Fazal Q Parray

Spectrum of abdominal organ injury in a primary blast type

IntroductionAbdominal organ injury in a primary blast type is always challenging for diagnosis. Air containing abdominal viscera is most vulnerable to effects of primary blast injury. In any patient exposed to a primary blast wave who presents with an acute abdomen, an abdominal organ injury is to be kept in a clinical suspicion.AimStudy various abdominal organ injuries occurring in a primary type of blast injury.Material and methods: All those who had exploratory laparotomy for abdominal organ injuries after a primary blast injury for a period of 10 years from January 1998 - January 2008 were included in this retrospective study.ResultsTotal 154 patients had laparotomy for abdominal organ injuries with a primary blast type of injury. Small intestine was damaged in 48 patients (31.1%) followed by spleen in 22.7% cases. 54 patients (35.06%) had more than one organ injured. Liver laceration was present in 30 patients (19.48%). Multiple small gut perforations were present in 37 patients (77.08%). Negative laparotomy was found in 5 patients (3.24%) whereas 3 (1.94%) had re-exploration. Mortality was present in 6 patients (3.89%).ConclusionsPrimary blast injury causes varied abdominal organ injuries. Single or multiple organ damage can be there. Small intestine is commonest viscera injured. Laparotomy gives final diagnosis.

Therapeutic Splenectomy in Immune Thrombocytopenic Purpura

The effects of splenectomy in 41 patients managed from 1982 to 1995 at Sher-i-Kashmir Institute of Medical Sciences, Srinagar (Jammu and Kashmir), India, were studied. Immune thrombocytopenic purpura (ITP) was the main indication for therapeutic splenectomy among all the hematologic disorders. The mean age was 30 years (range 7–64), and the male to female ratio was 1.05:1. The mean platelet count in the preoperative period was 31,751/mm3 (range 4000–85,000). All patients presented with thrombocytopenia, i.e., platelet count of <100,000/mm3. In addition, 5 patients presented with anemia, i.e., Hb <10 g%. Among the patients with thrombocytopenia, 30 patients presented with counts <50,000/mm3 and 11 patients presented with counts between 50,000–100,000/mm3. None of the patients presented with leukopenia. The morbidity observed was 15% and mortality was 2%. The response to splenectomy was complete for thrombocytopenia in 3 patients and partial in 5 patients; 4 patients failed to show any response. In anemic patients, 4 patients showed complete response and 1 patient showed no response. The prognosis was excellent in patients with platelet count >50,000/mm3, age <50 years, no concomitant disease, and disease of shorter duration.

Clinicopathological Profile and Surgical Results of Nonhealing Sinuses and Fistulous Tracts of the Head and Neck Region

PURPOSE The sinus and fistulous tracts in the head and neck region often pose a challenge to the surgeon, and are usually misdiagnosed, resulting in treatment failure. MATERIALS AND METHODS This study included 117 patients who presented to the Department of Dental and Maxillofacial Surgery, Department of General Surgery, and Department of Dermatology of the Sheri-Kashmir Institute of Medical Sciences Medical College (Srinagar, India) over a period of 7 years. All 117 patients were analyzed using clinical methods, radiologic studies, and laboratory investigations. RESULTS The mean age of patients was 30 years, with a male-to-female ratio of 3:2. A dental origin was noticed in 55% of these tracts, followed by tracts originating from infected implants or bone grafts (20%) and chronic osteomyelitis (11%). Eighty percent of these tracts had a mandibular origin (and from the anterior part) (53%). Maxillary tracts arose mostly from the posterior part of the bone (70%). The commonest presenting symptom was discharge from a nonhealing wound. Anterior mandibular tracts were straight and short (84%), whereas posterior mandibular tracts were mostly long and curved (75%). Misdiagnosed and mismanaged sinuses and fistulas were mostly of odontogenic origin (70%). Radiologic studies were the most useful diagnostic tools in tracts related to dental pathology, infected implants/bone grafts, and chronic osteomyelitis. Proper treatment of basic pathology was followed by complete healing in 96% of patients. CONCLUSION All patients with sinus or fistulous tracts in the head and neck region should be properly assessed and evaluated for proper diagnosis and treatment, to prevent the recurrence and chronicity of these lesions.

Pellet gunfire injuries among agitated mobs in Kashmir

BACKGROUND Pellet gunfire injuries inflicted while controlling agitated mobs has been studied. METHODS A total of 198 patients admitted to the Accident and Emergency Department with pellet gun injuries were studied in terms of anatomic site, severity and type of injury, treatment, and outcomes. RESULTS 72.7% of patients were aged 16-25 years. The most common sites of injury were the extremities (47.9%), abdomen (36.3%) and chest (31.3%). 59.5% of patients were found to have minor injuries. Of the 80 patients admitted to the hospital for their injuries, 43 (53.7%) required an operative procedure. Six deaths (3.03%) were observed. CONCLUSION While the pellet wound itself may seem trivial, if not appreciated for the potential for tissue disruption and injuries to the head, chest, and abdomen, there can be catastrophic results. Patients should be evaluated and managed in the same way as those sustaining bullet injuries.:

Isolated small bowel mesentery injury after steering wheel trauma

Background Isolated small gut mesentery injury after blunt abdominal trauma from the steering wheel in road traffic accidents is rare. These are always challenging to diagnose and pose a diagnostic dilemma. Objectives To study the pattern of small gut mesenteric injury by steering wheel blunt abdominal trauma in road traffic accidents in patients who had laparotomy. Patients and Methods A 10-year retrospective study was done to study isolated small gut mesentery injury. Results All patients who had isolated mesenteric small gut injury were males. Jejunal mesentery was involved in 13 whereas 4 had ileal mesentery injury. Tear were longitudinal or transverse. Conclusions Isolated small mesentery injury after blunt abdominal trauma from the steering wheel in road traffic accidents is rare. Tears are either longitudinal or transverse. Suture repair is to be done. Delay in reaching hospital or reaching the diagnosis could lead to morbidity and mortality. Isolated mesenteric injury should be considered in any patient with blunt abdominal trauma from steering wheel injury with no evidence of any solid organ injury in unstable patients.

Pre‑operative staging of rectal cancer using multi‑detector row computed tomography with multiplanar reformations: Single center experience

BACKGROUND Technical advancement in imaging has helped to stage and plan treatment modality for carcinoma rectum with still some objectives controversial. AIMS The aim of our study was to evaluate the accuracy of multidetector row computed tomography (MDCT) with multiplanar reformations in the pre-operative staging of rectal carcinoma and correlation with intraoperative and histopathologic staging of retrieved specimen with respect to the depth of tumor invasion (T-staging), lymph node metastasis (N-staging) and mesorectal fascia (MRF) involvement. MATERIALS AND METHODS The study was a prospective one and consisted of 52 patients with biopsy proved rectal carcinoma. MDCT studies were performed on a 64-slice computed tomography system. Images were reconstructed in axial, coronal and sagittal planes. MDCT findings were compared with intraoperative and pathologic (reference standard) findings. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were assessed. RESULTS The diagnostic accuracy of MDCT for T1/T2, T3 and T4 lesions was 77%, 86.5% and 100%, respectively. For perirectal lymph node metastasis (N+), the diagnostic accuracy of MDCT was 84.1%. The diagnostic accuracy of MDCT for MRF involvement was 91%. CONCLUSION MDCT is a reliable radiological tool for local staging of rectal cancer with excellent accuracy rates for T and N-staging of rectal cancer.

Encountering Meckel's diverticulum in emergency surgery for ascaridial intestinal obstruction

BackgroundMeckels diverticulum is the most common congenital anomaly of the gastrointestinal tract. In children with intestinal ascariasis, the diverticulum remains asymptomatic or rarely the Ascaris lumbricoides may lead to its complications in the presence of massive intestinal roundworm load. Given that preoperative diagnosis is seldom carried out, when Meckels diverticulum is found at laparotomy for obstructive intestinal complications of roundworm, the diverticulum should be removed as complications may occur at any time. The aim of this study was to describe the findings of concomitant presence of Meckels diverticulum who had surgical intervention in symptomatic intestinal ascariasis in children.MethodsA retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckels diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir.ResultsA total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckels diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckels diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction.ConclusionMeckels diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckels diverticulum in the intestinal ascariasis should have removal.

Subcutaneous internal lateral sphincterotomy (SILS) versus nitroglycerine ointment in anal fissure: a prospective study.

AIM To compare the results of subcutaneous internal lateral sphincterotomy under local anesthesia and nitroglycerin ointment treatments in acute and chronic anal fissures. METHODS This was a comparative, prospective study of 340 patients of acute and chronic anal fissure. The patients voluntarily opted either for the surgical procedure under local anesthesia, or the nitroglycerin treatment. All the patients were followed with regular checkups and complaints were documented. RESULTS Except for 1.75% patients having bleeding/hematoma formation, and with a dropout of 2.60% patients, no failure, recurrence or long term complications like incontinence, were observed in patients who underwent subcutaneous internal lateral sphincterotomy after a mean follow up of 28 months. With surgical treatment pain, bleeding per rectum and constipation showed significant improvement as compared to nitroglycerin treatment. Fissure healing was 100% in surgical group as compared to 56.90% in medical group (P=0.000, odds ratio=344.6). Nitroglycerin was equally effective in acute and chronic fissures (P=0.096). CONCLUSION Subcutaneous internal lateral sphincterotomy under local anesthesia is more curative, easy and safe, in the hands of a beginner as well as an experienced surgeon, with highest patient satisfaction, and should be considered as the first line of therapy in both chronic and resistant/recurrent acute anal fissures.

Colonic J pouch neo-rectum versus straight anastomosis for low rectal cancers

AIM The development of sphincter saving procedures for low carcinoma rectum has been the consequence of oncological and technological factors. The major disadvantage associated with these procedures is the development of anterior resection syndrome because of the resection of rectal reservoir. Colonic J pouch (CJP) neorectum has been practiced as an antidote to overcome this problem. We are working at a tertiary care center, which is a high volume center for rectal cancers. We thought it worthwhile to assess the efficacy of J Pouch neorectum viz.-a-viz. a straight coloanal anastomosis for low rectal cancers. MATERIALS AND METHODS Hospital based prospective randomized study (June 2007-December 2009) low rectal cancers (4-12 cm from the anal verge). One group (20 patients) subjected to low/ultralow anterior resection with straight anastomosis (SA) and other group (22 patients) to CJP. The two groups were compared on the basis of functional outcome. RESULTS Anastomotic leak, strictures, frequency of bowel movements, nocturnal bowel movements, use of retarding medication and incontinence to solids, liquids and gases were seen more in SA group. All these findings were statistically significant. CONCLUSIONS We conclude that CJP has a significant functional advantage over SA and improves the overall quality-of-life in patients of low rectal cancers and the advantage persisted over a period of more than 30 months.

Perianal giant condyloma acuminata [buschke lowenstein tumour] — first case report from the Kashmir valley

Buschke Lowenstein tumour or giant condyloma acuminata is a rare entity with only less then 50 cases reported in English literature so far. No such case has been reported from the Kashmir valley. They are considered as intermediate lesions between simple condyloma acuminata and invasive squamous cell carcinoma. A 57-year-old heterosexual male presented with a giant perianal condyloma. The lesion was surgically excised completely. Postoperatively patient was put on topical 5-FU ointment. Patient is recurrence free 6 months after surgery. The giant condyloma acuminate is an aggressive tumour with propensity for recurrance and malignant transformation. Surgical excision is the treatment of choice. One such rare case is discussed with review of literature.