries. Polytrauma patients present particular challenges as profile of the patient varies with different types and severity of injuries. Prediction of survival in trauma patients is an essential requirement of trauma care. Trauma and injury severity score (TRISS) have been considered as a standard of the quality of trauma care. Study was carried out to evaluate the performance of TRISS in predicting survival in patients of polytrauma.Methods: Prospective observational study was conducted in emergency department of a tertiary care centre. 100 patients were evaluated in the study for a period of 18 months between November 2019 and April 2021. Patient demographics, details of trauma, pattern of injuries and physiological status were recorded. Overall outcome were studied and data analysis was done on the basis of TRISS. Statistical analysis was performed using statistical package for the social sciences (SPSS) program for windows, version 25.0 (SPSS Chicago, Illinois).Results: Young patients with mean age of 34.54 were most commonly affected in polytrauma with male preponderance. Road traffic accidents were the most common mode of trauma followed by fall from height. Blunt trauma was the most common type of injury. TRISS strongly predicted survival in polytrauma patients (AUC 0.926 CI 95% 0.868-0.985). TRISS has high sensitivity 97.62% and specificity 62.50% at a cut off of 64.50%.Conclusions: TRISS is an effective method for predicting survival of polytrauma patients and thus can be utilized to evaluate and compare trauma care.
Background: In managing patients with intraabdominal emergency such as perforation of bowel due to trauma, intestinal tuberculosis or in patients with mechanical obstruction with strangulation, we are sometimes left with no other option but to constitute a jejunostomy as the patients general condition is very critical or there is intra-abdominal sepsis with high chances of anastomotic leak and eventual mortality. In this article we have evaluated outcomes of jejunal stoma in terms of morbidity and mortality.Methods: Study conducted in the Department of Surgery, VMMC and Safdarjung Hospital, New Delhi. 25 patients were evaluated in study for a period of 18 months between October 2018 and April 2020. Patient demographics, preoperative diagnosis, treatment strategies, surgical procedures, and the post-operative course were evaluated.Results: It was observed that the most common pathologies for formation of jejunostomy were trauma and tuberculosis. patients were readmitted, most commonly due to cause being dehydration and dyselectrolytaemia.80% patient had clavien dindo grade 1 pre-operative complications. Mean time for stoma closure was 5.4 weeks. Most common complication after closure of stoma was Surgical site infection i.e.,9 patients (36%). Overall mortality was 2 (8%).Conclusions: It is concluded from our study that if jejunostomy has to be made due to unavoidable circumstances then the patient requires regular clinical assessment of nutritional parameters and aggressive corrections of any abnormalities and an early closure of stoma. This shows that knowledge of clinical course of patient with jejunostomy can help us to better manage these patients.
Background: Appendectomy has been the treatment for acute appendicitis for years based on the understanding that acute appendicitis always leads to perforation and peritonitis. However, there is growing evidence that a significant proportion of patients can be successfully managed with conservative treatment without developing gangrene or perforation. Conservative treatment avoids discomfort, surgery-related morbidities and minimizes treatment cost.Methods: 60 patients taken up for conservative management were evaluated and followed up for 6 months. Study patients received intravenous antibiotics for 2 days. Repeated clinical and TLC monitoring were done. In patients whose clinical condition did not improve, appendectomy was performed. Follow-up at 10 days, 30 days, 3 months and 6 months were carried out to assess recurrence in conservatively managed patients.Results: In this study, the mean age was 25.65 years with a standard deviation of ±8.96 years. The incidence of uncomplicated appendicitis was 63.3% in males and 36.7% in females. Mean Alvarado score was 7.75 with a standard deviation of ±1.20. Failure of conservative management (conversion to appendectomy) was observed in 11.7% of patients and 4 patients (6.6%) had recurrence within 6 months. The overall treatment efficacy was 81.7%.Conclusions: In many cases, first attack of uncomplicated acute appendicitis can be treated successfully by conservative management. Treatment failure on primary admission as well as short-term recurrence up to six months after conservative treatment is low and acceptable. Incidence of complications like perforation and abscess formation are also statistically low.
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