Perforation of the colon is frequently encountered in surgical emergencies and requires urgent intervention. Free colonic perforations are diagnosed early due to the development of signs of ...peritoneal irritation. However, perforation of the posterior wall of the colon into the retro-peritoneal space poses a diagnostic challenge because of the absence of signs of peritoneal irritation and its atypical clinical presentation. The authors reported an unusual case of 42 years old female patient with idiopathic perforation of the posterior wall of the ascending colon that presented as a large retroperitoneal abscess. The abscess was diagnosed based on clinical and Computed Tomography (CT) findings, and the patient underwent incision and drainage of the abscess through a flank incision. There was initial improvement in the patient’s general condition, but on the fourth day, there was faecal discharge through the wound, indicating colonic perforation. The patient was immediately taken for an emergency laparotomy. Intraoperatively, the peritoneal cavity was found to be clean; however, upon mobilisation of the ascending colon, two large perforations on its posterior wall were found with faecal soiling of the retroperitoneal tissues. Right hemicolectomy with end ileostomy and closure of the transverse colonic end were performed. Histopathology revealed the absence of any definite pathology, and a diagnosis of spontaneous perforation was made. This unusual case highlights that this rare possibility should be considered as a differential diagnosis of a retroperitoneal abscess to enable early intervention, which is likely to save the patient.
We reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the assault. The bullet entered above the right zygomatic arch, travelling ...through the coronal plane, and exited from the left zygomatic arch. The patient was fully conscious at presentation and developed facial nerve palsy during his hospital stay. Non-contrast CT scan of the head revealed fractures of the right orbit, bilateral maxilla, bilateral pterygoid plates, ethmoid air cells, vomer and left zygoma, and without any cerebral damage. He was treated conservatively and the facial palsy was resolved. The patient survived without any complications. Such case has not been described in the available literature till date.
Fine needle aspiration (FNA) of the thyroid is a well-tolerated minimally invasive procedure. Thyroid abscess, as a complication of FNA in an immune-competent adult, is extremely rare. Diagnosis ...requires a high index of suspicion, for which treatment is intravenous antibiotics, drainage, and sometimes surgery. Here we present a case of thyroid abscess in an otherwise healthy man who presented with neck pain, rapidly increasing neck swelling, difficulty in swallowing, and hoarseness of the voice that developed two weeks after diagnostic FNA of a thyroid nodule which had been present for ten months. Despite antibiotic treatment, the abscess ruptured into the trachea, requiring surgical intervention. This highlights the importance of maintaining asepsis during FNA of the thyroid. Timely diagnosis of a thyroid abscess is essential to avoid life-threatening airway complications.
Inguinal hernia repair is a common procedure in general surgery today, and an ideal operation to treat inguinal hernia is still far to define. The synthetic prostheses commonly used in its repair can ...create a few clinical problems which have influenced many investigators to look for new hernia repair techniques, and an example of such efforts is Desarda’s method of inguinal hernia repair. The objective of this study was to clinically evaluate the technique of Desarda’s repair for inguinal hernia on parameters such as technical feasibility, post-operative pain, incidence of complications in terms of wound morbidity (seroma, surgical site infection, persistent pain), testicular atrophy, and recurrence rates. Among 30 patients selected, Desarda’s technique for inguinal hernia repair was evaluated, and outcome was measured in terms of post-operative pain, surgical site infection, seroma, testicular atrophy, and recurrence at 4 weeks, 6 months, 1 year, 2 years, and 5 years. In this prospective study over a period of 5 years, operating time observed was 49.60 ± 13.45 min; mean pain score observed using visual analogue scale (0–10) at 24 h was 2.4 ± 0.86. Complications noted were minimal, and most common complication noted was scrotal edema; none of the patients had recurrence or any long-term morbidity. Desarda’s technique of biological repair is a logical alternative considering the drawbacks of the use of mesh having shorter operative period, no chronic groin pain, minimal complications with no recurrence, and also being cost-effective.
Surgeons in their daily practice are at the forefront in preventing and managing infections. However, among surgeons, appropriate measures of infection prevention and management are often ...disregarded. The lack of awareness of infection and prevention measures has marginalized surgeons from this battle. Together, the Global Alliance for Infections in Surgery (GAIS), the World Society of Emergency Surgery (WSES), the Surgical Infection Society (SIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), the American Association for the Surgery of Trauma (AAST), and the Panamerican Trauma Society (PTS) have jointly completed an international declaration, highlighting the threat posed by antimicrobial resistance globally and the need for preventing and managing infections appropriately across the surgical pathway. The authors representing these surgical societies call all surgeons around the world to participate in this global cause by pledging support for this declaration for maintaining the effectiveness of current and future antibiotics.
Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, ...and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.
Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons ...are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the risk for surgical site infections and play a key role in their prevention. Surgeons are also at the forefront in managing patients with infections, who often need prompt source control and appropriate antibiotic therapy, and are directly responsible for their outcome. In this context, the direct leadership of surgeons in infection prevention and management is of utmost importance. In order to disseminate worldwide this message, the editorial has been translated into 9 different languages (Arabic, Chinese, French, German, Italian, Portuguese, Spanish, Russian, and Turkish).
There is ample evidence in the recent literature that gum chewing after elective colonic anastomosis decreases postoperative ileus (POI). But there are very few studies on small bowel anastomosis ...done in relaparotomy cases. This study aimed to evaluate the effect of gum chewing on the duration of POI following small bowel anastomosis performed for the closure of intestinal stoma, made as temporary diversion in the selected cases of typhoid perforation peritonitis.
Hundred patients undergoing elective small bowel anastomosis for the closure of stoma were randomly assigned to the study group (n=50) and the control group (n=50). The study group patients chewed gum thrice a day for 1 h each time starting 6 h after the surgery until the passage of first flatus. The control group patients had standard postoperative treatment.
Study and control group patients were comparable at inclusion. The mean time for the appearance of bowel sounds as well as the passage of first flatus was significantly shorter in the study group (P=0.040, P=0.006). The feeling of hunger was also experienced earlier in study group cases (P=0.004). The postoperative hospital stay was shorter in the study group, but the difference was not significant (P=0.059).
The cases of relaparotomy requiring additional adhesiolysis and small bowel anastomosis for stoma closure are benefited by postoperative gum chewing.
We report a very rare case of Meckel’s diverticulitis with ileal stricture at the base of the diverticulum in a young adult as a cause of recurrent small bowel obstruction lasting for 7 years. None ...of the pre-operative investigations were able to diagnose the cause of obstruction. The patient had undergone appendicectomy 3 years ago but without any relief. Thereafter he was given a therapeutic trial of anti-tubercular drugs, but his symptoms rather worsened with this treatment. Finally, the diagnosis of Meckel’s diverticulitis with ileal stricture was made on exploratory laparotomy. The patient recovered well following segmental ileal resection including the stricture and inflamed Meckel’s diverticulum. This unusual case highlights that such a rare clinical entity should be considered as a differential diagnosis while dealing with cases of recurrent distal ileal obstruction so as to avoid misdiagnosis and mismanagement as happened in the present case.
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