A Prospective Study of Surgical Site Infection with its Risk Factors and Their Correlation with the NNIS Risk Index.

Background: Surgical site infection (SSI) is the third most commonly reported nosocomial infection, accounting for 10%-40% of all nosocomial infections and is a major cause of postoperative morbidity. Knowledge of factors related to SSI can help in reducing its incidence and related morbidity, which in many studies is shown to account for 38% of all infections in surgical patients. Lack of extending nosocomial infection surveillance programme and prevention measures in countries like India is viewed as a major challenge for the future. Objectives: The aims of this work were (1) to study the SSI rate in patients undergoing both elective and emergency abdominal surgery and SSI with CDC, and NNIS risk index; and (2) to assess SSI along with body mass index (BMI), glycaemic status, smoking and duration of pre-operative hospital stay of patients. Materials and Methods: In total, 300 patients who underwent elective and emergency abdominal surgery were enrolled in the study as per inclusion and exclusion criteria. SSI with CDC's NNIS risk index were analysed considering BMI, glycaemic status, smoking and duration of pre-operative hospital stay of patients. Results: In total, 300 cases of abdominal surgeries (elective and emergency) were analysed, out of which 60 cases were diagnosed to have SSI as per the criteria. Conclusion: This study demonstrated that there is a significant increase in SSI with increasing NNIS score that is, the greater the NNIS score, the greater the risk of SSI. With an increase in age, BMI, glycaemic index and preoperative hospital stay, the risk of SSI increases. Smoking and associated comorbidities also increase the risk of SSI.

Difficult Laparoscopic Cholecystectomy Predictors and its Significance: Our Experience.

Background: Laparoscopic cholecystectomy (LC) has become the procedure of choice for the management of symptomatic gallstone disease. In LC, the surgeons encountered difficulties with acutely inflamed or gangrenous gallbladder (GB), dense adhesions at Calot's triangle, fibrotic and contracted GB, and cholecystoenteric fistula. Depending on the difficulty faced during the surgery, the outcome of LC may vary from abandoning the procedure or partial cholecystectomy to conversion into open cholecystectomy. Complications related to biliary tract or adjoining structures or vessels may also occur. Our aim was to assess the different preoperative factors in patients of cholelithiasis and ascertain the validity of the scoring system devised by Randhawa and Pujahari in preoperatively predicting the difficult LC in our hospital scenario. Materials and Methods: This hospital-based observational study was conducted in the Department of General Surgery for a period of 2 years. All diagnosed cases of cholelithiasis admitted for elective LC during the study period in our hospital were included in the study. Results: In total, 154 patients, aged≥50 years, history of hospitalization for acute cholecystitis (AC), body mass index of 25 kg/m2 and more, abdominal scar, palpable GB, GB wall thickness ≥4 mm, pericholecystic collection, impacted stone found to be significant factors to predict difficult LC preoperatively. Endoscopic retrograde cholangiopancreatography and pancreatitis were found as independent risk factor for difficult LC. Conclusion: We recommend that the scoring system should be regularly used as a protocol for predicting difficulty levels preoperatively in LC. It can help to decide the surgical approach, counsel the patients, and reduce the complication rate, rate of conversion, and overall medical cost. The scoring system proposed by Randhawa and Pujahari is effective but has some lacunae.

A Rare Case of Complete Agenesis of Dorsal Pancreas.

Agenesis of dorsal pancreas (ADP) is an extremely rare congenital anomaly that results from defective development of pancreas. Most ADP patients are asymptomatic; if symptomatic, they present with epigastric pain. About half of affected individuals develop diabetes mellitus (DM), resulting from reduced islet cell mass secondary to the absence of endocrine structures. Being very rare, it is generally not kept in mind while dealing these cases and are not suspected until imaging investigations are not done. In our case study, ADP was diagnosed during evaluation of the patient for recurrent pain abdomen and generalized weakness. How to cite this article: Jain A, Singh M, Dey S, Kaura A, Diwakar G. A Rare Case of Complete Agenesis of Dorsal Pancreas. Euroasian J Hepato-Gastroenterol 2017;7(2):183-184.

Ascaris lumbricoides causing infarction of the mesenteric lymph nodes and intestinal gangrene in a child: a case report.

Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene.

Ocular leech infestation.

A 67-year-old myopic man presented to the Ophthalmology Department of a teaching hospital in the mountainous state of Sikkim with complaints of red eye, ocular discomfort, and sensation of something moving in his right eye that led to occasional visual blurring from the previous four days. His symptoms started after washing his face in a stream. Clinical diagnosis was a leech in the limbus of the right eye at the 12 o'clock position. Ocular leech infestation should be considered in a patient with a history of swimming or face washing in streams and lakes. Herein we report a case of ocular leech infestation that presented as red eye with intermittent blurring of vision in the affected eye, and discuss the differential diagnosis and clinical significance.

Neonatal Fournier's gangrene.

Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any ages but it is rare in neonates and infants. Here, we report a case of Fournier's gangrene in a 21 day old male neonate who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gives good results and probably in our setting, to some extent, it is a preventable condition.

Alvarado scoring in acute appendicitis-a clinicopathological correlation.

Acute appendicitis is a clinical diagnosis, so it's impossible to have a definitive diagnosis by gold standard (histopathology) pre operatively. The treatment being surgical, negative appendicectomy rates are high. Present study was conducted to evaluate Alvarado scoring system for diagnosis of acute appendicitis and its co relation by histopathology. Retrospective study of consecutive patients admitted with suspected acute appendicitis during the period March 2005 to March 2007. The Alvarado scoring system was computed from admission notes and records and correlated with the histopathology reports. Out of 155 patients, 92 underwent appendicectomy with the intention to treat appendicitis and diagnosis was confirmed in 80 patients. Reliability of scoring system was assessed by calculating negative appendicectomy rate and positive predictive value. The normal appendicectomy frequency was 13% and positive predictive value was 86%. Alvarado scoring system is easy, simple, cheap, useful tool in pre operative diagnosis of acute appendicitis and can work effectively in routine practice.

Ruptured pseudoaneurysm of the radial artery.

A 40-year-old man presented with a progressively increasing swelling over the ventral aspect of the right wrist of 23 days duration following a laceration. The swelling was soft, pulsatile and was intermittently bleeding, with poor distal capillary filling and cold distal extremity. Clinically it was diagnosed as pseudoaneurysm of the radial artery and was sent for a duplex scan for confirmation. The lesion ruptured in the radiology department before the scan was done, and the patient went into hypovolaemia. In view of this, the patient underwent exploration of the pseudoaneurysm under brachial block, and the radial artery was found to be transected just proximal to the dorsal branch. It was decided to repair the artery as there was no evidence of adequate circulation supply or the patency of the ulnar artery preoperatively. Doppler study at 15 and 45 days postoperatively showed good flow through, with no evidence of thrombus.

Distal posterior tibial artery pseudoaneurysm after fracture calcaneous.

Here we report a case of pseudoaneurysm of distal posterior tibial artery following closed fracture of calcaneous. Association of pseudoaneurysm of posterior tibial artery with fracture of calcaneous is extremely uncommon. It is always suggested that pseudoaneurysm be treated by reconstruction, but here we present the case treated by ligation, obliteration and excision as it was situated distally and the plantar arch circulation was maintained. The purpose of this case report is to bring attention to this complication of vascular trauma, which may cause delayed symptoms long time after the injury as well as the rare incidence of posterior tibial artery involvement with fracture calcaneous.