Laparotomy For Intestinal Obstruction Research Articles

Anti-reflux surgery in neonates and infants: analysis of indications, outcomes, and link to mortality among primary and secondary gastroesophageal reflux patients

BackgroundThe indications and benefits of anti-reflux surgery (ARS) in neonates and infants are uncertain. Prematurity, operation before 1 year of age, neurological impairment (NI), and chronic lung disease (CLD) are risk factors for surgical failure. We aim to document the indications, management, and outcomes of ARS in this age group and compare them among primary and secondary gastroesophageal reflux (GERD).ResultsBetween January 2008 and December 2019, 24 males and 22 females had ARS; 13 (28.3%) for primary while 33 (71.7%) for secondary GERD. The mean gestational age was 34.6 weeks (range 24–41) and mean birth weight was 2000 gm (range 600–3300). The weight at time of referral ranged from 1.4 kg to 4 kg (mean 2.2 kg). There were no significant differences between the two groups regarding the previous data. The group of primary GERD presented mainly with recurrent aspiration (n = 8), recurrent apnea (n = 5), and recurrent desaturations with or shortly after feeds (n = 4). The group of secondary GERD were referred for poor sucking with failure to thrive (FTT) (n = 25), recurrent aspiration (n = 20), and gastrostomy request (n = 14). The risk factors for secondary GERD were neurologically impaired (n = 22), post-esophageal atresia (EA) repair (n = 9), hiatus hernia (n = 4), thoracic stomach (n = 2), N-type tracheoesophageal fistula (TEF, n = 4), and congenital esophageal stenosis (CES, n = 4). The operations included open Nissen’s fundoplication (ONF) (n = 4) and modified open Thal’s fundoplication (MOTF) (n = 42). There were 8 mortalities in the secondary group, unrelated to surgery. Morbidities after Nissen’s fundoplication included wrap migration, gas bloat, and reoperation in one, laparotomy for intestinal obstruction (IO) in one. Following MOTF, there were two cases of transient recurrent GERD which improved with time and laparotomy in one for IO.ConclusionsDiagnostic tests remain a challenge. Isolated TEF and CES may require fundoplication for staged management. Cases of the primary group did better with MTFO. Prematurity, CLD and age < 2 months were not significant risk factors for fundoplication failure or mortality. Neurological impairment was a risk factor for mortality.

Neonatal Abdominal Surgery, Our Experiences of 179 Cases

This is a retrospective study carried out in the Department of Pediatric Surgery, Faridpur Medical College Hospital and in Dr. Zahed Children Hospital at Faridpur, during the period of May 2002 to may 2016. Total 179 neonates were treated by laparotomy for intestinal obstruction after clinical diagnosis and resuscitation. The male to female ratio was 4:5. Most of the patients presented within 02 -25 days of age. In all cases diagnosis was done on history, clinical examination and investigations. The investigations were plain x-ray abdomen in all cases and contrast x-ray upper GIT in 10 cases and enema x-ray in 11 cases and sonogram in 15 cases. Serum electrolytes were not estimated in all patients. There were 34 postoperative mortality. We did loop diversion for 81 cases those who were in potential risk to develop septicemia. Oral feeding started at 3rd postoperative day in diversion cases and 4th postoperative day in resection and end to end anastomosis cases. Superficial wound infection was encountered in 39 cases. Anorectal malformation, IHPS, Exomphaious, Gastroschisis were not included in this study. Long term survival of neonatal abdominal surgery are excellent, however patients have substantial risk to develop intra-abdominal complications. Faridpur Med. Coll. J. Jul 2018;13(2): 82-84

Managerial experiences on Pediatric surgical tumors in Tribhuvan University Teaching Hospital

Pediatric tumors are least prioritized but serious problems. Multidisciplinary management improves survival. Incidences, types and follow up results on Nepalese pediatric tumors have not yet been studied. To highlight our center's experiences on pediatric tumors management and follow up is aimed. All pediatric surgical tumors admitted in pediatric surgery unit from 2065-2070 BS werer studied. Patients evaluated with or without chemo/radiotherapy pre or post surgery. Total of 22 cases from age four months to 13 years were studied. Tumor detection shown highest in age group below 3 years, followed by 5-10 years. Mean age was 54 months. Most common problem (22.7%) was Sacrococcygeal teratoma (histologically matured). 13% Nephroblastoma, 9% ovarian tumor, 9% Neuroblastoma and various others each were 4.45%. Majority underwent surgical excision of tumors. Three cases pre surgery and 5 post-surgery, received chemotherapy. Rest had only excision of tumor mass. Follow up were from three weeks to five years period. During this period, two patients expired (one due to complication of second cycle of chemotherapy and second one died with severe aspiration after second laparotomy for intestinal obstruction one year after initial Nephroblastoma excision.) One patient lost for follow up after excision of stage V Nephroblastoma and first cycle of chemotherapy. Management of pediatric tumors is complicated. Thus it needs better multidisciplinary centre of excellence for satisfactory results. Management is directed according to incidence, types, standard management protocol, which is not studied yet in Nepal. Research on pediatric tumors is virgin area. Large scale studies need to conduct in detail and a center of excellence is essential to provide better services.

Small Bowel Adenocarcinoma – Report of Two Cases and Review of Literature

Although accounting for 90% of the intestinal surface area, small bowel adenocarcinomas are not common. The majority of these lesions are incidentally detected during laparotomy for intestinal obstruction or perforation. The symptoms associated with these lesions are not very specific and preoperative diagnosis is rare. We report two cases of jejunal adenocarcinomas detected in patients undergoing laparotomy for acute abdomen and review the literature for small bowel adenocarcinomas.

Idiopathic sclerosing peritonitis

Sclerosing encapsulating peritonitis (SEP) is a rare complication of chronic peritoneal dialysis and beta-blocker (practolol) usage. The authors report a case of idiopathic SEP developing in a 39-year-old woman with associated ovarian cysts and kerato-conjunctivitis sicca syndrome. These associations have not been reported previously. The histological diagnosis of SEP was made after laparotomy for intestinal obstruction. The patient continues to have chronic intestinal failure, managed conservatively by long-term parenteral nutrition and steroids for more than 12 years.

The management of the perforated appendix: A controlled clinical trial

Abstract Seventy-one patients with peritonitis due to perforation of the appendix were treated by preoperative rectal metronidazole, appendicectomy and omission of skin closure. They were then randomized to have either no further antibacterial treatment, or rectal metronidazole twice-daily for 5 days. No major wound infections occurred, but 8 patients developed intraperitoneal abscesses. In addition, I died of a pulmonary embolus and 1 required further laparotomy for intestinal obstruction. Patients in the 5-day-metronidazole group suffered fewer intraperitoneal abscesses and less pyrexia, but the differences did not achieve statistical significance. This series shows a considerable improvement over a previously published series in terms of morbidity, duration of pyrexia and length of hospital stay.

Hirschsprung's disease. A clinical review.

Abstract Experience with 38 cases of Hirschsprung's disease seen over a 20-year period is described. Only 24 per cent of cases presented with a combination of symptoms and signs such as to suggest the correct diagnosis on clinical grounds. Barium-enema examination carries a high ‘true-positive’ rate, but cases reported as negative must be viewed critically. A radiological diagnosis of idiopathic megacolon should not be accepted without supplementary rectal biopsy and/or anorectal pressure studies. Survival without surgery is compatible with Hirschsprung's disease, but the dangers of enterocolitis must be acknowledged. Rectosigmoidectomy, which includes resection to an area of normal innervation proximally and excision of part of the internal sphincter of the rectum distally, produces a satisfactory late functional result at an acceptable mortality-rate. A colostomy prior to rectosigmoidectomy is advisable when there is a history of repeated attacks of subacute obstruction and one or more episodes of enterocolitis. A colostomy after rectosigmoidectomy is advisable in those cases which are submitted to laparotomy for intestinal obstruction in the period following operation, even when no mechanical cause for obstruction is demonstrable. Patients with problems relating to coprostasis following treatment of congenital anorectal disorders should be submitted to rectal biopsy, since a proportion of these patients reveal a deficiency of innervation of the distal large bowek which approximate to that seen in Hirschsprung's disease.

Adult Abdominal Tuberculosis in Benin City Nigeria

Eight adult patients were diagnosed as having abdominal tuberculosis in the University of Benin Teaching Hospital, Nigeria, over a six year period (January 1997 to December 2002). There were 7 females and 1 male aged between 20 and 55years (mean 30years); mean duration of symptoms before presentation was 14weeks. The main presenting symptoms were: abdominal pain (6), fever (4), weight loss (7), and ascites (6). Diagnosis was basically clinical in 2 patients, while surgery played a role in the management of others: cervical lymph node biopsy (2); peritoneal biopsy obtained through open appendicectomy (2) and exploratory laparotomy for intestinal obstruction (2). Only 1 and 2 patients tested positive for human immunodeficiency virus (HIV) and Mantoux respectively. Abdominal tuberculosis is a great mimic and the foremost diagnostic tool is the most ideal investigation and patients usually respond to a closely supervised anti-tuberculous therapy. There is a place for therapeutic trial in the patients. Key Words: Tuberculosis, Abdominal, Benin – City, Nigeria. Sahel Medical Journal Vol.7(4) 2004: 126-128

Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues.

The influence of recently published guidelines by the Surgical Infection Society (SIS) on current surgical practice are not well documented. The appropriateness of antibiotic administration in a cohort of surgical patients undergoing elective and emergency surgery in a department of surgery in an urban, community-based, private, 560-bed teaching hospital was retrospectively reviewed. The following were the criteria defining administration as appropriate as modified from SIS guidelines: Prophylactic use: (1) started prior to operation; (2) spectrum appropriate to the specific operation; (3) duration </= 24 hours. Therapeutic use: (1) started prior to operation; (2) spectrum appropriate to pathology; (3) Duration </= 24 hours for contamination or "resectable" infection and </= 5 days for established infection in the absence of clinical evidence of persisting infection. Any switchover from an appropriate agent to another appropriate or inappropriate agent in the same patient in the absence of microbiologic or clinical indication was considered inappropriate administration. We reviewed the charts of 211 randomly selected patients who underwent elective (n = 132) or emergency (n = 79) procedures during 1996. The operations included gastrectomy (n = 22), appendectomy (n = 27), open (n = 5) or laparoscopic (n = 27) cholecystectomy, colectomy (n = 28), hysterectomy (n = 8), laparotomy for intestinal obstruction (n = 11), mastectomy (n = 26), and ventral hernia repair (n = 37). A total of 17 antibiotics were used for prophylaxis and 21 for therapy. In 156 patients (74%) the administration was considered inappropriate. Eight patients in the inappropriate group developed diarrhea (two cases of Clostridium difficile-induced colitis) compared to two cases of diarrhea in the appropriate group (nonsignificant). The average duration of administration after elective and emergency operations was 3.3 and 5. 7 days, respectively. The total expense for excessive duration of administration was $18,533. Many surgeons are not familiar with the spectrum of antimicrobials and often do not distinguish between prophylactic and therapeutic administration. Antibiotic usage in current surgical practice is often inappropriate, excessive, and chaotic.

BILATERAL URETERAL OBSTRUCTION.

Dr. Dale E. Wenlund: This 63-year-old man was well until about one and a half years prior to the present admission, when he had a cholecystectomy. He subsequently noted a painful bulge in the region of the subcostal scar. Because of pain and anorexia, he lost 30 lb (1.36 kg) during the next 18 months and was unable to work. He entered the emergency ward with an obvious ventral hernia. Approximately 30 years prior to the present admission he had undergone a laparotomy for intestinal obstruction. There was no history of postoperative difficulty. Physical examination revealed an intelligent, cooperative male in good physical condition. His blood pressure level was 140/90 mm Hg; pulse, 82; and temperature, 99 F ( 210 C). He had no urinary symptoms. The abdomen was unremarkable except for an obvious ventral hernia. The hematocrit value was 32%. The white blood count and serum electrolyte levels were normal.

Laparotomy for Intestinal Obstruction in an Adult

Laparotomy for Intestinal Obstruction in an Adult

Successful Case of Laparotomy for Intestinal Obstruction

Successful Case of Laparotomy for Intestinal Obstruction

Abstract from a Clinical Lecture on Five Cases of Laparotomy for Intestinal Obstruction: The Mode of Operating

Abstract from a Clinical Lecture on Five Cases of Laparotomy for Intestinal Obstruction: The Mode of Operating