Background: Situs inverses totalis is a rare congenital anomaly with transposition of major organs to opposite side of the body. Due to atypical clinical presentation and due to contra lateral presence of the gall bladder, it causes clinical challenge to operate with complete reorientation of anatomy. Visual motor skills are particularly tested when it comes to lapararoscopy. Case: A 25 year, lady presented with left hypochondriac pain and diagnosed as calculus cholecystitis with situs inverses total is. After ruling out associated anamolies patient underwent elective laparoscopic cholecystectomy. Discussion: Around 60 cases of situs inverses total is with cholecystectomy have been reported till date. These cases cause technical and visuo-motor difficulty due to contra lateral deposition of gall bladder in left hypochondrium during laparoscopic cholecystectomy. Consumption of extra time also been reported during calot’s dissection, as it’s like operating on a mirror image. Conclusion: Laparoscopic cholecystectomy, the gold standard treatment for cholelithiasis, is a feasible option even in cases with SIT; in the hands of good experienced, ambidextrous laparoscopic surgeons.
Background: Valentino’s syndrome refers to acute abdomen with clinical presentation mimicking acute appendicitis in a Perforated gastric or duodenal ulcer. This occurs when suppurative fluid from duodenal perforation trickles down the paracolic gutter to the right iliac fossa causing peritonitis locally and causes periappendicitis. Less than 50 cases have been reported in literature of the same. Case report and discussion: A 42-year-old male was admitted to the general surgery department with pain in the right iliac fossa and epigastric region. A diagnostic laparoscopy was performed under the suspicion of Acute appendicitis, which was later converted to open laparotomy on finding a perforated duodenal ulcer. Review of Literature: Valentino syndrome is a rare condition in which a duodenal ulcer mimics acute appendicitis which is a diagnosed intraoperatively and managed surgically. Although the exact incidence is unknown, less than 50 cases have been reported worldwide. The first incidence reports back to 1926 when an Italian actor, Rodolfo Valentino who succumbed to this rare disease and it was named after him. Conclusion: Differential diagnosis of duodenal ulcer perforation should be considered for adult patient with diagnosis of acute appendicitis. X ray erect abdomen and diagnostic laparoscopy can help to overcome foot in mouth situation due to missed duodenal ulcer perforation. Keywords: Valentino syndrome.
Background: Scar endometriosis is a rare condition seen in post LSCS or hysterectomy or obstetric procedure, where functional endometrial tissue is seen outside uterine cavity. Case: A 34 year old female presented with cyclic pain during menstruation at the Pfannenstiel incision at the scar site, associated with 5 * 5 cm lump in the parietal abdominal plan. On clinical examination and investigations, preoperatively, it was suggestive of scar endometriosis. After excision, HPE confirmed to be scar endometriosis with 2 cm clear margins. Discussion: Scar endometriosis is a very rare disorder whose incidence was reported to be 0.03–0.45%. Clinical suspicion of scar endometriosis is very important in the patients with chronic pain at scar site, which is usually missed and can often lead to longterm morbidity of the patients. With histopathological confirmation it becomes absolutely necessary to prove iatrogenic implantation theory which is well accepted. Conclusion: Clinical suspicion of scar endometriosis depending on clinical presentation and history of previous obstetric procedure is important for surgeons and excision of the lesion with good margins is the treatment of choice to prevent chronic morbidity in patients due to pain and recurrent surgery.
Introduction: Traditionally antibiotics have been advised pre and post operatively in surgery for gall bladder. The knowledge about usage of a single dose prophylactic preoperative antibiotic in comparison to conventional usage of perioperative antibiotics in laparoscopic Cholecystectomy is limited. Hence, this study focuses on comparing the efficacy of a single dose prophylactic antibiotic versus the usage of pre and postoperative antibiotics in laparoscopic Cholecystectomy. Method: This is a prospective study conducted in the General Surgery department of Apollo Institute of Medical Sciences and Research. Over 192 consecutive patients subjected for laparoscopic Cholecystectomy were included in study. They were divided in two groups (A&B) after applying exclusion. 74 patients in group A were given single dose of preoperative prophylactic antibiotic. No further post-operative antibiotics were given. 78 patients in group B were given both pre and postoperative antibiotics. Infective complications and cost constraints were compared between both the groups. Statistical analysis was done using chi-square test wherever necessary. Results: there is no significant difference in the rate of incidence of wound infection in both the groups. Age and gender had no significant association for SSI. The overall cost of Group B was found to be significantly higher than Group A. Conclusion: Usage of single dose prophylactic preoperative antibiotics with no further post operative antibiotics would be sufficient to prevent surgical site infection in uncomplicated laparoscopic Cholecystectomy. Keywords: Prevention, Antibiotic Resistance, Laparoscopic Cholecystectomy.
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