Colorectal cancer is one of the most common surgically curable malignancies worldwide, having a good prognosis even with liver metastasis. This improved patient outcome is marred by anastomotic leaks (AL) in operated patients of colorectal cancer despite a microscopically margin-negative resection (R0). Various risk factors have been attributed to causing this. Preoperative non-modifiable factors are age, male sex, cancer cachexia, and neoadjuvant chemo-radiotherapy, and modifiable factors are comorbidities, peripheral vascular disease, anemia, and malnutrition. Intraoperative risk factors include intraoperative surgical duration, blood loss and transfusions, fluid management, oxygen saturation, surgical technique (stapled, handsewn, or compression devices), and approach (open, laparoscopic, or robotic). Postoperative factors like anemia, infection, fluid management, and blood transfusions also have an effect. With the advent of enhanced recovery after surgery (ERAS) protocols, many modifiable factors can be optimized to reduce the risk. Prevention is better than cure as the morbidity and mortality of AL are very high. There is still a need for an intraoperative technique to detect the viability of anastomotic ends to predict and prevent AL. Prompt diagnosis of an AL is the key. Many surgeons have proposed using methods like air leak tests, intraoperative endoscopy, Doppler ultrasound, and near-infrared fluorescence imaging to decrease the incidence of AL. All these methods can minimize AL, resulting in significant intraoperative alterations to surgical tactics. This narrative review covers the methods of assessing of integrity of anastomosis during the surgery, which can help prevent anastomotic leakage.
A postmenopausal woman presented with a predominantly right-sided abdominal lump, insidious in onset and not associated with any aggravating or relieving factors. Physical examination revealed a soft cystic mass extending from the right hypochondrium to the right iliac fossa region crossing the midline. Ultrasonography of the abdomen and pelvis showed a large cystic anechoic area noted in the abdomen extending from the epigastric region to the pelvis. Contrast-enhanced CT of the abdomen and pelvis showed a large non-enhancing cystic lesion in the pelvis suggesting the possibility of a right ovarian cyst or mesenteric cyst. Laparotomy was performed and the excised specimen was sent for histopathological analysis, which confirmed it to be an endometrial cyst.
The liver and lungs are the two organs most commonly affected by the endemic illness known as hydatid disease. The most typical reason for peritoneal echinococcosis is when a hepatic hydatid cyst ruptures into the peritoneal cavity. A cyst in the pelvic cavity is only deemed main if there are no additional hydatid cysts anywhere else. Here, we describe a solitary pelvic hydatid cyst that manifested without affecting the lungs or any other internal organs. Our patient, a 50-year-old lady, was diagnosed with a thin-walled big cystic mass in the pelvic area by ultrasonography. Her main symptoms were dull aching discomfort around the umbilicus and umbilical hernia. The most likely first diagnosis for her operation was an isolated pelvic mass. Clinical examination and imaging study were done and incidentally diagnosed as a pelvic hydatid cyst disease with dense adhesion between the omentum, bladder and left ovary and left fallopian tube. A laparotomy was performed. The cyst was removed successfully from the surrounding adhesion on the surgical attempt without undue complication. There are no indications of a disease recurrence in the post-operative follow-up.Gynecologists and surgeons should be apprised of the potential for a single main hydatid cyst in the pelvic region and must consider this condition when establishing a differential diagnosis of a primary cystic pelvic mass.
Intussusceptions are a common condition seen in children and are rarely seen in adults the etiology is not clearly understood the common know etiology for intussusceptions are polyps, Mikel's diverticulum, carcinomas and idiopathic.The patient presents with nonspecific abdominal pain, vomiting, loss of weight, emaciation, weakness, diarrhoea and in long-standing may lead to anorexia. Due to the low specificity of radiographs, USG is the more specific diagnostic tool for locating the intussusceptions. Here we present a 61-yearold patient who reported to the hospital with pain in the abdomen for two months on clinical examination and USG the patient showed signs of ileocecal intussusceptions which was managed by surgical resection and followed by medication post-operatively the patient was observed for 20 days and the sutures were removed and the patient was discharged. We conclude that surgical resection in the cases of ileocecal intussusceptions proved to be the most effective tool for relieving the symptoms and improving the functionality of the patient.
IntroductionAcute appendicitis is the commonest abdominal surgical emergency globally. The most accepted management of acute appendicitis is surgical, either open or laparoscopic appendectomy. Overlapping clinical presentations with many genitourinary and gynecological conditions lead to difficulty in accurate diagnosis, making negative appendectomies an unwanted reality. With the advancement in technology, there have been constant efforts to minimize negative appendectomy rates (NAR) using imaging modalities like USG of the abdomen and the gold-standard imaging test, the contrast-enhanced computed tomography of the abdomen. Due to the cost incurred and the lesser availability of such imaging modalities and needed expertise in resource-poor settings, various clinical scoring systems were devised to accurately diagnose acute appendicitis and thereby decrease NAR. We conducted our study to determine the NAR between the Raja Isteri Pengiran Anak Saleha Appendicitis score (RIPASA) and the modified Alvarado (MA) scoring methods. MethodsA prospective observational analytical study was conducted, including 50 patients presenting to our hospital with acute appendicitis and who underwent emergency open appendectomy. The need to operate was decided by the treating surgeon. Patients were stratified by both scores; the pre-operative scores were noted and were later compared with the histopathological diagnosis. ResultsA total of 50 clinically diagnosed patients with acute appendicitis were evaluated utilizing the RIPASA and the MA scores. The NAR was 2% using the RIPASA score vs 10% with the MA score. The sensitivity was 94.11% vs 70.58% (p<0.0001), the specificity was 93.75% vs 68.75% (p<0.0001), the positive predictive value (PPV) of 96.96% vs 82.75% (p<0.001), the negative predictive value (NPV) of 88.23% vs 52.38% (p<0.001), and NAR of 2% vs 10% (p<0.0001) in the RIPASA vs MA scoring method, respectively. ConclusionsRIPASA score is highly efficacious and statistically significant in diagnosing acute appendicitis with higher PPV at higher scores and higher NPV with lower scores leading to decreased NAR compared with MA score.
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