Debasis Naik

Gallbladder perforation: a single center experience of 32 cases

Backgrounds/Aims Gallbladder perforation is a rare but potentially fatal disease. We herein present our clinical experience in diagnosis and management of 32 cases of gallbladder perforation. Methods This retrospective study was conducted with inclusion of all cases of gallbladder perforation that presented to our hospital from January 2012 to November 2014. Cases of traumatic gallbladder perforation and patients younger than 12 years of age were excluded from this study. Results This study included 32 patients (13 males and 19 females). The mean age of patients was 55.9 years. Gallbladder perforation was most common in the 5th and 6th decade of life. The mean age of patients with type I, II, and III gallbladder perforation was 57.0 years, 57.6 years, and 49.8 years, respectively. The most common site of perforation was the fundus, followed by the body and Hartmanns pouch (24 : 5 : 2). Most of the type I gallbladder perforations were diagnosed intraoperatively, type II gallbladder perforations were diagnosed by enhanced abdominal computed tomography, and type III gallbladder perforations were diagnosed during laparoscopic cholecystectomy converted to open cholecystectomy for cholelithiasis. Mortality was highest in patients with type I gallbladder perforation. The mean hospital stay was 10.1 days, 6.4 days, and 9.2 days in patients with type I, II, and III gallbladder perforation, respectively. The histopathologic analysis in 28 patients who were operated on showed acute cholecystitis in 19 cases, acute-on-chronic cholecystitis in 4 cases, chronic cholecystitis in 4 cases, and mucinous adenocarcinoma of the gallbladder in a single case. Conclusions Gallbladder perforation represents a special diagnostic and surgical challenge. Appropriate classification and management are essential.

Harlequin Syndrome: A new observation after thyroidectomy.

Harlequin syndrome is caused by autonomic dysfunction, affecting sweating and flushing of the face and less commonly, the upper limb and upper chest. It results from compromise of vasomotor and pseudomotor sympathetic nerve supply to one side of face with over-reaction, presumably compensatory, of the corresponding fibres on the intact side. This syndrome is a rare phenomenon, and is even rare following thyroidectomy, but is a worrying symptom for both the patient and the surgeon. Till now only a single case of Harlequin syndrome has been reported following thyroidectomy, we hereby present the second case of Harlequin syndrome following thyroidectomy, in a 40 year old female.

Gallstone ileus- An uncommon cause of bowel obstruction: A case report and review of literature.

Gallstone ileus occurs when gallstone migrates from the gallbladder to the bowel through a cholecysto-enteric fistula, causing mechanical bowel obstruction. It is an uncommon cause of bowel obstruction. It occurs almost exclusively in the elderly, and accounts for 25% of mechanical small bowel obstruction in patients over the age of 65 years. Clinical diagnosis of gallstone ileus is difficult and usually depends on the radiographic findings. We present a case of 70 year old female with history of unstable angina,

Abdominal wall abscess, an unusual complication of Seton: A case report.

An anal fistula is a communicating tract between the inner anus or rectum and the external skin surrounding the anus. It causes chronic discharge of pus that typically has an offensive odor. The treatment of anal fistula has challenged physicians and healers for millennia. References to fistulous disease and use of both fistulotomy and seton can be found in the writing of Hippocrates, dating from 400 BC. Although the primary objective of operative procedure is to heal the fistula, equally important is the morbidity of the procedure. Seton have been used to manage anal fistula from hundreds of year; however, in the literature, Seton were commonly used only for high or complex anal fistula in order to avoid fecal incontinence or recurrence. The usual complications arising due to a seton procedure are discomfort, bleeding, local abscess formation, mucous or liquid stool discharge, recurrence and incontinence. We present a case of abdominal wall abscess arising as a complication of Seton procedure.

Role of Vacuum assisted Negative pressure wound therapy in management of Enterocutaneous fistulae arising within the open abdomen: three case studies.

An Enterocutaneous fistulae (ECF) also known Gastro-intestinal fistulae, communicates between stomach, small or large bowel and skin, allowing gastrointestinal contents to flow on to the skin. The majority of ECF (75% - 90%) are the result of previous surgeries but it is estimated that 10% - 25% of the patients may develop an ECF without having had a surgical procedure. Negative pressure wound therapy (NPWT) is used extensively in the acute and chronic wound care arena of health care. It has become a standard of care for many types of wound from non-healing diabetic foot ulcer and burns to traumatic and surgical wounds. Recently attention has been paid using this system for the treatment of catastrophic abdominal wounds and open abdomen with ECF. We present 3 cases of ECF arising within open abdomen managed successfully by Vacuum assisted Negative pressure wound therapy.