Peripheral vascular injuries due to blunt trauma (road traffic accident): management and outcome.

BACKGROUND: The present study was undertaken to analyze the pattern, presentation and management of peripheral vascular injuries due to road traffic accidents (RTA). METHODS: A prospective study of patients of peripheral vascular injuries due to road traffic accidents (RTA) between Jan. 2007 to Dec. 2011. A total of 192 patients presented with peripheral vascular injuries due to RTA during this period. All patients with vascular injury due to other causes were excluded from study. RESULTS: Most of the patients were managed by reverse saphenous vein graft followed by end to end anastomosis. Most of the patients had associated long bone fractures. Delayed presentation and associated long bone fractures had bad effect on outcome. Wound infection and thrombosis of the graft were the most important complication. Amputation rate was 4.68%. CONCLUSION: Vascular injury due to RTA requires prompt recognition and referral to a vascular center. Immediate revascularization has excellent results and less morbidity. Proper clinical examination and hand held Doppler examination are enough to reach the diagnosis.

Feeding jejunostomy: does the benefit overweight the risk (a retrospective study from a single centre).

BACKGROUND: The purpose of this study was to review the efficacy and safety of feeding jejunostomy in terms of achieving the nutritional goals in patients undergoing esophagectomy for carcinoma of oesophagus and complications associated hence with. METHODS: A total of 463 patients underwent esophagogastrectomy for carcinoma oesophagus during this period. All these patients underwent Witzel feeding jejunostomy for post-operative enteral nutrition. Enteral feeding was started after 24 h of surgery and increased gradually till target caloric and protein value was achieved. Nutritional goals achieved were reviewed. All complications related to jejunostomy were recorded. RESULTS: The study comprised of 463 patients who underwent elective esophagogastrectomy. Mean age was 58 +/- 8.4 in male patients and 55 +/- 4.2 years in female patients. Patients spend a mean of 19 +/- 8.4 (range 10-49) days on jejunostomy feed. The targeted calorie requirement was achieved by post-operative day 3 in 408 (88.12%) patients. The catheter blockage was one of the main complications during the course of feeding. Seven patients required relaparotomy for catheter blockage. CONCLUSION: Feeding jejunostomy is an effective, safe, economic and well tolerated method of providing nutrition to the patients of esophagogastrectomy. Feeding jejunostomy should be done in every patient undergoing esophagectomy at the time of laparotomy.