International Journal of Surgery and Surgical Sciences (IJSSS)

ISSN 2277-2413

Volume 1 (1) March 2013

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Research Papers

1. Analytical Study of Incidence and Risk Factors of Placenta Previa in a Tertiary Care Medical College Institute
Dr. Neha Agrawal¹, Dr. Madhuri Chandra², Dr. Aruna Kumar³, Dr. Divya Jethwani¹, Dr. Monika Dudve¹
Resident¹, Professor², Professor and HOD³
Department of Obstetrics & Gynaecology, Sultania Zanana Hospital & Gandhi Medical College, Bhopal, India.
Vol. 1(1) : pp 1-10 (2013)
Abstract: Objectives: To study risk factors and incidence of placenta previa at tertiary care centre in Bhopal.
Design: A hospital based prospective observational study
Material and methods: All antenatal patients admitted with placenta previa during the study period at tertiary care centre. In a prospective study, total number of deliveries were 10,160 out of which126 cases of placenta previa were identified.
Results: A total of 126 patients with placenta previa were reported and the incidence of patients with placenta previa in study period was 1.24%. Most of the women with placenta previa required caesarean section delivery (71.42%). Incidence of vaginal delivery (10.31%) was maximum in Type I placenta previa. 6 cases had obstetric hysterectomy 5 for accreta and 1 to control placental bed bleeding.15 patients admitted before term for bleeding per vaginum and were managed conservatively and discharged undelivered. Most common cause of maternal morbidity was anaemia 96.03% out of which 88.88% patient had blood transfusions. The incidence of maternal death in our study was 1.5%. Out of 107 babies majority of babies in this study were low birth weight (<2.5 kg) 62.6% of which was attributed to prematurity. Most common cause of fetal morbidity was asphyxia 50.46% followed by prematurity 40.20%.
Conclusion: In this study, the risk factors for placenta previa were short interpregnancy interval, scarred uterus/instrumentation and patient with addictions. Most of the women with placenta previa required caesarean section delivery. Most common cause of maternal morbidity was anaemia.
Keywords: Placenta previa, Caesarean section, Curettage, Interpregnancy interval, Placenta, Previa.

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2. Role of Laparoscopy in Diagnosis and Management of Chronic Abdominal Disorders
Dr. Ashish Kumar Dwivedi¹, Dr. Archana Shukla², Dr. Pradeep Kumar³, Dr. M.C. Songra⁴
Senior Resident¹, Assistant Professor², Associate Professor³, Professor and HOD⁴
Department of General Surgery, Gandhi Medical College, Bhopal, India.
Vol. 1(1) : pp 11-17 (2013)
Abstract: Diagnostic laparoscopy is being practiced for many decades by physicians and gynecologists. It is more frequently used in the diagnosis of various surgical disorders for last three decades. Many patients with chronic abdominal pain undergo various diagnostic tests with little or no change in their pain. Diagnostic laparoscopy may help in avoiding unnecessary laparotomy, provide accurate diagnosis and help in planning optimal therapy in these selected patients. Our objectives were to evaluate the role of laparoscopy in the diagnosis of chronic abdominal disorder and its impact on the management of these patients and to study the role of laparoscopy in preventing unnecessary laparotomy in selected medical patient and in patient with advanced abdominal malignancy.
A retrospective study of 70 patients with chronic abdominal disorder admitted in a surgical unit in a government medical college from June 2009 to December 2011 was carried out. Most of these patients were investigated by the physician. Investigations include hematology, biochemistry, radiology, ascitic fluid analysis, endoscopic and imaging studies and the Monteux test. They were referred for elective diagnostic laparoscopy and tissue biopsy. Diagnostic laparoscopy confirmed the diagnosis in all patients suspected of malignancy.(5) There was 80% impact of diagnostic laparoscopy on the management of patients with chronic abdominal disorders in our study. Diagnostic laparoscopy is proven to have a significant diagnostic and therapeutic role in a patient with chronic abdominal disorder, where the diagnosis remained uncertain after the laboratory and non-invasive investigation.
Keywords: Laparoscopy, Diagnostic laparoscopy, Abdominal disorder, Chronic abdominal disorder, Laparoscopy in diagnosis, CAD.

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3. A Comparative Study among Conventional Gauze Therapy and Vacuum - Assisted Closure Wound Therapy through a Prospective Randomized Trial
Dr. Vikas Kumar¹, Dr. P.K. Sharma², Dr. Arun Bhatnagar³, Dr. Ashish Kumar Dwivedi¹
Resident¹, Professor & HOD², Associate Professor³
Department of Surgery, Gandhi Medical College, Bhopal, India.
Vol. 1(1) : pp 18-23 (2013)
Abstract: Vacuum–assisted closure wound therapy (vacuum therapy) is used as a tool to bridge the period between debridement and definite surgical closure in full-thickness wounds. We performed prospective randomized clinical trial to compare the efficacy of vacuum therapy to conventional moist gauze therapy in the management of full thickness wounds.
In ideal world V.A.C. Dressing equipment should be available at hand at all times and to every patient in need. But shortage of equipment in developed country or even unavailability in developing world is a common phenomenon. So we describe a new method of VAC dressing application without using the standard VAC equipment from material readily available to any surgeon (surgical suction unit, foam, opsite) and present our experience where negative suction dressing was applied without use of standard equipment.
Keywords: Clinical randomized trial, Vacuum-assisted closure wound therapy, Conventional wound therapy, Assessment of wound healing, Surgical suction unit, VAC.

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Case Reports

1. Secondary Abdominal Pregnancy Following a Tubal Abortion with Previous History of Heterotropic Pregnancy - Quadruplet Intrauterine Pregnancy with Viable Rudimentary Horn Pregnancy - A Case Report
Dr. Sudha Chourasia¹, Dr. Juhi Agrawal², Dr. Divya Jethwani³, Dr. Neha Agrawal³, Dr. Monika Dudve³
Associate Professor¹, Assistant Professor², Resident³
Department of Obstetrics & Gynaecology, Sultania Zanana Hospital & Gandhi Medical College, Bhopal, India.
Vol. 1(1) : pp 24-26 (2013)
Abstract: Abdominal pregnancy represents a grave risk to the health of the pregnant woman. This is a case report of a 24-year-old primipara with repeated secondary abdominal pregnancy following ruptured tubal ectopic pregnancy. She had past history of heterotropic pregnancy following ovulation induction therapy. She delivered preterm quadruplets at home and visited the maternity hospital 1month 15 days later with acute abdomen. It was a secondary abdominal pregnancy from a ruptured rudimentary horn of a unicornuate uterus and live term female baby was delivered from the peritoneal cavity. It is a very rare condition. Mother and baby survived after such a catastrophe.
Keywords: Abdominal pregnancy, Tubal abortion, Heterotropic pregnancy, Quadruplet intrauterine pregnancy, Rudimentary horn pregnancy, Secondary abdominal pregnancy.

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2. Perforated Peptic Ulcer in a Diaphragmatic Hernia : A Rare Surgical Emergency
Dr. Mahim Koshariya¹, Dr. Samir Shukla², Dr. Puspendra Baghel³, Dr. Akhilesh Ratnakar⁴, Dr. AvinashPratap Singh³, Dr. Varun Pendro³, Dr. Zuber Khan³, Dr. ShrikantJagdish Jai³, Dr. Vaibhav Vikas³, Dr. A. Rai5, Dr. M. C. Songara⁶
Associate Professor¹, Assistant Professor², Resident³, Senior Resident⁴, Professor⁵, Professor and Head⁶
Department of Surgery, Gandhi Medical College & Associated Hamidia Hospital, Bhopal-462012, India.
Vol. 1(1) : pp 27-29 (2013)
Abstract: Diaphragmatic hernia is a condition in which abdominal viscera herniates into the thorax. These diaphragmatic hernias may be congenital or may develop after blunt or penetrating thoracic trauma and these hernias may remain undiagnosed until patient become symptomatic. Most of the diaphragmatic hernias are discovered incidentally on chest x-ray or during endoscopy performed for some other disease. Here we are reporting a rare case of perforated gastric ulcer in a diaphragmatic hernia. Only few such cases are reported in medical literature. An elderly male presented with upper abdominal pain and was diagnosed as diaphragmatic hernia. Exploratory laparotomy revealed stomach entering into the thoracic cavity and one gastric perforation. Diaphragmatic rent was repaired with gastric perforation repair and left side intercostal drainage tube. Patient was discharged without any post operative complication, with successful outcome.
Keywords: Diaphragmatic hernia, Thoracic trauma, Peptic perforation, Perforated peptic ulcer, Peptic ulcer, Hernia.

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3. Traumatic Bilateral Knee, Bone Infarctions in Young Male : An Unusual Presentation of Mild to Moderate Grade Trauma – A Case Report
Dr. Surendra Kumar
Senior Resident, Department of Orthopaedics, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India.
Vol. 1(1) : pp 30-35 (2013)
Abstract: Osteonecrosis is a common complication of corticosteroid therapy. In this study, we report the case of a patient with trauma of both knees one year back who had been diagnosed with knee osteonecrosis involving bilateral tibial and femur probably due to microvascular injury. A 22-year-old male patient presented with a history of twisting injury of both knees for which he had not taken proper medical treatment and splintages to immobilize the limb. He was taking some analgesics by some medical practitioner after some time he develop gradual onset pain initially during work but after some time experienced in rest also located anteriorly in the knee. Magnetic resonance imaging performed on admission showed osteonecrosis of the bilateral proximal tibial and distal femur, almost equally pronounced.
Osteonecrosis is a fairly common complication in patients with the history of corticosteroid use for the treatment of variety of systemic and rheumatic disorders but can also occurred due to trauma. The condition can manifest itself anywhere in the skeletal system, most commonly in the femoral head. Distal femur and proximal tibia with bilateral involvement is quite rare in the literature. Trauma of both knees and within one year gross osteonecrosis of bilateral knee joint is rarest presentation.
Keywords: Osteonecrosis, SPONK, Corticosteroid, Bisphosphonate, Traumatic bilateral knee, Trauma.

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4. Is Usg a Reliable Investigation for Large Hemithoracic Dermoid Cysts? – A Case Report
Dr. Hemant kumar Goel, Dr. Amber Malhotra, Dr. Onam Aggarwal
Department Of Surgery, Gandhi Medical College & Hamidia Hospital, Bhopal, India.
Vol. 1(1) : pp 36-38 (2013)
Abstract: A 16 year girl and a 30 year old man presented to us with a suspected intractable left sided pleural effusion and a pericardial cyst respectively, diagnosed after chest roentgenogram and USG chest. CECT chest revealed solid mass lesions in the hemithorax, in both the cases and the findings were later confirmed on surgical exploration. On histopathology, both were found to be dermoid cysts.
To the best of our knowledge, it is the first time that two cases of dermoid cysts of the thoracic cavity in an intimate relation to the pericardium and lungs are being reported. Both had been misdiagnosed on preliminary investigations and required CECT chest to clinch the diagnosis.
Keywords: Dermoid, Cyst, Thorax, Hemithoracic dermoid cyst, Dermoid cyst, HMC.

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5. Gastro-Jejuno-Colic Fistula : A Late Complication of GJ +Vagotomy
Dr. Shwetank Vashishtha, Dr. Mayank Nautiyal, Dr. Praveendra K. Sachan
Department of General Surgery, Himalayan Institute of Medical Sciences, Dehradun, UK, India.
Vol. 1(1) : pp 39-42 (2013)
Abstract: We herein report the case of a 49-year-old man with gastrojejunocolic fistula. It is one of the late severe complications of gastrectomy and gastrojejunostomy and is considered to be induced by a stomal ulcer due to inadequate resection of the stomach and incompleteness of vagotomy. Patients usually present with Diarrhoea, Weight loss and Eructation of faecal smelling gas, Epigastric pain, Fatigue, Nutritional deficiencies and faecal vomiting. The diagnostic workup should include barium enema, gastroscopy and sometimes colonoscopy and abdominal CT scan for excluding and ruling out the possibility of malignant extraluminal disease. The historical approach of the treatment of this rare entity was 2–3-phased operations which included colostomy. However today, medical management has recently been recommended as the first-line therapy, with parenteral and enteral support treatments. The preferred surgical approach is single-stage gastrocolic resection and anastomosis and this has been favoured to minimize mortality.
Keywords: Gastrojejunocolic fistula, Gastrectomy, Gastrocolic fistula, Recurrent peptic ulcer, Gastrojejunostomy, Billroth II reconstruction.

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6. Fibrous Dysplasia of Rib - An Unusual Cause of Chest Pain
Dr. Pushpendra Baghel¹, Dr. Ashish Kumar Dwivedi², Dr. Arvind Rai³, Dr. Devendra Chaudhary⁴
Junior Resident¹, Senior Resident², Professor³, Assistant Professor⁴
Department of General Surgery, Gandhi Medical College, Bhopal, India.
Vol. 1(1) : pp 43-45 (2013)
Abstract: Fibrous dysplasia of rib was not considered as part of the differential diagnosis of chest discomfort, since it is typically painless. We present a patient with left chest pain due to fibrous dysplasia of the fourth rib left side. This is a rare presentation described with fibrous dysplasia of the rib with left chest pain that mimicked angina.
Keywords: Fibrous dysplasia, Chest pain, Chest discomfort, Dysplasia, Fibrous dysplasia of rib.

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7. Simple Hepatic Cyst Laparoscopic Fenestration and Deroofing
Dr. G.J. Singh, Dr. R.S. Mohil, Dr.Vipul Kandwal, Dr. Pankaj, Dr. Umesh Jethwani, Dr. Abhinav Bansal, Dr. Jitender, Dr. Nikhil Bansal
Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Vol. 1(1) : pp 46-48 (2013)
Abstract: Simple hepatic cysts are believed to be congenital and relatively less common. This case report talks about 70 years old lady with known hypertensive, presented with history of pain and heaviness right upper abdomen since 4 to 5 years associated with dyspepsia. On clinical examination she was vitally stable, with no icterus, pallor, lymphadenopathy, nutrionally preserved, with performance status of 90, with adequate hydration status.
Keywords: Hepatic cyst, Cystic disease, Simple hepatic cyst, Laparoscopic fenestration, Deroofing, Simple hepatic cyst laparoscopic fenestration.

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8. Lower Extremity Arterial and Venous Thrombosis associated with Sciatico - Femoral Nerve Injury with Recanalisation of Vessels
Dr. Surendra Kumar
Senior Resident, Department of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Vol. 1(1) : pp 49-52 (2013)
Abstract: We report a case of 27 years old male patient with lower extremity venous and arterial thrombosis with both femoral and sciatic nerve injury due to fracture shaft of femur. Simultaneous involvement of entire major neurovascular axis is rare following fracture shaft of femur. Diagnosis may be delayed if high suspicion is not kept. Management of such a case is challenging as no clear guidelines exist. Conservative management for vascular and neurological injury was adopted in our patient after appropriate investigations leading to successful limb salvage.
Keywords: Deep vein thrombosis, Sciatic nerve, Superfecial femoral vein, Thrombosis, Sciatic nerve injury, Sciatico-femoral nerve injury.

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9. A Rare Case of Strangulated Inguinal Hernia with Uncommon Contents
Dr. Rajveer Choudhary, Dr. Praveen Garg, Dr. Lokendra kumar, Dr. Mahendra Singh, Dr. U. Prashant, Dr. Ashish Kumar, Dr. Rashpal Thakur, Dr. Ashwani Gupta
Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India.
Vol. 1(1) : pp 53-55 (2013)
Abstract: Sliding hernia, Littre’s hernia and Strangulated hernia are various uncommon varieties of an inguinal hernia. Although individual cases of Sliding hernia, Littre’s hernia and Strangulated hernia have been reported, three of them presenting simultaneously in a hernia is a rarest situation and has not been reported. Diagnosis is made intra-operatively and extra care is needed to prevent bladder and bowel injury. We report a case of right inguinal hernia, where posterior wall of the sac was formed by urinary bladder (Sliding hernia) and content of sac was ischemic ileum (Strangulated hernia) with Meckel’s diverticulum (Littre’s hernia).
Keywords: Sliding hernia, Littre’s hernia, Strangulated hernia, Hernia, Inguinal Hernia, Ischemic ileum.

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Review Paper

1. Management of Pancreatic Trauma - A Review
Dr. Umesh Jethwani, Dr. G.J. Singh, Dr. R.S. Mohil, Dr. Vipul Kandwal, Dr. Parneet Singh, Dr. Nikhil Bansal
Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India.
Vol. 1(1) : pp 56-60 (2013)
Abstract: Pancreatic trauma has always remained a challenge for the surgeons both in diagnosis and management. Although its incidence is rare, when occurs it is associated with multiple organ injuries. Main determinant of outcome is the state of main pancreatic duct. Late diagnosis is associated with increase in the mortality and morbidity rates. Early diagnosis and appropriate management results in favourable outcomes.
Keywords: Pancreatic trauma, Diagnosis, Pancreatic trauma management, Trauma, Trauma review, Trauma management.

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International Journal of Surgery and Surgical Sciences (IJSSS)
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Email :- research.ijsss@gmail.com, editor@ijsss.com
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