A study on clinicopathology, prognostic factors and its relation with outcome in patients undergoing emergency laparotomy for ileocaecal emergencies

Muruganandam, S (2016) A study on clinicopathology, prognostic factors and its relation with outcome in patients undergoing emergency laparotomy for ileocaecal emergencies. Masters thesis, Madras Medical College, Chennai.


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BACKGROUND: Ileocaecal emergency is a common problem encountered in Emergency room in tropical countries like India. Various conditions like Typhoid, TB and Blunt Injury Abdomen are recognized. Despite the availability of modern diagnostic facilities and advances in treatment regimens, this condition is still associated with a high mortality and unavoidable morbidity. The purpose of operative protocol is to correct the pathology while avoiding any serious complications. METHOD: This study is conducted in Rajiv Gandhi Government General Hospital in Institute of General Surgery as Retrospective and Prospective study with 50 individuals as subjects. RESULTS: This descriptive and observational study was carried out to determine the etiopathological and prognostic factors in patients undergoing emergency laparotomies for ileocaecal emergencies and the associated morbidity and mortality. Age of 50 patients ranged from 18-78 years. The male to female ratio was ~ 2 : 1. On analyzing the co morbid factors, Diabetes Mellitus was the predominant co morbid factor, present in 10% of patients with systemic hypertension seen in three patients (6%) followed by other factors like CKD, CAD etc . The Most common presentation was small bowel perforations (34%) followed by Obstructed hernia in 20 % of cases. Tachycardia and hypotension are predominant signs. Patients presenting to ER after > 72 hours of onset of symptoms had a mortality rate reaching upto 50%.The Most commonly performed surgery was Resection and Anastomosis (38%). Wound dehiscence and wound infection carries the most common morbidity. In deceased patients, MODS form the most common cause of mortality accounting around 62%. CONCLUSION: Acute bowel pathologies like perforations leading to peritonitis followed by malignancy and blunt injury abdomen are the leading causes of ileocaceal emergencies. The single most important predictor of the mortality seems to be the initial lag period between the onset of symptoms and when the patients are taken up for surgery. . In management Post operative patient education and counseling is of utmost importance. Adequate hydration, electrolyte correction, nutrition management and psychological support teams play a crucial role in bringing significant number of patients for reversal.

Item Type: Thesis (Masters)
Uncontrolled Keywords: clinicopathology ; prognostic factors ; patients ; undergoing emergency laparotomy ; ileocaecal emergencies.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 27 Sep 2017 01:46
Last Modified: 27 Sep 2017 01:46
URI: http://repository-tnmgrmu.ac.in/id/eprint/3373

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