Isolated adult ileocecal intussusception in sigmoid colon due to non-specific inflammation.

Adult ileocecal intussusception due to non-specific inflammation is a rare condition. Intussusception is the intestinal segment telescoping into the adjacent intestinal lumen. Typically, a pathological lesion is discovered with a high percentage of malignancy. Intussusception of the most common ileocolic kind includes the appendix, but it is uncommon for an appendix to serve as the lead point. The patient was admitted to the emergency department with a complaint of acute intestinal obstruction. After getting a diagnostic workup, an exploratory laparotomy was done, and the ileocecal and ascending colon segment was intussuscepted directly into the sigmoid colon. Transverse and descending colon were normal, and resection of necrosed intussuscepted bowel, primary repair of sigmoid colon with ileostomy with transverse colon as distal mucus fistula done, after the 3-month restoration of bowel continuity done, patient discharged and doing well. After the diagnosis of intussusception, the best surgical choice is in the hands of an experienced surgeon.

A Clinical Comparative Study of Rectus Sheath Closure Techniques in Emergency Exploratory Laparotomy: Evaluating "Far-Near-Near-Far" vs. Conventional Closure Approach.

BACKGROUND: Midline exploratory laparotomy is essential in emergency surgery, and effective closure of the abdominal wall is crucial for optimal healing and reduced complications. The far-near-near-far technique for rectus sheath closure has gained attention due to potential advantages over conventional closure due to the fact that even if one suture gives way it does not affect the nearby suture and the rectus sheath is still held in place. This study aims to compare these techniques in emergency exploratory laparotomy. METHODS: This single-center prospective observational study included all patients undergoing emergency exploratory laparotomy at a tertiary care hospital. Patients were categorized into two groups based on the closure technique used: conventional closure or far-near-near-far technique. Sociodemographic data and comorbidities were collected. Operative time, closure time, and postoperative complications were assessed. Statistical analysis was performed using IBM SPSS Statistics 22.0 (IBM Corp., Armonk, NY). RESULTS: The study included patients with a mean age of 42.14 years. Operative and closure times did not significantly differ between the groups. There was no significant difference in comorbidities between the two techniques. The incidence of wound infection, dehiscence, burst abdomen, incisional hernia, and sinus formation did not significantly differ between the groups. Late complications were also similar. CONCLUSION: The far-near-near-far technique for rectus sheath closure in emergency exploratory laparotomy showed comparable outcomes to conventional closure methods. No significant differences were found in operative time, closure time, or postoperative complications. This study contributes to the understanding of different closure techniques, allowing surgeons to make informed decisions.

Performance validation of different trauma scoring systems among polytrauma patients having predominantly blunt abdominal trauma.

INTRODUCTION: Blunt abdominal trauma substantially contributes to mortality and morbidity in patients with polytrauma. Appropriate clinical assessment is important in setups lacking facilities of advanced diagnostics (abdominal computed tomography scans and ultrasonography) to decide if the patients' needs exceed the facilities available. This study aimed to assess the utility of the commonly used trauma scores in predicting the outcome (favorable or unfavorable) in patients with predominantly blunt abdominal trauma. STUDY DESIGN AND METHODS: In this prospective observational study of 12-month duration, we calculated three scores (Glasgow Coma Scale [GCS], Revised Trauma Score [RTS], and Injury Severity Score [ISS]) in patients brought to emergency department and fulfilling the inclusion criteria. These patients were categorized into two categories (favorable and unfavorable) depending on their treatment outcome. The difference in the mean scores for both outcomes in each score was calculated and further inferences were obtained by using the unpaired t test. A receiver-operating characteristic curve for each score was drawn to understand the trade-off between sensitivity and specificity at each cutoff value and for determining area under curve (AUC) for all three scores. RESULT: A total of 103 patients were recruited in the study (88 men and 15 women) with the mean age of 31.03 (±13.40) years and 34.47 (±18.04) years, respectively. The difference in the scores was maximum for ISS and minimal for RTS. The visual impression, as well as AUC values, shows that ISS performed well to discriminate between the favorable and unfavorable outcomes in each cutoff values (AUC -0.806, lower bound 0.678 to upper bound 0.934) compared to GCS and RTS scores. The Youden's J statistic for ISS value of 42 was maximum (0.298) and corresponding sensitivity and specificity were 0.651 and 0.647. CONCLUSION: ISS is superior as compared to GCS and RTS in predicting outcome in polytrauma patients with a blunt abdominal injury. ISS value of <42 predicts a favorable outcome.

A Rare Case of Renal Pelvic Hydatid Cyst Masquerading as Renal Calculi.

Background: Hydatid disease of urinary tract is most common in the kidney. In kidney, hydatid cysts are most commonly found in the renal parenchyma. Isolated hydatid cysts in the renal pelvis are extremely rare with only three cases reported in the literature. Case Presentation: We present a case of isolated hydatid cysts in the renal pelvis masquerading as renal pelvic calculi, which were diagnosed during surgery and confirmed on histopathology. Conclusion: Hydatid cysts can masquerade as renal calculi. Preoperative modalities may miss the correct diagnosis. Histopathology in suspected cases can confirm the diagnosis so that proper chemotherapy can be offered to patient to avoid recurrence.