New Indian Journal of Surgery

Objective: To document and correlate different indications and findings of EGD scopyin our endoscopy unit.

Methods: A retrospective descriptive study of 519 patients who underwent Esophagogastro duodenoscopy (EGD scopy) was conducted in the Endoscopy Unit of Department of General surgery of Tertiary Care Centre. Included patients underwent EGD scopy. Demographic data including indications and endoscopic findings of the patients were collected via study proforma.

Results: Total five hundred and nineteen patients were studied; Out of all 64.54% were males and 35.06% were females. Epigastric pain or pain abdomen was the commonest indication (41.23%) followed by dysphagia (13.48%), Hematemesis (10%), vomiting and regurgitation, screening (9.05% and 7.51% respectively). The most common endoscopic findings were gastritis (35.45%), GERD (9.82%), Varices (9.02%), Carcinoma (7.32%), GI Ulcer (5.78%), hiatal hernia (5.58%), stricture (3.08%) and normal (20.03%).

 Conclusion: The most common indication was Epigastric pain or pain abdomen for EGD scopy and indications were relevant to findings.

Background: Gastric Outlet Obstruction may be caused by a heterogeneous group of diseases that include both benign and malignant conditions. In adults, mechanical obstruction due to ulcers, tumors or gastric polyps are common causes of gastric outlet obstruction. Until introduction of effective ulcer therapy duodenal ulcer was the commonest cause of gastric outlet obstruction and malignancy was attributed to only 20% of the cases.

Objectives: To study the modes and presentation of presentation of gastric outlet obstruction among patients suffering from Duodenal ulcer diseases.

Materials and Methods: A Hospital based Prospective study was conducted at Tertiary Care Centrefrom October 2017 to September 2019. A total of 100 cases of Gastric outlet obstruction were diagnosed during the study period. An elaborate study of these cases with regard to the history, clinical features, routine and special investigations, pre-operative treatment, operative findings, postoperative management and complications in post-operative period is done.

Results: A total of 100 cases with gastric outlet obstruction were analyzed in our study. Out of the 100 cases with gastric outlet obstruction, 28 (28%) were diagnosed with cicatrizes duodenal ulcer and 72 (72%) of them had carcinoma antrum. Majority of the study subjects presented with pain, vomiting and anorexia on admission. Pallor was seen in nearly 68% of the study subjects followed by 56% of the cases with VGP and 54% with succession Splash. Only 28% of the subjects had palpable mass on palpation.

Conclusion: Upper Gastro intestinal endoscopy should be mandatory in all suspected cases of gastric outlet obstruction. It can diagnose the cause of obstruction very effectively than any other investigative modality. Effective treatment in carcinoma stomach depends on early diagnosis.

Background: Lower limb amputation is a major but preventable public health problem in a developing nation such as India. It is a burden for the patients as well as their families not only economically but also socially and psychologically. The duration of treatment lasts from a few days to several months and depends on the extent of disease, level of amputation and patient’s comorbid status. The purpose of this study is to outline the demographics, various indications and the complications of lower limb amputations, the newer interventions in the management of lower limb amputations and to evaluate our experience in managing such patients presenting at a tertiary care hospital in South India.

Methodology: This is a prospective study done between the period of December 2019 and December 2020 at Sapthagiri Medical College and Research Centre, Bengaluru, Karnataka, India. All patients undergoing lower limb amputation during this time period were included in the study.

Results: A total of 50 patients were included into the study. Majority of the patients were males (72%). The most common indication for major limb amputation is peripheral arterial occlusive disease (PAOD) 50% and Diabetic foot in 36.96%. Below knee amputation was the most common procedure performed in 52.17%. The most common additional procedures performed were wound debridement in 23.91%, secondary suturing in 19.57%. Revision amputation rate was 8.7%. Post-operative complication rate was 39.13% and surgical site infection was the most common complication accounting for 17.39%. 8% of the patients underwent vascular interventions which prevented major limb loss.

Conclusion: Diabetic foot and PAOD of lower limbs that progressed to gangrene are the most common indications for lower limb amputations, majority of which can be prevented by health education and early presentation. Appropriate management by applying newer trends such as vascular intervention can help in reducing morbidity.

A right iliac fossa mass is a ‘temple of surprises’ and a common presentation at emergency department, requiring skill and keeness to diagnose. Patients with right iliac fossa mass will be dealt by a general practitioner, a surgeon or a gynecologist and knowledge of anatomy, with detailed history, clinical examination directing towards the pathological process followed by lab analysis and imaging leads to a diagnosis.

The most common differential diagnosis encountered are: appendicular mass, appendicular abscess, ileocecal tuberculosis, right ovarian mass, right ectopic kidney, rectus sheath hematoma, carcinoma caecum and ameboma, actinomycosis and crohn’s disease.

An important differential diagnosis is often between an appendicular mass, carcinoma of the caecum and ileocecal tuberculosis.3 In Subcontinent, tuberculosis has been the main cause of intestinal obstruction and perforation.

Cecal carcinoma is more common in the elderly and higher socio-economic group consuming less brous diet.1,5,6 Appendicular masses are seen in relatively younger people with both conservative and operative strategies. Other less common causes are diagnosed and managed accordingly.7

Seroma, wound infection, skin flap necrosis, nipple necrosis (after nipple-areolar sparing mastectomy [NSM]), are all complications of mastectomy. ICDs (intercostal chest drains) are frequently employed in medical, surgical, and critical care settings. Incorrect placement or management of intercostal chest drains can lead to significant morbidity and even mortality. The risk of acquired infection is directly proportional to the duration of ICD placement in-situ. For patients with sepsis and septic shock, therapeutic priorities include securing the airway (endotracheal intubation and mechanical ventilation), correcting hypoxemia, and establishing vascular access for the early administration of fluids and antibiotics. Hence, ICD tubes that are kept in-situ for a long duration must be managed according to the approved guidelines by qualified personnel and under adequate supervision.

Carcinoma Breast is a common occurrence in women. Most common pathological type being invasive ductal carcinoma: No Special Type. Carcinoma breast is a systemic disease and its management requires a multimodal treatment including surgery, chemotherapy, radiotherapy, hormonal therapy and immune therapy based on the type and stage of the disease. Here we are presenting a case series of rarer pathological types of carcinoma breast namely. 1: Solid papillary carcinoma with neuroendocrine differentiation, 2: Metaplastic carcinoma of breast, 3: Invasive carcinoma breast mimicking as sclerosing adenosis.

Background: Among biliary pathology, Gallbladder Stones are the most common. There are well established risk factors associated with formation of Gallstone. Since Biliary motility is affected by thyroid hormone, Patients with hypothyroidism will have Gallbladder Hypokinesia and deranged lipid metabolism leading to formation of Gallstones.

Aims & Objectives: The aim of this study is to find out the hypothyroidism is a risk factor in formation of specific type of Gall stone.

Methods: A total of 50 patients with gallstone disease were included in the study. Thyroid function tests were performed in all of them. And divided in to two group, Group-A 25 Euthyroid patients and Group-B 25 Hypothyroid patients and morphological type of gallstones assessed post operatively (Pigment or Cholesterol stones).

Results: Of the 50 patients included in the study, Group A patient had 18 Pigment stones and 7 Cholesterol stones in Gallbladder and Group B patient had 15 Pigment stones and 10 Cholesterol stones in Gallbladder. On Statistical analysis, the p-value is 22067. The result is not significant at p<.05.

Conclusion: Gallstones are more common in patient with hypothyroidism compared to general population but hypothyroidism does not promote any specific type of stone formation. Which suggest that Hypothyroidism is not the individual risk factor for gallstone formation.