Saurabh Agrawal

The outcome of surgery for perforated peptic ulcer in modern times

Peritonitis due to perforated peptic ulcer (PPU) is one of the commonest surgical emergencies attended by a general surgeon. Perforation is an acute life-threatening complication of peptic ulcer disease. In most cases it requires urgent surgical management and is associated with a high rate of mortality and morbidity. Nowadays surgery for PPU, after initial resuscitation, consists of laparotomy/laparoscopy with peritoneal lavage and closure of perforation with or without omental patch. Cellan-Jones in 1929 and Graham in 1937 described their techniques of closure of perforation and reported a mortality rate of 17%. The addition of definitive acid reducing procedures after repair of PPU although popular in mid and late twentieth century has been made redundant after the introduction of proton pump inhibitors. Despite the passage of time and improvements in care of critically ill patients, PPU still has a substantial mortality.

Clinico-Pathological Profile and Surgical Outcome of Patients of Gastrointestinal Tuberculosis Undergoing Laparotomy

Tuberculosis is one of the earliest diseases affecting the mankind. Abdominal tuberculosis constitutes a common public health issue in developing countries like ours. Gastrointestinal tuberculosis often involves the ileocecal region. Surgery in case of abdominal tuberculosis is required to overcome the deleterious effects of the disease like tissue disorganization, obstruction and perforatio. AIMS AND OBJECTIVES 1. To study the various clinical profiles of gastrointestinal tuberculosis in patients undergoing laparotomy; 2. To study the surgical pathology of gastrointestinal tuberculosis; 3. To study the various surgical treatment modalities based upon the intraoperative findings and its outcome. Results: This is a prospective study over 12 months at Himalayan Institute of Medical Sciences, SRHU, Swami Ram Nagar, Dehradun. This study was done to study the clinic-pathological profile of gastrointestinal tuberculosis undergoing laparotomy. Incidence of gastro intestinal tuberculosis was seen highest in age group 15 to 25 years with male predominance. Most commonly presentation being intestinal obstruction with ileo-caecal as the most common area involved and right hemicolectomy as the commonest procedure done. Common surgical pathologies were ileo-caecal mass and ileal perforation and this also has relation to pulmonary tuberculosis. CONCLUSION Inspite of specific antituberculous drugs and vast measures against the disease, including chemoprophylaxis and pasteurisation abdominal tuberculosis remains a fairly common disease even today. Gastrointestinal tuberculosis has an indolent course and the common mode of presentation is usually sub acute or chronic. Prompt surgical exploration, vigilant postoperative care and administration of ATD helped to treat the patients successfully with their complete cure and rehabilitation.