Intravenous fluids in acute pancreatitis: a prospective study

Background: Fluid therapy is the mainstay of treatment in the management of acute pancreatitis. Most guidelines recommend aggressive fluid therapy in the initial 48-72 hours. We aimed to compare the occurrence, persistence or worsening of systemic inflammatory response syndrome (SIRS) and occurrence organ failure in patients with acute pancreatitis receiving normal and high volume fluid therapy in the first 24 hours.Methods: This was a prospective observational study. Consecutive adult patients admitted with acute pancreatitis were included in the study. SIRS was defined according to the criteria. Organ failure and local complications were defined according to Atlanta classification. Patients were divided into two groups according to the rate of fluid administered in the initial 24 hours: Normal volume group which received fluids at a rate <150 ml/hour and high volume group >150 ml/hour.Results: A total 60 patients were included in the study with 30 each in the two groups. Persistence or worsening of SIRS at 48 hours was more in normal volume fluid group compared to the high volume fluid group (p=0.076). Organ failure at 48 hours was more in normal volume fluid group compared to the high volume fluid group (p=0.074). Incidence of local complications equal in both group.Conclusions: Our study did not show any statistically significant difference in outcomes in patients with acute pancreatitis receiving normal or high volume fluids in the initial 24 hours. Further multi-centric randomised control trials are required to analyze the outcomes of high and normal volume fluid resuscitation in acute pancreatitis.

Primary omental infarction: a report of a series of cases in an Indian tertiary care hospital

Primary omental infarction is a relatively rare and often presents as right sided abdominal pain. It is often diagnosed as appendicitis and is usually picked up intra-operatively, or - as often seen nowadays - on imaging. We describe a series of four cases of primary omental infarction that presented to us with varying clinical features. Three of them had a short history of right sided abdominal pain, whereas the fourth patient had a longer history of left sided abdominal pain. All 4 were managed operatively, with the fourth having presented with an intra-abdominal abscess that required laparotomy. Primary omental infarction is a diagnosis which must be considered in any case of acute abdomen. Cases diagnosed with certainty on imaging may be managed conservatively but must be followed up closely. Need for surgical intervention should be considered in select cases.

Cecal Endometriosis: An Unusual Cause of Adult Ileocolic Intussusception.

Endometriosis is defined as the presence of endometrial tissue outside the endometrium and the myometrium. The gastrointestinal tract is the most common site for extrapelvic endometriosis, affecting 5-15% of women in the childbearing age group; the rectum and the sigmoid colon are the most common sites involved. Terminal ileal and cecal involvement is rare and may mimic malignancy of the colon. It is even rarer for endometriosis of the cecum to cause intussusception. The diagnosis of endometriosis in the ileocecal region is seldom made preoperatively in the absence of the previous endometriosis. Ileocolic endometriosis presenting predominantly as a mural mass and causing intussusception is very rare with few reports in world literature. We report a case of ileocolic endometriosis causing intussusceptions in an adult.

Emergency Abdominoperineal Resection for Rectal Prolapse with Gangrenous Bowel.

Rectal prolapse is a relatively rare condition. Most cases are chronic and present electively. However, a complete rectal prolapse with gangrenous bowel is an uncommon life-threatening emergency condition. Gangrenous bowel significantly increases morbidity and mortality and thus an urgent surgical intervention is always indicated. We describe a case with the above mentioned rare presentation, and he was successfully treated with an emergency abdominoperineal resection (APR). Irreducible rectal prolapse with gangrenous bowel is rarely encountered and literature on this presentation is very scanty. Here, we present a patient with complete rectal prolapsed with gangrenous bowel treated successfully with emergency APR.