Gastrointestinal (GI) tract perforation is a surgical emergency. The epidemiology and etiology of... more Gastrointestinal (GI) tract perforation is a surgical emergency. The epidemiology and etiology of perforation vary considerably across geography. Lower GI tract perforations in the elderly predominate in the West compared to upper GI perforations in the younger population in the tropics. Fungi and viruses have been reported to cause GI perforations in immuno-compromised individuals but it is rare in immuno-competent individuals. We report a very rare case of gastric perforation secondary to fungal gastritis in an immunocompetent 35-year-old female who presented with features of peritonitis. At emergency laparotomy, gastric perforation was found which was repaired by the Cellan-Jones method. Perforation edge biopsy findings were consistent with fungal etiology. She responded well to Antifungal therapy. We conclude that fungal etiology can be considered in patients with gastric perforation without any history of peptic ulcer disease (PUD) or use of oral non-steroidal anti-inflammatory drugs.
Intestinal obstruction is one of the most important cause of acute abdomen. An internal herniatio... more Intestinal obstruction is one of the most important cause of acute abdomen. An internal herniation is an uncommon yet relevant clinical entity causing an acute intestinal obstruction that can occur after major bowel surgery. Here, we describe a case of acute intestinal obstruction caused by internal herniation in a patient with muscle-invasive urinary bladder carcinoma who underwent robot-assisted radical cystectomy with an ileal conduit. We also discuss the management of adjuvant chemotherapy-induced leukopenia.
Jejunal diverticulum is a very rare disease. Diagnosis of this condition is a challenge owing to ... more Jejunal diverticulum is a very rare disease. Diagnosis of this condition is a challenge owing to non-specific complaints of the patient. Fifteen percent cases of jejunal diverticula present with acute abdomen. Approximately 77% of small bowel diverticular disease occur with multiple diverticula. Here we describe a case of complicated isolated jejunal diverticula presenting with perforation, which was successfully treated with resection of the involved segment with anastomosis.
Introduction There is established evidence on the role of enhanced recovery after surgery (ERAS) ... more Introduction There is established evidence on the role of enhanced recovery after surgery (ERAS) protocols in elective surgeries but its effectiveness in emergency surgeries has been nominally studied. We aimed at studying the feasibility and effectiveness of ERAS protocols in patients undergoing emergency abdominal surgery for intestinal perforation and small bowel obstruction and compare their surgical outcomes with conventional care. Materials and methods This prospective randomized study was performed for a period of 16 months. A total of 100 patients presenting either with intestinal perforation or acute small bowel obstruction were recruited; 50 each in the ERAS and the conventional care groups. The primary outcomes studied were the postoperative length of stay and 30-day morbidity and mortality. Results It was seen that the median (interquartile range) of the duration of hospital stay in the ERAS group was 4 (1) days while it was 7 (3) days in the conventional care group, whi...
Acute appendicitis is a common clinical condition, but sometimes diagnosis is delayed when append... more Acute appendicitis is a common clinical condition, but sometimes diagnosis is delayed when appendix is at rare location. Subhepatic appendicitis is a rare condition. Diagnosis of subhepatic appendicitis is further delayed when there is cholelithiasis on Ultrasonography of abdomen. We are reporting a case of subhepatic appendicitis in young male with diagnostic difficulties and our experience.
Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version ... more Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 24.0, statistical software. REsULTs The study enrolled 103 consecutive cases of laparoscopic cholecystectomy in which 74 were female (71.84%) and 29 males
Background: North India has a very high incidence of Carcinoma gallbladder (GBC). The aim of the ... more Background: North India has a very high incidence of Carcinoma gallbladder (GBC). The aim of the study was to identify the hotspot regions and relationship of gallstones to GBC in two northern states of India. Materials and Methods: It was a retrospective, observational, hospital-based cohort study. The data of patients with locally advanced (LA) or metastatic GBC from January 2019 to December 2019 were evaluated for geographical distribution of cases, and their clinical spectrum was compared with the presence or absence of associated cholelithiasis. Statistical analysis was performed using R Statistical software version 3.6.2. Results: Forty-two patients were enrolled in our study. A high burden of GBC was observed from Western Uttar Pradesh (District Bijnor 12(29%) and Muzaffarnagar 7(17%)) and Uttarakhand (District Haridwar 7(17%), whereas the remaining 16(38%) patients were residents of other districts of Uttarakhand (UK) and Western Uttar Pradesh (UP). In our study, only 17(40.5%) patients had associated cholelithiasis. Metastatic disease at presentation was seen in nearly 59% of patients with cholelithiasis and 52% of patients without cholelithiasis. Jaundice was the most common presentation in 12(70.6%) patients, followed by pain in 9(nearly 53%) patients with GBC associated with gallstones. Whereas in patients with GBC without gallstones, loss of appetite and loss of weight was the most common presentation in 16(64%) followed by jaundice in 13(52%). Conclusion: Most cases with LA or metastatic GBC in the present study were not associated with cholelithiasis. Clinical spectrum of either LA or metastatic GBC is similar, irrespective of presence or absence of gallstones.
Background: A combination of serum tumor markers are used in the evaluation and prognosis of carc... more Background: A combination of serum tumor markers are used in the evaluation and prognosis of carcinoma gallbladder (GBC). Aim of the study was to find the significance of combined use of CA19-9, CA125 and CEA in advanced stage of GBC and to find the cut-off value of each of these tumor markers in metastatic GBC. Methods: This was a retrospective observational cohort study over 1 year, which was carried out in 42 cases of advanced GBC. The patients were grouped in to locally advanced and metastatic stage on the basis of CECT scan findings. CA19-9, CA125 and CEA were assayed in all patients. These tumor markers were analysed with these two groups of GBCs. Statistical analysis was performed using R statistical software v3.6.2.Results: Out of 42 cases CA19-9 was elevated in 18 (78%), CA125 in 16 (70%) and CEA in 9 (39%) patients with metastatic disease. The cut-off value of CA19-9, CA125 and CEA was determined by ROC curve were >109 U/ml, 55.4 U/ml and 2.56 μg/l respectively. CA19-...
Background: Evaluation of bowel habit is useful indicator of functional gastrointestinal disorder... more Background: Evaluation of bowel habit is useful indicator of functional gastrointestinal disorders. Assessment of bowel habit is retrospective in nature and it is best done by questionnaire technique. Aims and objectives of the study was to look for the bowel habit in common benign anorectal disorder.Methods: One-hundred patients with benign anorectal diseases who presented in the Surgery out patient’s department (SOPD) at AIIMS Rishikesh, India from January 2014 to December 2016 were included in the study. Inclusion criteria were all the cases of benign anorectal disorder attended in the Surgery OPD and exclusion criteria were cases with malignant anorectal disease. Patients were assessed on 7 questionnaires as bowel movements (number/day), consistency, feeling of incomplete defecation and/or difficult evacuation, straining at defecation, bleeding per rectum, pain during defecation, use of laxatives. These questionnaires were given to all these patients and asked to prepare a four-...
Congenital diaphragmatic hernia (CDH) is extremely rare in adults. Bochdalek hernia (BH) is the c... more Congenital diaphragmatic hernia (CDH) is extremely rare in adults. Bochdalek hernia (BH) is the commonest among all congenital diaphragmatic hernias. It is due to incomplete fusion of pleuroperitoneal folds during early fetal development. It remains asymptomatic in many adults. It usually occurs on the left side and common in male (62%). Open or laparoscopic surgical repair is the treatment of choice. We are reporting a rare case of BH in an adult female with intra-thoracic left kidney and splenic flexure of the colon, who presented with non-specific abdominal symptoms. Key message: BH in adults is usually present with vague abdominal symptoms. We advocate the use of CECT scan of the abdomen in the management of all cases with non-specific abdominal symptoms.
Background: There are wide range of benign breast diseases reported from India. Breast lumps are ... more Background: There are wide range of benign breast diseases reported from India. Breast lumps are one of the commonest presentations. Although most of the breast lumps are benign but patient become anxious due to fear of malignancy. Due to this, there is an increase in the use of screening mammography and the fine needle aspiration cytology (FNAC) or core needle biopsy (CNB), most of which yield benign findings. This study is aimed to evaluate the incidence of different types of benign breast lumps in respect to age, size, side and site, relation with parity and use of oral contraceptive pills and analyses of this result in relation with the past and recent study on benign breast diseases.Methods: This study was conducted at Rajendra Institute of Medical Sciences, Ranchi (India) over a period of one and half years. Inclusion criteria was the cases with palpable breast lumps which were reported benign on either FNAC or CNB and exclusion criteria was the cases with breast malignancy an...
Background: Spleen is the meeting ground of medicine and surgery and most patients for elective s... more Background: Spleen is the meeting ground of medicine and surgery and most patients for elective splenectomy are primarily evaluated by physicians and then referred to the surgeons. Both physicians and surgeons need to be aware of the utility of splenectomy as a therapeutic option in various medical conditions. This study looks at the indications for elective splenectomy and the outcomes over a decade at a tertiary care centre in North India. It also evaluates the adherence to protocols recommended for prevention of OPSI in adults.Methods: A hospital based prospective observational study was conducted at a tertiary care hospital situated in Uttarakhand, North India, over a duration of 10 years from October 2006 to October 2016. The inclusion criteria for the study were all the patients undergoing splenectomy for the non-traumatic indications.Results: Sixty-one patients underwent splenectomy in the 10 years’ duration. The age range of patients was from 17-79 years with twenty-six male...
Background: Gastrointestinal tract perforation is one of the common surgical emergency all over t... more Background: Gastrointestinal tract perforation is one of the common surgical emergency all over the world. Menekse et al devised POMPP score (predictive score of mortality in perforated peptic ulcer) to predict the morbidity and mortality in peptic ulcer perforation. The objective of this study was to assess the validity of POMPP score in peptic ulcer perforation and to assess its usefulness in gastrointestinal perforation due to causes other than the peptic ulcer.Methods: Fifty consecutive cases, who had undergone exploratory laparotomy for gastrointestinal perforation peritonitis, were included in the study. “These patients were assessed at the time of admission on the basis of Age >65 years, BUN >45mg/dl (Blood Urea Nitrogen) and Albumin <1.5g/L and a score of 1 point each had been given”. The total score was compared with the outcome of the disease in relation with mortality.Results: In our study, 42% of gastrointestinal perforation were due to peptic ulcer, 22 % due to...
Emergency Whipple's procedure is done in endoscopy-related perforation, uncontrollable intraduode... more Emergency Whipple's procedure is done in endoscopy-related perforation, uncontrollable intraduodenal tumor bleeding and traumatic pancreaticoduodenal injury. It has a high mortality and morbidity rate. We are presenting a case of pancreaticoduodenal injury of grade IV, in which emergency Whipple's procedure was done with good post operative recovery.
In this study all patients with proven small bowel and mesenteric injuries as diagnosed at laparo... more In this study all patients with proven small bowel and mesenteric injuries as diagnosed at laparotomy will be reviewed in order to better understand the presentation and diagnosis of such injuries in the patient with BAT.
Gallstone ileus is a rare complication of cholelithiasis seen in patients with a long history of ... more Gallstone ileus is a rare complication of cholelithiasis seen in patients with a long history of cholelithiasis. It occurs more in the older age group and in the female gender. These patients have poor general condition and therefore selection of appropriate treatment is difficult. The clinician has to make a decision between immediate one-stage or two-stage closure of the cholecysto-intestinal fistula or waiting for natural closure. We have discussed the management of a rare cause of small bowel obstruction due to complication of untreated cholelithiasis.
Jejunal diverticulum is a very rare disease. Diagnosis of this condition is a challenge owing to ... more Jejunal diverticulum is a very rare disease. Diagnosis of this condition is a challenge owing to non-specific complaints of the patient. Fifteen percent cases of jejunal diverticula present with acute abdomen. Approximately 77% of small bowel diverticular disease occur with multiple diverticula. Here we describe a case of complicated isolated jejunal diverticula presenting with perforation, which was successfully treated with resection of the involved segment with anastomosis.
Gallstone ileus is a rare complication of cholelithiasis seen in patients with a long history of ... more Gallstone ileus is a rare complication of cholelithiasis seen in patients with a long history of cholelithiasis. It occurs more in the older age group and in the female gender. These patients have poor general condition and therefore selection of appropriate treatment is difficult. The clinician has to make a decision between immediate one-stage or two-stage closure of the cholecysto-intestinal fistula or waiting for natural closure. We have discussed the management of a rare cause of small bowel obstruction due to complication of untreated cholelithiasis.
Intestinal obstruction is one of the most important cause of acute abdomen. An internal herniatio... more Intestinal obstruction is one of the most important cause of acute abdomen. An internal herniation is an uncommon yet relevant clinical entity causing an acute intestinal obstruction that can occur after major bowel surgery. Here, we describe a case of acute intestinal obstruction caused by internal herniation in a patient with muscle-invasive urinary bladder carcinoma who underwent robot-assisted radical cystectomy with an ileal conduit. We also discuss the management of adjuvant chemotherapy-induced leukopenia.
Gastrointestinal (GI) tract perforation is a surgical emergency. The epidemiology and etiology of... more Gastrointestinal (GI) tract perforation is a surgical emergency. The epidemiology and etiology of perforation vary considerably across geography. Lower GI tract perforations in the elderly predominate in the West compared to upper GI perforations in the younger population in the tropics. Fungi and viruses have been reported to cause GI perforations in immuno-compromised individuals but it is rare in immuno-competent individuals. We report a very rare case of gastric perforation secondary to fungal gastritis in an immunocompetent 35-year-old female who presented with features of peritonitis. At emergency laparotomy, gastric perforation was found which was repaired by the Cellan-Jones method. Perforation edge biopsy findings were consistent with fungal etiology. She responded well to Antifungal therapy. We conclude that fungal etiology can be considered in patients with gastric perforation without any history of peptic ulcer disease (PUD) or use of oral non-steroidal anti-inflammatory drugs.
Intestinal obstruction is one of the most important cause of acute abdomen. An internal herniatio... more Intestinal obstruction is one of the most important cause of acute abdomen. An internal herniation is an uncommon yet relevant clinical entity causing an acute intestinal obstruction that can occur after major bowel surgery. Here, we describe a case of acute intestinal obstruction caused by internal herniation in a patient with muscle-invasive urinary bladder carcinoma who underwent robot-assisted radical cystectomy with an ileal conduit. We also discuss the management of adjuvant chemotherapy-induced leukopenia.
Jejunal diverticulum is a very rare disease. Diagnosis of this condition is a challenge owing to ... more Jejunal diverticulum is a very rare disease. Diagnosis of this condition is a challenge owing to non-specific complaints of the patient. Fifteen percent cases of jejunal diverticula present with acute abdomen. Approximately 77% of small bowel diverticular disease occur with multiple diverticula. Here we describe a case of complicated isolated jejunal diverticula presenting with perforation, which was successfully treated with resection of the involved segment with anastomosis.
Introduction There is established evidence on the role of enhanced recovery after surgery (ERAS) ... more Introduction There is established evidence on the role of enhanced recovery after surgery (ERAS) protocols in elective surgeries but its effectiveness in emergency surgeries has been nominally studied. We aimed at studying the feasibility and effectiveness of ERAS protocols in patients undergoing emergency abdominal surgery for intestinal perforation and small bowel obstruction and compare their surgical outcomes with conventional care. Materials and methods This prospective randomized study was performed for a period of 16 months. A total of 100 patients presenting either with intestinal perforation or acute small bowel obstruction were recruited; 50 each in the ERAS and the conventional care groups. The primary outcomes studied were the postoperative length of stay and 30-day morbidity and mortality. Results It was seen that the median (interquartile range) of the duration of hospital stay in the ERAS group was 4 (1) days while it was 7 (3) days in the conventional care group, whi...
Acute appendicitis is a common clinical condition, but sometimes diagnosis is delayed when append... more Acute appendicitis is a common clinical condition, but sometimes diagnosis is delayed when appendix is at rare location. Subhepatic appendicitis is a rare condition. Diagnosis of subhepatic appendicitis is further delayed when there is cholelithiasis on Ultrasonography of abdomen. We are reporting a case of subhepatic appendicitis in young male with diagnostic difficulties and our experience.
Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version ... more Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 24.0, statistical software. REsULTs The study enrolled 103 consecutive cases of laparoscopic cholecystectomy in which 74 were female (71.84%) and 29 males
Background: North India has a very high incidence of Carcinoma gallbladder (GBC). The aim of the ... more Background: North India has a very high incidence of Carcinoma gallbladder (GBC). The aim of the study was to identify the hotspot regions and relationship of gallstones to GBC in two northern states of India. Materials and Methods: It was a retrospective, observational, hospital-based cohort study. The data of patients with locally advanced (LA) or metastatic GBC from January 2019 to December 2019 were evaluated for geographical distribution of cases, and their clinical spectrum was compared with the presence or absence of associated cholelithiasis. Statistical analysis was performed using R Statistical software version 3.6.2. Results: Forty-two patients were enrolled in our study. A high burden of GBC was observed from Western Uttar Pradesh (District Bijnor 12(29%) and Muzaffarnagar 7(17%)) and Uttarakhand (District Haridwar 7(17%), whereas the remaining 16(38%) patients were residents of other districts of Uttarakhand (UK) and Western Uttar Pradesh (UP). In our study, only 17(40.5%) patients had associated cholelithiasis. Metastatic disease at presentation was seen in nearly 59% of patients with cholelithiasis and 52% of patients without cholelithiasis. Jaundice was the most common presentation in 12(70.6%) patients, followed by pain in 9(nearly 53%) patients with GBC associated with gallstones. Whereas in patients with GBC without gallstones, loss of appetite and loss of weight was the most common presentation in 16(64%) followed by jaundice in 13(52%). Conclusion: Most cases with LA or metastatic GBC in the present study were not associated with cholelithiasis. Clinical spectrum of either LA or metastatic GBC is similar, irrespective of presence or absence of gallstones.
Background: A combination of serum tumor markers are used in the evaluation and prognosis of carc... more Background: A combination of serum tumor markers are used in the evaluation and prognosis of carcinoma gallbladder (GBC). Aim of the study was to find the significance of combined use of CA19-9, CA125 and CEA in advanced stage of GBC and to find the cut-off value of each of these tumor markers in metastatic GBC. Methods: This was a retrospective observational cohort study over 1 year, which was carried out in 42 cases of advanced GBC. The patients were grouped in to locally advanced and metastatic stage on the basis of CECT scan findings. CA19-9, CA125 and CEA were assayed in all patients. These tumor markers were analysed with these two groups of GBCs. Statistical analysis was performed using R statistical software v3.6.2.Results: Out of 42 cases CA19-9 was elevated in 18 (78%), CA125 in 16 (70%) and CEA in 9 (39%) patients with metastatic disease. The cut-off value of CA19-9, CA125 and CEA was determined by ROC curve were >109 U/ml, 55.4 U/ml and 2.56 μg/l respectively. CA19-...
Background: Evaluation of bowel habit is useful indicator of functional gastrointestinal disorder... more Background: Evaluation of bowel habit is useful indicator of functional gastrointestinal disorders. Assessment of bowel habit is retrospective in nature and it is best done by questionnaire technique. Aims and objectives of the study was to look for the bowel habit in common benign anorectal disorder.Methods: One-hundred patients with benign anorectal diseases who presented in the Surgery out patient’s department (SOPD) at AIIMS Rishikesh, India from January 2014 to December 2016 were included in the study. Inclusion criteria were all the cases of benign anorectal disorder attended in the Surgery OPD and exclusion criteria were cases with malignant anorectal disease. Patients were assessed on 7 questionnaires as bowel movements (number/day), consistency, feeling of incomplete defecation and/or difficult evacuation, straining at defecation, bleeding per rectum, pain during defecation, use of laxatives. These questionnaires were given to all these patients and asked to prepare a four-...
Congenital diaphragmatic hernia (CDH) is extremely rare in adults. Bochdalek hernia (BH) is the c... more Congenital diaphragmatic hernia (CDH) is extremely rare in adults. Bochdalek hernia (BH) is the commonest among all congenital diaphragmatic hernias. It is due to incomplete fusion of pleuroperitoneal folds during early fetal development. It remains asymptomatic in many adults. It usually occurs on the left side and common in male (62%). Open or laparoscopic surgical repair is the treatment of choice. We are reporting a rare case of BH in an adult female with intra-thoracic left kidney and splenic flexure of the colon, who presented with non-specific abdominal symptoms. Key message: BH in adults is usually present with vague abdominal symptoms. We advocate the use of CECT scan of the abdomen in the management of all cases with non-specific abdominal symptoms.
Background: There are wide range of benign breast diseases reported from India. Breast lumps are ... more Background: There are wide range of benign breast diseases reported from India. Breast lumps are one of the commonest presentations. Although most of the breast lumps are benign but patient become anxious due to fear of malignancy. Due to this, there is an increase in the use of screening mammography and the fine needle aspiration cytology (FNAC) or core needle biopsy (CNB), most of which yield benign findings. This study is aimed to evaluate the incidence of different types of benign breast lumps in respect to age, size, side and site, relation with parity and use of oral contraceptive pills and analyses of this result in relation with the past and recent study on benign breast diseases.Methods: This study was conducted at Rajendra Institute of Medical Sciences, Ranchi (India) over a period of one and half years. Inclusion criteria was the cases with palpable breast lumps which were reported benign on either FNAC or CNB and exclusion criteria was the cases with breast malignancy an...
Background: Spleen is the meeting ground of medicine and surgery and most patients for elective s... more Background: Spleen is the meeting ground of medicine and surgery and most patients for elective splenectomy are primarily evaluated by physicians and then referred to the surgeons. Both physicians and surgeons need to be aware of the utility of splenectomy as a therapeutic option in various medical conditions. This study looks at the indications for elective splenectomy and the outcomes over a decade at a tertiary care centre in North India. It also evaluates the adherence to protocols recommended for prevention of OPSI in adults.Methods: A hospital based prospective observational study was conducted at a tertiary care hospital situated in Uttarakhand, North India, over a duration of 10 years from October 2006 to October 2016. The inclusion criteria for the study were all the patients undergoing splenectomy for the non-traumatic indications.Results: Sixty-one patients underwent splenectomy in the 10 years’ duration. The age range of patients was from 17-79 years with twenty-six male...
Background: Gastrointestinal tract perforation is one of the common surgical emergency all over t... more Background: Gastrointestinal tract perforation is one of the common surgical emergency all over the world. Menekse et al devised POMPP score (predictive score of mortality in perforated peptic ulcer) to predict the morbidity and mortality in peptic ulcer perforation. The objective of this study was to assess the validity of POMPP score in peptic ulcer perforation and to assess its usefulness in gastrointestinal perforation due to causes other than the peptic ulcer.Methods: Fifty consecutive cases, who had undergone exploratory laparotomy for gastrointestinal perforation peritonitis, were included in the study. “These patients were assessed at the time of admission on the basis of Age >65 years, BUN >45mg/dl (Blood Urea Nitrogen) and Albumin <1.5g/L and a score of 1 point each had been given”. The total score was compared with the outcome of the disease in relation with mortality.Results: In our study, 42% of gastrointestinal perforation were due to peptic ulcer, 22 % due to...
Emergency Whipple's procedure is done in endoscopy-related perforation, uncontrollable intraduode... more Emergency Whipple's procedure is done in endoscopy-related perforation, uncontrollable intraduodenal tumor bleeding and traumatic pancreaticoduodenal injury. It has a high mortality and morbidity rate. We are presenting a case of pancreaticoduodenal injury of grade IV, in which emergency Whipple's procedure was done with good post operative recovery.
In this study all patients with proven small bowel and mesenteric injuries as diagnosed at laparo... more In this study all patients with proven small bowel and mesenteric injuries as diagnosed at laparotomy will be reviewed in order to better understand the presentation and diagnosis of such injuries in the patient with BAT.
Gallstone ileus is a rare complication of cholelithiasis seen in patients with a long history of ... more Gallstone ileus is a rare complication of cholelithiasis seen in patients with a long history of cholelithiasis. It occurs more in the older age group and in the female gender. These patients have poor general condition and therefore selection of appropriate treatment is difficult. The clinician has to make a decision between immediate one-stage or two-stage closure of the cholecysto-intestinal fistula or waiting for natural closure. We have discussed the management of a rare cause of small bowel obstruction due to complication of untreated cholelithiasis.
Jejunal diverticulum is a very rare disease. Diagnosis of this condition is a challenge owing to ... more Jejunal diverticulum is a very rare disease. Diagnosis of this condition is a challenge owing to non-specific complaints of the patient. Fifteen percent cases of jejunal diverticula present with acute abdomen. Approximately 77% of small bowel diverticular disease occur with multiple diverticula. Here we describe a case of complicated isolated jejunal diverticula presenting with perforation, which was successfully treated with resection of the involved segment with anastomosis.
Gallstone ileus is a rare complication of cholelithiasis seen in patients with a long history of ... more Gallstone ileus is a rare complication of cholelithiasis seen in patients with a long history of cholelithiasis. It occurs more in the older age group and in the female gender. These patients have poor general condition and therefore selection of appropriate treatment is difficult. The clinician has to make a decision between immediate one-stage or two-stage closure of the cholecysto-intestinal fistula or waiting for natural closure. We have discussed the management of a rare cause of small bowel obstruction due to complication of untreated cholelithiasis.
Intestinal obstruction is one of the most important cause of acute abdomen. An internal herniatio... more Intestinal obstruction is one of the most important cause of acute abdomen. An internal herniation is an uncommon yet relevant clinical entity causing an acute intestinal obstruction that can occur after major bowel surgery. Here, we describe a case of acute intestinal obstruction caused by internal herniation in a patient with muscle-invasive urinary bladder carcinoma who underwent robot-assisted radical cystectomy with an ileal conduit. We also discuss the management of adjuvant chemotherapy-induced leukopenia.
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