Objective: To evaluate the role of CT abdomen in the localization of acute lower gastrointestinal bleeding. Summary Background Data: The source of bleed in acute lower gastrointestinal bleeding is often difficult to localize. The role of CT in the evaluation of this group of patients has not been clearly addressed. Methods: A retrospective review of all patients with acute lower gastrointestinal bleeding over a 3-year period was carried out. When endoscopy failed to localize the source and bleeding continued, angiography and/or scintigraphy were carried out. In contrast, those who had normal endoscopies and had clinically stopped bleeding, underwent CT abdomen. Results: CT done in 7 patients with no evidence of active bleed identified a lesion in 6 (86%). Conclusions: CT may be useful in acute lower gastrointestinal bleeding where endoscopy fails to localize a lesion and bleeding has stopped temporarily.

INTRODUCTIONPrelabour membrane rupture before 37 weeks of gestation is referred to as preterm premature rupture of membranes (PPROM). Incidence of PPROM is about 2% of all pregnancies. 1 The consequences of PPROM for the neonate fall into three major overlapping categories. The first is the significant neonatal morbidity and mortality associated with prematurity. Secondly the complications during labor and delivery increase the risk for neonatal resuscitation and thirdly infection. The relative contributions of prematurity and perinatal infections to perinatal mortality are responsible for most of the controversy surrounding the optimal management of PPROM. Complications such as respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC) contribute to most of the cases of neonatal mortality.Since the goal of management in PPROM is prolongation of pregnancy, the most commonly accepted management scheme less than 36 weeks is expectant, with patient ABSTRACT Background: Prelabour membrane rupture before 37 weeks of gestation is referred to as preterm premature rupture of membranes (PPROM). Incidence of PPROM is about 2% of all pregnancies. This prospective study aims to determine fetal and early neonatal outcome of pregnancies with PPROM. Methods: The study was conducted in 190 antenatal women with PPROM between 24 weeks to 36weeks of gestation over a period of 18 months. Their babies were followed up till discharge from Pediatric new born unit. Results: Prevalence of PPROM was 0.8%, accounting for 19% of preterm deliveries. 61% of women with PPROM showed evidence of lower genito-urinary tract infection, 28% had anemia, 48% gave history of coitus during pregnancy. Mean gestational age of membrane rupture was 32 weeks, the mean latency between membrane rupture and delivery was 4.4 days. Chorioamnionitis developed in 13% of women with PPROM, cord prolapse in 4% and abruption in 3%. The gestational age wise survival was 40% in babies weighing less than 1.5kg, 88% in babies weighing 1.5 to 2.5kg and 93% in those more than 2.5kg. The predominant causes of neonatal mortality were hyaline membrane disease (HMD) in babies born before 28 weeks, HMD and sepsis between 29 to 33 weeks and sepsis in babies born after 34 weeks. Conclusions: Screening and treatment of risk factors may contribute to prevention of PPROM. Neonatal survival depends on gestational age and availability of advanced NICU facilities. Patients and family members should be counseled regarding the outcome of pregnancies with PPROM. A team effort by the obstetrician and neonatologist in a tertiary care setting can ensure a healthy and fruitful life for mother and baby.

Peritoneal tuberculosis, carcinomatosis and pancreatic ascites are often considered as differential diagnosis of hemorrhagic ascites. Endometriosis can rarely present as hemorrhagic ascites and closely mimic these conditions. When this occurs without common clinical features of endometriosis, it can create a diagnostic challenge to the treating physician. We present three patients with endometriosis who presented with hemorrhagic ascites; two of them did not have gynecological symptoms or significant pelvic disease. These patients were evaluated several times in many centers and even received multiple courses of anti-tuberculous treatment. The diagnosis was made by histologic examination of parietal peritoneum obtained by laparoscopy or laparotomy. The diagnosis was missed possibly because of the atypical presentation, lack of clinical suspicion and incomplete assessment. In conclusion, this potentially treatable condition should be considered as a differential diagnosis for hemorrhagic ascites in a premenopausal woman.

PLR may be useful to differentiate PDAC from benign IHM in patients with chronic pancreatitis.

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The post-surgical complications and oncological clearance of LRR done with low-tie IMA and selective D3 lymphadenectomy were found equivalent to ORR. Low-tie IMA without routine splenic flexure mobilisation had no technical issues regarding the anastomosis.

This study aims to assess quality of life (QoL), functional outcome, and social impact following ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP) since Indian data is limited. Data was collected prospectively from patients who underwent IPAA for UC or FAP from 2004 to 2013. QoL and functional outcome at 1, 3, and 5 years after surgery, return to work, and change of job (social impact) were documented. QoL was assessed using the validated Cleveland Global Quality of Life (CGQL) score, the normal score being 1.0. Twenty-five patients were analyzed. Mean CGQL scores before surgery and at 1, 3, and 5 years were 0.5, 0.63, 0.73, and 0.8, respectively. FAP patients had better scores at 3 and 5 years. Only 40 % returned to same job. Sixty-four percent returned to work within a year. The median number of bowel movements per 24 h was less for FAP patients at 3 and 5 years. UC patients on long-term steroids had poorer function at 3 years. Long-term QoL and functional outcomes following IPAA are acceptable. Initial deterioration in QoL, mainly in FAP and long-term adverse social impact in both groups should not be underestimated. UC patients on long-term steroids showed delayed improvement in pouch function.

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