Background: An enterocutaneous fistula is the abnormal communication between two epithelialized surfaces, one of which is a hallow organ. The discharge of intestinal content into the skin constitutes major nursing challenge. The most important complications include infection and sepsis, electrolyte imbalances and malnutrition, which when not managed properly will lead to grave outcome. Aims: To evaluate the causative factors, the various modes of management and the outcome of such intervention. Methods: Retrospective study of the patients admitted and treated for enterocutaneous fistula due to operative causes were evaluated in Dept of General Surgery S.C.B. Medical College and Hospital, Cuttack from 2014 to 2016. Results: Enterocutaneous fistula frequently follow emergency surgery on gastrointestinal tract, particularly the ileum, duodenum and colon, usually occurring around the 7th postoperative day and most end in spontaneous closure with conservative therapy. Surgery should be restricted to treatment of specially indicated patients like prolonged continuous fistulous discharge, abdominal wound dehiscence and deep seated intra peritoneal abscess. Conclusions: The total management of enterocutaneous fistula involves skilled nutritional support, stoma therapy, elimination of sepsis and finally a carefully timed, well-judged and well carried out surgery which will result in favourable outcome in patients with this dreaded complication.
Background and Aims Etomidate, an intravenous (IV) induction agent known for its stable myocardial action, can produce myoclonus which can be detrimental for the cardiac patients. Though lignocaine has proven its efficacy in attenuating the etomidate-induced myoclonus, the ideal dose of lignocaine is not known. The aim of our trial was to analyze two different doses of lignocaine on the occurrence and intensity of etomidate induced myoclonus. Materials and Methods A total of 120 patients were randomly assigned into three groups of 40 each. Patients in group A were injected lignocaine 0.5 mg/kg intravenously, group-B patients were injected lignocaine 1 mg/kg intravenously, and group-C patients were injected saline placebo. After 2 minutes, anesthesia was induced with 0.3 mg/kg of etomidate over 30 seconds. The patients were assessed for myoclonus using clinical severity scoring system during first 2 minutes of induction. Our primary outcome was the incidence of myoclonus. The severity of myoclonus and adverse effects were the secondary outcomes. Results No remarkable variation was found regarding demographic profile among three groups. Incidence of myoclonus in groups A and B was 35% and in group C was 98%, the difference being statistically significant. Both doses of lignocaine reduced the severity of myoclonus up to same extent. Conclusion Pretreatment with IV lignocaine 0.5mg/kg and 1 mg/kg IV remarkably decreased the occurrence and severity of myoclonus induced by etomidate up to same extent.
Background: Aim of our study is pre-operative prediction of conversion using clinical, hematological, biochemical and ultra sonographic parameters in laparoscopic cholecystectomy. Methods: 748 patients underwent laparoscopic cholecystectomy in our institute during the period of 2008 to 2011 are included in this study. Clinical parameters are age, sex, BMI, Fever, tenderness, Duration from last attack, total duration of symptoms, diabetic status. Haematological parameters included are total leukocyte count, serum amylase. Ultrasonographic parameters included are gall bladder wall thickness, number of stones, pericholecystic edema, CBD diameter. Patients having jaundice, CBD stones, raised alkaline phosphatise are excluded from the study. All patients were operated by senior laparoscopic surgeons. Before converting, opinion from the other experienced surgeon was taken. Results: Mean patient age was 34.2 years. Conversion rate is 4.02%. The mean age in non-converted cases was not statistically different from the conversion group (p>0.05). The conversion rate in males was also not significantly different from that in females (p>0.05). Logistic univariate analysis showed that age, sex, duration of symptoms are not statistically significant(p>0.05) but body mass index (BMI), fever, number of stones, number of attacks, previous history of acute cholecystitis, obesity, presence of tenderness, gall bladder wall thickness on ultrasonography (USG) and raised total leucocyte counts (TLC) were significant for conversion(p < 0.05). Stepwise logistic regression showed that only number of attacks, obesity, TLC & wall thickness were significant. The predictive scoring system was calculated by β-coefficients of the variables found significant on logistic regression. Increasing scores are associated with significantly increased conversions rate. Evaluating the significance of this scoring system with prediction of conversion, it was noticed that the test was highly significant for prediction of conversion. Conclusion: Pre operative prediction for difficult laparoscopic cholecystectomy is possible, it can help the patient as well as the surgeon prepare better for the intraoperative risk and risk of conversion to open cholecystectomy.
Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive surgery. LC can cause moderate to severe postoperative pain due to small keyhole entries on the abdominal wall. The oblique subcostal transversus abdominis plane block (OSTAP) has been used for postoperative analgesia after LC but found not so effective. Our aim is to compare the effectiveness of erector spinae block with OSTAP block for postop analgesia after LC. Materials and Methods: This prospective, randomized study was conducted at a tertiary care hospital. Seventy patients, 18 to 65 years old posted for LC were divided into two equal groups of 35 each. Erector spinae plane block was performed in the ESP group and oblique subcostal transverses abdominis plane block was performed in the OSTAP group. Postoperative rescue analgesic consumption, time to 1 st rescue analgesia, numerical rating score (NRS), and any complications in 1 st 24 hrs between the groups were compared. Results: Postoperative rescue analgesic (paracetamol) consumption was 1.9± 0.85gm in ESP group and 2.84 ± 0.29gm in OSTAP group which was statistically significant. Time to 1 st rescue analgesia request was 360.34±28.94 mins in ESP group and 280.51±45.66 mins in OSTAP group which was statistically significant. Although NRS scores at almost all time-points were lower in the ESP group compared to OSTAP block, the difference was significant in 1 st 6 hrs. Conclusion: Ultrasound guided ESP block reduced postoperative rescue analgesic consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery.
Background: Aim: Peptic perforation is one of the commonest surgical emergencies met with but due to poor socioeconomic status, lack of health consciousness and want of diagnostic & treatment facilities at the peripheral healthcare level, they present considerably late most of the time. Our aim was to study the factors affecting prognosis. Methods: A prospective review was made in all charts of parameters between the period June 2014 to Dec 2016. After admission detailed history was elicited from the patient and a thorough clinical examination was done and the available investigations were done to approach at the diagnosis. Long term follows up was done & patients lost to follow up were excluded from the study. Results: Gas was present under one or both domes of the diaphragm in 76 (89.4%) cases. In rest 9 (10.6%) cases no free gas under diaphragm was see. In 77 cases (91.7%) perforation was present in the first part of duodenum (anterior or superior wall). 7 cases (8.3%) had perforation in the pyloric region. 25.7% cases had 1-5 mm size, 35.3% cases had 6-10 mm and 77 % cases had perforation more than 10 mm diameter respectively. Conclusion: Hence from the ongoing discussions it may be concluded that; a common surgical emergency called 'perforated peptic ulcer' is associated with a significant mortality. As the variables like age, perforation size and site, co-existent medical diseases are not changeable. It is early intervention that holds the key to lower the mortality of this otherwise fatal condition.
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