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Singh PK, Sethi MK, Mishra TS, Kumar P, Ali SM, Sasmal PK, Mishra SS. Comparison of surgical site infection (SSI) between negative pressure wound therapy (NPWT) assisted delayed primary closure and conventional delayed primary closure in grossly contaminated emergency abdominal surgeries: a randomized controlled trial. Langenbecks Arch Surg 2023; 409:19. [PMID: 38150073 DOI: 10.1007/s00423-023-03202-x] [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] [Received: 07/23/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE NPWT has been tried in many surgical fields, including colorectal, thoracic, vascular, and non-healing wounds, for the prevention of SSI. However, its efficacy in the prevention of SSI-grade IV closed abdominal wounds is yet to be explored. METHODS All patients with grade IV abdominal wounds were included in the study. They were randomized into the conventional arm and the VAC arm after confirming the diagnosis intra-operatively. The sheath was closed, and the skin was laid open in the postoperative period. In the VAC arm, the NPWT dressing was applied on postoperative day (POD)-1 and removed on POD-5. In the conventional arm, only regular dressing was done postoperatively. The skin was closed with a delayed primary intention on POD-5 in both arms. The sutures were removed after 7 to 10 days of skin closure. RESULTS The rate of SSI (10% in the VAC arm vs. 37.5% in the conventional arm, p-value = 0.004) was significantly lower in the VAC arm, as were the rates of seroma formation (2.4% in the VAC arm vs. 20% in the conventional arm, p = 0.014) and wound dehiscence (7.3% vs. 30%, p = 0.011). The conventional arm had a significant delay in skin closure beyond POD5 due to an increased rate of SSI, which also led to a prolonged hospital stay (5 days in the VAC arm vs. 6.5 days in the conventional arm, p-value = 0.005). CONCLUSION The VAC dressing can be used routinely in grade IV closed abdominal wounds to reduce the risk of SSI and wound dehiscence.
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Affiliation(s)
- Pradeep Kumar Singh
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Mahesh Kumar Sethi
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India.
| | | | - Pankaj Kumar
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - S Manwar Ali
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
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Ogbuanya AUO, Ugwu NB, Enemuo VC, Nnadozie UU, Eni UE, Ewah RL, Ajuluchuku UE, Umezurike DA, Onah LN. Emergency laparotomy for peritonitis in the elderly: A Multicentre observational study of outcomes in Sub-Saharan Africa. Afr J Emerg Med 2023; 13:265-273. [PMID: 37790994 PMCID: PMC10542594 DOI: 10.1016/j.afjem.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Background Globally, interest in surgical diseases in the elderly was rekindled recently mainly due to a surge in the aging population and their increased susceptibility to infections. In sub-Saharan Africa, infective diseases are major causes of high morbidity and mortality especially in elderly cohorts, hence this study was set to evaluate current status of this scourge in the elderly in our environment. Aim To document the aetiologic factors and analyze the impact of selected clinical and perioperative indices on mortality and morbidity rates of peritonitis in the elderly. Methods This was a multicenter prospective study involving elderly patients aged 65years and above managed between October 2015 and September 2021 in Southeast Nigeria. Results Of the 236 elderly patients examined, approximately two-third (150, 63.6%) were aged 65-74years. The rest were aged ≥ 75years. There were 142(60.2%) males and 94(39.8%) females. Perforated peptic ulcer (89,37.7%) was the most common cause of peritonitis followed by ruptured appendix (59, 25.0%), then typhoid perforation (44,18.6%). However, typhoid perforation was the deadliest with a crude mortality rate of 40.9%. Overall, morbidity and mortality rates were 33.8% and 28.5% respectively. The main independent predictors of mortality were peritonitis arising from typhoid perforation (p = 0.036), late presentation (p = 0.004), district location of hospital (p = 0.011) and intestinal resection (p = 0.003). Conclusion Generalized peritonitis is a cause of significant morbidity and mortality in the elderly patients in our environment. Perforated peptic ulcer was the most common cause, but typhoid perforation remains the deadliest. Late presentation, district hospital setting and bowel resection were associated with elevated mortality.
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Affiliation(s)
- Aloysius Ugwu-Olisa Ogbuanya
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
- Department of surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu state, Nigeria
- Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Nigeria
- Department of Surgery, District Hospital, Nsukka, Enugu State, Nigeria
| | - Nonyelum Benedett Ugwu
- Department of surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu state, Nigeria
- Department of Anaesthesia, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Vincent C Enemuo
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of surgery, University of Nigeria, Nsukka, Enugu State, Nigeria
- Department of surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Ugochukwu U Nnadozie
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Uche Emmanuel Eni
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Richard L Ewah
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
- Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Nigeria
- Department of Anaesthesia, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
| | - Uzoamaka E Ajuluchuku
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Daniel A Umezurike
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Livinus N Onah
- Department of Obstetric and Gynaecology, Enugu State University Teaching Hospital Enugu, Nigeria
- Department of Obstetric and Gynaecology, Enugu State University of Science and Technology, Enugu, Nigeria
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Dev S, Pokhrel KM, Mulmi U, Devkota S, Dev B, Bhattarai A. Chicken bone-induced ileal perforation peritonitis mimicking duodenal perforation peritonitis: a case report. Ann Med Surg (Lond) 2023; 85:6202-6205. [PMID: 38098546 PMCID: PMC10718394 DOI: 10.1097/ms9.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/07/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Foreign body ingestion can lead to bowel perforation and peritonitis. We present a case of a 54-year-old male who ingested a chicken bone, resulting in ileal perforation that mimicked duodenal perforation peritonitis. Case Presentation The patient has a history of peptic ulcer disease and regularly used non-steroidal anti-inflammatory drugs over the counter, adding more evidence to the provisional diagnosis of duodenal perforation. Exploratory laparotomy revealed the ileal perforation and the chicken bone was successfully removed. Wedge resection of the perforated segment and ileo-ileal anastomosis were performed. Discussion Although history, examination, and investigation were more in favor of duodenal ulcer, our patient had ileal perforation due to chicken bone. Prompt identification and early surgical intervention are crucial to prevent complications and reduce mortality rates. The patient had an uneventful recovery. Conclusion Timely referral to a tertiary care center is essential for early surgical intervention and successful management of bowel perforation caused by a foreign body.
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Affiliation(s)
- Santosh Dev
- Department of General Surgery, Tribhuvan University Teaching Hospital
| | - Kailash Mani Pokhrel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu
| | - Utsha Mulmi
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu
| | - Shishir Devkota
- Department of General Surgery, Tribhuvan University Teaching Hospital
| | - Barsha Dev
- Nepalgunj Medical College and Teaching Hospital, Banke, Nepal
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Neupane S, Koirala DP, Kharel S, Silwal S, Yadav KK. Clinical profile and management of perforation peritonitis in Bharatpur hospital, Nepal: A prospective study. Ann Med Surg (Lond) 2022; 82:104528. [PMID: 36268443 PMCID: PMC9577425 DOI: 10.1016/j.amsu.2022.104528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The most common surgical emergency in general surgery is perforation peritonitis. It is a serious condition with a mortality rate of up to 20%, and it is the third most common cause of surgical abdomen after appendicitis and intestinal obstruction. The aim of this study to discuss clinical profile and management of perforation peritonitis in a hospital in central Nepal. Methods This prospective study was done for one year at Bharatpur Hospital, Chitwan Nepal. In our study, only patient above 15 years were included and those who were not fit for anesthesia and surgery were excluded. Most of the patient were diagnosed clinically supported by lab investigations and imaging like X-ray and ultrasonography of abdomen. The variables analyzed were the risk factors of the patient like smoking, alcohol, liver disease and previous abdominal surgeries. Results The majority of the patients were in the age group 50–59 years in male and 40–49 years in female. Among sixty cases, 31 were female and 29 were male with Female: Male ratio of 1.06:1. The most common cause of perforation found was peptic ulcer compromising 88.3% (53 cases) followed by appendicular perforation accounting 8.3% (5 cases). Similarly, Tubercular perforation was found in 3.3%. Smoking was most common risk factor accounting 88.3%, followed by alcohol consumption (48.33%) while, 15% of patients had positive history of NSAIDs consumption. On imaging, 38.33% patient had air fluid level on X-ray and 78.33% had gas under diaphragm. On blood investigation, leukocytosis was found in 53.33% of patients, hyponatremia in 10% of patients and hypokalemia in 18.33% of patients. While on urine examination, albumin was found in 5% of patients. The repair of perforation along with omentopexy was done in 73.3% of patients while only repair was done in 15% of patients. Only 8.3% opted for appendectomy while a very few patients (3.3%) went for resection with anastomosis. The Postoperative complications found were wound infection (43.3%), paralytic ileus (18.33%), sepsis (15%), followed by electrolyte imbalance (11.6%), postoperative bowel obstruction (6.6%) and burst abdomen (1.6%). While, there were only 3 cases of mortality. Conclusions Perforation peritonitis is a frequently encountered surgical emergency. Various factors like age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention are associated with morbidity and mortality. A successful management depends upon early surgical intervention, source control and exclusive intraoperative peritoneal lavage. Perforation Peritonitis is a serious condition with a mortality rate of up to 20%. Age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention affect morbidity and mortality. Early surgical intervention, source control and exclusive intraoperative peritoneal lavage are solutions.
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Altiero M, Orabona GD, Laccetti E, Rengo A, Danzi R, Romano F, Di Serafino M, Iacobellis F, Francica G, Scaglione M, Romano L. The Use of Ceus Software with No Contrast Media Administration in the Diagnosis of Pneumoperitoneum. Diagnostics (Basel) 2022; 12:diagnostics12020401. [PMID: 35204492 PMCID: PMC8871049 DOI: 10.3390/diagnostics12020401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/22/2022] [Accepted: 01/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Pneumoperitoneum is defined by the presence of free air in the abdominal cavity; gastrointestinal perforation is an important cause of this pathological condition. In emergency situations, radiology is considered vital in the early detection and identification of the site and cause of the perforation, which is critical for proper surgical planning. Aim: The aim of our study was to evaluate a new diagnostic US tool, based on the US contrast-specific software generally used during contrast-enhanced US examination (CEUS), without the administration of sonographic contrast media, and to describe the specific imaging features in the detection of free intra-peritoneal air. Subjects and Methods: One hundred and fifty-seven consecutive and hemodynamically stable patients, who arrived in our E.D. with an acute abdomen between April 2018 and October 2019, underwent US and CT examination, performed by three radiologists (with 5, 5, and 25 years of experience). The US was performed first and divided into two steps, using B-mode US and both B-mode and contrast-specific software US, with no contrast media administration. All the patients underwent CT examination. Results: In 32 out of 157 patients, the surgery confirmed GI perforation. CT correctly detected 31 out of 32 patients; the contrast-specific software US identified 30 perforated patients. CT reached a sensitivity value of 97% and specificity value of 100%; contrast-specific software US demonstrated higher values than B-mode US in sensitivity (93% vs. 70%, respectively) and specificity (98% vs. 88%, respectively). Conclusion: the use of contrast-specific software in emergencies improves image quality, and reaches higher levels of sensitivity and specificity with no time delay compared to standard US examination, helping radiologists expedite diagnoses.
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Affiliation(s)
- Michele Altiero
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
- Correspondence:
| | - Ettore Laccetti
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Alessandro Rengo
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Roberta Danzi
- Department of Radiology, S. Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
| | - Federica Romano
- Department of Radiology, Monaldi Hospital, 80131 Naples, Italy;
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
| | - Giampiero Francica
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Mariano Scaglione
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
- Department of Radiology, University of Sassari, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
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Elfanagely O, Elfanagely Y, Pratt A. A rare anatomical variation complicating a diffuse abdominal pain presentation: A case report of colonic perforation in situs inversus totalis. Int J Surg Case Rep 2021; 87:106456. [PMID: 34597972 PMCID: PMC8488479 DOI: 10.1016/j.ijscr.2021.106456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Situs inversus totalis (SIT) is a rare anatomical variation of the thoracic and abdominal organs. It is a congenital anomaly with an incidence of 1:10,000 to 1:20,000. Patients with SIT do not have a decreased survival rate as compared to patients without SIT because SIT generally does not have a pathophysiologic significance. However, the anatomical variations in SIT can cause some challenges when assessing intraabdominal and intrathoracic symptoms or performing operations. CASE PRESENTATION We report a case of a 93-year-old woman with a past medical history of hypertension, hyperlipidemia, atrial fibrillation, and situs inversus totalis who presented with diffuse abdominal pain for 4 days. Abdominal exam was significant for diffuse tenderness. Computed tomography (CT) imaging was significant for pneumoperitoneum. She emergently underwent an exploratory laparotomy, descending hemicolectomy and left in discontinuity with an open abdomen. On postoperative day 2 she underwent a stamm feeding gastrostomy tube, incisional hernia repair, and maturation of end colostomy. Her remaining hospital course was complicated by a pelvic collection, which was managed by a percutaneous guided drain placement. She was ultimately discharge to rehab on hospital day 15. DISCUSSION SITS can present a particularly challenging situation to clinical diagnoses and surgical procedures. However, when identified, these patients should warrant special considerations prior to proceeding with surgical intervention. This includes radiologic imaging and proper planning prior to the operating room, when possible. CONCLUSION We herein present a case of colonic perforation in a patient with situs inversus totalis. Proper planning, thorough imaging, and careful execution are necessary to ensure patient safety and care in patients with SIT. However, in the case of emergency this should not delay definitive management.
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Affiliation(s)
- Omar Elfanagely
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Yousef Elfanagely
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Abimbola Pratt
- Division of Trauma, Acute Care Surgery & Critical Care, Department of Surgery, Hackensack Meridian Health, USA
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Valiveru RC, Cherian A, Srinivasan K, Maroju NK. Use of a Clinical Audit System in Implementing Surviving Sepsis Campaign Guidelines in Patients With Peritonitis. Cureus 2021; 13:e15961. [PMID: 34211817 PMCID: PMC8236269 DOI: 10.7759/cureus.15961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Sepsis is the predominant cause of morbidity and mortality in patients with peritonitis. "Surviving Sepsis Campaign" (SSC) is an international effort in reducing mortality based on evidence-based guidelines. This study aims to assess the impact of audit-based feedback in a Plan-Do-Study-Act (PDSA) format on improving the implementation of the SSC guidelines in patients with generalized peritonitis at our center. Methods This prospective observational study was conducted in four audit cycles in PDSA format. Multi-departmental inputs were taken to suggest modifications in practice. A questionnaire-based analysis of reasons for non-compliance was performed to find out the opinions and reasons for non-compliance. Morbidity, mortality, and the length of ICU and hospital stay among these patients were also analyzed. Results Baseline compliance with intravenous (IV) bolus administration, central venous pressure (CVP)-guided fluids, and inotropes support when indicated were 100%. Over the course of the three audit cycles, statistically significant improvement in compliance was noted for obtaining blood cultures before antibiotics, antibiotic administration within three hours of presentation, and serum lactate measurement. Overall bundle compliance improved from 9.2% to 64.7% by the end of audit cycle III. Conclusions This study demonstrates that audit-based feedback is a dependable means of improving compliance with SSC guidelines. It brings about improvement by educating users, modifying their behavior through feedback, and enhances process improvement by identifying and correcting systemic deficiencies in the organization.
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Affiliation(s)
- Ramya C Valiveru
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Anusha Cherian
- Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | | | - Nanda K Maroju
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Hameed T, Kumar A, Sahni S, Bhatia R, Vidhyarthy AK. Emerging Spectrum of Perforation Peritonitis in Developing World. Front Surg 2020; 7:50. [PMID: 33102512 PMCID: PMC7522547 DOI: 10.3389/fsurg.2020.00050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Gastrointestinal perforations constitute a major cause of patients with acute abdomen pain coming to the surgery emergency room. Incidence, site of perforation, and age is different in the developing world and is showing new trends. The etiological spectrum in the developing world is different from the western world. This study was conducted to find out the latest trends in perforation peritonitis in India. Methods: This study was conducted in a single surgical unit of Darbhanga Medical College and Hospital, India. A total of 350 consecutive patients with perforation peritonitis were studied in terms of age, sex, seasonal variation, biochemical parameters, clinical presentation, radiological and intraoperative findings, surgical intervention, and postoperative outcome. Results: The most common cause of perforation peritonitis in our study was a duodenal ulcer (~50%) followed by typhoid (20%), traumatic (14.5%), appendicular (7.4%), and tubercular (3.1%) cases. Males were three times more commonly affected than females. Peak incidence was noted in the 2nd and 3rd decades of life. Peptic ulcer perforations were common in autumn and winter and typhoid perforations were common during the summer and rainy seasons. Conclusion: Spectrum of perforation peritonitis cases in this part of world is different from developed western countries. It is different in respect of younger age at presentation, site of perforation, and etiological factors. Infective pathology makes up to a quarter of total cases in the developing world. The developing world has more perforation peritonitis cases involving the upper gastrointestinal tract, while the western world has a predominance of lower gastrointestinal tract perforations.
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Affiliation(s)
- Tariq Hameed
- Department of Surgery, Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Awadh Kumar
- Department of Surgery, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Shivanand Sahni
- Department of Surgery, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Rahul Bhatia
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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Cervantes-García D, Bahena-Delgado AI, Jiménez M, Córdova-Dávalos LE, Ruiz-Esparza Palacios V, Sánchez-Alemán E, Martínez-Saldaña MC, Salinas E. Glycomacropeptide Ameliorates Indomethacin-Induced Enteropathy in Rats by Modifying Intestinal Inflammation and Oxidative Stress. Molecules 2020; 25:molecules25102351. [PMID: 32443501 PMCID: PMC7287897 DOI: 10.3390/molecules25102351] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022] Open
Abstract
Nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy is considered a serious and increasing clinical problem without available treatment. Glycomacropeptide (GMP) is a 64-amino acid peptide derived from milk κ-casein with numerous biological activities. The aim of this study was to investigate the protective effect of GMP on NSAID enteropathy in rats. Enteropathy was induced by seven days oral indomethacin administration. Rats were orally GMP treated from seven days previous and during the establishment of the enteropathy model. Changes in metabolism, hematological and biochemical blood alterations, intestinal inflammation and oxidative damage were analyzed. Integrity barrier markers, macroscopic intestinal damage and survival rate were also evaluated. GMP treatment prevented anorexia and weight loss in animals. Furthermore, prophylaxis with GMP ameliorated the decline in hemoglobin, hematocrit, albumin and total protein levels. The treatment had no therapeutic efficacy on the decrease of occludin and mucin (MUC)-2 expression in intestinal tissue. However, GMP markedly decreased neutrophil infiltration, and CXCL1, interleukin-1β and inducible nitric oxide synthase expression. Nitric oxide production and lipid hydroperoxide level in the small intestine were also diminished. These beneficial effects were mirrored by preventing ulcer development and increasing animal survival. These results suggest that GMP may protect against NSAID enteropathy through anti-inflammatory and antioxidant properties.
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Affiliation(s)
- Daniel Cervantes-García
- Department of Microbiology, Basic Science Center, Autonomous University of Aguascalientes, Aguascalientes 20131, Mexico; (D.C.-G.); (A.I.B.-D.); (M.J.); (L.E.C.-D.); (V.R.-E.P.)
- National Council of Science and Technology, Mexico City 03940, Mexico
| | - Armida I. Bahena-Delgado
- Department of Microbiology, Basic Science Center, Autonomous University of Aguascalientes, Aguascalientes 20131, Mexico; (D.C.-G.); (A.I.B.-D.); (M.J.); (L.E.C.-D.); (V.R.-E.P.)
| | - Mariela Jiménez
- Department of Microbiology, Basic Science Center, Autonomous University of Aguascalientes, Aguascalientes 20131, Mexico; (D.C.-G.); (A.I.B.-D.); (M.J.); (L.E.C.-D.); (V.R.-E.P.)
| | - Laura E. Córdova-Dávalos
- Department of Microbiology, Basic Science Center, Autonomous University of Aguascalientes, Aguascalientes 20131, Mexico; (D.C.-G.); (A.I.B.-D.); (M.J.); (L.E.C.-D.); (V.R.-E.P.)
| | - Vanessa Ruiz-Esparza Palacios
- Department of Microbiology, Basic Science Center, Autonomous University of Aguascalientes, Aguascalientes 20131, Mexico; (D.C.-G.); (A.I.B.-D.); (M.J.); (L.E.C.-D.); (V.R.-E.P.)
| | - Esperanza Sánchez-Alemán
- Department of Morphology, Basic Science Center, Autonomous University of Aguascalientes, Aguascalientes 20131, Mexico; (E.S.-A.); (M.C.M.-S.)
- Unit of Familiar Medicine #8, Mexican Institute of Social Security, Aguascalientes 20180, Mexico
| | - María C. Martínez-Saldaña
- Department of Morphology, Basic Science Center, Autonomous University of Aguascalientes, Aguascalientes 20131, Mexico; (E.S.-A.); (M.C.M.-S.)
| | - Eva Salinas
- Department of Microbiology, Basic Science Center, Autonomous University of Aguascalientes, Aguascalientes 20131, Mexico; (D.C.-G.); (A.I.B.-D.); (M.J.); (L.E.C.-D.); (V.R.-E.P.)
- Correspondence: ; Tel.: +52-449-910-8424
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Tochie JN, Agbor NV, Frank Leonel TT, Mbonda A, Aji Abang D, Danwang C. Global epidemiology of acute generalised peritonitis: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e034326. [PMID: 31919127 PMCID: PMC6955529 DOI: 10.1136/bmjopen-2019-034326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Globally, acute generalised peritonitis (AGP) is a common medical and surgical emergency which is a major contributor to non-trauma deaths despite improvements in diagnosis and surgical and intensive care management. In order to determine the global burden of AGP, geared at tailoring key interventions to curb its morbidity and mortality, we proposed this first ever systematic review and meta-analysis to estimate the contemporary prevalence, and to determine the most frequent AGP and the case fatality rate of AGP, at the global scene. METHODS AND ANALYSIS We intend to search AfricanJournalsOnline, Americana em Ciências da Saúde, Citation index, EMBASE, Global Index Medicus, Literatura Latino Africa Index Medicus, Medline and Scientific Electronic Library Online databases from 1 January 2009 to 31 July 2019 to identify studies that reported the prevalence, types of AGP, and case fatality rate of AGP in the global population without any language restrictions. Study selection, data extraction and risk of bias assessment will be conducted independently at each level by a pair of independent investigators. Random-effects meta-analysis will be used to pool studies judged to be clinically homogeneous. The presence of heterogeneity will be evaluated using the χ² test on Cochrane's Q statistic and quantified with the I² statistics. Publication bias will be evaluated statistically and visually using the Egger's test and funnel plots, respectively. Findings will be reported and compared by countries, WHO regions and globally. ETHICS AND DISSEMINATION Since this study will be based on published data, it does will not require an ethical approval. The findings will be published in a scientific peer-reviewed journal. They will also be presented at scientific conferences and to relevant public health actors. PROSPERO REGISTRATION NUMBER CRD42019143331.
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Affiliation(s)
- Joel Noutakdie Tochie
- Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | - Ndip Valirie Agbor
- Department of General Medicine, Ibal Sub-Divsional Hospital, North West Region, Oku, Cameroon
| | | | - Aime Mbonda
- Department of Surgery, National Social Insurance Fond Hospital, Yaounde, Cameroon
| | - Desmond Aji Abang
- Global Health System Solutions (GHSS) and Faculty of Sciences, University of Buea, Buea, Cameroon
| | - Celestin Danwang
- Department of Surgery and Sub-Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
- Epidemiology and Biostatistics Unit, UCL Institute of Experimental and Clinical Research, Bruxelles, Belgium
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Jean Paul A. Descriptive and correlational study of the epidemiological, clinical and etiological characteristics of peritonitis in the surgical department of the HUEH during the period from January 2013 to December 2018: A protocol study. Int J Surg Protoc 2020; 18:1-4. [PMID: 31897445 PMCID: PMC6921144 DOI: 10.1016/j.isjp.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023] Open
Abstract
Introduction Generalized secondary peritonitis is one of the most common emergencies encountered in surgical departments with a mortality of up to 20%. While early prognostic assessment of peritonitis is essential for the objective classification of the severity of the disease, the late presentation of the majority of patients to health facilities affects this situation, further complicating effective management and promoting the occurrence of complications. In Haiti, few studies on surgical pathologies are available, and with regard to peritonitis, only two thesis works have been listed on the subject. This study aims to: explore the demographic, clinical and etiological characteristics of peritonitis in the main referral hospital in the metropolitan region of the Haiti, and evaluate the main delays and its relationship with the severity of the disease by measuring the MPI score. Methodology It is a correlational descriptive study, retrospectively carried out over a period of 6 years, from January 2013 to December 2018 in the surgical department of the Hospital of the State University of Haiti. The study population is composed of all patients diagnosed, hospitalized and operated on in the peritonitis ward during the study period Pearson's correlation with α < 0.05 was used as the significance threshold and the correlation of complications and duration of management by Spearman's correlation to assess the relationship between sex, age group, complications and length of hospital stay. A multiple linear regression will be done for the most significant correlations. The comparison of the means was made by the Z test, with α < 0.05 as the significance threshold, and the student T test for variables with two modalities such as complication. The ANOVA test was used to cross-reference dependent and independent variables with more than 2 modalities, and the Pearson chi-square test for qualitative variables with etiological and demographic diagnoses.
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Key Words
- ANOVA, Analysis of variance
- APACHE, Acute physiology and chronic health evaluation
- Diagnosis
- Epidemiology
- FMP, Faculty of Medicine and Pharmacy
- HR, Heart rate
- HUEH, Hospital of the State University of Haiti
- Hb, Hemoglobin
- LABMES, Laboratory of Ethical Medicine and Societies
- MPI score
- MPI, Mannheim peritonitis index
- Management
- Peritonitis in Haiti
- RR, Respiratory rate
- SAPS, Simplified acute physiology score
- SSS, Sepsis severity score
- T, Temperature
- Treatment and complication
- UEH, State University of Haiti
- WBC, White blood cell
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Affiliation(s)
- Axler Jean Paul
- Faculty of Medecine and Pharmacy of the State University of Haiti, State University Hospital of Haïti, Haiti
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Jean Paul A, Toussaint S, Alouidor J. Descriptive and correlational study of peritonitis in the surgical department of the State University hospital of Haïti (HUEH): A cross sectional study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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13
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Kumar-M P, Shafiq N, Kumar P, Gupta A, Malhotra S, M N, Gautam V, Ray P, Gupta R, Gupta V, Deen Yadav T, Verma GR, Singh R, Singh G. Antimicrobial susceptibility patterns of organisms causing secondary abdominal infections in patients with perforated abdominal viscus. Ther Adv Infect Dis 2019; 6:2049936119865796. [PMID: 31391942 PMCID: PMC6669836 DOI: 10.1177/2049936119865796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Secondary peritonitis, following intestinal perforation, constitutes a significant proportion of cases admitted as a surgical emergency and has a mortality rate of 6–21% worldwide. As a part of an antimicrobial stewardship program, we noted considerable variation among the choice of empirical regimens among such cases. Hence, we conducted a prospective study to generate the evidence for a rational empiric regimen for patients with secondary peritonitis following intestinal perforation. Methods: The study included a complete follow up of 77 cases of secondary peritonitis admitted during a 12 month period. The intraoperative fluid (peritoneal) sample of the patient was sent for culture and sensitivity pattern analysis. Results: The sites of perforation as seen in decreasing order were lower gastrointestinal (GI) (50.6%), upper GI (36.4%), and unclassified (13%). The most common organism found in the intraoperative fluid was Escherichia coli (47.9%) followed by Klebsiella pneumoniae (12.5%). amikacin, cefoperazone-sulbactam, piperacillin-tazobactam and imipenem were sensitive in 22 (out of 23 tested), 5 (out of 9), 13 (out of 13) and 22 (out of 22) isolates of E. coli and 3 (out of 6), 1 (out of 3), 4 (out of 6), 4 (out of 6) isolates of K. pneumoniae, respectively. The most common empirical antibiotic was cefoperazone-sulbactam (38.7%) followed by piperacillin-tazobactam (29.3%). Conclusion: Based on our prospective study, piperacillin-tazobactam or imipenem should be used empirically in patients presenting with complicated intra-abdominal infections secondary to perforated viscus, especially if they have sepsis or septic shock.
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Affiliation(s)
- Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Room No. 4017, Research Block B, Chandigarh 160012, India
| | - Pradeep Kumar
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Thakur Deen Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - G R Verma
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajinder Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gurpreet Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Rickard J. Treating Surgical Infections in Low- and Middle-Income Countries: Source Control, Then What? Surg Infect (Larchmt) 2019; 20:192-196. [PMID: 30698510 DOI: 10.1089/sur.2018.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Surgical infections present a significant burden of disease globally. Management focuses on source control and appropriate antibiotic therapy. This remains a challenge in low- and middle-income settings, where access to surgical care and antibiotics is limited. This paper discusses the complex challenges facing the management of surgical infections in low- and middle-income countries.
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Affiliation(s)
- Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Vashistha N, Singhal D, Budhiraja S, Aggarwal B, Tobin R, Fotedar K. Outcomes of Emergency Laparotomy (EL) Care Protocol at Tertiary Care Center from Low-Middle-Income Country (LMIC). World J Surg 2018; 42:1278-1284. [PMID: 29159605 DOI: 10.1007/s00268-017-4333-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency laparotomy mortality ranges between 10 and 20% in best of Western healthcare systems and is currently a major focus for quality improvement programs. In contrast, emergency surgery scenario in LMIC is largely undefined, often neglected and complex (large burden of diseases but only limited capacity for adequate treatment). We evaluated the efficacy of 'EL care protocol' aimed at cost-effective optimal utilization of best available local expertise and infrastructure. METHODS One hundred and two consecutive adult patients (≥16 years) who underwent EL from December 2012-December 2015 at a private tertiary hospital were retrospectively analyzed. The patients who underwent emergency laparoscopic procedures were excluded from the analysis. The EL care protocol included. (1) Admission to surgical intensive care unit for pre- and postoperative optimization. (2) Preferred radiologic investigation: abdominal computed tomography (CT) scan. (3) Surgery and critical care by senior surgical gastroenterologists and internists/anesthesiologists, respectively. Outcome measures were procedure-related complications (Clavien-Dindo classification), readmissions and costs. RESULTS Of the 102 patients, there were 62 males and 40 females with median age of 60 (range 16-93) years. There were no complications in 22 (21.6%) patients, while Clavien-Dindo complications grade I or II occurred in 48 (47%) patients. Grade V Clavien-Dindo complications and the 30-day mortality were similar of 19 (18.6%). The readmission rate was 8 (7.8%). The expected mortality for the study group by P-POSSUM score was 31.2 (30.6%). The ratio (O/E) of observed to expected mortality was 0.61. The all inclusive median cost of treatment was INR 379,255 ($5590). CONCLUSIONS LMIC centers should develop their own center-specific EL care protocols to improve outcomes of EL.
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Affiliation(s)
- Nitin Vashistha
- Department of Surgical Gastroenterology, Max Super Speciality Hospital, Saket, New Delhi, 110017, India
| | - Dinesh Singhal
- Department of Surgical Gastroenterology, Max Super Speciality Hospital, Saket, New Delhi, 110017, India.
| | - Sandeep Budhiraja
- Department of Internal Medicine, Max Super Speciality Hospital, Saket, New Delhi, 110017, India
| | - Bharat Aggarwal
- Department of Radiology, Max Super Speciality Hospital, Saket, New Delhi, 110017, India
| | - Raj Tobin
- Department of Anesthesiology, Max Super Speciality Hospital, Saket, New Delhi, 110017, India
| | - Kamal Fotedar
- Department of Anesthesiology, Max Super Speciality Hospital, Saket, New Delhi, 110017, India
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Ahmed Z, Khan SA, Chhabra S, Yadav R, Kumar N, Vij V, Saxena D, Talera D, Kankaria J, Gupta S, Bugalia RP, Goyal A, Yadav BL, Jenaw RK. Our experience with surgery in situs inversus: Open peptic perforation repair and laparoscopic cholecystectomy in 1 patient and 3 patients respectively. Int J Surg Case Rep 2016; 29:34-38. [PMID: 27810609 PMCID: PMC5094291 DOI: 10.1016/j.ijscr.2016.10.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Situs inversus is a rare autosomal recessive condition associated with complete transposition of abdominal+/- thoracic organs. Surgical diagnosis and surgical procedures in patients with situs inversus is tricky because of the mirror image anatomy of intra-abdominal organs. MATERIALS AND METHODS A retrospective analysis of 2152 and 1497 patients who underwent laparoscopic cholecystectomy and open peptic perforation repair respectively from June 2014-June 2016 was done. 1 patient and 3 patients with situs inversus underwent open peptic perforation repair and laparoscopic cholecystectomy respectively. A 10mm left para-median port 5cm caudally from xiphoid was used for grasping the infundibulum. Two 5mm ports placed 10cm caudally from costal margin in the mid-clavicular and anterior axillary line were used for dissecting and retracting fundus respectively. A 10mm supra-umbilical camera port was used. RESULTS A 40year male with situs inversus totalis underwent open peptic perforation repair. Laparoscopic cholecystectomy was done in 3 female patients with situs inversus aged 33-46year (mean 41year). Mean operative time for laparoscopic cholecystectomy was 59min (39-93). There were no intraoperative or post-operative complications. Histopathology revealed chronic inflammation in peptic perforation and cholecystitis. CONCLUSION Perforation peritonitis in situs inversus can cause diagnostic confusion with free gas under the left hemi diaphragm. Laparoscopic cholecystectomy in situs inversus is ergonomically inconvenient and technically difficult for right handed surgeons. We describe an ergonomically convenient port placement for right handed surgeons in situs inversus.
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Affiliation(s)
- Zeeshan Ahmed
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Sami A Khan
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Sanjeev Chhabra
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Rahul Yadav
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Nitin Kumar
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Vikesh Vij
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Dhananjay Saxena
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Devender Talera
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Jeevan Kankaria
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Shalu Gupta
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Rajendra P Bugalia
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Amit Goyal
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Bhanwar L Yadav
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
| | - Raj K Jenaw
- Department of General Surgery, SMS Medical College and Hospital, JLN Marg, Jaipur 302004 Rajasthan, India.
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Franco-Paredes C, Khan MI, Gonzalez-Diaz E, Santos-Preciado JI, Rodriguez-Morales AJ, Gotuzzo E. Enteric Fever: A Slow Response to an Old Plague. PLoS Negl Trop Dis 2016; 10:e0004597. [PMID: 27171237 PMCID: PMC4865160 DOI: 10.1371/journal.pntd.0004597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gómez, México D.F., México
- Phoebe Putney Memorial Hospital, Albany, Georgia, United States of America
- * E-mail:
| | - M. Imran Khan
- Precision Developmental Research and Advocacy Consultants, Karachi, Pakistan
| | | | - Jose I. Santos-Preciado
- Unidad de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Hospital General de México, México, D.F., México
| | - Alfonso J. Rodriguez-Morales
- Public Health and Infectious Disease Research Group, Facultad de Ciencias Médicas, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical, Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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Chichom-Mefire A, Fon TA, Ngowe-Ngowe M. Which cause of diffuse peritonitis is the deadliest in the tropics? A retrospective analysis of 305 cases from the South-West Region of Cameroon. World J Emerg Surg 2016; 11:14. [PMID: 27069503 PMCID: PMC4827245 DOI: 10.1186/s13017-016-0070-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/06/2016] [Indexed: 12/16/2022] Open
Abstract
Background Acute diffuse peritonitis is a common surgical emergency worldwide and a major contributor to non-trauma related death toll. Its causes vary widely and are correlated with mortality. Community acquired peritonitis seems to play a major role and is frequently related to hollow viscus perforation. Data on the outcome of peritonitis in the tropics are scarce. The aim of this study is to analyze the impact of tropic latitude causes of diffuse peritonitis on morbidity and mortality. Methods We retrospectively reviewed the records of 305 patients operated on for a diffuse peritonitis in two regional hospitals in the South-West Region of Cameroon over a 7 years period. The contributions of various causes of peritonitis to morbidity and mortality were analyzed. Results The diagnosis of diffuse peritonitis was suggested on clinical ground only in more than 93 % of cases. The most common causes of diffuse peritonitis included peptic ulcer perforation (n = 69), complications of acute appendicitis (n = 53) and spontaneous perforations of the terminal ileum (n = 43). A total of 142 complications were recorded in 96 patients (31.5 % complication rate). The most common complications included wound dehiscence, sepsis, prolonged paralytic ileus and multi-organ failure. Patients with typhoid perforation of the terminal ileum carried a significantly higher risk of developing a complication (p = 0.002). The overall mortality rate was 15.1 %. The most common cause of death was septic shock. Differential analysis of mortality of various causes of peritonitis indicated that the highest contributors to death toll were typhoid perforation of terminal ileum (34.7 % of deaths), post-operative peritonitis (19.5 %) and peptic ulcer perforation (15.2 %). Conclusion The diagnosis of diffuse peritonitis can still rely on clinical assessment alone in the absence of sophisticated imaging tools. Peptic ulcer and typhoid perforations are still major contributors to death toll. Patients presenting with these conditions require specific attention and prevention policies must be reinforced.
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Affiliation(s)
- Alain Chichom-Mefire
- Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaoundé, Cameroon
| | - Tabe Alain Fon
- Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaoundé, Cameroon
| | - Marcelin Ngowe-Ngowe
- Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaoundé, Cameroon
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Affiliation(s)
- Binit Sureka
- Department of Radiology and Interventional Radiology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
| | - Kalpana Bansal
- Department of Radiology and Interventional Radiology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
| | - Ankur Arora
- Department of Radiology and Interventional Radiology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
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Valiveru RC, Maroju NK, Srinivasan K, Cherian A. Clinical audit system in implementing Surviving Sepsis Campaign guidelines in patients with peritonitis. Crit Care 2014. [PMCID: PMC4273802 DOI: 10.1186/cc14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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