Jejunal diverticula are uncommon and usually asymptomatic. Very rarely, they can lead to acute complications such as bleeding, diverticulitis, perforation and obstruction. Incidence of faecolith in jejunal diverticula is also rarely reported. In this report we outline our experience of acute small bowel obstruction due to the dislodgement of the faecolith from diverticula into the jejunum, where patient was previously asymptomatic and successful management of the case.
NEED FOR STUDYThe present study is to use a simple bedside tool as a scoring system to assess the severity of acute pancreatitis and to predict its risks for morbidity and mortality. The main criteria of this study is to highlight the ease of using this tool to identify the severity of acute pancreatitis as early as possible in order to reduce the complications, risks and to improve the outcome and overall survival. MATERIALS AND METHODSOur study is a single centre, prospective observational study conducted at Rajarajeshwari Medical College Hospital, Bangalore, India from September 2014 to September 2015. Forty six patients, both males and females presenting within 24 hours of onset of symptoms diagnosed with acute pancreatitis were included in the study. Informed consents were obtained from all patients. Cases of chronic pancreatitis and acute on chronic pancreatitis were excluded. Pediatric patients of age less than 14 years and geriatric patients more than 70 years were excluded. RESULTSWe observed that biliary pancreatitis was the most common with male population more affected than females. Pain abdomen was the most common presentation in the entire study population. Necrotizing pancreatitis was most commonly associated with ICU admission and prolonged hospital stay. Patients with organ failure and BISAP score more than 3 were found to have prolonged hospital stay. SIRS was the most common component of BISAP scoring system seen in 91.3%. Elderly patients with age more than 60 years (6 pts.) had high BISAP score (5). All patients with shock had BISAP score of >3. A BISAP score of ≥3 was associated with higher morbidity than scores of <3. CONCLUSIONBISAP is a simple and a quick tool over other scoring systems and is similar to other scoring systems to predict the severity and prognosis of acute pancreatitis. In summary we have studied the ease of BISAP scoring system and its advantage in early recognition of acute pancreatitis, thus taking early steps to provide specific treatment to prevent complications, reduce the risks and to improve the overall survival.
ABSTRACT
Background: Stoma is an artificial opening of intestinal or urinary tract to the abdominal wall. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it.Methods: This is a retrospective descriptive observational study carried out in a surgical unit of Rajarajeswari Medical College and Hospital, Bangalore from August 2015 to August 2016. Data was collected by previous record files including age, gender, history of presenting illness, indication, type of stoma, type of surgery, appropriate operative findings and follow up of the cases. The results were collected, analysed and compared with other studies.Results: A total of 25 patients were evaluated age ranged between 20-70 years. Out of 25 patients 17 were admitted in emergency while 8 in out-patient department. The most common type of stoma made was loop ileostomy (44%) followed by end ileostomy (28%), end colostomy (16%) and loop colostomy (12%). Main indication for a stoma formation was enteric perforation (56%) followed by carcinoma colon and rectum (32%), perianal sepsis (21%), Koch’s abdomen (11%), penetrating injuries (11%). Of the various complications encountered with intestinal stoma, peristomal skin Excoriation (16%) was the most common complication observed followed by other complications as mentioned in study.Conclusions: In spite of enormous exposure of general surgeons towards stoma formation the complications are inevitable. Early detection of complication and its timely management is the keystone.
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