Background: The concept of Complete Mesocolic Excision(CME) as a surgical techniquefor colonic carcinoma.was first introduced in the west in 2008. CME follows the sameprinciple as Total MesorectalExcision(TME) in rectal carcinoma. We have adopted this newtechnique since 2014. Objective: Here we describe the CME technique in open and laparoscopic right hemicolectomy,and our initial experience of the surgery. Methods: This is a prospective observational study. Data collected from 24 patientsadmitted under our care in BIR DEM General Hospital from January 2015 to January 2017with carcinoma caecum or ascending colon. Results: Out of 24 patients 14 patients opted for laparoscopic right hemicolectomy and 10patients choose open right hemicolectomy. In laparoscopic right hemicolectomy with CMEthe mean operating time was 152 minutes, amount of blood loss ranges 70-100ml.Number of lymphnodes removed enbloc with specimen 25-30(mean27). Distance oftumor from mesenteric margins at the point of vascular tie 11-15 cm. In open righthemicolectomy with CME mean operating time was 142 minutes, estimated blood loss120-300 ml, harvested lymph nodes within mesocolic envelop 24-31(mean27), anddistance of tumor from vascular tie is 9-15 cm. there is one major complication of uretericinjury. Histopathology shows resection margin are free of tumor in all except 2 cases. Conclusion: Right hemicolectomy with CME in both open and laparoscopic approach canbe easily adopted by general surgeons and colorectal surgeons who are performing'standard technique' or 'conventional technique' routinely for right hemicolectomy. Withthe encouraging results available from centers who are routinely performing CME incolonic surgery it is now considered as the new bench mark of quality of standard colonicsurgery. Journal of Surgical Sciences (2017) Vol. 21 (1) :15-18
Background: Fourniers gangrene is the necrotising fasciitis of the genitalia and perineum, with associated poly microbial infection. Evidence based data in the very recent years suggest that it is associated with significant and potential risk of organ failure or death.Aim: This study was designed to be conducted among the patients suffering from Fourniers gangrene with a view to assess the probable prevalence rate of potentially adverse clinical consequences during course of treatment, overall mortality and to observe the microbiological pattern in our surgical practice.Method & materials: This cross sectional study was conducted among the 69 patients of Fourniers gangrene in BIRDEM General Hospital, Dhaka, Bangladesh from Jan 10.2013 to Sept 01 .2016, using the purposive sampling method.Results: The results of this study reflects that majority (43.4%) of the study population were in 51 to 60 years age group( Mean age 43±1.7 years) in study population. By using the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, it was found that in most of the patients (approx 56.5%), a suspicious score ranging 06-08 was observed and only in 10.1% patients, a specific score of ?08 was observed. In 27.5% patients systemic complications like DIC, ARDS, MODS, MSOF and severe sepsis were observed in 1.4%, 4.3%, 10.1%, 4.3% and 5.7% cases respectively. Mortality rate was approximately 4.3%. Majority (84.1%) of the patients were associated with type 1 (Polymicrobial) bacterial infection, whereas in case of 15.9% patients, it was associated with type 2 (Monomicrobial) infection. Escherichia coli was the most frequently observed micro-organisms associated with approximately 39.1% of all cases. S. aureus, Staphylococcus pyogenes, Enterococci species, E.coli and Pseudomonas species were recorded to be associated with 17.4%, 27.5%, 21.7%, 39.1 and 10.1% cases respectively.Conclusion: This study suggests that Fourniers gangrene is associated with significant systemic complications. Poly microbial infections are most predominant and E coli infection was commonest organism involved.Bangladesh Crit Care J March 2017; 5(1): 28-32
Adult colorectal intussusception is a relatively rare condition. It is different from that of a child in that, most cases have an organic etiology like a malignant or benign neoplasm. This is a 40 year female patient presenting with passage of blood and mucous per rectum later diagnosed as sigmoidorectal intussusception due to submucous lipoma in sigmoid colon that was protruding through anus giving the appearance of a large polypoid rectal growth.
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