A 40-year-old female presented to the neuro physician with complains of headache, giddiness, vomiting and loose stools and altered sensorium since past one day. On examination, deviation of angle of mouth towards right, weakness of left upper and lower limbs, GCS 8/15 and an extensor plantar reflex was seen.CT scan showed bilateral diffuse cerebral oedema. Suspecting a cerebrovascular stroke and increasing intracranial tension, the patient was intubated and started on Inj. Mannitol (150 ml i.v. Q4H) and antibiotics. As the patient was intubated, she was sedated using Inj. Midazolam till fifth day of treatment, when she was extubated. Inj. Dexomethasone (8 mg iv QD) and intravenous fluids were also started. The patient was extubated on fifth day and was started on Inj. Enoxaparin 60 mg subcutaneously BD on sixth day.On the eighth day of treatment (day 3 on enoxaparin) patient complained of sudden development of abdominal pain. This was accompanied by tachycardia and sudden fall in blood pressure. The general surgery department was consulted for the above complaints. On examination, the patient was found to have extreme tenderness, and a vague mass was felt in the right iliac fossa, suprapubic region and left iliac fossa with positive Carnett's sign and Fothergill sign. Repeat complete blood count, ultrasonography abdomen and pelvis, and CT scan abdomen and pelvis were advised.Blood count reports showed a drop in haemoglobin level from 14.6 gm% at the time of admission to 7.1 gm% on the fourth day of enoxaparin treatment. Platelet count which was 353,000 cells/cu mm on admission had fallen to 252,000 cells/cu mm on the day of pain and then fell to 183,000 cells/cu mm the next day. The ultrasonography abdomen and pelvis showed a focal thick walled heterogeneous pelvic collection in the infra-umbilical region.CT scan abdomen and pelvis showed a large (15.3 cm 3 x 12.2 cm 3 x 7.4 cm 3 ) collection, approximately 720 ml, heterogeneous hyper dense collection in the right infra-umbilical anterior abdominal wall, proximally limited to the rectus sheath in epigastric region. Inferiorly extended to preperitoneal space of abdominal cavity crossing the mid line and extending to left side. There was extension into suprapubic region posterior to pubic symphisis and in prevesical region. Compression of bowel loops and bladder was also seen. The reports were suggestive of a Grade III rectus sheath haematoma [Table/ Fig-1].Fluid aspiration cytology report from the infra-umbilical region showed few scattered polymorphs with abundant red blood cells in the background with no evidence of malignant cells. Keywords: AbSTRACTRectus sheath haematoma is a well-documented condition with an elusive diagnosis. It is an uncommon complication of anti-coagulation therapy, which can have a mortality of upto 25%. The patient discussed here is a 40-year-old female who was on Inj. Enoxaparin, who developed severe abdominal pain and hypovolemia after three days of treatment. Ultrasonography and CT scan showed a large rectus sheath haematoma on the...

Background: The advantages of laparoscopic appendicectomy over open appendicectomy were questioned because the recovery period with open appendicectomy was brief. In this study, the two techniques were compared with respect to post-operative pain and duration of us of an analgesic, complications such as vomiting, ileus, intra-abdominal abscess, wound infection, length of post-operative stay, and return to routine work.Methods: 50 patients who met the inclusion criteria were included in the study was subjected to either of the two procedures after randomisation and statistical analysis was done.Results: The patients who underwent laparoscopic appendicectomy had less post-operative pain with lesser analgesic use, less post- operative complications such as vomiting, ileus, wound infection, shorter hospital stay and early return to routine work.Conclusions: Laparoscopic appendicectomy is a better procedure in selected patients with acute or recurrent appendicitis.

Abdominal vascular injuries are amongst the most lethal injuries encountered by modern day trauma and vascular surgeons. Penetrating injuries to aorta have a wide spectrum of presentation mortality being 50-70%. 38-year-old male presented to emergency department with stab injury to abdomen with a knife stuck in-situ. Patient was conscious with herniating bowel loops from stab site. Bilateral limbs had good pulsations and no neurological deficit. Patient was taken for emergency laparotomy and found to have complete jejunal transection with near transection of aorta with knife stuck in the vertebra. Primary repair of aorta was done with prolene 5-0 along with jejuno-jejunal anastomosis. Patient was transfused with 12 units of blood and 8 units of FFP. Postoperatively patient recovered well and was discharged on post-operative day (POD) 14 with good recovery and follow up was uneventful. Spectrum of penetrating aortic injuries varies from stable patients to severely exsanguinated in vicious cycle of shock, acidosis, coagulopathy and arrhythmias causing high mortality and morbidity. Our case had contained retroperitoneal hematoma with stable vitals and good general condition and due to early diagnosis and timely institution of surgery the patient survived and recovered uneventfully. All abdominal stab injuries are to be taken as having vascular injuries. Surgery has to be taken up as an integral part of resuscitation with quickest and most effective diagnostics along with lifesaving procedures to have lesser morbidity and mortality.

Background: Incisional hernia (IH) remains a very frequent postoperative complication and common hernias in middle aged population more commonly in females. The two techniques most frequently used are the onlay repair and sublay repair. Various studies have been conducted to compare the advantages and disadvantages of sublay and onlay mesh repair in incisional hernia and the superiority of sublay mesh repair. These studies whether they hold good for the population is a pertinent question. In view of this, author need to study the appropriate surgical techniques sublay versus onlay repair in the set up.Methods: Author conducted randomized comparative study of 100 patients having incisional hernia admitted to various surgical units of SNMC and HSK Hospital, Bagalkot during the period December 2014 to June 2016.Results: In present study of 100 cases, females have more incidence of incisional hernias than males. In onlay technique seroma formation was found in 72% of patients postoperatively and 4% in sublay technique. Surgical site infection (SSIN) was noticed in 8% of sublay technique whereas 12% in onlay technique. There is no recurrence in sublay group whereas onlay had 12% recurrence.Conclusions: Sublay technique is superior to onlay concerning the hospital stay, complications and recurrence.

Background: Burns due to accidents are a common cause of morbidity and mortality in the Indian sub-continent. The causes being preventive, warrant a better understanding of the epidemiology to know the seriousness of the situation, implement better medical care and prevent such accidents. Aim was to study the morbidity and mortality related to percentage of burns.Methods: This is a retrospective observational study where patients admitted with burns 2013 and 2015 were evaluated. Data with respect to sex, age, percentage of burns, air-way burns, mode and cause of burns, cause of death and length of hospitalization were analyzed.Results: 65.3% of the patients were females and 34.7% males, with a male: female ratio of 0.53:1. A total mortality of 43.71% was seen. Maximum patients belonged to age group 21-40 years which also constituted 28.74% (highest) of the above total mortality. More than 50 % mortality was seen in patients with more than 41% burns. Air way burns were present in 41.31% of the cases; of which 85.51% of cases did not survive. Death due to hypovolemic shock (42.47%) was the main cause of death in the initial 4 days of admission; whereas septicemic shock (57.53%) from the 5th day onward.Conclusions: Morbidity and mortality due to burns is still very high in India, especially in young adults of age groups 21- 40 years. A higher case load for females as seen, being nearly double in in relation to males. Better fluid resuscitation regimens with adequate control of infection is the need of the hour to bring down the mortality. Female sex and more than 41% burns predicts higher mortality. Involvement of the respiratory tract, also predicts higher mortality and may be taken as a reliable indicator of the severity of burns. In the present scenario, we should stress more over the prevention of burns, to easily make available affordable and cheap medical care for the patients and to minimize post burn disability as much as possible.

Background: Foot ulcers and amputations are a major cause of morbidity as well as emotional and physical disability for people with diabetes. A cumulative life time incidence of diabetic foot ulcer (DFU) is as high as fifteen percent making it a leading cause of non-traumatic amputations worldwide. The objective of the study was to assess the outcome of diabetic foot ulcer based on Meggitt-Wagner classification system.Methods: It was a retrospective review of 130 patients with diabetic foot ulcer managed at a tertiary care teaching hospital from January 2010-August 2016 in Bagalkot, North Karnataka, India.Results: In this study most of the patients were in the age group of 51-60 years, most of them being male 85%, 49.23% of patients with ulcers were over the plantar aspect of the foot and 40% of ulcers were Grade 2. 11.53% of patients required disarticulation of toes. 3.07% of patients required below knee amputation and 2.30% of patients require above knee amputations. 42.30% of the patients had peripheral neuropathy and 12.30% of the patients had associated peripheral arterial disease.Conclusions: Even though Meggitt-Wagner classification system is considered Gold Standard it has many disadvantages. The neuropathic changes, charcoats osteoarthropathy and associated vascular pathology has not taken into consideration, hence the outcome of the ulcer cannot be predicted.

Background: Fissure in Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF).Methods: Prospective comparative study conducted on 90 patients randomly divided into two groups Group A under Local anaesthesia (LA) and Group B under Spinal anaesthesia (SA) respectively. The primary outcome variables studied were postoperative pain, hospital stay, and cost effectiveness.Results: A total of 90 patients randomly divided into 45 patients in each group. There was no statistically difference in the pain at surgery, but post-operative pain was significantly less in LA group at 5th hour, 24 hours after surgery. Hospital stay in LA group is significantly less when compared to SA group (1.92, 3.75 respectively).Conclusions: LAS can be comfortably performed under LA with added advantages.

Background: Despite technological advances the diagnosis of appendicitis is still based primarily clinical assessment. The diagnosis of atypical appendicitis remains clinically challenging and is one of the most commonly missed problems in the emergency department. Ultrasonography is highly operator dependent with a consequently wide reported sensitivity range.Methods: This is a prospective study conducted in the department of surgery. All patients with right lower abdominal pain, admitted to HSK hospital Bagalkot, in whom acute appendicitis was suspected were analysed from January 2013 to June 2014.Results: In the present study appendix was visualized in 85% of the patients and periappendiceal collection was found in 7% of patients. Faecolith was found only in 1 case. Out of these 74 cases were uncomplicated acute appendicitis. Perforated acute appendicitis was diagnosed in 6 cases. One case was diagnosed as appendicular abscess and 4 cases were diagnosed as chronic appendicitis. Based on clinical assessment 4 patients were subjected to surgery after 48hours.Conclusions: Graded compression US remains our first line method in rural setup in the evaluation of patients referred with clinically suspected acute appendicitis.