Surgical Problem Research Articles

Sepsis management of the acute care surgery patient: What you need to know

ABSTRACT Increasingly, acute care surgeons have taken over the management of general surgery consult patients in the hospital, many of whom present with sepsis and/or in septic shock. In this article, we will discuss the intricacies of sepsis management for acute care surgery. The underlying tenants of sepsis management will be outlined with specific attention to the nuances associated with surgical patients. Ultimately, when a surgical problem is identified, this management will culminate with the need for specific source control — the unique aspect when a surgical as opposed to a medical disease process is the cause of sepsis. However, surgeons must also be competent in the other components of sepsis management including antimicrobial therapy and hemodynamic support. This article is designed for the surgeon or for any provider caring for patients with a potential acute care surgical problem, recognizing that different practice settings will vary with regard to resource availability for laboratory tests, invasive monitoring, diagnostics, and surgeon availability.

Evaluation of Postoperative Adhesions in a Subsequent Cesarean Section Following the Use of Dextrin Hydrogel Spray as Adhesion Barrier for Laparoscopic Myomectomy

Objectives: Laparoscopic myomectomy (LM) is a procedure with a high rate of postoperative adhesions, which can lead to complications such as bowel obstruction and subsequent surgical problems, making anti-adhesion measures important. Various anti-adhesion materials are already on the market and have shown efficacy, but dextrin hydrogel spray (AdSpray™), an anti-adhesion material launched in 2017, has not yet been reported in the field of gynecology, although there are papers showing its usefulness in the surgical field such as repeat hepatectomy and ileostomy closure. Thereby, we investigated the postoperative status of AdSpray™ in LM. Materials and Methods: We report 24 cases in which AdSpray™ was used at Teine Keijinkai Hospital from 2018 to 2021 for LM, followed by cesarean section (CS) from 2019 to 2022. Adverse effects related to AdSpray™ and the presence of uterine adhesions in CS were examined. Results: Adhesions were observed in 4 (16.7%) cases, none of which resulted in significant adverse effects of AdSpray™. Conclusion: AdSpray™ was effective in preventing adhesion and may be an option as an anti-adhesion material in LM.

Spectrum of exploratory laparotomy for acute abdomen in a central Gujarat tertiary care centre

Background: Exploratory laparotomy is one of commonest emergency surgeries performed in the world. Despite technological advance imaging, the fundamental technique of exploratory laparotomy has remained unchanged over years. Studies quantifying the spectrum of laparotomy in central Gujarat are lacking. Methods: A retrospective study of 249 patients of emergency exploratory laparotomy for acute abdomen in SSG Hospital Baroda from May 2022 to May 2024 was done and data involving clinical presentation, imaging, operative findings and post- operative course were studied and analysed. The cases were divided into gastro-intestinal perforation, gastro-intestinal obstruction and miscellaneous cause. Results: The most common cause of exploratory laparotomy in study was perforation peritonitis including 59 ileal, 16 jejunal, 49 pre-pyloric, 29 duodenal, 1 body of stomach, 17 appendicular and 8 colon. With post op major complications like burst-11%, leak-5%, pneumonia-5%, multi-organ failure-6.5% and ileus 5%, wound infection 18%. The overall mortality was 15%. Out of 58 cases of laparotomy for obstruction including adhesions (29.3%), obstructed inguinal hernia (12%), tuberculosis (32%), malignancy (13.8%), internal hernia (12.6%). The miscellaneous causes were ruptured liver abscess (9), rupture ectopic pregnancy (2), twisted ovarian tumour (1). Conclusions: Acute abdomen remains a significant surgical problem. Peptic perforation remains a common cause of acute abdomen with high morbidity and mortality, despite improves medical management, though there is a declining trend in incidence, tuberculosis remains an important cause.

Early combined arthroscopic and open management of combined ACL and PCL tibial spine avulsion in a knee dislocation: A case report

A 35-year-old man presented with right knee pain following a tree stump landing on his leg two days prior. Evaluation revealed a knee dislocation injury (KD III M) with displaced avulsion fractures of the anterior cruciate ligament and posterior cruciate ligament, with the fragments flipped 180 degrees. Additional injuries identified through preoperative imaging (computer tomography, magnetic resonance imaging) and physical examination included bony medial patellofemoral ligament tear, bony posterolateral corner injury, complete medial collateral ligament tear, and medial/lateral meniscus root bony avulsions. The injury was treated utilizing a single-staged arthroscopic and open ligament repair and reconstruction. Bicruciate avulsion fractures in the setting of a knee dislocation injury is a challenging surgical problem in which arthroscopic management of bicruciate tibial spine injuries can be utilized successfully.

Robotic-Assisted Pleurectomy Is a Safe and Effective Surgical Treatment for Spontaneous Pneumothorax

IntroductionSpontaneous pneumothorax is a common thoracic surgical problem. To prevent recurrence, surgical options include blebectomy, mechanical or chemical pleurodesis, pleurectomy, or a combination of these operations. Pleurectomy is associated with lower recurrence rates but may be technically challenging via video-assisted thoracoscopic surgery. We report the first series of robotic-assisted pleurectomy (RAP) for spontaneous pneumothorax. MethodsA retrospective, single-center analysis was conducted on consecutive patients undergoing RAP for spontaneous pneumothorax from 2017 to 2023. Patients with prior surgery on the same side for pneumothorax were excluded. Demographics, comorbidities, functional status, intraoperative and perioperative variables were collected. 30-d readmission, 30-d mortality, and recurrence were recorded. ResultsThirty-six patients underwent RAP during the study period with a median follow-up of 36 mo. Patients had a median age of 41.5 (interquartile range [IQR] 21.5-68) y and were mostly male (80.6%) and past smokers (44.4%) with 66.6% having a primary spontaneous pneumothorax. The median time to chest tube removal was 3 d (IQR 2-3) and the median length of stay was two days (IQR 2-4). Complications occurred in seven patients with the majority (85.7%) having a grade 2 Clavien-Dindo classification score. There was no 30-d mortality or recurrence. ConclusionsRobotic-assisted pleurectomy for spontaneous pneumothorax is a safe and effective operation that can be used to prevent future recurrence.

ASSESSMENT OF THE ANATOMICAL STRUCTURE OF CANALIS SINUOSUS IN THE ANTERIOR MAXILLA TO AVOID SURGICAL COMPLICATIONS

Aims: The study's objective was to evaluate the canalis sinuosus (CS) anatomical structure in the front maxilla in order to prevent surgical problems in an adult Yemeni population sample acquired using cone-beam computed tomography (CBCT). Materials and Methods: A retrospective descriptive cross-sectional study was carried out to assess 226 participants' CBCT pictures. 452 sides in total were assessed. There were 140 females (61.9%) and 86 males (38.1%) among the samples. The age distribution was 18–34 years (65%) and over 35 years (35%), with a mean age of 32.13. Version 25 of the Statistical Package of the Social Sciences (SPSS) was used for all statistical analyses. Result: It was discovered that 160 right (35.4%) and 175 left (38.7%) of the 226 patients and 452 sides had CS. Among these individuals, 117 (51.8%) had unilateral CS and 109 (48.2%) had bilateral CS. The CS was 8.12 mm from the nasal cavity floor (D1), 6.99 mm from the buccal cortical bone ridge (D2), and 13.47 mm from the crest of the alveolar ridge (D3), as the mean distances were measured. Males and females had somewhat higher mean values for the linear measurements D1 and D3, but females had slightly higher mean values for the linear measurement D2. The CS had a mean diameter of 1.11 mm. Left central incisor area was the most commonly observed location of CS, and palataly was the most frequently recorded location of CS. Conclusion: Since the CS is present in 100% of adult Yemenis, it is imperative that general practitioners and maxillofacial surgeons become more knowledgeable about the position and structure of the CS. Peer Review History: Received 19 May 2024; Reviewed 12 July 2024; Accepted 23 August; Available online 15 September 2024 Academic Editor: Dr. Iman Muhammad Higazy, National Research Center, Egypt, imane.higazy@hotmail.com Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Gorkem Dulger, Duzce University, Turkey, gorkemdulger@yandex.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Concurrent presentation of unrelated perforated appendicitis and high-grade small bowel obstruction: A case report

Small bowel obstruction and acute perforated appendicitis are common surgical problems independently. At times, acute appendicitis may present with small bowel obstruction due to the localized inflammatory process. This results in mechanical small bowel obstruction usually near the terminal ileum. However, it is extremely rare to have both abdominal processes occurring simultaneously, but not related to one another. In this study, we present a case of a healthy 62-year-old female patient who had concurrent high-grade small bowel obstruction due to a chronic adhesive band and perforated appendicitis, seemingly completely independent of each other.

A study to assess the effectiveness of art therapy on pre-operative anxiety among patients undergoing surgery admitted in surgical wards of Sree Balaji Medical College and hospital, Chennai-44

The study explores the concept of health, mental wellness, and nursing. Health involves achieving human potential through goal-directed behaviour, self-care, and satisfying relationships. Mental wellness is a positive attribute, promoting emotional well-being and flexibility. Nursing focuses on protecting, promoting, and optimizing health and abilities, preventing illness and injury, and alleviating suffering. Surgery involves cutting or closing wounds. This study used an evaluative approach to assess the effectiveness of art therapy on preoperative anxiety among patients undergoing surgery. A one-group pretest-posttest design was used, with observations made before and after art therapy. The study aimed to evaluate the effects of art therapy on anxiety levels in patients undergoing surgery. The study was conducted at Sree Balaji Medical College and hospital in Chennai-44, a 1300-bed hospital with advanced facilities. The hospital admits 40-50 patients daily due to surgical problems, with 20-30 surgeries occurring in the operation theatre. Patients are accommodated in different surgical wards and shifted to the surgical Intensive Care Unit for observation. After stabilization, they return to their previous ward. The study included all patients admitted for surgery at Sree Balaji Medical College and hospital during the study period. The study involved 60 surgical patients admitted to Sree Balaji Medical College and Hospital, Chennai-44, using a convenient sampling technique, based on availability. Table 1 shows the demographic distribution of 60 patients undergoing surgery, with 20 patients aged 21-30, 31.7% aged 31-40, 31.6% aged 41-50, and 16.7% above 50. The majority were male, with 60.0% being married, and 73.3% were married. 5% were illiterate, while 8.3% had secondary education. 25.5% were unemployed, while 45% were private employees, and 20% had their own business. All patients had prior knowledge about surgery, with 33.3% getting information from relatives, 11.7% from television, and 55% from doctors. The study found a significant association between demographic variables such as educational status, family income, and type of surgery and post-operative anxiety levels in patients undergoing surgery at Sree Balaji Medical College and hospital. The pretest anxiety score significantly differed from the post-test anxiety score. The study concluded that conducting art therapy pre-operatively can reduce anxiety levels and promote recovery during surgery.

Predictors of Morbidity and Mortality of Gastrointestinal Perforation in Children

Background: Gastrointestinal perforation is a common surgical problem in paediatric surgical ward in our country. It carries a high morbidity and mortality in children. The predictors of postoperative morbidity and mortality are still not well established. Objectives: The objective of this study was to identify the predictors of morbidity and mortality following surgery for gastrointestinal perforation in children. Methods: This was a single centre cross sectional type of descriptive observational study carried out in the Department of Paediatric Surgery, Mymensingh Medical College Hospital with 16-month duration from 1st January, 2017 to April 30, 2018, in children aged from 2-12 years. Predictors related to postoperative morbidity and mortality were investigated. Results: A total of 40 patients were selected for this study with mean age of 8.92±2.61 years. Male: female was 1.5:1. Analysis indicated that factors associated with postoperative morbidity and mortality were low BMI, poor nutritional status, low serum total protein and albumin, delay in seeking treatment and contaminated peritoneal collection. Appendicular perforation was the highest number perforation in 23(57.5%) patients. Ileal perforation was the second highest number 8(20%). Appendectomy was the highest surgical procedure 21(52.5%), followed by resection-anastomosis and wound excision & repair 3(7.5%) each. Serum total protein and albumin were below normal limit among 15(37.5%) and 35(87.5%) patients respectively. 13(32.5%) patients received treatment 72 hours after onset of symptom and 18(45%) patients undergone operation within 24-48 hours of admission. Postoperative complications developed in 30 patients. Among them SSI were in 20(66.66%), SIRS in 9(30%) and leakage of repair in 1(3.33%) patient. Mortality rate was 5%. Conclusion: Poor nutritional status, low total serum protein and albumin, delay in initiation of treatment, and contaminated peritoneal fluid are the predictors of morbidity and mortality of gastrointestinal perforation in children.

Open suture repair versus PermacolTM mesh repair of small ventral hernias in patients with end-stage kidney disease.

Ventral hernia is a common surgical problem among patients with end-stage kidney disease (ESKD), while the optimal repair technique for small ventral hernias is controversial. This study aimed to compare the outcomes of open suture repair versus biological mesh repair of small ventral hernias with defect size ≤2 cm in ESKD patients. Data from consecutive ESKD patients who underwent elective ventral hernia repair with defect size ≤2 cm at a single institution from January 2012 to January 2022 were retrospectively reviewed. Outcomes of open suture repair were compared to PermacolTM mesh repair. The primary outcome was recurrence rate. Secondary outcomes included post-operative complications, peri-operative and post-operative dialysis regimen. Forty-seven ventral hernia repairs were included, with 20 being suture repairs and 27 being PermacolTM mesh repairs. Median age at hernia repair was 60 (range 32-81) years old. Pre-operatively, 42 patients (89.4%) were on peritoneal dialysis (PD). Paraumbilical hernia (59.6%) was most common. Median hernia defect size was 15 mm (range 2-20 mm). Upon median follow-up of 56 (range 9-119) months, more patients in the suture repair group developed recurrence (30% vs. 0%, p = 0.004). Median time to recurrence was 10 (range 5-16) months. There was no wound or mesh infection. The majority of patients underwent intermittent PD peri-operatively and were able to resume on PD in the long run. Ventral hernia repair is indicated in ESKD patients even for small defects; repair with PermacolTM mesh was associated with a lower recurrence rate when compared to suture repair and post-operative morbidity was low.

Aortic root enlargement versus stentless valve implantation for avoidance of patient-prosthesis mismatch in patients with small aortic root: protocol for a systematic review

IntroductionAvoiding patient-prosthesis mismatch (PPM) in patients with small aortic annulus (SAA) during aortic valve replacement (AVR) is still a challenging surgical problem. Among surgical options available, aortic root enlargement (ARE)...

The Impact of the Chlorhexidine Gel (WISDOM®) on Postoperative Sequelae Associated with the Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical Trial

Background: One of the most prevalent procedures in oral surgery is the removal of impacted mandibular third molars, typically accompanied by trismus, edema, and pain. Several methods and biomaterials were implemented to mitigate or avoid these surgical problems. Objectives: To evaluate the efficiency of chlorhexidine gel (WISDOM®) in minimizing postoperative sequelae associated with the impacted mandibular third molar that will be surgically extracted and its role in promoting early soft tissue closure of the surgical site. Methods: The study design was a double-masked and randomized, controlled clinical study that included healthy patients needing the removal of a mandibular third molar through surgery. The participants were randomly assigned to two groups. The extraction site of the study group was filled with a mixture of gel foam and WISDOM®. In contrast, we filled the extraction sites of the control group patients with gel foam and sutured the surgical sites for both groups. The patients were evaluated on the first, third, and seventh postoperative days for pain, swelling, trismus, and early soft tissue healing. Results: Sixty eligible patients were enrolled in this study. The study group exhibited a statistically significant decrease in pain, edema, trismus, and early soft tissue healing on the first, third, and seventh postoperative days compared to the control group. Conclusions: WISDOM® gel can effectively reduce postoperative pain, trismus, and swelling and promote early soft tissue healing after surgical removal of an impacted mandibular wisdom tooth.

Determining Deviation of the Growth Pattern of Preterm Infants and Its Causes According to the Fenton Growth Chart: A Longitudinal Follow-up Study

Background: Birth weight is a crucial indicator of infant health. In Iran, child growth monitoring for children under six years old is integrated into the healthcare system. However, existing growth charts have limitations in accurately representing preterm infants. Objectives: This study was conducted to determine the frequency of postnatal growth retardation and its causes in preterm infants from hospitalization to six months after birth. Methods: After informing parents, we recruited 255 preterm singleton infants born at the Afzalipour Medical Education and Health Center in Kerman, Iran, over one year. The Fenton growth chart was used to compare the anthropometric characteristics of the infants at birth, and at ages 7, 14, and 28 days, and then monthly up to 6 months. A special questionnaire also recorded the type of feeding, length of hospital stay, use of mechanical ventilation and oxygen, duration of total parenteral nutrition (TPN), and associated causes and complications. Results: The mean Z-score weights at birth, discharge, one month, three months, and six months were -0.34, -1.19, -0.85, -0.94, and -1.79, respectively. The mean Z-score heights at birth, discharge, one month, three months, and six months were 0.74, 0.20, -0.07, -0.79, and -2.5, respectively. Additionally, the mean Z-scores for head circumference at birth, discharge, one month, and three months were 0.41, -0.19, -0.53, and -1.17, respectively. Deviation from the Fenton preterm growth chart was detected in 109 infants (42.7%) at the time of discharge, 79 infants (31%) at one month, 82 infants (32.2%) at three months, and 134 infants (52.5%) at six months of age. Conclusions: The weight at discharge and the length of NPO [due to surgical problems, feeding intolerance, necrotizing enterocolitis (NEC), etc.] were significantly inversely related. Preterm infants grow more slowly in hospitals, so their longitudinal growth data should be interpreted carefully. The incidence of postnatal growth failure can be reduced by improving NICU quality, optimizing nutrition, and increasing enteral feeding rates.

A meta-analysis examining the impact of obesity on surgical site wound complications in patients undergoing primary ovarian cancer surgery.

The meta-analysis sought to evaluate and compare the effect of obesity on surgical site wound problems in subjects after primary ovarian cancer surgery. The results found by this meta-analysis were analyzed, and then odds ratio (OR) and mean difference (MD), at 95% confidence intervals (CIs), were calculated. These models might be dichotomous or contentious, random, or fixed effect models. The current meta-analysis included nine exams from 2009 to 2023, including 4362 females with primary ovarian cancer surgeries. Obesity had a significantly higher risk of surgical site wound infections (OR, 2.90; 95% CI, 2.27-3.69, p < 0.001), and wound problems (OR, 4.14; 95% CI, 1.83-9.34, p < 0.001) compared to non-obesity in females with primary ovarian cancer surgeries. It was revealed, by examining the data, that obesity was associated with significantly higher incidence of surgical site wound infections, and wound problems compared to non-obesity in females with primary ovarian cancer surgeries. However, attention should be given to the values because some of the comparisons included a small number of chosen studies,.

An efficient model for extracting respiratory and blood oxygen saturation data from photoplethysmogram signals by removing motion artifacts using heuristic-aided ensemble learning model

Patients with surgical, pulmonary, and cardiac problems, continual monitoring of Oxygen Saturation of a Person (SpO2) and Respiratory Rate (RR) is essential. Similarly, the persons with cardiopulmonary health issues, RR estimation is crucial. The performance of the ventilator assistance and lung medicines are evaluated using SpO2 and RR. For the persons, those who are living alone with respiratory illnesses need a compulsory estimation of RR. In case of serious illness, the RR might face abrupt changes. The immobility of the disturbance and RR makes the RR evaluation from the PhotoPlethysmoGraphic (PPG) signals is a difficult challenge. So, an efficient RR and SpO2 estimation framework from the PPG signal using the deep learning method is developed in this paper. At first, the PPG signal is collected from standard data sources. The collected PPG signals undergo signal pre-processing. The pre-processing procedures include Motion Artifacts (MA) removal and filtering techniques. The pre-processed signals are split into distinct windows. From the split windows of the signals, the spectral features, RR, and Respiratory Peak Variance (RPV) features are extracted. The retrieved features are selected optimally with the help of Advanced Golden Tortoise Beetle Optimizer (AGTBO). The weights are chosen optimally with the same AGTBO. The optimally selected features are fused with the optimal features to get the weighted optimal features. These weighted optimal features are fed into the Ensemble Learning-based RR and SpO2 Estimation Network (ELRR-SpO2EN). The ensemble learning model is developed by combining Multilayer Perceptron (MLP), AdaBoost, and Attention-based Long Short Term Memory (A-LSTM). The performance of the developed RR and SpO2 estimation model is compared with other existing techniques. The experimental analysis results revealed that the proposed AGTBO-ELRR-SpO2EN model attained 96 % accuracy for the second dataset, which is higher than the conventional models such as MLP (90 %), Adaboost (92 %), A-LSTM (92 %), and MLP-ADA-ALSTM (94 %). Thus, it has been confirmed that the designed RR and SpO2 estimation framework from PPG signals is more efficient than the other conventional models.

Common paediatric surgical problems in Bangladesh: experience in tertiary care center, Dhaka, Bangladesh

Common paediatric surgical problems in Bangladesh: experience in tertiary care center, Dhaka, Bangladesh

Synchronising a stereoscopic surgical video stream using specular reflection.

A stereoscopic surgical video stream consists of left-right image pairs provided by a stereo endoscope. While the surgical display shows these image pairs synchronised, most capture cards cause de-synchronisation. This means that the paired left and right images may not correspond once used in downstream tasks such as stereo depth computation. The stereo synchronisation problem is to recover the corresponding left-right images. This is particularly challenging in the surgical setting, owing to the moist tissues, rapid camera motion, quasi-staticity and real-time processing requirement. Existing methods exploit image cues from the diffuse reflection component and are defeated by the above challenges. We propose to exploit the specular reflection. Specifically, we propose a powerful left-right comparison score (LRCS) using the specular highlights commonly occurring on moist tissues. We detect the highlights using a neural network, characterise them with invariant descriptors, match them, and use the number of matches to form the proposed LRCS. We perform evaluation against 147 existing LRCS in 44 challenging robotic partial nephrectomy and robotic-assisted hepatic resection video sequences with simulated and real de-synchronisation. The proposed LRCS outperforms, with an average and maximum offsets of 0.055 and 1 frames and 94.1±3.6% successfully synchronised frames. In contrast, the best existing LRCS achieves an average and maximum offsets of 0.3 and 3 frames and 81.2±6.4% successfully synchronised frames. The use of specular reflection brings a tremendous boost to the real-time surgical stereo synchronisation problem.

Describing an old trick in posterior thoracal and lumbar ımplant removal surgery: follow-up results for at least 10 years

Study designRetrospective case series.ObjectivesWe aimed to describe with a novel surgical approach for the removal of posterior thoracolumbar implant in patients with symptomatic failure of the implant and present our preliminary results with this method.MethodsThis retrospective, single-center study was performed in the neurosurgery department of a university hospital. Data were gathered from the medical files of 314 patients (243 women, 77.39%; 71 men, 22.61%) with symptomatic thoracolumbar implant failure that underwent implant removal operation using our novel technique between 2010 and 2020. Symptoms, radiological findings, intraoperative findings as well as clinical outcomes were evaluated.ResultsIn our series, the average age was 46.5 years (range: 21–84) with a mean follow-up duration of 7 years (range: 3 months to 10 years). Preoperatively, the most common symptoms were leg pain and numbness of the lower extremity. Postoperatively, no major complications were noted. Clinical progression of symptoms was avoided by surgery in all patients, while we came across removal difficulties due to screw–screwdriver mismatch in 15 of 314 surgeries (4.78%). Our novel approach allowed successful screw removal including these challenging cases.ConclusionsWe suggest that our novel approach is a practical and effective for the removal of posterior thoracolumbar implant in cases with symptomatic failure attributed to screw–screwdriver mismatch. Further trials are warranted to assess the efficacy of this technique to overcome surgical problems associated with screw removal.

The incidence and risk factors for unplanned readmission within 90 days after surgical treatment of spinal fractures.

Unplanned readmissions after spine surgery are undesired, and cause significant functional, and financial distress to the patients and healthcare system. Though critical, knowledge about readmissions after surgery for traumatic spinal injuries (TSI) is scarce and under-evaluated. Consecutive patients surgically treated for TSI and who had unplanned readmission within 90 days post-discharge were studied. Peri-operative demographic and surgical variables, surgical treatment, level of injury, delay in surgery, ASIA score, other organ injuries, peri-operative complications, smoking, ICU stay, co-morbidity, and the length of hospital stay were studied and correlated with the causes for readmission. Among 884 patients, 4.98% (n = 44) had unplanned readmissions within 90 days of discharge. Notably, 50% (n = 22) patients were readmitted within the first 30 days. The common causes of readmissions were urinary tract related problems (27%, n = 12), pressure ulcers (20.4%, n = 9), respiratory problems (13.6%, n = 6), surgical wound related problems (14%, n = 7,) limb injuries (11.4%, n = 5), and others (11%, n = 5). The total beds lost secondary to readmissions was 314 days, and the mean bed-days lost per patient was 7.2 ± 5.1. Thirteen peri-operative risk factors were associated with unplanned readmissions, among which, smoking (OR 2.2), diabetes (OR 2.4), and pressure sore during index admission (OR 16.7) were strong independent predictors. The incidence of unplanned readmissions after TSI was 5%, which was similar to elective spine surgeries but the causes and risk factors are different. Non-surgical complications related to urinary tract, respiratory care and pressure sores were the most common causes. Pre-operative smoking status, diabetes mellitus and pressure sores noted in the index admission were important independent risk factors.

Acute Intestinal Obstruction Due to an Anomalous Ileosigmoid Band – A Case Report

We report a case of a 30-year-old female who presented with symptoms and signs of intestinal obstruction. The patient reported no previous history of abdominal surgery or trauma while clinical and radiographic examinations were not diagnostic. Patient planned for exploratory laparotomy in view of complete intestinal obstruction. Exploratory laparotomy with limited resection of gangrenous segment with primary closure of abnormal ileosigmoid communication with proximal ileostomy with distal mucous fistula. Intraoperatively distal 60cm of ileum, caecum and part of ascending colon was gangrenous there was a fibrous band extending from parities to ileum approximately 60 cm proximal to IC junction. Congenital bands are extremely rare. Their exact incidence is still unknown and usually observed in childhood. This case, therefore, represents an unusual surgical problem in an older individual in which the diagnosis was clinically unexpected. Small bowel obstruction is the most common surgical disorder of the small intestine. Adhesions are by far the most frequent causes followed by hernias, tumors, intussusception, foreign bodies, gallstones, and inflammatory bowel disease. Obstruction by a congenital band is extremely rare and usually observed in childhood. This report presents a 30-year-old female with symptoms of intestinal obstruction, subsequently treated by ligation and division of a congenital band.