Bilateral basal ganglia bleed in traumatic brain injury: A case report.

Intracerebral haemorrhage can be classified into traumatic and non-traumatic. Traumatic Basal Ganglia Haemorrhage (TBGH) has been reported in 2.4-3% cases of all closed head injuries whereas the incidence is higher in postmortem studies (9.8%), nevertheless, a bilateral TBGH is an extremely rare entity. According to our search through literature, only 12 case reports of bilateral TBGH have been published previously. A simple bilateral TBGH is rarely seen without any other lesions as it is usually associated with skull fractures, haemorrhages or brainstem injuries, making its incidence more during autopsies. We present a 30-year old male patient who had a traumatic brain injury (TBI) secondary to Road Traffic Accident (RTA) with GCS of 12/15, having no other co-morbids. CT-scan revealed bilateral basal ganglia bleed and the patient improved on conservative management only.

Knowledge and practices of general surgeons and residents regarding spilled gallstones lost during laparoscopic cholecystectomy: a cross sectional survey.

BACKGROUND: Gall bladder perforation, gallstone spillage and loss are commonly reported from Laparoscopic Cholecystectomy (LC). Though rare, lost gallstones can cause a variety of complications presenting variably from within 1 month to 20 years postoperatively. Our objective was to investigate knowledge and practices of surgeons and surgical residents regarding spilled gallstones lost during laparoscopic cholecystectomy. METHODS: An observational, cross-sectional survey, using a questionnaire based on 13 self-answered close-ended questions, was conducted at 6 different post-graduate centers in Karachi, Pakistan. RESULTS: Of the 82 participants, 23 (28%) were consultant surgeons while 59 (72%) were general surgery residents. 86% of participants were aware that stones lost during LC can cause complications. Out of the 18 reported complications presented, only 20% participants identified more than 8 complications for which they can consider lost gallstones causal. 28% of participants weren't aware about the expected postoperative duration for presentation of complications. Only 15% of our participants expected complications beyond 5 years of the procedure. 72% of participants will not convert to open cholecystectomy to retrieve lost gallstones. While 88% of participants agreed that lost gallstones should be documented in operative notes, only 70% reported that it's actually done in practice. 55% of participants agreed to have possibility of lost gallstones as part of the informed consent but in practice it's included according to only 31% of participants. 68% of participants believe that patients should be informed if gallstones are lost but in actual practice only 41% participants inform patients when gallstones are lost during procedure. CONCLUSIONS: We conclude that there is a dearth of awareness regarding diversity of complications from lost gallstones and about their variable postoperative duration of presentation. The practices involving lost gallstones management, documentation and patient information were found to vary widely. Proper awareness is imperative as it may compel surgeons to undertake all possible measures to retrieve spilled gallstones and progress towards better and standardized practices in managing lost gallstones.