ABSTRACT
Background: Rectal prolapse is a pelvic floor disorder that can occur in men and women of all ages. It results in pain, bleeding per rectum, seepage, diarrhoea or constipation and a disabled quality of life. With the advent of twentieth century, perineal operative procedures have become more common. Perineal procedures though have lower morbidities but have higher recurrence rate and high incidence of post-operative constipation. Novel abdominal approaches to rectal prolapse repair also became common during the first half of this century. Numerous types of surgical procedures have been attempted. Most techniques developed till now have some advantages and some short comings. CT Speakman and Pollen et al have shown in their studies that division of lateral ligaments caused new onset constipation and they attributed this effect to denervation of rectum. As the issue of recurrence and post-operative constipation remained unsettled.Methods: This was an observational study to assess the incidence of recurrence and post-operative constipation in patients of rectal prolapse. In well selected patients, we performed complete rectal mobilization with division of lateral ligaments. We assessed the patients on the basis of Clevland clinical constipation scoring system.Results: Out of 25 patients, 4 patients developed constipation, 2 had mild and 2 had moderate constipation and 2 patients had recurrence. Patients were kept under six monthly follow-up till a period of eighteen months.Conclusions: Only rectal mobilization with division of lateral ligaments can be a good surgical option in patients of rectal prolapse not having severe constipation.
ABSTRACT
Background: The study was done with the aim to determine the clinical profile of patients with hollow viscous perforation and to compare MPI and APACHE II scoreMethods: This study was a prospective and retrospective observational study conducted in the department of General Surgery, Gandhi Medical College and associated Hamidia Hospital from the June 2017 to August 2019The possible score ranges from 0-47. All necessary preoperative data was recorded. Blood sample was taken and relevant blood investigations were done. Patients were resuscitated with iv fluids. Nasogastric tube and urinary cather insertion were done. The parameters of modified APACHE II score and Manheim’s peritonitis index were recorded at the time of admission. Patients underwent emergency laprotomy and correction of pathology was done.Results: Out of total 100 patients 79% were males, 21% were females, majority 45% belonged to the age group 26-35 years. To calculate the cut off point for mortality ROC curve was constructed. ROC curve analysis predicted that Manheim’s score of 22 or more would predict mortality. Out of total 16 deaths, 14 cases had Manheim’s score of 22 or more thus, giving the score a sensitivity of 87.5% and specificity of 77.38% and overall accuracy of 79% in our study. ROC also predicted that APACHE II score of 15 or more would predict mortality. Thus, giving APACHE II score a sensitivity of 93.75%, specificity of 100% and accuracy of 99%.Conclusions: We consider MPI to be a more simpler prognostic indicator than APACHE II score.