Clinical Profile of Patients with Postoperative Adhesive Intestinal Obstruction and its Association with Intraoperative Peritoneal Adhesion Index.

UNLABELLED: Adhesions following surgery represent a major unsolved problem. They occur after 50% to 100% of all surgical interventions in the abdomen and may complicate the work of the surgeon considerably. Peritoneal adhesions are pathological bands that typically form between the omentum, the small and large bowels, the abdominal wall, and other intra-abdominal organs. These bands may be a thin film of connective tissue, a thick fibrous bridge containing blood vessels and nerve tissue, or a direct adhesion between two organ surfaces. AIMS AND OBJECTIVES: 1. To study the clinical profile of patients with adhesive intestinal obstruction undergoing laparotomy. 2. To assess and analyze the intra-operative peritoneal adhesion index (PAI) in individual cases. 3. To associate the clinical profile with peritoneal adhesion index in patients of adhesive intestinal obstruction. RESULT: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), SRH University, Dehradun, India over a period of 12 months. A total of 30 patients with diagnosis of post operative adhesive intestinal obstruction were recruited in the study. It was observed that adhesions over each abdominal region contributed equal to the total PAI. In this study it was observed that the patients who had previous emergency surgery had higher incidence of adhesions, than elective surgery whereas those patients who underwent both elective and emergency surgeries, the incidence of adhesions were lowest. Analysis of variance with respect to abdominal scar resulted that the difference between groups was observed to be statistically not significant (P 0.05), so patients with all type of abdominal scars of previous surgeries has equal chance of developing adhesions. CONCLUSION: PAI is a sensitive tool for clinical and intra-operative assessment of adhesive intestinal obstruction for the quantification of the adhesions and gives a precise description of the underlying intra-abdominal condition while planning a surgical management of the disease.

To Study the Aetiological Factors and Outcomes of Urgent Re-Laparotomy in Himalayan Hospital.

BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Relaparotomy (UR), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing URs, their outcomes and factors that affect mortality. METHODS: Observational, Prospective Study. The study included all the patients who underwent urgent re-laparotomy following laparotomy (emergency, elective) in Himalayan Hospital from 01.01.2013 to 01.06.2014 and excluded those who underwent laparotomy outside. RESULTS: UR was performed for 40 out of 1050 patients (4.2%), of which males were 25 and females 15. The average time interval between the index laparotomy and urgent re-exploration was 6.4 days. The most common reason for mortality was multi organ failure with septic shock. The most common criteria for re-exploration were anastomotic leak (n=13), followed by pyoperitoneum (n=11) and persistent peritonitis (n=6). Comparing the index surgery, lower gastro-intestinal procedures were most usually involved (n=21, 47.7%), followed by hepato-pancreato-biliary surgeries (n=8, 18.2%). There were 6 cases of upper gastro-intestinal surgeries that reexplored (13.6%). CONCLUSION: UR that is performed following complicated abdominal surgeries has high mortality rates. In particular, they have higher mortality rates following GIS surgeries or when infectious complications occur.

Clinico-Pathological Profile and Surgical Outcome of Patients of Gastrointestinal Tuberculosis Undergoing Laparotomy.

Tuberculosis is one of the earliest diseases affecting the mankind. Abdominal tuberculosis constitutes a common public health issue in developing countries like ours. Gastrointestinal tuberculosis often involves the ileocecal region. Surgery in case of abdominal tuberculosis is required to overcome the deleterious effects of the disease like tissue disorganization, obstruction and perforatio. AIMS AND OBJECTIVES: 1. To study the various clinical profiles of gastrointestinal tuberculosis in patients undergoing laparotomy; 2. To study the surgical pathology of gastrointestinal tuberculosis; 3. To study the various surgical treatment modalities based upon the intraoperative findings and its outcome. Results: This is a prospective study over 12 months at Himalayan Institute of Medical Sciences, SRHU, Swami Ram Nagar, Dehradun. This study was done to study the clinic-pathological profile of gastrointestinal tuberculosis undergoing laparotomy. Incidence of gastro intestinal tuberculosis was seen highest in age group 15 to 25 years with male predominance. Most commonly presentation being intestinal obstruction with ileo-caecal as the most common area involved and right hemicolectomy as the commonest procedure done. Common surgical pathologies were ileo-caecal mass and ileal perforation and this also has relation to pulmonary tuberculosis. CONCLUSION: Inspite of specific antituberculous drugs and vast measures against the disease, including chemoprophylaxis and pasteurisation abdominal tuberculosis remains a fairly common disease even today. Gastrointestinal tuberculosis has an indolent course and the common mode of presentation is usually sub acute or chronic. Prompt surgical exploration, vigilant postoperative care and administration of ATD helped to treat the patients successfully with their complete cure and rehabilitation.