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Shetty V, Mathai MJ, Ali IM. Multiple Tubercular Intestinal Perforations: A Case Report. Cureus 2024; 16:e66352. [PMID: 39246992 PMCID: PMC11378003 DOI: 10.7759/cureus.66352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 09/10/2024] Open
Abstract
Intestinal tuberculosis (TB) is a frequently encountered pathology by surgeons all over India. There exists a vast body of knowledge about this disease; however, a detailed understanding of its presentation as well as surgical management is essential for every Indian surgeon, given its rampant nature. This report discusses the case of a 28-year-old female presenting with severe left upper abdominal pain, non-bilious vomiting, and fever, who was ultimately diagnosed with small bowel TB leading to perforations. Despite a history of pulmonary TB treated a year prior, the patient exhibited significant clinical and imaging findings, including pneumoperitoneum and peritonitis. Exploratory laparotomy revealed multiple tubercular perforations in the mid-jejunum and a stricture causing proximal jejunal dilatation. Surgical intervention involved resection of the affected segment and end-to-end anastomosis. Histopathological analysis confirmed TB as the cause. This case underscores the importance of considering TB in the differential diagnosis of small bowel perforations and highlights the critical role of timely surgical intervention and comprehensive management in improving patient outcomes.
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Affiliation(s)
- Varun Shetty
- General Surgery, Dr. D. Y. Patil Medical College Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Mathew John Mathai
- General Surgery, Dr. D. Y. Patil Medical College Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
| | - Iqbal M Ali
- General Surgery, Dr. D. Y. Patil Medical College Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND
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Verma A, Kothari R, Mishra A, Agrawal P, Sharma D. Defunctioning ileostomy for typhoid ileal perforations: Out of the frying pan into the fire? Trop Doct 2024; 54:245-247. [PMID: 38562099 DOI: 10.1177/00494755241241830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Typhoid ileal perforation (TIP) is a common surgical emergency in low-middle income countries (LMICs). Its high surgical morbidity and mortality is due to its often late presentation or diagnosis, the patient's malnutrition, severe peritoneal contamination and unavailability of intensive care in most peripheral hospitals. This prompted the philosophy of minimizing the crisis by avoiding any repair or anastomosis, limiting the surgery in these physiologically compromised patients and performing only a temporary defunctioning ileostomy (DI) which could then be closed 10-12 weeks later.
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Affiliation(s)
- Amrendra Verma
- Assistant Professor, Department of Emergency Medicine, Government NSCB Medical College, Jabalpur, MP, India
| | - Reena Kothari
- Professor, Department of General Surgery, Government NSCB Medical College, Jabalpur, MP, India
| | - Arpan Mishra
- Associate Professor, Department of General Surgery, Government NSCB Medical College, Jabalpur, MP, India
| | - Pawan Agrawal
- Professor, Department of General Surgery, Government NSCB Medical College, Jabalpur, MP, India
| | - Dhananjaya Sharma
- Professor, Department of General Surgery, Government NSCB Medical College, Jabalpur, MP, India
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Eswaravaka S, Suhrid C, Rao B, Prabhakar S, Pandya J. Revisiting Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) Scores: Are They Valid in Cases of Ileal Perforation? Cureus 2024; 16:e65733. [PMID: 39211669 PMCID: PMC11360275 DOI: 10.7759/cureus.65733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Ileal perforation due to typhoid is common in tropical countries, and the ensuing secondary peritonitis is treated by resuscitation and surgery. The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) was developed to predict postoperative outcomes to overcome systemic obstacles in any healthcare setup and is considered fairly accurate. The Portsmouth-POSSUM (P-POSSUM) score was developed as a corrective scoring system for overestimations made by the POSSUM score vis-à-vis mortality. Our study aimed to examine the validity of these two scores in the postoperative prediction of surgical outcomes in patients with ileal perforation. Materials and methods An observational study involving 40 patients diagnosed with ileal perforations was undertaken over 18 months. The postoperative outcome for each patient was calculated as per the POSSUM and P-POSSUM parameters. Statistical analysis was done using SPSS (IBM Corp., Armonk, NY) and the results were tabulated. Results We found that age, gender, respiratory dysfunction, propensity for multiple surgeries, duration of surgery, co-morbidities, underlying malignancy, and systolic blood pressure played a significant role in determining postoperative outcomes. Haemoglobin, potassium, and urea levels were also found to be significantly associated with outcome. Cardiac signs, pulse, white blood cell count, Glasgow Coma Scale score, sodium, and electrocardiography, part of the physiological score parameters, were found to be insignificant in the prediction of postoperative outcomes. Among the intraoperative parameters, peritoneal soiling was found to be insignificant. Conclusion Some parameters inherent to POSSUM and P-POSSUM calculations appear to bear no statistical significance to the final score, highlighting that these need to be revisited and perhaps modified to further simplify the calculation. The POSSUM score is an excellent predictor of postoperative morbidity and mortality in ileal perforation patients but is of questionable reliability due to its tendency to overestimate them. P-POSSUM has a better predictive power of postoperative mortality by correcting POSSUM mortality overestimation.
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Affiliation(s)
- Saikrishna Eswaravaka
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Chirantan Suhrid
- General Surgery, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, IND
| | - Bhavya Rao
- Surgical Oncology, King George's Medical University, Lucknow, IND
| | - Sundaresh Prabhakar
- General Surgery, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, IND
| | - Jayashri Pandya
- General Surgery, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, IND
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Kumar D, Sharma A, Rana SK, Prinja S, Ramanujam K, Karthikeyan AS, Raju R, Njarekkattuvalappil SK, Premkumar PS, Chauhan AS, Mohan VR, Ebenezer SE, Thomas MS, Gupta M, Singh A, Jinka DR, Thankaraj S, Koshy RM, Dhas Sankhro C, Kapil A, Shastri J, Saigal K, Perumal SPB, Nagaraj S, Anandan S, Thomas M, Ray P, John J, Kang G. Cost of Illness Due to Severe Enteric Fever in India. J Infect Dis 2021; 224:S540-S547. [PMID: 35238366 PMCID: PMC8892542 DOI: 10.1093/infdis/jiab282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lack of robust data on economic burden due to enteric fever in India has made decision making on typhoid vaccination a challenge. Surveillance for Enteric Fever network was established to address gaps in typhoid disease and economic burden. METHODS Patients hospitalized with blood culture-confirmed enteric fever and nontraumatic ileal perforation were identified at 14 hospitals. These sites represent urban referral hospitals (tier 3) and smaller hospitals in urban slums, remote rural, and tribal settings (tier 2). Cost of illness and productivity loss data from onset to 28 days after discharge from hospital were collected using a structured questionnaire. The direct and indirect costs of an illness episode were analyzed by type of setting. RESULTS In total, 274 patients from tier 2 surveillance, 891 patients from tier 3 surveillance, and 110 ileal perforation patients provided the cost of illness data. The mean direct cost of severe enteric fever was US$119.1 (95% confidence interval [CI], US$85.8-152.4) in tier 2 and US$405.7 (95% CI, 366.9-444.4) in tier 3; 16.9% of patients in tier 3 experienced catastrophic expenditure. CONCLUSIONS The cost of treating enteric fever is considerable and likely to increase with emerging antimicrobial resistance. Equitable preventive strategies are urgently needed.
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Affiliation(s)
| | - Atul Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh,India
| | - Saroj Kumar Rana
- Postgraduate Institute of Medical Education and Research, Chandigarh,India
| | - Shankar Prinja
- Postgraduate Institute of Medical Education and Research, Chandigarh,India
| | | | | | | | | | | | | | | | | | | | - Madhu Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh,India
| | - Ashita Singh
- Chinchpada Christian Hospital, Maharashtra,India
| | | | - Shajin Thankaraj
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Assam,India
| | - Roshine Mary Koshy
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Assam,India
| | | | - Arti Kapil
- All India Institute of Medical Sciences, New Delhi,India
| | - Jayanthi Shastri
- TopiwalaNational Medical College and BYL Nair Charitable Hospital, Mumbai,India
| | | | | | | | | | - Maria Thomas
- Christian Medical College and Hospital, Ludhiana,India
| | - Pallab Ray
- Postgraduate Institute of Medical Education and Research, Chandigarh,India
| | - Jacob John
- Christian Medical College, Vellore,India
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