Contamination Of Peritoneal Cavity Research Articles

Enteric perforation with peritonitis

Background: Typhoid fever, also known as enteric fever, is a systemic infection by Salmonella typhi or by the related but less virulent Salmonella paratyphi. Patient with perforation present with sign and symptoms of peritonitis complains of pain abdomen along with distension abdomen, obstipation and vomiting. Enteric perforation in managed surgically. Aims and objective: To study various epidemiological factors in relation with enteric perforation with peritonitis and to compare the outcomes of various procedures of enteric perforation with peritonitis.Methods: The present study was performed on 50 patients of enteric perforation with peritonitis admitted in various surgical wards of RNT medical college hospital, Udaipur. Those patients who underwent conservative treatment or drainage under local anesthesia were not included in this study.Results: Enteric perforation was more common in young males, maximum cases were in 3rd decade followed by 2nd and 4th. Male:female ratio was 1:77:1. Most common symptoms were acute pain abdomen and fever. Constipation (60%) abdominal distension (40%) and vomiting (52%) were other predominate complains. Simple repair of perforation was done in 25 patients. Repair was done in double layer (inner layer) by continuous vicryl and outer by interrupted silk. Mortality was 14%, almost equal irrespective to procedure chosen for management of enteric perforation peritonitis.Conclusions: To deal with enteric perforation(s) operative procedure has to be decided to greater caution taking into consideration patient’s general condition, gut condition, number and site of perforation and contamination of peritoneal cavity.

Factors affecting the outcome of intestinal anastomosis: a prospective study

Background: Anastomotic leak is one of the most dreaded complications after intestinal anastomosis. The prevalence of anastomotic leak is 0.5%-30% in literature and resulting mortality rate is 10%-15%. Various risk factors are known to be associated with it. This study was undertaken with the aim to identify and evaluate these predisposing factors.Methods: A prospective study was conducted from March 2019 to February 2020 at Teerthankar Mahaveer medical college and research centre, Moradabad. All patients undergoing hand-sewn gastro-intestinal anastomosis electively as well as in emergency were included in this study. The total number of cases studied were 80.Results: Post-operative anastomotic leaks were present in 10% and associated mortality was 100%. Increasing age was associated with leakage (p=0.02) and 75% patients with leaks were male. The following were observed to be significant risk factors associated with anastomotic dehiscence: diabetes mellitus (p=0.05), pallor (p=0.01), low haemoglobin (p=0.003), altered TLC count (p=0.008) low serum protein (p=0.001), albumin (p=0.001) longer operative time (p=0.02). Other predisposing factors like serum creatinine, hyperbilirubinema, elective/emergency surgeries, contamination of peritoneal cavity and time taken to perform the anastomosis were insignificant statistically.Conclusions: This study identified and assessed the various risk factors associated with anastomotic leaks and found age, sex, anaemia, sepsis, hypoproteinemia, hypoalbuminemia, increased operative-time to be significant and we concluded that controlling these factors will help in minimizing the chances of anastomotic dehiscence.

Improvised Laparostomy Pack to Manage Laparostomy for Injuries due to Improvised Explosive Devices (IEDs).

Splinters of improvised explosive devices [IEDs] cause multiple intestinal perforations and random pattern visceral injuries causing contamination of peritoneal cavity. This necessitates multiple peritoneal toilets and relook surgeries. Surgical management is to perform laparostomy to avoid life threatening complication, like abdominal compartment syndrome and fulminant sepsis. "Peshawar pack" is a three-layer temporary abdominal dressing pack for managing laparostomy. It is prepared in operation room and applied on patients with ease. Patients with abdominal injuries due to blasts of IEDs, managed with Peshawar pack during June 2014 to June 2016, were studied to determine the effectiveness and practical utility of Peshawar pack. Data was analysed by SPSS version 22. Total numbers, means +SD and frequencies with percentages were described. In fifty-five patients selected for the study, effective drainage of peritoneal cavity and control of peritoneal sepsis was achieved in all cases. Mobilisation out of bed was possible in 38 cases [70%] within 3-5 days and evisceration during mobilisation occurred in 02 cases [3.6%]. There was no case of iatrogenic gut injury. Complete fascial closure in staged manner was achieved in 53 cases [96%]. Peshawar pack is a simple, practical, and effective method for laparostomy care in abdominal injuries due to blast of IEDs.

A case series of laproscopic management of hydatid cyst of liver

Background:Hydatid cyst is zoonosis caused due to Echinococcus species mainly, Echinococcus granulosus and Echinococcus multilocularis. It was first described by Hippocrates as “liver full of water”. In developing countries like India, Iran, China and Mediterranean countries it is still remains a major problem. It can involve any organ and can mimic almost any pathological condition.Methods: The present study was carried out from January 2014 to December 2015. Total 20 cases of liver hydatid operated laproscopically studied prospectively. Omentoplasty with external drainage was done as sole operative modality. Postoperative follow up was done on 2nd week, 1, 3 and 6 months. Results:Among the observed patients most common age group was 31-40 years (40%), with male predominance (60%). Abdominal pain was most presenting symptom (65%). Right lobe involved involved in 75% patients. Cysts are usually single (90%). Bleeding and contamination of peritoneal cavity with scolices was main intra-operative complication (5% each). Mean operative time was 99.95 minutes. In post-operative period biliary leak was major complication (10%). Cosmetic results were good with barely visible scar (90%).Conclusions:Surgery is the gold standard treatment for hydatid liver and laproscopic technique is gaining more and more importance with advantage of being minimal invasive and less complications with better patient satisfaction.

A modified technique for the laparoscopic management of large gastric bezoars

Bezoar is an intraluminal mass formed by the accumulation of undigested material anywhere in the gastrointestinal system. Most of small bezoars are removed by gastrointestinal endoscopy, while the best approach for the larger ones is surgical removal. Currently, laparoscopic technique is successfully used in the treatment of bezoars, which are used to be managed by open surgery. In the laparoscopic treatment of bezoars, contamination of peritoneal cavity is a major problem. We describe a modified laparoscopic technique in which an endobag is placed in the stomach instead of the peritoneal cavity in order to avoid spillage of the bezoar during laparoscopic removal.

RETROSPECTIVE ANALYSIS OF TYPHOID ILEAL PERFORATION IN CHILDREN

BACKGROUND: Objective of the study is to find out the most suitable procedure for surgicaltreatment of typhoid ileal perforation in children. It is a Descriptive retrospective study, conducted atDepartment of Pediatric surgery Lady Reading Hospital Peshawar from January 2012 to June 2014.MATERIALS AND METHODS: This study included all patients who had operative findings oftyphoid ileal perforation. All the patients were admitted at Pediatric Surgery Unit Lady ReadingHospital Peshawar, as emergency. A total of 78 patients were managed during the study period. Patientswere admitted, nasogastric tube was inserted, intravenous fluids and antibiotics in the form ofquinolones, metronidazole and gentamycin were administered. Informed consent from the parents wastaken in all cases. Surgical Procedure was tailored according to the peroperative findings. Data wasanalyzed using SPSS version 16.RESULTS: Out of 78 patients, 49(62.8%) were male and 29(37.1%) were female. The mean age ofpresentation was 10.4 years. Duration of symptoms ranged from 7 to 20 days. The commonestsymptoms observed were fever in 78(100%),pain abdomen 78(100%),abdominal distension28(35.89%)and vomiting in 51(65.38%).The choice of surgical procedure was done peroperativelydepending on the extent of contamination of peritoneal cavity and the general condition of the patient.Mean hospital stay was 8 days.CONCLUSION: Early presentation and referral to tertiary care hospital can improve the mortality andmorbidity in children with typhoid ileal perforation. All patients who underwent ileostomy recoveredwell and is the procedure of choice in patients who present late.KEY WORDS: Typhoid ileal perforation, surgical options, ileostomy.