A prospective, non-randomized study to determine the role of intraperitoneal drain placement in perforation peritonitis.

BACKGROUND: Surgical site infection continues to be a major problem after laparotomy for perforation peritonitis, as it increases morbidity and hospital stay and decreases the quality of life. Intra-abdominal drain placement is a routine practice in perforation peri-tonitis. The aim of our study is to compare the incidence of surgical site infection in two groups of patients who were operated for perforation peritonitis: The first group received the intraperitoneal drain, while no drain was placed in the second group. METHODS: The present single-center, prospective, non-randomized study was conducted in the Department of General Surgery at the Postgraduate Institute of Medical Education and Research, India. A total of 122 patients underwent exploratory laparotomy for gastroduodenal and small bowel perforation peritonitis, of which 100 participants were included in this study, based on specified cri-teria for inclusion and exclusion. A total of 50 participants each were included in the drain group and the no drain group, respectively. A drain was placed in every alternate patient with perforation peritonitis who received primary closure or resection anastomosis. Patients with diabetes, renal failure, and hemodynamic instability and those who presented more than 72 h since symptom onset were excluded from the study. Peritoneal fluids were cultured. The primary endpoint was to identify the incidence of surgical site infections (SSIs) in the two groups. We also compared the time taken for the return of bowel movements, duration for which a nasogastric tube was inserted, whether any intervention was performed under local or general anesthesia within 30 days of surgery, the duration of hospital stay, and the ease of diagnosing repair leak in the post-operative period in both the groups. RESULTS: Demographics of participants in both the groups were matched. No significant difference was observed between the drain and no-drain groups with respect to the incidence of surgical site infection (p=0.779). The duration of surgery and length of hospital stay were significantly lower in the no drain group. A significant difference was observed between the two groups concerning the peritoneal culture growth, and increased bacterial growth was seen in the drain group. No significant difference in morbidity was noted between the two groups, which was classified according to the Clavien-Dindo classification. CONCLUSION: Routine use of intra-abdominal drains was not found to be effective in preventing SSIs, but a selection bias cannot be ruled out. Patients with no drains had a significantly shorter duration of hospital stay.

Demographic Patterns, Risk Factors, and Outcomes of Abdominal Aortic Aneurysms in Young Adults ≤55 Years: An Experience in a Tertiary Care Centre of India.

Introduction Abdominal aortic aneurysms (AAA) are uncommon in young adults ≤55 years of age. There is a lack of literature on clinical characteristics, risk factors, and therapeutic outcomes so we present a case series of 11 patients of AAA aged ≤55 years. Methods We included single-center retrospective case series between 2013 to 2020. We reviewed 44 patients who were operated for AAA in a tertiary care center in India. We identified 13 patients who were ≤55 years; two patients with incomplete records were excluded. A patient information sheet was used to retrieve demographic data, clinical presentation, outcomes, and follow-up. Results Out of 11 patients, 10 were men. Nine patients (81.8%) had symptomatic AAA. The majority (45.4%) exhibited an infrarenal aneurysm and the median size of the aneurysm was 5.8 cm (IQR: 5.5-6.4 cm). Eight patients (72.7%) had a history of smoking. Hypertension was observed in six patients and one patient had associated coronary artery disease. Clamping time was > 45 minutes among three patients; all smokers. Blood loss was > 500 ml in five patients. The median length of hospital stay was 10 days (7-40); more among patients with metabolic equivalents (METS) score < 4, 14.5 (8-19) days. No grade III-IV complications and mortality were noted with a median follow-up of 15 months, with all patients living. Conclusion The aneurysm was symptomatic in the majority of participants. An association of smoking in increasing both the median clamping time and length of hospital stay was seen. No mortality and good disease-free follow-up suggested good outcomes.

Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms.

A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.

Uma mulher de 45 anos com hipotireoidismo conhecido e sem outras comorbidades teve achado incidental de múltiplos aneurismas da artéria renal direita. O maior aneurisma media 5 x 4,5 cm e tinha origem no ramo segmentar inferior, juntamente com dois pequenos aneurismas originários do ramo segmentar superior da artéria renal direita. Realizamos o reparo ex vivo com enxerto reverso de veia safena, sob preservação a frio, seguido de autotransplante renal ortotópico. O pós-operatório ocorreu sem intercorrências, e a paciente teve o rim direito preservado no seguimento de 1 ano. Neste artigo, relatamos o tratamento bem-sucedido de múltiplos aneurismas complexos da artéria renal direita e descrevemos a técnica cirúrgica utilizada para o reparo bem-sucedido.

Clinical profile and management of external jugular vein aneurysms.

OBJECTIVE: External jugular vein (EJV) aneurysm is an extremely uncommon clinical condition. We have studied the clinical profile and need for surgery in this present seven case series of primary external jugular vein aneurysms. METHOD: Over the past three years, we have diagnosed and managed aneurysms of external jugular vein in seven patients, who presented with swelling in the posterior triangle of the neck. Venous duplex was obtained in all the patients, followed by computed tomography (CT) in three patients and one patient reported with magnetic resonance (MR) venography from another hospital. Three patients had symptoms ranging from mild intermittent discomfort to moderate pain underwent excision of aneurysm after ligation of both ends of EJV. Four patients had swelling on the lateral side of the neck due to EJV aneurysm, with no other associated symptoms. They were kept on six monthly follow-ups. RESULT: We operated three patients, as they were symptomatic, of which only two had thrombus in the aneurysmal sac. All three symptomatic patients had aneurysm of size >5 cm. Post-surgery and on subsequent follow-ups they were asymptomatic. The four asymptomatic patients kept on conservative management did not develop any thrombosis of aneurysm sac in follow up. CONCLUSION: Surgical excision is indicated for symptomatic patients with EJV aneurysm, preferably for size > 5 cm because of their higher association with thrombosis or symptoms. Asymptomatic patients can be managed non-operatively with regular surveillance by clinical examination and venous duplex or can be treated if patients insist due to cosmetic reasons.

Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms / Reparo Ex Vivo de Aneurismas Intraparenquimatosos Múltiplos da Artéria Renal

Abstract A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.

Resumo Uma mulher de 45 anos com hipotireoidismo conhecido e sem outras comorbidades teve achado incidental de múltiplos aneurismas da artéria renal direita. O maior aneurisma media 5 x 4,5 cm e tinha origem no ramo segmentar inferior, juntamente com dois pequenos aneurismas originários do ramo segmentar superior da artéria renal direita. Realizamos o reparo ex vivo com enxerto reverso de veia safena, sob preservação a frio, seguido de autotransplante renal ortotópico. O pós-operatório ocorreu sem intercorrências, e a paciente teve o rim direito preservado no seguimento de 1 ano. Neste artigo, relatamos o tratamento bem-sucedido de múltiplos aneurismas complexos da artéria renal direita e descrevemos a técnica cirúrgica utilizada para o reparo bem-sucedido.

Rupture of Unscarred Uterus With Intestinal Prolapse From Vagina Following Criminal Abortion.

A 21-year-old unmarried and primigravida female indulged in criminal abortion at 18 weeks of gestation with the help of a village midwife. Instrumentation was done, and it led to uterine perforation with prolapse of 200 cm of small bowel through vagina. She was managed with resection of 160 cm of necrotic small bowel, repair of the uterine defect, and end jejunostomy, which was anastomosed with distal ileum three months later. This case highlights the risks of illegal abortion and the primitive societal mindset that forces unmarried women to resort to such means.